Early cataract
Symptoms can be improved with :
· new eyeglasses
· brighter lighting
· anti-glare sunglasses
· magnifying lenses.
If it cannot be improved, surgery is then performed.
Types of surgery :
1. Phacoemulsification ( aka small incision cataract surgery)
· A small incision is made on the side of the cornea.
· A tiny probe is inserted into the eye.
· This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction
2. Extracapsular surgery.
· A longer incision is made on the side of the cornea and then the cloudy core of the lens is removed in one piece.
· The rest of the lens is removed by suction. After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL).
· An IOL - clear, plastic lens that requires no care and becomes a permanent part of the eye.
· Light is focused clearly by the IOL onto the retina, improving the patient’s vision.
* Intraocular lens - commonly called an IOL, is a tiny artificial lens for the eye.
· An IOL permanently replaces the eye's natural lens when it is removed during cataract surgery.
· Because an IOL is a permanent replacement for the natural lens, it is used in the majority of all cataract surgery patients.
· The IOL provides better vision than thick eyeglasses do, and it is much more convenient than a contact lens because it doesn't have to be taken on and off the eye.
· IOLs come in different focusing powers, just as contact lenses or prescription eyeglasses do.
· An IOL is placed in the center of the pupil, either in front of or behind the iris. It is most commonly placed behind the iris where the natural lens was located.
· Most of the IOLs implanted today are made of silicone or acrylic materials.
· These lenses can be folded and inserted through a small (approximately 3 millimeter) incision during cataract surgery.
· Examples of lenses :
1. Monofocal lens: These lenses are the most commonly implanted lenses today. They have equal power in all regions of the lens and can provide high-quality vision at a single focal point (either near or far). They usually require only a light pair of spectacles for optimal distance vision correction. However, monofocal lenses do not correct astigmatism, an irregular oblong corneal shape that can distort vision at all distances, and require corrective lenses for all near tasks, such as reading or writing.
2. Toric lens: Toric lenses have more power in one specific region in the lens (similar to spectacles with astigmatism correction in them) to correct astigmatism, which can further improve unaided distance vision for many individuals. Due to the difference in lens power in different areas, the correction of astigmatism with a toric lens requires that the lens be positioned in a very specific configuration. While toric lenses can improve distance vision and astigmatism, they still require corrective lenses for all near tasks, such as reading or writing.
3. Multifocal lens: Multifocal intraocular lenses have a variety of regions with different power within the lens that allows individuals to see at a variety of distances, including distance, intermediate, and near. While promising, multifocal lenses are not for everyone. They can cause significantly more glare than monofocal or toric lenses. Further, multifocal lenses cannot correct astigmatism, and some patients require additional surgery such as LASIK to correct astigmatism and maximize their unaided vision.
· Weeks to years after cataract surgery, the capsule ( where the lens was removed from, and where the IOL is inserted into ) may become cloudy or wrinkled and cause blurred vision
· A simple laser procedure that makes an opening in the back, or posterior, part of the capsule to restore normal vision.
· A special laser is targeted at the back of the capsule and makes a small opening. The technique is painless and only takes a few minutes. It is performed on an outpatient basis.
· Rare complications can occur, including:
o Detachment of the retina
o Increased intraocular pressure
o Dislocation of the IOL through the posterior capsule opening
Risks :
· Infection and bleeding.
· slightly increases risks of retinal detachment.
· Myopia (nearsightedness), can further increase the risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in the field of vision.
· Swelling
· Small fragments of lens which can become lodged behind the vitreous or back cavity of the eye.
· Potential for loss of sight.
Pre Surgery :
· Perform a thorough eye examination. Before the surgery,the eye will be measured to determine the proper power of the intraocular lens that will be placed in the eye.
· Temporarily stop taking certain medications that increase the risk of bleeding during surgery.
· Tests may be performed, which includes measuring the curve of the cornea and the size and shape of the eye.
During Surgery :
· Drops will be put into the eye to dilate the pupil.
· The area around the eye will be washed and cleansed.
· The operation usually lasts less than one hour and is almost painless.
Post Surgery :
· Tell patients to keep their eye clean, wash hands before touching the eye, and use the prescribed medications to help minimize the risk of infection.
· Tell them that, itching and mild discomfort are normal after cataract surgery.
· Some fluid discharge is also common.
· The eye may be sensitive to light and touch.
· The patient may to use eyedrops, a few days after surgery to help healing and decrease the risk of infection.
· Ask the patient not to rub or press the eye
· Avoid strenuous activities
· Wear eyeglasses or an eye shield
Problems that might occur after surgery :
Infection
Bleeding
Inflammation (pain, redness, swelling)
loss of vision
double vision
high or low eye pressure.
The eye tissue that encloses the IOL may become cloudy and may blur vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery. An after-cataract is treated with a laser, which uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG(yttrium-aluminum-garnet) laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems.
Alternative treatment :
In some cases, cataracts are mild enough to be treated naturally, with various herbs, exercises and other alternative therapies.
From Nutrient Protocols from 2001, written by Alan R Gaby, M.D. with contributions from Jonathan V. Wright, M.D
· Limit consumption of lactose-containing foods (milk products). In animal studies, galactose, a component of lactose, has been shown to promote cataracts formation.
· A riboflavin deficiency has been implicated in cataracts development. Therefore, a supplemental dosage of riboflavin, 10-50 mg/day, may help treat or at least slow the progression of cataracts formation.
· Taking Vitamin C, 1000 mg, two times a day may help to decrease damage caused by free radicals, in turn helping to treat cataracts.
200-600 mg/day of N-Acetylcysteine (NAC) along with zinc and copper may treat cataracts by working to destroy free radicals. 12
· Ayurveda - to bathe the eye with an eye wash made of triphala tea which can be found in most Indian pharmacies and some natural health stores. The tea is composed of a powder of three Indian tree fruits. The recommendation is to wash the affected eye in the steeped, cooled tea up to three times a day.
· Imagery - An image should appeal to each individual in order to work successfully. Different imagery sessions can be found in books, on tapes or by seeking the expertise of a professional who works with imagery therapy.
· Reflexology - Foot reflexology charts and reflexology books are available to help locate the points which should be stimulated for cataracts treatment.
· Juice therapy- based on the body's need for additional antioxidants, vitamins and minerals with which it can fight the free radicals and damaging molecules that are attacking the protein of the lenses. However, most juicing experts agree that juicing therapy will only slow down the progression, not reverse the condition. 13
LASIK eye surgery :
Laser-Assisted In Sito Keratomileusis
A laser vision correction surgery that is meant to reduce a person's need for glasses or contacts. Unfortunately, those with Cataracts are typically not candidates for the LASIK procedure.
The exact LASIK process involves an incision in the corneal flap so the inner eye is exposed.
A laser will shoot down waves that smooth the abnormalities in the cornea that cause imperfect vision.
References :
http://www.nei.nih.gov/health/cataract/cataract_facts.asp
American Academy of ophthalmology : http://www.medem.com/?q=medlib/article/ZZZUMFCHREE
http://www.medem.com/?q=medlib/article/ZZZY9VMAC8C
http://www.medem.com/?q=medlib/article/ZZZRICYGREE
http://www.mayoclinic.com/print/cataract-surgery/MY00164/METHOD=print&DSECTION=all
http://www.emedicinehealth.com/cataracts/page11_em.htm
http://www.cataract.com/alternative-treatment-options.html
http://www.cataract.com/conventional-treatment-options.html
http://www.cataract.com/types-of-intraocular-lenses.html
http://www.cataract.com/actual-process-and-procedure.html
http://www.cataract.com/risks-of-cataract-surgery.html
http://www.cataract.com/lasik-eye-surgery.html
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