A cataract is a clouding of the lens in the eye which leads to a
decrease in vision. Cataracts often develop slowly and can affect
one or both eyes. Symptoms may include faded colors, blurry vision,
halos around light, trouble with bright lights, and trouble seeing at
night. This may result in trouble driving, reading, or recognizing
faces. Poor vision caused by cataracts may also result in an
increased risk of falling and depression. Cataracts are the cause
of half of blindness and 33% of visual impairment worldwide.
Cataracts are most commonly due to aging but may also occur due to
trauma or radiation exposure, be present from birth, or occur
following eye surgery for other problems. Risk factors include
diabetes, smoking tobacco, prolonged exposure to sunlight, and
alcohol. Either clumps of protein or yellow-brown pigment may be
deposited in the lens reducing the transmission of light to the retina
at the back of the eye. Diagnosis is by an eye examination.
Prevention includes wearing sunglasses and not smoking. Early on
the symptoms may be improved with glasses. If this does not help,
surgery to remove the cloudy lens and replace it with an artificial
lens is the only effective treatment. Surgery is needed only if the
cataracts are causing problems and generally results in an improved
quality of life.
Cataract surgery is not readily available in
many countries, which is especially true for women, those living in
rural areas, and those who do not know how to read.
About 20 million people are blind due to cataracts. It is the cause
of approximately 5% of blindness in the United States and nearly 60%
of blindness in parts of Africa and South America.
cataracts occurs in about 10 to 40 per 100,000 children in the
developing world, and 1 to 4 per 100,000 children in the developed
world. Cataracts become more common with age. More than half
the people in the United States had cataracts by the age of 80.
1 Signs and symptoms
2.5 Skin diseases
2.6 Smoking and alcohol
2.7 Inadequate vitamin C
2.10 Other diseases
6.1 Postoperative care
10 See also
12 External links
Signs and symptoms
An example of normal vision on the left versus vision with cataracts
on the right
Bilateral cataracts in an infant due to congenital rubella syndrome
Signs and symptoms vary depending on the type of cataract, though
considerable overlap occurs. People with nuclear sclerotic or
brunescent cataracts often notice a reduction of vision. Those with
posterior subcapsular cataracts usually complain of glare as their
The severity of cataract formation, assuming no other eye disease is
present, is judged primarily by a visual acuity test. Other symptoms
include frequent changes of glasses and colored halos due to hydration
Age is the most common cause. Lens proteins denature and degrade
over time, and this process is accelerated by diseases such as
diabetes mellitus and hypertension. Environmental factors, including
toxins, radiation, and ultraviolet light, have cumulative effects,
which are worsened by the loss of protective and restorative
mechanisms due to alterations in gene expression and chemical
processes within the eye.
Post traumatic rosette cataract of a 60-year-old male
Blunt trauma causes swelling, thickening, and whitening of the lens
fibers. While the swelling normally resolves with time, the white
color may remain. In severe blunt trauma, or in injuries that
penetrate the eye, the capsule in which the lens sits can be damaged.
This damage allows fluid from other parts of the eye to rapidly enter
the lens leading to swelling and then whitening, obstructing light
from reaching the retina at the back of the eye. Cataracts may develop
in 0.7 to 8.0% of cases following electrical injuries. Blunt
trauma can also result in star- or petal-shaped cataracts.
Cataracts can arise as an effect of exposure to various types of
radiation. X-rays, one form of ionizing radiation, may damage the DNA
of lens cells.
Ultraviolet light, specifically UVB, has also been
shown to cause cataracts, and some evidence indicates sunglasses worn
at an early age can slow its development in later life. Microwaves
, a type of nonionizing radiation, may cause harm by denaturing
protective enzymes (e.g., glutathione peroxidase), by oxidizing
protein thiol groups (causing protein aggregation), or by damaging
lens cells via thermoelastic expansion. The protein coagulation
caused by electric and heat injuries whitens the lens. This same
process makes the clear albumen of an egg become white and opaque
Christmas tree cataract (Diffuse illumination)
The genetic component is strong in the development of cataracts,
most commonly through mechanisms that protect and maintain the lens.
The presence of cataracts in childhood or early life can occasionally
be due to a particular syndrome. Examples of chromosome abnormalities
associated with cataracts include 1q21.1 deletion syndrome,
cri-du-chat syndrome, Down syndrome, Patau's syndrome, trisomy 18
(Edward's syndrome), and Turner's syndrome, and in the case of
neurofibromatosis type 2, juvenile cataract on one or both sides may
be noted. Examples of single-gene disorder include Alport's syndrome,
Conradi's syndrome, cerebrotendineous xanthomatosis, myotonic
dystrophy, and oculocerebrorenal syndrome or Lowe syndrome.
The skin and the lens have the same embryological origin and so can be
affected by similar diseases. Those with atopic dermatitis and
eczema occasionally develop shield ulcer cataracts.
Ichthyosis is an
autosomal recessive disorder associated with cuneiform cataracts and
nuclear sclerosis. Basal-cell nevus and pemphigus have similar
Smoking and alcohol
Cigarette smoking has been shown to double the rate of nuclear
sclerotic cataracts and triple the rate of posterior subcapsular
cataracts. Evidence is conflicting over the effect of alcohol.
Some surveys have shown a link, but others which followed people over
longer terms have not.
Inadequate vitamin C
Low vitamin C intake and serum levels have been associated with
greater cataract rates. However, use of supplements of vitamin C
has not demonstrated benefit.
Some medications, such as systemic, topical, or inhaled
corticosteroids, may increase the risk of cataract
development. Corticosteroids most commonly cause posterior
subcapsular cataracts. People with schizophrenia often have risk
factors for lens opacities (such as diabetes, hypertension, and poor
nutrition) but antipsychotic medications are unlikely to contribute to
cataract formation. Miotics and triparanol may increase the
Nearly every person who undergoes a vitrectomy—without ever having
had cataract surgery—will experience progression of nuclear
sclerosis after the operation. This may be because the native
vitreous humor is different to the solutions used to replace the
vitreous (vitreous substitutes), such as BSS Plus. This may also
be because the native vitreous humour contains ascorbic acid which
helps neutralize oxidative damage to the lens and because traditional
vitreous substitutes do not contain ascorbic acid. As such,
for phakic patients requiring a vitrectomy it is becoming increasingly
common for ophthalmologists to offer the vitrectomy with a combined
prophylactic cataract surgery procedure to prophylactically prevent
Metabolic and nutritional diseases
Aminoaciduria or Lowe's syndrome
Galactosemia / galactosemic cataract
Cytomegalic inclusion disease
Secondary to other eye diseases:
Retinopathy of prematurity
Sunflower cataract of a 40 years old male with
Wilson's disease and
Ultrasound scan of a unilateral cataract seen in a fetus at 20 weeks
Cross-sectional view, showing the position of the human lens
Cataracts may be partial or complete, stationary or progressive, or
hard or soft. The main types of age-related cataracts are nuclear
sclerosis, cortical, and posterior subcapsular.
Nuclear sclerosis is the most common type of cataract, and involves
the central or 'nuclear' part of the lens. This eventually becomes
hard, or 'sclerotic', due to condensation on the lens nucleus and the
deposition of brown pigment within the lens. In its advanced stages it
is called a brunescent cataract. This type of cataract can present
with a shift to nearsightedness, causing problems with distance vision
though reading is less affected.
Cortical cataracts are due to the lens cortex (outer layer) becoming
opaque. They occur when changes in the fluid contained in the
periphery of the lens causes fissuring. When these cataracts are
viewed through an ophthalmoscope, or other magnification system, the
appearance is similar to white spokes of a wheel. Symptoms often
include problems with glare and light scatter at night.
Posterior subcapsular cataracts are cloudy at the back of the lens
adjacent to the capsule (or bag) in which the lens sits. Because light
becomes more focused toward the back of the lens, they can cause
disproportionate symptoms for their size.
An immature cataract has some transparent protein, but with a mature
cataract, all the lens protein is opaque. In a hypermature or
Morgagnian cataract, the lens proteins have become liquid. Congenital
cataract, which may be detected in adulthood, has a different
classification and includes lamellar, polar, and sutural
Cataracts can be classified by using the lens opacities classification
system LOCS III. In this system, cataracts are classified based on
type as nuclear, cortical, or posterior. The cataracts are further
classified based on severity on a scale from 1 to 5. The LOCS III
system is highly reproducible.
Different types of cataracts
Posterior polar cataract of an 8 year old boy in left eye
Nuclear sclerosis cataract of a 70 year old male
Cortical cataract of a 60 year old male
Retroillumination of cortical cataract
Posterior subcapsular cataract of a 16 year old girl with IDDM
Intumescent cataract of a 55 year old male
Anterior subcapsular cataract having back shadow
Posterior subcapsular cataract by retroillumination
Nuclear sclerosis and posterior polar cataract of a 60 year old
Dense white mature cataract of a 60 year old male
Risk factors such as
UVB exposure and smoking can be addressed.
Although no means of preventing cataracts has been scientifically
proven, wearing sunglasses that counteract ultraviolet light may slow
their development. While adequate intake of antioxidants (such
as vitamins A, C, and E) has been thought to protect against the risk
of cataracts, clinical trials have shown no benefit from
supplements; though evidence is mixed, but weakly positive, for a
potential protective effect of the nutrients lutein and
Statin use is somewhat associated with a lower
risk of nuclear sclerotic cataracts.
Cataract surgery, using a temporal-approach phacoemulsification probe
(in right hand) and "chopper" (in left hand) being done under
operating microscope at a navy medical center
Slit lamp photo of posterior capsular opacification visible a few
months after implantation of intraocular lens in eye, seen on
The appropriateness of surgery depends on a person's particular
functional and visual needs and other risk factors. Cataract
removal can be performed at any stage and no longer requires ripening
of the lens. Surgery is usually 'outpatient' and performed using local
anesthesia. About 9 of 10 patients can achieve a corrected vision of
20/40 or better after surgery.
Several recent evaluations found that cataract surgery can meet
expectations only when significant functional impairment due to
cataracts exists before surgery. Visual function estimates such as
VF-14 have been found to give more realistic estimates than visual
acuity testing alone. In some developed countries, a trend to
overuse cataract surgery has been noted, which may lead to
Phacoemulsification is the most widely used cataract surgery in the
developed world. This procedure uses ultrasonic energy to
emulsify the cataract lens.
Phacoemulsification typically comprises
Anaesthetic – The eye is numbed with either a subtenon injection
around the eye (see: retrobulbar block) or topical anesthetic eye
drops. The former also provides paralysis of the eye muscles.
Corneal incision – Two cuts are made at the margin of the clear
cornea to allow insertion of instruments into the eye.
Capsulorhexis – A needle or small pair of forceps is used to create
a circular hole in the capsule in which the lens sits.
Phacoemulsification – A handheld ultrasonic probe is used to break
up and emulsify the lens into liquid using the energy of ultrasound
waves. The resulting 'emulsion' is sucked away.
Irrigation and aspiration – The cortex, which is the soft outer
layer of the cataract, is aspirated or sucked away. Fluid removed is
continually replaced with a saline solution to prevent collapse of the
structure of the anterior chamber (the front part of the eye).
Lens insertion – A plastic, foldable lens is inserted into the
capsular bag that formerly contained the natural lens. Some surgeons
also inject an antibiotic into the eye to reduce the risk of
infection. The final step is to inject salt water into the corneal
wounds to cause the area to swell and seal the incision.
Extracapsular cataract extraction (ECCE) consists of removing the lens
manually, but leaving the majority of the capsule intact. The lens
is expressed through a 10- to 12-mm incision which is closed with
sutures at the end of surgery. ECCE is less frequently performed than
phacoemulsification, but can be useful when dealing with very hard
cataracts or other situations where emulsification is problematic.
Manual small incision cataract surgery (MSICS) has evolved from ECCE.
In MSICS, the lens is removed through a self-sealing scleral tunnel
wound in the sclera which, ideally, is watertight and does not require
suturing. Although "small", the incision is still markedly larger than
the portal in phacoemulsion. This surgery is increasingly popular in
the developing world where access to phacoemulsification is still
Intracapsular cataract extraction (ICCE) is rarely performed. The
lens and surrounding capsule are removed in one piece through a large
incision while pressure is applied to the vitreous membrane. The
surgery has a high rate of complications.
Slit lamp photo of anterior capsular opacification visible a few
months after implantation of intraocular lens in eye, magnified view
A South African woman experiences newfound eyesight after a patch was
removed after surgery to remove an eye cataract.
The postoperative recovery period (after removing the cataract) is
usually short. The patient is usually ambulatory on the day of
surgery, but is advised to move cautiously and avoid straining or
heavy lifting for about a month. The eye is usually patched on the day
of surgery and use of an eye shield at night is often suggested for
several days after surgery.
In all types of surgery, the cataractous lens is removed and replaced
with an artificial lens, known as an intraocular lens, which stays in
the eye permanently. Intraocular lenses are usually monofocal,
correcting for either distance or near vision. Multifocal lenses may
be implanted to improve near and distance vision simultaneously, but
these lenses may increase the chance of unsatisfactory vision.
Serious complications of cataract surgery include retinal detachment
and endophthalmitis. In both cases, patients notice a sudden
decrease in vision. In endophthalmitis, patients often describe pain.
Retinal detachment frequently presents with unilateral visual field
defects, blurring of vision, flashes of light, or floating spots.
The risk of retinal detachment was estimated as about 0.4% within 5.5
years, corresponding to a 2.3-fold risk increase compared to naturally
expected incidence, with older studies reporting a substantially
higher risk. The incidence is increasing over time in a somewhat
linear manner, and the risk increase lasts for at least 20 years after
the procedure. Particular risk factors are younger age, male sex,
longer axial length, and complications during surgery. In the highest
risk group of patients, the incidence of pseudophakic retinal
detachment may be as high as 20%.
The risk of endophthalmitis occurring after surgery is less than one
Corneal edema and cystoid macular edema are less serious but more
common, and occur because of persistent swelling at the front of the
eye in corneal edema or back of the eye in cystoid macular edema.
They are normally the result of excessive inflammation following
surgery, and in both cases, patients may notice blurred, foggy vision.
They normally improve with time and with application of
anti-inflammatory drops. The risk of either occurring is around one in
100. It is unclear whether NSAIDs or corticosteroids are superior at
reducing postoperative inflammation.
Posterior capsular opacification, also known as after-cataract, is a
condition in which months or years after successful cataract surgery,
vision deteriorates or problems with glare and light scattering recur,
usually due to thickening of the back or posterior capsule surrounding
the implanted lens, so-called 'posterior lens capsule opacification'.
Growth of natural lens cells remaining after the natural lens was
removed may be the cause, and the younger the patient, the greater the
chance of this occurring. Management involves cutting a small,
circular area in the posterior capsule with targeted beams of energy
from a laser, called Nd:YAG laser capsulotomy, after the type of laser
used. The laser can be aimed very accurately, and the small part of
the capsule which is cut falls harmlessly to the bottom of the inside
of the eye. This procedure leaves sufficient capsule to hold the lens
in place, but removes enough to allow light to pass directly through
to the retina. Serious side effects are rare. Posterior capsular
opacification is common and occurs following up to one in four
operations, but these rates are decreasing following the introduction
of modern intraocular lenses together with a better understanding of
Vitreous touch syndrome is a possible complication of intracapsular
Disability-adjusted life years
Disability-adjusted life years for cataracts per
100,000 inhabitants in 2004:
Age-related cataracts are responsible for 51% of world blindness,
about 20 million people. Globally, cataracts cause moderate to
severe disability in 53.8 million (2004), 52.2 million of
whom are in low and middle income countries.
In many countries, surgical services are inadequate, and cataracts
remain the leading cause of blindness. Even where surgical
services are available, low vision associated with cataracts may still
be prevalent as a result of long waits for, and barriers to, surgery,
such as cost, lack of information and transportation problems.
In the United States, age-related lens changes have been reported in
42% between the ages of 52 and 64, 60% between the ages 65 and
74, and 91% between the ages of 75 and 85. Cataracts affect
nearly 22 million Americans age 40 and older. By age 80, more than
half of all Americans have cataracts. Direct medical costs for
cataract treatment are estimated at $6.8 billion annually.
In the eastern Mediterranean region, cataracts are responsible for
over 51% of blindness. Access to eye care in many countries in this
region is limited. Childhood-related cataracts are responsible for
5–20% of world childhood blindness.
Cataract surgery § History
The first references to cataracts and their treatment in Ancient Rome
are found in 29 AD in De Medicinae, the work of the Latin
encyclopedist Aulus Cornelius Celsus. Archaeological evidence of
eye surgery in the Roman era also exists.
Galen of Pergamon (ca. 2nd century CE), a prominent Greek physician,
surgeon and philosopher, performed an operation similar to modern
cataract surgery. Using a needle-shaped instrument,
Galen attempted to
remove the cataract-affected lens of the eye.
Cataract surgery was described by the Indian physician, Suśruta
(about 200 AD).
Muslim ophthalmologist Ammar Al-Mawsili, in his Choice of Eye
Diseases, written circa 1000, wrote of his invention of a syringe and
the technique of cataract extraction while experimenting with it on a
"Cataract" is derived from the
Latin cataracta, meaning "waterfall",
and from the
Ancient Greek καταρράκτης (katarrhaktēs),
"down-rushing", from καταράσσω (katarassō) meaning "to
dash down" (from kata-, "down"; arassein, "to strike, dash").
As rapidly running water turns white, so the term may have been used
metaphorically to describe the similar appearance of mature ocular
opacities. In Latin, cataracta had the alternative meaning
"portcullis" and the name possibly passed through French to form
the English meaning "eye disease" (early 15th century), on the notion
of "obstruction". Early Persian physicians called the term
nazul-i-ah, or "descent of the water"—vulgarised into waterfall
disease or cataract—believing such blindness to be caused by an
outpouring of corrupt humour into the eye.
Acetylcarnosine drops have been investigated as a medical treatment
for cataracts. The drops are believed to work by reducing oxidation
and glycation damage in the lens, particularly reducing crystallin
crosslinking. Some benefit has been shown in small
manufacturer sponsored randomized controlled trials but further
independent corroboration is still required.
Femtosecond laser mode-locking, used during cataract surgery, was
originally used to cut accurate and predictable flaps in LASIK
surgery, and has been introduced to cataract surgery. The incision at
the junction of the sclera and cornea and the hole in capsule during
capsulorhexis, traditionally made with a handheld blade, needle, and
forceps, are dependent on skill and experience of the surgeon.
Sophisticated three-dimensional images of the eyes can be used to
guide lasers to make these incisions. Nd:YAG laser can also then break
up the cataract as in phacoemulsification.
Stem cells have been used in a clinical trial for lens regeneration in
twelve children under the age of two with cataracts present at
birth. The children were followed for six months, so it is unknown
what the long-term results will be, and it is unknown if this
procedure would work in adults.
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V · T · D
ICD-10: H25-H26, H28, Q12.0
Cataract at Curlie (based on DMOZ)
Pictures of different types of cataracts
Video describing history and science of seeing cataracts in your own
eye on YouTube
Diseases of the human eye (H00–H59
Thygeson's superficial punctate keratopathy
Pellucid marginal degeneration
Terrien's marginal degeneration
Persistent pupillary membrane
Ocular ischemic syndrome / Central retinal vein occlusion
Central retinal artery occlusion
Bietti's crystalline dystrophy
Central serous retinopathy
Epiretinal membrane (Macular pucker)
Vitelliform macular dystrophy
Leber's congenital amaurosis
Glaucoma / Ocular hypertension / Primary juvenile glaucoma
Leber's hereditary optic neuropathy
Persistent fetal vasculature / Persistent hyperplastic primary
Persistent tunica vasculosa lentis
Familial exudative vitreoretinopathy
Foster Kennedy syndrome
Optic disc drusen
Toxic and nutritional
Chronic progressive external ophthalmoplegia
Esotropia / Exotropia
Conjugate gaze palsy
One and a half syndrome
Anisometropia / Aniseikonia
Leber's congenital amaurosis
Blindness / Vision loss / Visual impairment
Argyll Robertson pupil
Marcus Gunn pupil
BNF: cb11953097t (data)