What Is A Cataract?

A cataract is a clouding of the lens in the eye that affects vision. According to the NHS, most cataracts are related to ageing, and they’re very common in older people.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

There are many different types of cataracts. Not all cataracts cause symptoms. If a cataract causes no symptoms, it can usually be left alone. If symptoms, such as blurred vision, occur then cataracts can be treated very successfully with surgery.

The Lens

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye.

In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain. The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.

What Causes Cataracts?

The lens lies behind the iris and pupil. It works much like a camera lens. It focuses light onto the retina at the back of the eye where an image is recorded. The lens also adjusts the eye’s focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

As you become older, you might also find that the lens begins to acquire a brownish shade. If you have advanced lens discolouration, you may not be able to identify blues and purples.

Cataracts are associated with the sun and so are far more common in areas of the world such as India and Africa. Other causes include injury, diabetes, smoking, certain drugs, and some ocular diseases.

Whilst cataracts are commonest in older people, they can occur at any age. Some children are born with cataracts, this is known as congenital cataracts.

Cataract Symptoms

The most common cataract symptoms are:
• Cloudy or blurry vision
• Colours seeming to fade
• Glare, headlights, lamps, or sunlight might appear too bright. A halo may appear around lights
• Poor night vision
• Double vision or multiple images in one eye.
• Frequent prescription changes

Because cataracts normally develop very slowly over many years, most people don’t notice the gradual deterioration in their vision until it starts to interfere with their daily activity, or it is spotted by their optometrist.

Different Types of Cataracts

• Secondary Cataract: Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
• Traumatic Cataract: Cataracts can develop after an eye injury, sometimes years later.
• Congenital Cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
• Radiation Cataract: Cataracts can develop after exposure to some types of radiation.

How Is A Cataract Detected?

Cataracts are detected through a comprehensive eye exam that includes:
• Visual Acuity Test: This eye chart test measures how well you can see at various distances.
• Dilated Eye Exam: Drops are placed in your eyes to widen, or dilate, the pupils. Your optometrist uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems.
• Tonometry: An instrument measures the pressure inside the eye.

How Are Cataracts Treated?

The most effective treatment for cataracts is an operation to remove the cataract and replace the cloudy lens with a clear artificial implant.

The lens of each eye should be clear in order for your eyes to work properly. When glasses no longer improve your vision, the only way to restore your vision is by having the cataract removed by surgery.

The Cataract Operation

Cataract surgery is one of the most common and quickest surgeries performed today. Modern cataract surgery, called phacoemulsification, is usually performed under local anaesthetic as a day case procedure. During the surgery, a tiny incision is made into the eye and the lens removed with an ultra-sound probe. The capsule of the lens is left behind and this is used to house the new lens implant. The whole procedure takes between 15 and 20 minutes and the visual recovery is very quick with most patients noticing improved vision within a matter of days.

Lens Implant Types

Each patient and each eye are different. Measurements are taken prior to surgery, called biometry, to establish the correct lens power for the individual eye. Lens implants also come in different types. The two major categories of lens implants are:

Monofocal Lenses

The vast majority of patients have this lens type put in. These provide good distance vision, but glasses are required for close work.

Multifocal Lenses

These lenses offer a high probability of achieving glasses independence, providing patients the ability to see far as well as to read without glasses.

However, patients can experience a reduction in contrast sensitivity, especially in dim lighting, as well as halos and glare around lights at night.

The pre-operative preparations for patients interested in multifocal lens implants are more involved than when monofocal lenses are being used, a wider range of issues need to be discussed, and the post-operative management is more intensive. These are the major reasons that these lenses are not offered on the NHS.

Current Cataract Research

The National Eye Institute is conducting and supporting a number of studies focusing on factors associated with the development of age-related cataracts.

These studies include:

• The effect of sunlight exposure, which may be associated with an increased risk of cataracts.
• Vitamin supplements, which have shown varying results in delaying the progressions of cataracts.
• Genetic studies, which show promise for better understanding cataract development.

For further support and information about living with cataracts, the RNIB is a good additional resource.

Cataracts aren’t the only age-related eye condition worth knowing about — our guide to Age-Related Macular Degeneration (AMD) covers another common one, including symptoms and treatment options.

For more on age-related eye conditions and how to manage them, see our full eye health guide. If you have any concerns about your vision, book an eye exam with your local D.I. Blow Opticians.

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In the UK, around 98% of children will survive but early diagnosis is really important.

This guide is going to go over the details of retinoblastoma, including the signs & symptoms and the importance of early diagnosis.

Signs & Symptoms

Retinoblastoma is a rare condition, so it is important to note that the following symptoms can be caused by other conditions, regardless it is important to get your child’s eyes checked.

• White Eye or Glow: You might see a while glow in the eye, sometimes described as a ‘cat’s eye’, a white pupil or white reflection in a photo where a flash has been used, or when your child is in artificial light or a darkish room.
• Squint: A squint, where the eyes do not look in the same direction, can sometimes be a symptom of retinoblastoma. In many cases, it’s nothing more than a squint, but all children should be checked out just in case.
• Red, Sore, or Swollen Eye: Your child’s eye may become very inflamed for no obvious reasons and with no sign of infection. This symptom is usually accompanied by one or more of the other signs described here.
• Change in Iris Colour: The iris can change colour in one eye, sometimes only in one area.
• No Red Eye: In a photo where one eye has ‘red eye’ (which is normal), the other eye may look black. This can be a sign that something is not right.
• Deterioration in Sight: Your child’s vision may begin to deteriorate, or they may have poor vision from birth. You may notice that they don’t focus, fix and follow as well as other children of the same age.

Cause

Retinoblastoma is often linked to a change in a gene that controls the growth of the eye. The change in this gene means cells in the back of the eye, retina, can grow uncontrollably. The changed gene may be passed to a child by their parents, or the gene may change as a child grows.

Unfortunately, it is not possible to prevent retinoblastoma, but screening tests can pick it up early. These tests can be carried out from birth.

Getting Diagnosed

If you’re worried that your child is showing a symptom of retinoblastoma, take them to your local optician/optometrist to have their eyes examined as soon as possible.

Test for retinoblastoma may include:
• A Red Reflex Test: A specialist will look at the back of the eye using a light.
• An Ultrasound Scan: Where a small device will be placed on the eye to take images of the inside of the eye.
• A Blood Test: To test for changes in the gene which can sometimes cause retinoblastoma.
• A Vision Test: To check your child’s eyesight.
• An MRI Scan: To check parts of the head around the eyes.

If you have any unusual photos of your child’s eye/s, take these to the optometrists with you for them to examine.

If retinoblastoma is suspected, an urgent referral will be made for your child to be seen at one of the two retinoblastoma treatment centres in the UK – The Royal London Hospital in Whitechapel, or Birmingham Children’s Hospital. An appointment will be made for your child to be seen within a week and the retinoblastoma service team will contact you, usually by telephone, before your appointment.

Treatment

Retinoblastoma can usually be successfully treated if found early. Treatment aims to get rid of the cancer but there is a high chance your child may lose some, or all, of their vision in the affected eye.

The treatment your child will have will depend on:
• The size of the cancer.
• Where the cancer is.
• If it has spread.
• Your child’s age and health.

You may be offered a combination of treatments including chemotherapy, laser treatment, cryotherapy, radiotherapy, and surgery.

Laser Treatment: Laser treatment uses a strong beam of light directed into the eye to kill cancer cells. Your child may have laser treatment for retinoblastoma if the tumour is small. Very small tumours may be successfully treated with laser therapy alone.

Cryotherapy: Cyrotherapy uses freezing to kill cancer cells. A small device is placed on the eye to freeze the cancer. Your child might have cryotherapy if the tumour is small or if the tumour is on the outer edge of the retina.

Chemotherapy: Chemotherapy is medicine that kills cancer cells. Your child might have chemotherapy to shrink the tumour before having another treatment or to treat cancer that’s in both eyes or has spread.

Radiotherapy: Radiotherapy uses radiation to kill cancer cells. It’s usually done by putting a small piece of radioactive material in the eye, or sometimes by aiming a beam of radiation at the tumour (proton beam therapy). Your child might have radiotherapy if the tumour is small, or other treatments have not worked.

Surgery: Sometimes surgery might be needed to remove the affected eye. This is called enucleation. Surgery may be needed because the cancer is spreading to other parts of the eye or other treatments have not worked. If your child’s eye is removed, it will be replaced with an artificial eye that looks and moves similar to their other eye.

Children will have regular follow-ups to check for any recurrence of the cancer and for any problems which may arise as a result of the treatment they were given.

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Retinoblastoma is one of several children’s eye conditions worth being aware of — our guide to Down’s syndrome and eye care covers another, more common one affecting children.

For more on eye conditions and general eye health, see our full eye health guide.

If you’re worried about your child’s eye health, book your child in for a comprehensive eye exam with your local D. I. Blow Opticians today.

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