Cataract
DR. A. K. KHAN
Professor of Ophthalmology &
Dean, Health and Medical Science
Gono Bishawbidalaya. Savar, Dhaka.
Orientation program for 4th year MBBS 2014
The healthy eye
• Light rays enter the eye
through the cornea, pupil and
lens.
• These light rays are focused
directly onto the retina, the
light-sensitive tissue lining
the back of the eye.
• The retina converts light rays
into impulses; sent through
the optic nerve to your brain,
where they are recognized as
images.
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What is a cataract?
Healthy lens
Lens with a cataract
Clouding of the normally Can be compared to a
clear lens of the eye. window that is frosted or
yellowed.
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What is a cataract?
• A clear lens refracts • A cloudy lens
light onto the retina and prevents light from
fine-tunes our focusing focusing sharply on
ability. the retina.
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A cataract is not:
• A film over the eye.
• Caused by overusing the eyes.
• Spread from one eye to the other.
• A cause of irreversible blindness.
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Symptoms of cataracts
• Painless blurring of
vision.
• Glare or light sensitivity.
• Poor night vision and/or
difficulty driving at night.
• Double vision in one eye.
• Needing brighter light to Yellowing of colors
read.
• Fading or yellowing of
colors.
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What causes cataracts?
• Aging of the eye (most common).
• Family history.
• Medical problems, such as diabetes.
• Injury to the eye.
• Medications, especially steroids.
• Long-term, unprotected exposure to sunlight.
• Previous eye surgery.
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How quickly does a cataract
develop?
• Most age-related cataracts progress gradually over a period
of years.
• Non-age-related cataracts, especially in younger people and
people with diabetes, may progress rapidly over a short
time.
• Cataract development varies among individuals, and may
even be different between the two eyes.
• Protection from excessive sunlight may help slow the
progression of cataracts (UV-protective sunglasses or
regular eyeglasses).
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How is a cataract treated?
• Surgery is only way to remove cataracts.
• If symptoms of cataract are not affecting your normal
activities, surgery may not be needed.
• Sometimes a simple change in your eyeglass(usually
minus power glass) prescription can help delay the
need for surgery.
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When should cataract surgery be performed?
• When cataracts cause enough vision
loss to interfere with your daily
activities:
Performing your job
Driving safely
Reading and watching TV in comfort
Taking medication
• You and your ophthalmologist (Eye
Specialist) should decide together
when surgery is appropriate.
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Right eye cataract and left eye no cataract
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Right eye cataract and left eye after cataract operation
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Cataract
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Cataract
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Congenital cataract
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How is cataract surgery performed?
• Local or topical anesthesia.
• Small incision is given and no stiches are required
• Two varieties of surgery are popular:
Phoco surgery
SICS or Manual phaco surgery
• Requires only 4 to 6 hours stay in hospital after
operation.
• But for rural and patients coming from far distance its
better stay till first follow-up usually after 12 to 24
hours for safety reason.
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How phaco surgery performed?
• A small incision is made close to
the edge of the cornea.
• A tiny, high-frequency ultrasound
instrument is inserted that breaks
up center of the lens.
• Broken-up cloudy lens material is
removed through the incision.
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How is cataract surgery performed?
• Intraocular lens (IOL) implant is
inserted into your eye to replace
the cloudy lens.
• IOL is customized for your eye;
restores focusing power.
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How is cataract surgery performed?
• IOL usually placed behind the
iris (posterior chamber lens).
• Sometimes placed in front of
iris (anterior chamber lens).
IOL in eye
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What can I expect from cataract surgery?
• Most cataract surgical procedures are performed
without complications and result in immediate
improvement in vision.
• You will apply eye drops for several weeks following
surgery to reduce the possibility of infection and/or
inflammation in the eye.
• You may need an eyeglass prescription to obtain your
clearest vision following surgery.
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Posterior capsulotomy
• In a small number of cases, the
natural capsule supporting IOL
can become cloudy after cataract
surgery.
• Posterior Capsulotomy: laser
surgery to open cloudy capsule
and restore clear vision.
Posterior Capsulotomy
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Bangladesh scenario
There are approximately 6,75,000 blind adult in Bangladesh.
Cataract comprises 80% of avoidable blindness in
Bangladesh
One Ophthalmologist for every 210,000.
Present CSR is about 1200 per million, against 1800
necessary to deal with new cases and 3000 to control
cataract blindness.
There is huge backlog in cataract surgery.
Price for IOL cataract surgery is too high for the majority of
the population.
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Cataract surgery to restore clear vision
• More than 95% of cataract surgeries are performed with no
complications and improved vision.
• Patient and ophthalmologist should decide together when
cataract surgery is appropriate for you.
• Whenever you see a case of cataract, please advise
him/her to consult an eye doctor or near by health care
center as soon as possible to restore vision. Delay in doing
surgery may cause painful complications and loss of vision.
Thank you 26
