Cataract

Quick Overview

• symptoms: Deterioration of vision, glare sensitivity, seeing “as through a veil / fog”
• Causes: Age, genetic factors, other diseases (eg diabetes mellitus), eye inflammation, injury or malformations
• Diagnosis: u. a. Patient interview, eye test, various examinations of the eye by means of light (Brückner text, slit lamp)
• Treatment: surgery
• Forecast: good chances of success at surgery

Cataract: symptoms

If the gaze worsens and the world seems to vanish behind a veil, this could be a sign of the eye disease cataract. “Gray” because the lens turns grayish in advanced disease. The name suffix “Star” is derived from the rigid look that sufferers have when they are (almost) blinded by the eye disease.

Depending on the stage, cataract causes different symptoms. At the beginning of the disease the sight deterioratesBe affected increasingly sensitive to blinding, In the middle of the field of vision arises a kind fogthrough which objects are blurred or perceived as behind a veil.

This mist becomes denser over time and spreads to the entire visual field as the disease progresses. Colors, contrasts and contours fade gradually and seem to merge with each other. Spatial perception and thus orientation skills are worsening.

Often sufferers ignore the symptoms first, overplay them or attribute them to other causes such as tiredness. Especially when Gray age starSymptoms that develop as a result of the normal aging process, symptoms are often attributed to the age-related decline in the eyes and not to a manifest eye disease such as cataracts.

Individual and complete failures of the field of vision, as they occur in the case of the glaucoma, do not exist with the cataract.

Cataracts: symptoms during the course of the disease

As the disease progresses, symptoms of cataracts can become more severe in everyday life. This includes:

• significant glare sensitivity (eg in bright sunlight or flashlight)
• indistinct visual perception
• worse light-dark adjustment
• Effort while reading or watching TV
• limited spatial vision
• Uncertainty in traffic

These symptoms may vary in each patient. You do not necessarily have to (all) occur.

Cataracts in the late stages makes a normal everyday life almost impossible: the visual performance can deteriorate so dramatically in a short time that it amounts to blindness.

If cataracts affect both eyes, it is often difficult for sufferers to assess how far advanced their vision is. This becomes dangerous in traffic, for example.

Cataract: Relatives should be alert for signs

Precisely because those affected often misjudge or deny vision loss, it is important that relatives know and correctly interpret cataracts. In the early stages of the disease, those affected become more insecure with their usual activities, for example while driving or reading. You can tell by the fact that the patients often show a strained facial expression.

In later stages, the deterioration of vision can be so bad that sufferers are often wrong, if you give them something or want to take something into their own hands. In addition, they take a long time to find their way around an environment in which they are unfamiliar. Therefore, they often avoid foreign and unknown regions. Even in your own home environment, orientation becomes more difficult. Most people with cataracts tend to keep a close eye on things, so that they can find everything without full eyesight.

Congenital cataract: symptoms

Children can also get cataracts. Physicians then speak of the infantile or congenital cataract. The lens opacification may already exist at birth or develop during the first years of life. The first sign is often that the children start to squint.

Left untreated, the loss of visual acuity can affect the development of the visual system, which is particularly susceptible to disturbances in the first few months of life. If cataracts are not recognized and treated in the baby, it may result in a so-called low-vision (amblyopia). This can no longer be remedied at the latest on reaching puberty. Therefore, go to the doctor immediately if there are signs of cataracts in the child!

Cataract: causes and risk factors

The eye lens is usually clear and flexible, that is, the little eye muscles can deform it. This deformation and the liquid that surrounds the lens allow us to see close and distant objects uniformly sharp (accommodation).

As the age increases, the flexibility of the eye lens naturally diminishes, which can result in lens opacification. That’s why about 90 percent of all cataracts are old-age cataracts (Gray age star). He occurs about the age of 60 on. According to statistics, almost half of the 52-64-year-old cataracts, without knowing it. Because at the beginning of the disease is often no visual disturbance perceptible. From 65 years, almost everyone has a clouding of the eye lens.

The medical term for cataract – cataract – comes from the Greek and means “waterfall”. In the past, it was assumed that clotted fluid in the eye caused the lens opacity.

In addition to the age-related diminishing flexibility of the eye lens, there are other possible causes of cataracts. These include:

• diabetes (Diabetes mellitus): In this metabolic disease, the sugar content in eye water (and blood) is increased. Excess sugar (glucose) gets lodged in the lens, which swells up. As a result, the arrangement of lens fibers shifts and the lens becomes opaque. Doctors speak of this Cataract diabetica, Pregnant women with diabetes mellitus may develop a cataract in the womb.
• other metabolic diseases: In addition to diabetes, other metabolic disorders can promote cataract. These include calcium deficiency (hypocalcaemia), parathyroid hyperparathyroidism, excess ferritin in the blood (an iron-storage protein), and an inborn dysregulation of the milk’s galactose (galactosemia) contained in breast milk.
• Eye disorders: A cataract will be by other eye diseases Cataracta complicata called. Possible triggers include eye inflammation (such as inflammation of the middle eye skin = uveitis) or severe myopia. A cataract caused by other eye diseases Cataracta complicata called.
• Eye injuries: Bruising of the eyeball by a punch or a tennis ball, puncture wounds or deeply penetrated foreign bodies can also cause a cataract. Doctors then speak of Cataracta traumatica.
• Congenital eye malformations: If cataracts are innate, there are two possible reasons for this: On the one hand a genetic defect that leads to a malformation of the eye and thus to a clouding of the lens. This applies to about 25 percent of all congenital cataract diseases. On the other hand, certain infectious diseases during pregnancy (rubella, toxoplasmosis, herpes) can lead to the child being born with a cataract. This innate cataract will Cataract congenita called.
• Other causes: Lenticular defects, malnutrition, heavy smoking, radioactive radiation and ultraviolet (UV) light can also trigger cataracts. Very rarely, medication or poisoning is the reason for the lens opacity.

Cataract: examinations and diagnosis

For the diagnosis of cataract a close examination by the ophthalmologist is necessary. The beginning is a detailed conversation between doctor and patient Survey of the medical history (Anamnesis): Among other things, the doctor inquires about the exact symptoms and any existing underlying diseases (diabetes, eye diseases, etc.).

After that, the Checked over visual function, For this purpose, sometimes the pupil is first dilated using special eye drops. The following investigations help with the diagnosis cataract:

• Brückner test: In this examination, the doctor examines the eye. As the retina reflects some of the light, lens opacities become visible as dark spots.
• Investigation at the slit lamp microscope: The slit lamp is a microscope for enlarging the eye with a light source that can be swiveled to both sides. The bundled, slit-shaped light beam shines through the transparent eye areas. This allows the doctor to examine the retina on the fundus and recognize what type of cataract is present and what the cause might be.
• Corneal examinations: In addition, the doctor can measure the thickness of the cornea (pachymetry) or their top and back surfaces by means of computer-assisted methods (Pentacam). This will determine whether the cornea is evenly curved (otherwise it may need to be surgically compensated with special lenses). In addition, it is examined whether the cell layer, which supplies the cornea and ensures its transparency, is in order (determination of the endothelial cell density).
• General eye test: In addition, the ophthalmologist routinely examines general vision during the examination, for example using eye charts, and if other eye diseases are present.

If cataracts are already well advanced, the lens opacity is already visible to the naked eye.

Other investigations: Sometimes cataract is the first sign of another underlying disease. Especially in young patients, therefore, additional investigations are needed, such as skin and muscle tests and blood tests. So can be about tetany (pathological muscle cramps), myotonia (Myopathy), skin diseases, Wilson’s disease (congenital disorder of copper metabolism) or Diabetes mellitus determine.

Cataract: treatment

Cataracts can only be effectively treated by surgery. The cloudy lens is (partially) removed and replaced by an artificial lens. The procedure can usually be performed on an outpatient basis in the doctor’s office. When surgery is performed depends on various factors, for example, how much the lens opacity affects everyday life.

The risks of the procedure are comparatively low. Complications are rare. However, patients should avoid physical exertion and activities involving a lot of dust or dirt for the first time thereafter. In addition, the freshly operated eye should not come into contact with water and soap.

Especially in young people can after surgery a so-called PCO arise, which should then also be removed.

Read all about the surgical cataract treatment in the article cataract surgery.

Cataract: Disease course and prognosis

Cataracts go untreated slowly, but steadily – the vision is getting worse until the person on the diseased eye goes blind. This can be stopped only with one operation: In this country, about 600,000 such interventions are made per year, worldwide, there are more than 100 million per year. An aging cataract can usually be completely cured by the procedure – most patients regain 50 to 100 percent of their visual acuity.

If the cataract is another eye disease (such as green star or macular degeneration), the prognosis is less good. The same is true when cataract is caused by a common disease like diabetes.

Cataract: Prevention

An age-related cataract (cataract) can not be prevented so far – either by medication or other measures such as eye exercises.

On the other hand, external factors that can trigger cataracts can be very well controlled and eliminated. For example, you should always wear safety goggles for activities such as grinding or drilling that could injure the eye. When staying in the sun (especially when skiing), good sunglasses will protect your eyes from the dangerous UV rays. Also in the solarium you should wear protective glasses.

In addition, go to the ophthalmologist every 12 to 24 months from the age of 40 to check your eyesight. Cataracts can be detected by a regular eye test even if the symptoms are hardly pronounced.

If you want to get pregnant, you should first check your vaccine protection and, if necessary, have it freshened up. Thus, infection can be prevented by the Cataract in the baby can arise.

Additional information:

Guideline:

• Guideline “Cataract (Adipose) in Adulthood” of the German Ophthalmological Society and the Scientific Society of Ophthalmologists (2012)

Support Groups:

• Federal Association AUGE e.V.