Cataract of the eye: signs, symptoms and main treatments. What are the first signs of eye cataracts What are the signs of cataracts

Cataract is one of the most common eye diseases that occurs today among the elderly. The natural lens of our eye is the lens, which transmits light rays through itself and refracts them. It is located in the eyeball, between the vitreous body and the iris. When it comes to such a diagnosis as a cataract, the symptoms of which are manifested due to partial or complete clouding of the lens, the latter loses its own transparency, after which the eye perceives only a small part of the light rays.

As a result, vision is significantly reduced, which leads to blurred and fuzzy visual perception, which, if not treated in time, leads to complete blindness.

General description of the disease

Considering this disease, it is not entirely true to say that it occurs exclusively among the elderly, because it is relevant for any age category. In addition, cataract is traumatic and congenital, radiation and complicated, it is also caused by common diseases.

The formation of congenital cataracts is facilitated by the transfer of certain infections by a pregnant woman (, etc.). Also, the possibility of the appearance of this disease can be discussed when taking potent medications during pregnancy or when exposed to radiation during this period. At the same time, it can be argued that the causes of congenital cataracts, in particular, are still not fully understood, because cases of its occurrence in newborns with perfectly healthy parents are not uncommon.

A cataract can form in one eye or both. Basically (unless we are talking about the occurrence of cataracts due to trauma), the development of the disease occurs symmetrically on both sides.

Cataract of the eye: symptoms

The development of cataracts occurs quite slowly, without pain. The very beginning of the disease can cover only a small part of the lens, which does not even affect vision. Over time, the size of the cataract is subject to increase, and by the time it becomes an obstacle to the perception of light rays, vision deteriorates. Among the main symptoms of cataracts, we highlight the following:

• Blurred vision ("as if in a fog");
• Increased sensitivity to exposure to bright light;
• The appearance of a sensation of flashes and glare, which is especially evident at night;
• When reading, there is a need for additional lighting;
• There is an increase in the change of diopters for contact lenses and glasses;
• Light sources are surrounded by a "halo";
• Color perception is weakened;
• Arises;
• With the second eye closed, viewing objects leads to their bifurcation.

External changes, as a rule, are absent in the eyes with cataracts. Itching, irritation, redness, pain - all these are not symptoms characteristic of a cataract, however, these manifestations may indicate the presence of another type of disease. Also, cataracts are not dangerous for the eyes until the moment when the eye becomes completely white. Already in this case, additional symptoms of cataract are expressed in the development of inflammation, headaches and eye pain. Meanwhile, such a veil occurs quite rarely, which implies the need for surgical intervention.

Stages and types of cataract

Cataract, the symptoms of which manifest themselves in varying degrees depending on the progression of the disease, has four stages of its own development, namely:

I stage- initial cataract. The lens (mainly in the periphery) has areas with opacities, while a significant part of it has transparency. Manifestations of the disease in this period can be very different. So, some patients do not experience visual impairment, others complain of the appearance of "flies" before their eyes, others experience changes in refraction (refractions in the optical system, expressed in myopia, hyperopia), which requires a relatively quick change in diopters in lenses / glasses;

II stage- Immature cataract. In this case, the lens noticeably becomes cloudy, vision is reduced. The patient is able to count the fingers only near the face. Due to the increase in the lens, the anterior chambers of the eyes become less deep. The stage is also referred to as the "swelling stage". An increase in the lens often provokes an increase in intraocular pressure ( secondary);

III stage- mature cataract. Here, a complete clouding of the lens is formed, which completely reduces vision. The patient sees hand movements only near the face;

IV stage wrinkling or liquefaction of the lens. The quality of vision remains similar to the previous stage, sometimes it can even improve. Subsequently, spontaneous resorption of the formation becomes possible, for which, however, a lot of time is required - years, or even decades (which is more often).

In addition to congenital and acquired forms of cataract, it can also be traumatic and electrical.

• Traumatic cataract formed when the eye is injured. Thus, mechanical damage to which the lens capsule is exposed leads to the penetration of moisture from the anterior chamber into the lens, after which it, accordingly, becomes cloudy.
• cataract electric It is formed due to the passage of a significant electric current through the eye, as well as due to exposure to x-rays, gamma rays and infrared rays. Ultrasound and other hazards also affect the eyes when considering the possibility of cataracts.

Secondary cataract: symptoms

This type of cataract should be placed in a separate subparagraph, because it develops due to a surgical effect aimed at eliminating the cataract (that is, in its primary form, after which the disease, in fact, should be excluded). The secondary cataract is characterized by thickening and clouding in the region of the posterior lens capsule, which, accordingly, leads to a deterioration in visual perception.

Modern ophthalmology in the process of surgery allows you to save the lens capsule in the treatment of cataracts. It is also an elastic thin bag into which an intraocular lens is implanted after the removal of the clouded lens. The occurrence of a secondary cataract is associated with the growth of the epithelium along the capsule (more precisely, its posterior surface), which provokes a decrease in transparency and deterioration of vision.

It should be noted that this kind of turbidity is not the cause of the incompetence of the specialists who performed the surgical intervention, but only act as a result of certain cellular reactions occurring in the specified capsular bag.

Symptoms of secondary cataract are defined by the following manifestations:

• Gradual loss of vision;
• Lights arising from the action of light sources and from the sun;
• "Misty" vision.

Cataract treatment

Cataract treatment can be carried out through surgical and medical treatment. Thus, surgical treatment of cataracts is best performed at the stage of formation maturity: the lens fibers are quite cloudy, while they are removed from the lens capsule without any special difficulties. It should be noted, however, that the main indication for the operation is not the degree of maturity of the cataract, but the general state of vision.

As for drug treatment, it is ineffective for congenital cataracts. In other cases, it is indicated for patients whose cataract is in the initial stage of the senile form, as well as for patients who have a cataract of a different type of origin (radiation, toxic, etc.).

The diagnosis of cataracts, as well as the determination of the appropriate treatment based on the general condition of the patient, is carried out by an ophthalmologist.

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Diseases with similar symptoms:

Myopia is a pathological condition, during the progression of which a sick person begins to poorly distinguish objects located far from him. He can hardly read the signs, see the numbers of cars, he may not even recognize his friend from a distance of several meters. Medical statistics are such that it is myopia that is the most common visual impairment that occurs in both adults and children (children's myopia is not uncommon). This disease can progress and have varying degrees of severity.

The most common eye disease among people of mature and old age, of course, is a cataract. It causes a significant decrease in vision, difficulties in professional activities, restriction of self-care of a person, and in advanced cases becomes the cause of irreversible blindness. At the same time, timely access to a qualified ophthalmologist and high-quality surgical treatment ensure the restoration of vision and a return to a normal lifestyle.

A cataract is a clouding of the lens. In the development of this pathology, a violation of metabolic processes in the lens and the intraocular fluid that nourishes it plays a role.

Classification and causes of cataracts

There are two large groups - congenital and acquired cataracts.

The first appear even in the prenatal period of fetal development under the influence of infectious or endocrine diseases of a pregnant woman. After birth, the cloudy lens does not allow the child's visual analyzer to form correctly, causing the development of amblyopia and. Surgical treatment for cataract removal is indicated in the first months of life, but even after the operation, long courses of laser stimulation of the retina will be required, which will activate its functional abilities.

Acquired senile cataracts are more common. They develop after 50 years. In a group of 70-year-old people, clouding of the lens can be found in half. In this case, the appearance of the disease is associated with the aging of the body as a whole and the slowing down of metabolic processes in the tissues of the eye in particular.

In addition to age, the formation of lens opacities is associated with some eye diseases or pathologies of other organs. Such cataracts are called complicated. They develop with moderate and high myopia, glaucoma, diseases of the choroid, pigmentary dystrophies and retinal detachments. Common diseases that can cause clouding of the lens include other endocrine pathologies, bronchial asthma, diseases of the connective tissue, joints, blood, which require long-term use of steroid hormones, some skin diseases (, eczema). The appearance of cataracts is promoted by the action of external factors - mechanical, chemical, thermal and radiation.

Symptoms of a cataract

The manifestations of cataracts depend on the location of the opacities in the lens. In the cortical form, changes begin in the periphery and do not affect vision for a long time. As soon as the opacities reach the central zone of the lens, vision decreases, the patient may notice a fog, a veil before the eyes. If the changes are localized on the posterior lens capsule, then visual impairment occurs early. Such patients see better in low light, because a wide pupil passes rays to the retina through the still unchanged transparent areas of the lens.

A feature of the nuclear form of cataract is the so-called myopization of the lens. Opacities in the nucleus strongly refract light rays, due to which the patient develops myopia, even if it was not there before. If the patient suffered from myopia before the appearance of cataracts, then its degree increases. Distance vision improves with minus glasses, and the need to use plus glasses for reading disappears, for which patients are incredibly happy, attributing the appearance of this metamorphosis to anything but the development of cataracts. Such a period does not last long, over time the glasses cease to help, vision both far and near decreases, a fog appears before the eyes.

As a rule, a cataract is a two-sided pathology, and after a short period of time, having arisen in one eye, it appears in the other, and the rate of development of opacities in the lenses in the right and left eyes is different.

Cataract is a progressive disease, it undergoes several stages of development:

• initial - characterized by high or slightly reduced vision. The patient does not show any complaints, the presence of a cataract can be determined by an ophthalmologist during the examination. Often such a cataract is an accidental finding discovered during medical examinations.
• immature - characterized by a pronounced decrease in vision. The patient complains of a thick fog before his eyes, no improvement in vision when using glasses. The disease leads to difficulties in self-care and performance of professional duties. The patient needs surgical treatment.
• mature - characterized by the absence of objective vision. The patient sees only the contours of objects located at arm's length from him. In this case, urgent surgical treatment is required.
• overripe - there is no objective vision, the patient can determine the light from a flashlight directed into the eye, or the presence of a bright window in the room. Such a cataract is visible to others as a white film in the pupil area. The patient needs emergency surgery. Cataracts at this stage of development can cause numerous complications. Dangerous is the development of secondary glaucoma due to compression of the surrounding tissues of the eye by an enlarged clouded lens. The ligaments that hold the lens are also involved in the dystrophic process, torn, they lead to dislocation of the lens into the vitreous body. The proteins of the overripe lens, of which it consists, are perceived by the tissues of the eye as foreign, which can cause the development of iridocyclitis.

Cataract diagnostics

If you suspect a cataract, you should consult a doctor. Any delay can lead to complications that threaten blindness.

The patient undergoes a standard ophthalmological examination, which includes the determination of refraction and visual acuity, the study of the boundaries of the visual fields, intraocular pressure. With the help of an echobiometer, the optical power of the implanted artificial lens is determined. The doctor examines the anterior segment of the patient's eye behind a slit lamp, and the retina, if visible, with an ophthalmoscope. If it is difficult to visualize the posterior segment of the eye, ultrasound is used, which will reveal pathological changes in the retina.

Cataract treatment

In the initial stage of cataract development, drops of Quinax, Vita-Yodurol, Oftan-Katahrom, Taufon are used. They prevent the progression of opacities, but cannot resolve existing ones. It must be remembered that the drugs and the mode of their use are prescribed only by an ophthalmologist.

The main method of treating the disease is surgical - cataract phacoemulsification with implantation of an artificial posterior chamber intraocular lens. Surgery is performed in 99% of patients. A favorable outcome of treatment should be expected in the case when the patient presents with an immature cataract, that is, he still sees. Phacoemulsification is a modern treatment method that has been used in Russia for the past 20 years. The operation is performed under local anesthesia. The cloudy lens is destroyed by an ultrasonic tip, which is inserted into the eye through a 2.2 mm long corneal incision. An artificial flexible lens is then implanted into the lens capsule. There is no need for suturing the surgical wound. The operation takes less than 20 minutes. Vision is restored on the first day after the intervention to the level that was before the development of cataracts. The recovery period is 4 weeks, the patient must follow the doctor's recommendations and instill drops that have an anti-inflammatory effect. After a month, you can return to your normal lifestyle.

If the patient has a hard mature or overmature cataract, which is complicated by weakness of the ligaments that support the lens (the so-called subluxation of the lens), intra- or extracapsular cataract extraction is performed. The essence of the intervention is to remove the whole lens in its capsule or without it through a corneal incision 12–14 mm long. The lens is implanted rigid, it is sutured to the iris or attached to the lens capsule. A continuous suture is applied to the corneal incision, which will have to be removed after 4-6 months. Immediately after the intervention, vision is poor due to postoperative reverse astigmatism. But after the removal of the suture, the patient begins to see in the same way as before the formation of the cataract. The rehabilitation period is long, up to two months. This is due to the risk of divergence of the postoperative wound.

In view of the greater traumatic nature of the described methods of treating cataracts, one should not delay contacting an ophthalmologist, and surgical removal of the cloudy lens using its phacoemulsification should be planned already when the visual acuity of the eye is 0.4.

Treatment of secondary glaucoma and iridocyclitis, which arose due to overmaturation and swelling of the cataract, is to remove the cloudy lens against the background of symptomatic antihypertensive therapy.

Unfortunately, the symptoms of eye cataracts are known to almost half of the adult population of the Earth. The disease does not depend on age and can also develop in young people, but still, more often this diagnosis is made to people after 50 years of age. What is hidden under the terrible word "cataract"?

A cataract is a clouding of the lens of the eye. Translated from ancient Greek, "cataract" means "waterfall", since during the disease, the patient begins to look at the world around him, as if through a falling water stream.

Cataract does not appear in one day, vision falls gradually and a person has time to react to the disease and start treatment on time to avoid irreversible consequences. With rapid detection and timely measures taken, it is possible to help the sick person with the help of medications.

Stages of eye cataract: signs

Symptoms of eye cataract directly depend on the stage of its development. According to the clinical course, doctors usually divide the degree of the disease into 4 stages.

Initial or maturing cataract - clouding of the lens begins from the periphery, while its center remains transparent. A noticeable deterioration in vision during this period, as a rule, is not observed. The very first symptoms of the initial stage of the disease are expressed in:

• the appearance of black flies, dots, strokes, before the eyes;
• bifurcation of objects;
• fear of bright light;
• vision falls in the dark;
• reducing the brightness of the image;
• short-sighted people temporarily regain the ability to read without the help of glasses;

With an immature or swelling degree of the disease, the central optical region of the lens becomes cloudy, which leads to a decrease in visual acuity. Other symptoms of immature cataract:

• surrounding objects are seen as cloudy and forked;
• in some cases, there is an increase in the volume of the lens, leading to increased eye pressure;
• the area of ​​clouding of the eye becomes much larger;
• the iris and pupil become whitish;
• the brightness of colors decreases, the image acquires yellow tones;
• feeling of mist before the eyes.

The mature form of cataract is characterized by a final and uniform clouding of the lens, the pupil becomes white or dirty gray. The patient ceases to distinguish between objects, at best, hands brought close to the face are available for his vision. He perceives only light sensations, which may also disappear with time, but at this stage, blindness can and should be fought.

In the overripe form of cataract, there are two forms of development. The first is a decrease in the volume of the lens due to the moisture lost by it and the formation of wrinkles on its capsule. The second is characterized by liquefaction and expansion of the lens, which makes it difficult for the outflow of eye fluid, resulting in increased intraocular pressure. The main symptoms of an overripe cataract are:

• complete irreversible loss of vision;
• the pupil is completely covered with a milky-white film;
• symptoms of cataracts in the early stages.

As mentioned above, if you pay attention to the symptoms of cataracts in the early stages, then it is possible to cope with the disease without surgery. It is very important to diagnose the disease at the very beginning of its development and take appropriate measures.

Signs of developing cataract

The symptoms of an impending cataract are very specific, at the first such signs, it is necessary to urgently contact an ophthalmologist for an accurate diagnosis.

The most important and the first symptom of approaching cataracts is considered to be deterioration of vision in the dark. If a person begins to poorly navigate in the dark, driving a car at night becomes difficult, it's time to pay a visit to the ophthalmologist.

The second symptom is a blurred and bifurcated contour of objects, at first this symptom is not clearly expressed, but begins to progress over time. Glasses are not able to help in solving this problem. Other signs:

1. Around a light bulb or other light source, the patient may observe an iridescent halo. This phenomenon is explained by the fact that some of the rays are scattered in the clouded lens and do not fall on the retina.
2. If the clouding of the lens begins from the center, then vision at dusk becomes much sharper than in daylight.
3. Sensation of a veil before the eyes, colors are perceived more faded with a yellowish coating.
4. The patient lacks conventional lighting, constantly wanting to add an additional light source.
5. In some cases, farsightedness or myopia begins to progress.
6. The pupil changes color to a paler one.

Symptoms of cataracts in adults

Cataract, like many other diseases, is rapidly “getting younger”. Recently, doctors are increasingly making this diagnosis for patients under the age of 40. But still, the main reason for the development of the disease is old age, the amount of ultraviolet rays accumulated over the years of life and metabolic disorders.

Cataracts in adults can be caused by a number of factors: smoking, heredity, eye damage, and medical conditions such as hypertension or diabetes.

Depending on the type of cataract, its symptoms also differ:

1. Nuclear cataract - characterized by a slight clouding of the central region of the lens and has the appearance of a white spot with sharply defined borders.
2. Subcapsular cataract - localized in the posterior region of the lens and looks like a white cloudy ball. Difficulty reading and "afraid" of bright light.
3. Cortical - a fairly common type of disease. It is formed around the nucleus of the lens and has a layered structure in which cloudy and transparent layers alternate. Over time, it spreads to the center of the lens.
4. Soft - expressed in clouding of the lens as a whole, over time it liquefies and dissolves.

Incorrect diagnosis and untimely treatment of cataracts leads to such complications as complete loss of vision, secondary glaucoma, lens displacement, and retinal atrophy.

Cataract responds well to surgical treatment. Today, there are effective techniques that remove the damaged lens. The operation technology allows simultaneous implantation of an artificial lens. If a cataract is accompanied by an increase in eye pressure (glaucoma), then it is not completely possible to restore vision after surgery.

Cataracts develop in both the elderly and middle-aged people. Often this is a complication of diabetes and alcoholism. Irreparable damage to vision causes substance abuse and open exposure to sunlight. The following symptoms are characteristic of cataract combined with glaucoma:

• Brown tint of objects;
• Fluffiness and glow of the picture;
• Blurred and diplopia vision.

The reason for such visual defects is degenerative changes in the macula.

If a cataract is suspected, each person should consult an ophthalmologist. Comprehensive diagnostics consists of the following methods:

• Determination of refraction (farsightedness and myopia);
• Examination of the lens and anterior chamber of the eye;
• Computer perimetry (determination of the field of view);
• Tonometry (determination of eye pressure);
• Retinal examination;
• ultrasound of the eye;

Acuity is necessarily determined, and keratotopography (determination of the curvature of the cornea), according to indications.

Cataract is the aging of the lens of the eye, therefore general health measures that relate to lifestyle, nutrition and regimen serve as prevention. People who maintain physical activity and proper nutrition can, if not avoid, then significantly delay the aging of the lens and the body as a whole.

There are specific recommendations. The formation of cataracts occurs under the direct influence of ultraviolet rays, as a catalyst for free radicals. Sun damage to the lens cells is the trigger for its clouding.

Similarly, hormonal drugs, corticosteroids and agents that increase sensitivity to UV rays affect the eye. Tableted contraceptives and caffeine-containing drinks have a negative effect. After 40 years, blood glucose control and preventive examination by an ophthalmologist are mandatory.

The first signs of a cataract in the eye

The first signs of a cataract in the eye

Most eye diseases are the scourge of the elderly. Cataracts are no exception, the chance of falling ill of which is especially high after 40. Since the result of the disease is complete blindness, it is important for the patient to recognize the first alarm bells in time: this will stop the pathology and keep vision at a high level without surgical intervention. The main difficulty in early diagnosis is the asymptomatic first stage of cataract. As a rule, this pathology is detected already in a neglected state, when degenerative changes in the eye have begun. They are irreversible, so surgical treatment is indispensable. However, there are some signs of cataracts in the early stages that should not be ignored.

First symptoms:

• deterioration of night vision;
• periodic appearance of optical effects before the eyes: front sights, stripes, spots, iridescent rings, etc .;
• fear of bright light;
• difficulties in reading small print - the contrast between the text and the background is broken;
• short-term split in the eyes;
• disturbances in color differentiation.

If you do not observe anything like this, this does not yet indicate health. Signs of a cataract are usually seen in both eyes at the same time. However, the course of the disease is asymmetric: on one eye, the process occurs faster than on the other. At an early stage, visual acuity is reduced by 30%. If it was possible to detect a cataract at this stage, then it is likely to do without surgical interventions. When vision is reduced by almost 50% or more, the treatment involves the installation of an artificial lens.

When do the first signs of cataract appear?

The initial stage of a cataract can be quite protracted. According to statistics, about 10% of patients suffer from a transient form of cataract, when only 2-3 years occur from the onset of the disease to the last stage. In most patients (in 70% of cases), this process takes about 8-10 years. For others, it takes 15 years.

But in any case, the first symptoms are sometimes completely absent or are irregular. When serious vision problems begin, this indicates the second or even third stage of the disease. Therefore, it is so important to pay attention to any changes in vision. For example, the patient notices that all objects are painted in a yellowish tint. Because of this, the ability to distinguish some colors also deteriorates - a clear reason to visit an ophthalmologist.

Signs of an eye cataract at this stage are clearly visible during a routine ophthalmological examination:

• Inside the lens, cavities in the form of watery cracks (vacuoles) are visible.
• The lens swells, increases in size.
• There may be a slight increase in eye pressure, which is associated with swelling of the lens.
• The color of the pupil becomes lighter. In a healthy eye, it is black, with a developing cataract it turns pale, turns gray. At the advanced stage - dairy.

Pathological changes in the lens at the beginning of a cataract do not affect the optical part of this organ, so the initial signs are not accompanied by visual impairment. As the vacuoles grow and spread to the central part, a decrease in visual acuity begins. This happens especially rapidly and abruptly in the second stage.

How to determine a cataract at home?

You can conduct a simple test: try to read the same book at dusk and in good light. If in the first case it was easier for you to recognize the text, this indicates a developing pathology. The fact is that at dusk the pupil dilates, so the clouded area of ​​​​the lens does not interfere with reading. But in good light, the pupil becomes very small. Therefore, even a slight turbidity in this area leads to reading problems.

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A cataract is a disease in which the lens becomes cloudy and loses its transparency, as a result of which the bangs begin to see poorly. With a long course of cataracts, clouding of the lens can be so significant that a person is completely blind. The main manifestation of cataract is the appearance of a sensation of "fog" before the eyes, through which objects are seen as if through a haze, a layer of water or misted glass. In addition, cataracts worsen vision at night, impaired ability to recognize colors, double vision and increased sensitivity to bright light.

Unfortunately, the only treatment that completely eliminates cataracts is surgery, during which the cloudy lens is removed and a special transparent lens is inserted into the eye instead. But such an operation is not always necessary. So, if a person sees normally, then conservative treatment is recommended to stop the progression of cataracts and maintain vision at the current level, which will be an adequate replacement for surgery.

Brief description of the disease

Currently, according to the World Health Organization, cataract is the most common eye disease in the world. However, the frequency of its occurrence is different in people of different age groups. So, in people under 40 years of age, cataracts develop extremely rarely, and in this age group, cases of a congenital disease that developed in a child in the womb before he was born are recorded mainly. Among people 40-60 years old, cataract occurs in 15%, in the group of 70-80-year-olds the disease is already fixed in 25-50%, and among those who have crossed the 80-year mark, cataracts are detected to some extent in everyone. Thus, cataract is an urgent and frequently encountered medical problem, as a result of which the disease and methods of its treatment are intensively studied, due to which significant progress has been made in recent years in the success of therapy.

With a cataract, one of the structures of the eye is affected - the lens, which becomes cloudy. To understand the essence of the disease, it is necessary to know the position and functions of the lens in the system of the human visual analyzer.

So, the lens is a biconvex, elliptical, absolutely transparent structure located behind the iris (see Figure 1) with a maximum diameter of 9-10 mm.

Picture 1- The structure of the eye.

Since the lens is completely transparent, even with a careful look into the pupil or at the iris of the eye, it is not visible. By structure, the lens is a gel-like mass enclosed in a dense capsule of connective tissue that holds the necessary shape of the organ. The gel-like content is transparent, so that light rays pass through it freely. The shape of the lens is similar to an ellipse, which is extended from one corner of the eye to the other, and the curved surfaces adjacent to the pupil are optical lenses that can refract light rays. The lens does not contain blood vessels that would violate its complete transparency, as a result of which its cells are nourished by diffusion of oxygen and various necessary substances from the intraocular fluid.

According to the functional purpose, the lens plays a very important role. Firstly, it is through the transparent lens that light rays pass into the eye and are focused on the retina, from where the image for analysis and recognition is transmitted to the structures of the brain along the optic nerve. Secondly, the lens not only transmits light waves into the eye, but also changes the curvature of its surfaces in such a way that the rays are focused exactly on the retina. If the lens did not change its curvature, adjusting to different illumination intensities and distances of the objects under consideration, then the light rays passing through it would not be focused exactly on the retina, as a result of which a person would see blurry rather than clear images. That is, with a constant curvature of the lens, a person's vision would be poor, he would see like those suffering from myopia or hyperopia and not wearing glasses.

Thus, we can say that the main function of the lens is to ensure that the image of the surrounding world is focused directly on the retina. And for such focusing, the lens must constantly change its curvature, adjusting to the conditions of visibility of the environment. If an object is close to the eye, then the lens increases its curvature, thereby increasing the optical power. If the object is far from the eye, then the lens, on the contrary, stretches and becomes almost flat, and not convex on both sides, due to which the optical power decreases.

In fact, the lens of the eye is similar to an ordinary optical lens that refracts light rays with a certain force. However, unlike a lens, the lens is able to change its curvature and refract rays with different strengths required at a given time, so that the image is focused strictly on the retina, and not closer or behind it.

Accordingly, any change in the shape, size, location, degree of transparency and density of the lens leads to visual impairment of greater or lesser severity.

And a cataract is a clouding of the lens, that is, a loss of transparency due to the formation of a different number of dense and opaque structures in its gel-like subcapsular contents. As a result of a cataract, the lens ceases to transmit a sufficient amount of light rays, and a person ceases to see a clear picture of the world around him. Due to the turbidity of the lens, vision becomes, as it were, "foggy", the outlines of objects become fuzzy and blurry.

The causes of cataracts have not yet been reliably established, but, nevertheless, scientists identify a number of predisposing factors, against the background of which a person develops a cataract. These factors contribute to the development of cataracts, so they are conventionally referred to as the causes of this disease.

At the level of biochemistry, cataracts are caused by the breakdown of proteins that make up the gel-like contents of the lens. Such denatured proteins are deposited in the form of flakes and cloud the lens, which leads to cataracts. But the reasons for the denaturation of lens proteins are very diverse - these can be age-related changes in the body, injuries, chronic inflammatory eye diseases, radiation, metabolic diseases, etc.

The most common predisposing factors for cataracts are the following conditions or diseases:

• hereditary predisposition;
• Age-related changes in the body;
• Endocrine diseases (diabetes mellitus, hypothyroidism, hyperthyroidism, muscular dystrophy, etc.);
• Exhaustion due to starvation, malnutrition, or severe past illnesses (for example, typhoid, malaria, etc.);
• Excessive exposure of the eyes to ultraviolet radiation;
• radiation exposure;
• Poisoning with poisons (mercury, thallium, ergot, naphthalene);
• Skin diseases (scleroderma, eczema, neurodermatitis, poikiloderma Jacobi, etc.);
• Injuries, burns, eye surgery;
• Myopia of a high degree (more than 4 diopters, etc.);
• Severe eye diseases (uveitis, iridocyclitis, retinal detachment, etc.);
• Infections transferred during pregnancy (influenza, rubella, herpes, measles, toxoplasmosis, etc.) - in this case, the newborn may have a congenital cataract;
• Taking glucocorticosteroid drugs (Prednisolone, Dexamethasone, etc.).

Depending on the age of cataract onset, the disease can be congenital or acquired. Congenital cataracts occur even during fetal development, as a result of which the baby is born with a visual defect. Such congenital cataracts do not progress over time and are limited in area.

Acquired cataracts appear during life due to the influence of various causative factors. The most common among the acquired are senile cataracts, due to age-related changes in the body. Other types of acquired cataracts (traumatic, toxic due to poisoning, caused by systemic diseases, etc.) are much less common than senile ones. Unlike congenital, any acquired cataracts progress over time, increase in size, worsening vision more and more, which, ultimately, can lead to complete blindness.

Cataracts are divided into several types, depending on the nature and localization of lens opacities. Determining the type of cataract is important to determine the optimal strategy for its treatment.

Cataract of any kind and localization consistently passes from the moment of appearance 4 stages of maturity- initial, immature, mature and overripe. At the initial stage, the lens becomes hydrated, gaps appear in the gel-like mass that fills it, which violate the transparency of the entire structure. However, since the cracks are located along the periphery, and not in the pupil area, this does not prevent a person from seeing, so he does not notice the development of the disease. Further, at the stage of immature cataract, the number of foci of opacification increases, and they are in the center of the lens opposite the pupil. In this case, the normal passage of light through the lens is already disrupted, as a result of which a person's visual acuity decreases and a feeling of seeing surrounding objects appears as if through fogged glass.

When the opacities fill the entire lens, the cataract becomes mature. At this stage, the person sees very poorly. The pupil with a mature cataract acquires a characteristic white tint. Then comes the stage of overripe cataract, in which the disintegration of the lens substance and the wrinkling of its capsule occurs. At this stage, the person is completely blind.

Cataract progression rate, i.e. passing through all four stages of development, can be different. So, in one person, cataracts can progress very slowly, so that vision remains satisfactory for many years. And in other people, on the contrary, cataracts can progress very quickly and lead to complete blindness literally within 2 to 3 years.

Symptoms of a cataract depending on the stage of the disease may be different. At the first stage, a person does not suffer from visual impairment, but notices often repeated episodes of double vision, flashing "flies" before the eyes, a yellowish color of all surrounding objects, as well as some blurring of the visible picture. Blurred vision is often described by people - "seeing as if in a fog." In connection with the symptoms that have appeared, it becomes difficult to read, write and perform any work with small details.

At the stage of immature and mature cataracts, visual acuity sharply decreases towards myopia, objects begin to blur before the eyes, there is no discrimination of colors, a person sees only blurry contours and outlines. A person no longer sees any small details (people's faces, letters, etc.). By the end of the stage of mature cataract, a person ceases to see anything at all, and only light perception remains.

In addition, at any stage of development, cataracts are characterized by increased photosensitivity, poor vision in the dark, and the appearance of a halo around lighting fixtures when looking at them.

For diagnosing cataracts an ophthalmologist checks visual acuity (visometry), determines the field of view (perimetry), the ability to distinguish colors, measures intraocular pressure, examines the fundus of the eye (ophthalmoscopy), and also makes a detailed study of the lens using a slit lamp (biomicroscopy). In addition, sometimes additional refractometry and ultrasound scanning of the eye can be performed, which are necessary to calculate the optical power of the lens and determine the method of the operation to replace the lens. Based on the results of examinations, the diagnosis of cataract is confirmed or refuted. In cataracts, visual acuity is usually impaired, color discrimination is impaired, and, most importantly, clouding of the lens is visible when examined with a slit lamp.

Cataract treatment may be operative or conservative. If the disease is detected in the initial stages, when vision practically does not suffer, then conservative therapy is carried out aimed at slowing down the progression of cataracts. In addition, conservative therapy is recommended in all cases where a cataract does not prevent a person from engaging in any normal activity. Currently, various eye drops containing vitamins, antioxidants, amino acids and nutrients are used as a means of conservative treatment of the disease (for example, Oftan-Katachrom, Quinax, Vitafacol, Vitaiodurol, Taufon, Taurine, etc.). However, it must be remembered that eye drops are not able to lead to the disappearance of existing opacities in the lens, but can only prevent the appearance of new foci of opacity. Accordingly, eye drops are used to maintain vision at the current level and prevent the progression of cataracts. In many cases, such conservative therapy is very effective and allows a person to live for a long period of time without resorting to surgery.

Surgical treatment of cataracts consists in removing opacities and then installing a special lens in the eye, which, in essence, is like a lens prosthesis. This artificial lens performs the functions of a lens, allows a person to completely and permanently get rid of cataracts and restore vision. Accordingly, the only complete and radical treatment of cataract is surgery.

Currently, ophthalmologists, knowing that surgery is the treatment with the most visible positive result, recommend the removal of opacities and the installation of a lens in almost all cases of cataract. This position of actively promoting the surgical treatment of cataracts is due to the convenience for the doctor, who simply needs to perform a relatively simple operation, after which the patient can be considered cured. But conservative therapy requires effort from both the doctor and the patient, since it is necessary to constantly apply eye drops in courses, undergo examinations and control vision. And yet, despite the advantages of surgery, in many cases, cataracts are preferable to conservative therapy, which stops the progression of the disease.

Causes of cataract

The causes of congenital cataracts are divided into two large groups - these are genetic anomalies and the impact of adverse factors during pregnancy that can disrupt the formation of the lens of the fetal eye.

Genetic anomalies, among the manifestations of which there is a congenital cataract, include the following diseases or conditions:

• Pathologies of carbohydrate metabolism (diabetes mellitus, galactosemia);
• Pathologies of calcium metabolism;
• Pathologies of connective tissue or bones (chondrodystrophy, Marfan syndrome, Weil-Marchesani syndrome, Apert syndrome, Conradi syndrome);
• Skin pathologies (Rothmund's syndrome, Block-Sulzberger's syndrome, Schaefer's syndrome);
• Chromosomal abnormalities (Down syndrome, Shershevsky-Turner syndrome, Marinescu-Sjögren syndrome, Axenfeld syndrome).

• Rubella, toxoplasmosis or cytomegalovirus infection, transferred in the first 12 to 14 weeks of pregnancy;
• The effect of ionizing (radioactive) radiation on the body of a pregnant woman in any period of gestation;
• Rhesus incompatibility of the fetus and mother;
• Fetal hypoxia;
• Lack of vitamins A, E, folic (B 9) and pantothenic (B 5) acids, as well as protein;
• Chronic intoxication of the body of a pregnant woman with various substances (for example, smoking, drinking alcohol, drugs, taking contraceptives or abortion pills).

So, the following diseases or conditions can be the causes of acquired cataract:

• Hereditary predisposition (if parents, grandparents had a cataract, then the risk of its occurrence in a person in old age is very high);
• Female gender (women develop cataracts several times more often than men);
• Age-related changes in the body (slowdown of metabolism, accumulating pathological changes in cells, deterioration of immunity and chronic diseases in combination lead to the formation of opacities in the lens);
• Alcohol, drug use and smoking;
• Endocrine diseases (diabetes mellitus, hypothyroidism, hyperthyroidism, muscular dystrophy, obesity, etc.);
• Chronic autoimmune or inflammatory diseases that worsen the condition of the vessels (for example, rheumatoid arthritis, etc.);
• Exhaustion due to starvation, malnutrition or severe past diseases (for example, typhoid, malaria, etc.);
• Anemia;
• Excessive exposure of the eyes to ultraviolet radiation (stay in the sun without protective glasses);
• Exposure to the eyes of strong thermal radiation (for example, work in a hot shop, frequent visits to hot baths, saunas);
• Exposure to radiation, ionizing radiation or electromagnetic waves on the eyes or the body as a whole;
• Poisoning with poisons (mercury, thallium, ergot, naphthalene, dinitrophenol);
• Down's disease;
• Skin diseases (scleroderma, eczema, neurodermatitis, poikiloderma Jacobi, etc.);
• Trauma, burns, eye surgery;
• Myopia of a high degree (3 degrees);
• Severe eye diseases (uveitis, iridocyclitis, chorioretinitis, Fuchs syndrome, pigmentary degeneration, retinal detachment, glaucoma, etc.);
• Infections transferred during pregnancy (flu, rubella, herpes, measles, toxoplasmosis, etc.) - in this case, the newborn may have a congenital cataract;
• Reception for a long time or in high dosages of glucocorticosteroid drugs (Prednisolone, Dexamethasone, etc.), tetracycline, amiodarone, tricyclic antidepressants;
• Living or working in adverse environmental conditions.

Varieties of cataract

First of all, cataracts are divided into congenital and acquired. Accordingly, congenital cataracts are formed in the fetus during fetal development, as a result of which the baby is born already with an eye pathology. Acquired cataracts develop during a person's life under the influence of predisposing factors. Congenital cataracts do not progress, that is, the number of opacities and their intensity do not increase over time. And any acquired cataracts progress - over time, the number of opacities and the degree of their intensity in the lens increase.

Acquired cataracts are divided into the following types depending on the nature of the causative factor that caused them:

• Age (senile, senile) cataracts developing as a result of age-related changes in the body;
• Traumatic cataracts developing as a result of injury or contusion of the eyeball;
• Radiation cataracts developing as a result of exposure to the eyes of ionizing, radiation, x-ray, infrared radiation or electromagnetic waves;
• Toxic cataracts developing with prolonged use of drugs, smoking, alcohol abuse or poisoning;
• Complicated cataracts developing against the background of other eye diseases (uveitis, iridocyclitis, glaucoma, etc.);
• Cataracts against the background of severe chronic pathologies(for example, diabetes mellitus, thyroid disease, metabolic disorders, dermatitis, etc.);
• Secondary cataracts, developing after one operation to remove a cataract and install an artificial intraocular lens (lens).

Figure 2- Types of cataracts depending on the location and form of opacities.

Congenital cataracts can be represented by any of the above types, and acquired ones are only nuclear, cortical and complete. According to the form of opacities, cataracts can be very diverse - stellate, disc-shaped, bowl-shaped, rosette, etc.

Age-related cataracts, in turn, go through the following stages of development, which are also their types:

• Primary cataract. An excess of fluid appears in the lens, as a result of which water gaps form between the fibers, which are foci of opacities. Opacification usually appears in the peripheral part of the lens, and rarely in the center. Foci of opacities, when viewed inside the pupil in transmitted light, look like spokes in a wheel. At this stage, vision is not significantly affected.
• Immature cataract. Opacification from the peripheral extends to the optical zone of the lens, as a result of which a person's vision deteriorates sharply. The fibers swell, causing the lens to increase in size.
• mature cataract. The entire lens is cloudy, and a person sees practically nothing, but can only distinguish whether it is light or dark indoors or outdoors.
• overripe cataract. There is a breakdown of the fibers and a liquefaction of the lens substance, accompanied by an inflammatory process, which leads to an increase in intraocular pressure and complete blindness. If the substance of the lens is completely liquefied before the removal of this structure, then its nucleus descends, and such a cataract is called Morganian. Sometimes the lens substance liquefies, but the shell remains dense, in which case it shrinks. The operation to remove the lens at this stage is performed only in order to save the eye, since vision during the transition of a cataract to an overripe one, as a rule, is irretrievably lost due to damage to the structures of the eye analyzer by toxic decaying lens structures. An overmature cataract looks like a large (dilated) milky white pupil with numerous white spots. Rarely, an overripe cataract looks like a black pupil due to excessive sclerosis of the lens nucleus.

Cataract diagnostics

• Visometry- determination of visual acuity.
• Perimetry– definition of fields of view.
• Ophthalmoscopy- examination of the fundus.
• Tonometry– measurement of intraocular pressure.
• biomicroscopy– examination of the eye with a slit lamp (it is this method that is decisive for confirming cataracts, since during such an examination the doctor can accurately see the number and shape of opacities in the lens).
• Color testing(aimed at finding out how well a person distinguishes colors - it is very important for the detection of cataracts, since with this disease the ability to distinguish colors deteriorates sharply).
• Refractometry and ophthalmometry are made to determine the linear parameters of the eye - the length of the eyeball, the thickness of the lens and cornea, the radius of curvature of the cornea, the degree of astigmatism, etc. The measured parameters allow the doctor to calculate the characteristics of the artificial lens, which is optimal for a person and can be inserted into the eye during the operation.
• Ultrasound eye scan- is carried out to exclude other diseases of the eye, such as retinal detachment, hemorrhage, destruction of the vitreous body.
• OCT examination(optical coherence tomography) - allows you to determine all the parameters of the eye, identify the type of cataract and the best option for surgical treatment; in addition, OCT examinations can be used for dynamic monitoring of the state of the eye and vision both after surgery and at the stage of preparation for it or during ongoing conservative treatment.

In addition, in some cases, in addition to assessing the state of the retina, optic nerve and visual cortex of the cerebral hemispheres, functional diagnostics are performed using electrooculography (EOG), electroretinography (ERG) and visual evoked potentials (VEP) recording.

Symptoms of a cataract

Clinical picture of a cataract

We will consider the clinical manifestations of each stage of acquired cataracts and the distinctive features of the symptoms of congenital cataracts separately in order to avoid confusion.

Symptoms of acquired cataracts. At the initial stage of a cataract, a person has the following clinical symptoms:

• Diplopia (double vision) in an eye affected by a cataract. To identify this symptom, you need to alternately close your eyes and fix whether there is doubling in any of them. With the progression of the cataract and its transition to the immature stage, doubling in the eye disappears.
• Fuzziness of the visible picture of the surrounding world (see Figure 3). When looking at both close and distant objects, a person sees them as if vaguely, as if looking through fog, a layer of water or misted glass. Glasses and contact lenses do not correct this defect of blurry vision.
• Sensation of running or flashing "flies", spots, stripes and balls before the eyes.
• Glare, flashes and flashes of light before the eyes in a dark room.
• Visual impairment in darkness, twilight, twilight, etc.
• Light sensitivity, in which any light sources appear too bright, hurt the eyes, etc.
• When looking at a light source, a halo is seen around it.
• Difficulty distinguishing fine details such as facial features, letters, etc. As a result, it becomes difficult for a person to write, read, and also perform any activities related to the need to distinguish fine details well (for example, sewing, embroidery, etc.).
• Loss of the ability to distinguish colors, because, firstly, they become very pale, and secondly, they acquire a yellowish tint. It is especially difficult for a person to distinguish between blue and purple colors.
• The need for frequent replacement of glasses or lenses, tk. visual acuity decreases very quickly.
• Temporary improvement in vision, especially if the person had farsightedness before developing cataracts. In this case, he notices that he was suddenly able to see well up close without glasses. But such an improvement is short-lived, it passes quickly, after which there is a sharp deterioration in visual acuity.
• Whitish or grayish spots around the perimeter of the pupil.

With the transition of a cataract from the initial stage to the immature stage, myopia sharply increases in a person. In addition, he sees very poorly any objects located far away (at a distance of 3 meters and further from the eye). Nebula and blurring of the visible picture of the surrounding world, photosensitivity, difficulty in distinguishing small details and inability to distinguish colors increase, but double vision, flickering of “flies”, spots, flashes, and a halo around the light source disappear. The light sensitivity becomes so strong that a person sees better in cloudy weather or at dusk than in daylight or in good artificial light. At the same time, large foci of milky-white cataract spots are clearly visible in the depth of the pupil (see Figure 4). During the entire stage of immature cataract, vision deteriorates, the person sees worse and worse, the ability to distinguish more and more details is lost, and only the vision of blurred outlines of surrounding objects remains.

Figure 4- Pupil in immature cataract.

When a cataract passes into the mature stage, a person loses objective vision, and only light perception remains. That is, a person does not even see the outlines of surrounding objects, his eye is able to distinguish only light or dark at the present moment in the room or on the street. The pupil in the center becomes whitish-gray, and black-violet areas are visible along its edges.

When a cataract passes into the overripe stage, a person becomes completely blind and even loses light perception. At this stage, treatment is absolutely useless, since vision will not be restored. Surgery for overripe cataracts is performed only to save the eye, because. the disintegrating lens masses are toxic to all other eye tissues, which can lead to glaucoma or other serious complications. An overmature cataract is also called a morgania cataract or a milk cataract because the pupil is completely milky white. Sometimes with an overripe cataract, the pupil turns black due to excessive sclerosis of the lens nucleus.

Symptoms of congenital cataracts. With congenital cataracts, the child is still too young to say that he does not see well, so their symptoms are indirect, detected by a doctor or parents. So, the symptoms of congenital cataract in children are as follows:

• The child does not look exactly at people's faces;
• The child does not react to the appearance of people's faces, as well as large or colorful objects in his field of vision;
• The child cannot find small objects, although they are in his field of vision;
• In bright sunlight or artificial light, the child looks askance, sideways, or covers his eyes;
• Nystagmus (repeated wandering movements of the eyes);
• In the photographs of the child, he does not have a "red eye".

lens for cataract

Further, in the second, immature stage due to the stratification of the fibers, a sufficient amount of nutrients does not penetrate into them, as a result of which the proteins of the structural components of the lens break down. The decayed proteins cannot be removed anywhere, since the lens is covered with a capsule, as a result of which they are deposited in the previously formed gaps between the fibers. Such deposits of decomposed proteins are clouding of the lens. At this stage, the lens increases in size and can provoke an attack of glaucoma due to a violation of the outflow of intraocular fluid.

In the third stage of mature cataract all the proteins of the lens gradually disintegrate, and it turns out to be all occupied by turbid masses.

Stage 4 overripe cataract the cortical substance of the lens disintegrates, as a result of which its dense nucleus is separated from the capsule and falls to the back wall. The entire lens is wrinkled. The process of disintegration of the cortical substance is accompanied by inflammation, as a result of which a rupture of the lens membrane and the release of necrotic masses into the chambers of the eye are possible. And since the masses of the decaying cortical substance are toxic, the development of complications in the form of iridocyclitis, glaucoma, etc. is possible. The lens at the fourth stage of cataract is recommended to be urgently removed in order to avoid possible complications and at least save the eye, albeit completely blind.

Vision with cataracts

Objects located far away (3 meters and further from the eye), a person sees poorly, and those objects that are close cannot be seen due to the blurring of the picture. Blurred vision is not corrected with glasses or lenses.

In addition, when looking at light sources, a person sees a halo around them, so it is difficult for him to drive a car in the dark or walk along a street lit by lanterns, as the glare from llamas leads him astray. In addition to the specific vision of light sources, photophobia appears with cataracts, when any normal lighting (solar or artificial) seems too bright and irritating to the eyes. Because of photophobia, paradoxically, a person sees better on cloudy days or at dusk, and not in sunny clear weather.

With a cataract, it is very difficult for a person to distinguish colors because they become pale, especially blue, indigo and purple. In addition, all colors acquire a certain yellowish tint. The colored world becomes, as it were, pale, fuzzy.

Also, with a cataract, a person is worried about double vision, constantly flashing flashes and flashes of light before the eyes in the dark.

If a person was farsighted before the onset of cataracts, he may find that he is suddenly able to see well up close and even read without glasses. This short-term improvement in vision is due to the fact that a cataract changes visual acuity towards myopia. But as the disease progresses, myopia will increase, and the acquired ability to read without glasses will disappear.

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Complications

• obscurative amblyopia - consists in atrophy of the retina with complete loss of vision (this complication is typical for congenital cataracts);
• Dislocation lens- displacement of the lens into the chamber of the eye with separation from the ligament holding it;
• Blindness - loss of vision with the impossibility of its restoration by any known methods of therapy;
• Phacogenic glaucoma- a sharp increase in intraocular pressure due to a violation of the outflow of intraocular fluid due to an increase in the size of the lens;
• Phacolytic iridocyclitis- inflammation of the iris and ciliary body, which can lead to a significant deterioration in vision.

Cataract of the eye: definition, causes, signs and symptoms, diagnosis and treatment, surgery (opinion of an ophthalmologist) - video