Early Detection and

Management of Cataract
ANATOMY OF THE LENS
A biconvex structure attached to the ciliary
process by the zonular fibre, between iris &
vitreous humour

Non-vascular, Colourless and Transparent.

Divided into nucleus, cortex and capsule

Consists of stiff elongated, prismatic cells known

as lens fibre, very tightly packed together

Helps to refract incoming light and focus

it onto the retina
STRUCTURE OF THE
LENS:
 LENS CAPSULE
 ANTERIOR LENS
EPITHELIUM
 LENS FIBER
 CATARACT
WHAT IS CATARACT?
Cataract is a clouding of the natural intraocular crystalline lens that
focuses the light entering the eye onto the retina. This cloudiness
can cause a decrease in vision and may lead to eventual blindness if
left untreated
INCIDENCE
Incidence of Lens opacities in the “normal”
population with aging.
AGE GROUP (YEARS) LENS OPACITY (%)
50 – 59 65
60 – 69 83
70 – 79 91
> 80 100
CAUSES
CATARACT

DISEASE
ASSOCIATED

TRAUMATIC AND CONGENIT

INFLAMMATORY
AL

DRUG -
INDUCED AGE
METABOLIC
MORPHOLOGICAL CLASSIFICATION

CLASSIFICATION
 CLASSIFICATION

Age related
Age is by
related farfar
is by thethe
most
mostcommon
commontype of of
type cataract andand
cataract it isit divided into
is divided 3 types
into 3 types
based onon
based thethe
anatomy
anatomy of of
thethe
human lens:
human lens:

Subcapsular Nuclear Cortical

cataract cataract
cataract
 Anterior
subcapsular Involves the Wedge shaped or
cataract nucleus of lens. radial spoke-like
 Posterior Yellow to brown opacities.
subcapsular coloration
cataract
Sub capsular
Cortical
Nuclear
Sclerosis
CLASSIFICATION
CLASSIFICATION
BASED ON DEGREE OF MATURITY
MATURE IMMATURE

Cataract is one in which Cataract is one in which

the lens is completely the lens is partially
opaque. opaque.

HYPERMATUR MORGAGNIAN
E Cataract is a
Cataract is shrunken hypermature cataract in
and wrinkled anterior which liquefaction of
capsule due to leakage the cortex has allowed
of water out of the lens the nucleus to sink
inferiorly
IMMATURE CATARACT

Opacification becomes more diffuse and irregular

• IRIS SHADOW IN
IMMATURE CATARACT
Iris shadow still visible.
• When there is any clear cortex
between the iris and the opacity
(greyish white in immature senile
Lens is not completely opaque
cataract), the shadow of the iris which
falls upon the opacity, as light is cast
Wedge shaped opacities at periphery of the lens
upon the eye is visible through the
clear cortex. This is called the ‘iris
shadow’ and is a common sign in
immature senile catarct.
Progress gradually
13
IMMATURE CATARACT
WHAT IS THE IRIS SHADOW?
 Black crescent
 Due to the presence of clear interval between
iris and lens opacity
 MATURE CATARACT

 Symptoms
- Usually severe decrease in vision.
 Features
- Complete opacification of the lens
capsule, cortex and the
nucleus
- Lens appears pearly white in
colour.
 Also known as ripe cataract.
 May progress to hypermature cataract
 May be complicated with phacolytic
glaucoma.
MATURE VS IMMATURE
HOW TO DIFFERENTIATE MATURE AND IMMATURE CATARACT?

IMMATURE CATARACT MATURE CATARACT

 Visual acuity is
reduced to counting
fingers
 Lens is partially opaque
 Iris shadow is present
 Fundus may be visible
 Visual acuity is reduced to
hand movement or
perception of light
 Lens in totally opaque
 No iris shadow is present
 No fundus details
 HYPERMATURE CATARACT

 Which is characterized by wrinkling

of the capsule due to liquefied lens
cortex and morgagnian cataract
(sinking of lens nucleus inferiorly
within the capsule)
 This can cause inflammation, eye
pain and headache (if complicated
by glaucoma)
 A hypermature cataract is rare and
needs removal
 MORGAGNIAN CATARACT

 Complete cortex is liquefied and

appears milky white in colour.

 Nucleus settles at the bottom

 Calcium deposits may also be

seen on the lens capsule.
CLINICAL PRESENTATION
PRESENTING COMPLAINTS AND HISTORY

 Decreased visual acuity is the commonest complaint.

- Progressive and painless
- Worse in bright light

 There may be complaint of glare and monocular diplopia if the

cataract splits the visual axis

 A myopic shift in the refraction with progression of cataract may

also be noted

 Some complain of a white reflex in the pupil

CLINICAL PRESENTATION
PAST MEDICAL HISTORY

 May reveal risk factors such as

- Trauma
- Intrauterine infections
- Diabetes or other metabolic
disorders

FAMILY HISTORY

 Cataract may have occurred in other members of the

family in the hereditary variants.
PE FINDINGS
 Visual acuity is impaired for both distance and near and
patient may even be blind.

 Opacity in the lens

 Ocular adnexia and intraocular structures when examined

may reveal lesions that may point at
- The cause, type and eventual visual prognosis

 If RAPD positive, this indicates an optic nerve disease or

extensive macular lesions
- Visual prognosis guarded in such cases
VISUAL ACUITY

Blurred vision due to scattering of light on the retina

VISUAL ACUITY
VISUAL ACUITY
LENS OPACITY

Cataractous eye – Poor red

reflex
Normal eye – Good
red reflex
MANAGEMENT
 TREATMENT
The treatment of cataracts is :
1. Glasses
2. Better lighting
3. Surgery
a. Phacoemulsification
b. ECCE
c. ICCE (not performed now)

Sometimes a cataract should be removed even if it doesn't cause major

problems with vision, if it is preventing the treatment of another eye
problem, such as age-related macular degeneration, diabetic
retinopathy or retinal detachment
TREATMENT
The aim of treatment is:
1. Improve vision
2. Increase mobility and independence
3. Relief from the fear of going blind
INDICATIONS
1. Work or lifestyle is affected by vision problems caused by the cataract.

2. Glare caused by bright lights is a problem.

3. Cannot pass a vision test

4. Have double vision.

5. Notice a big difference in vision when you compare one eye to the
other.

6. Have another vision-threatening eye disease, such as diabetic

retinopathy or macular degeneration.
SURGERY: ICCE
 Intracapsular cataract extraction
 Involves extraction of the entire lens, including the
posterior capsule and zonules
 Weak and degenerated zonules are a pre-requisite for this
method
 This is the surgery of choice if there is markedly
subluxated or dislocated lens
 This technique of surgery has largely been replaced by
ECCE
SURGERY: ECCE
 Extracapsular cataract extraction
 An 5 mm to 6 mm incision is made in the eye where the
clear front covering of the eye (cornea) meets the
white of the eye (sclera).
 Another small incision is made into the front portion of
the lens capsule. The lens is removed, along with any
remaining lens material.
 An IOL may then be placed inside the lens capsule.
the
Andincision is closed.

*it is usually done if the cataract is too large to be destroyed

by ultrasound
SURGERY: ECCE
COMPLICATIONS
Infection in the eye (endophthalmitis).

Swelling and fluid in the center of the nerve layer

(cystoid macular edema)

Swelling of the clear covering of the

eye (corneal edema)

Bleeding in the front of the eye (hyphema)

Detachment of the nerve layer at the back of the eye

(retinal detachment)
ICCE VS ECCE
ECCE ICCE
Small incision 5-6mm Large incision 10-12mm
Posterior lens conserved Removal entire lens
No stiches required, self healing
Required stiches, long
rehabilitation
time
IOL implant Aphakic eye
Post operative complication minimal
Added risk for retinal
detachment, corneal edema
and vitreous loss
PHACOEMULSIFICATION
 Two small incisions are made in the eye where the clear front covering
(cornea) meets the white of the eye (sclera).
 A circular opening is created on the lens surface (capsule)
 A small surgical instrument (phaco probe) is inserted into the eye.
 Sound waves (ultrasound) are used to break the cataract into small pieces.
Sometimes a laser is used too. The cataract and lens pieces are removed from the
eye using suction.
 An intraocular lens implant (IOL) may then be placed inside the lens
capsule.
 Usually, the incisions seal themselves without stitches.
PHACOEMULSIFICATION
COMPARISON
THANK YOU