CATARACT

• A condition in which the normally clear lens of the eyes become opaque, which results in decreased or blurry vision
• The word ‘cataract' has been derived from the Greek word 'katarraktes’ which means waterfall’
• Patients( usually between 50- 70 years) frequently complain of Web-like appearance, blurry vision, sensitivity to light and glare, Increasing difficulty with vision at night, Double vision, and haloes from lights should be suspected as cataract cases

CLASSIFICATION

Etiological classification

• Congenital and developmental cataract
  • Acquired cataract
  • Senile cataract
  • Traumatic cataract 
  • Complicated cataract
  • Metabolic cataract
  • Electric cataract
  • Radiational cataract
  • Toxic cataract
  • Cataract associated with skin diseases (Dermatogenic cataract)
  • Cataract associated with osseous diseases
  • Cataract with miscellaneous syndromes

Morphological classification 

• Capsular cataract. It involves the capsule and maybe
  • Anterior capsular cataract
  • Posterior capsular cataract
• Subcapsular cataract. It involves the superficial part of the cortex (just below the capsule)and includes
  • Anterior subcapsular cataract
  • Posterior subcapsular cataract
• Cortical cataract. - involves the major part of the cortex
• Supranuclear cataract. - involves only the deeper parts of the cortex (just outside the nucleus)
• Nuclear cataract. - involves the nucleus of the crystalline lens
• Polar cataract. - involves the capsule and superficial part of the cortex in the polar region only and may be:
  • Anterior polar cataract
  • Posterior polar cataract

Congenital and developmental cataracts

• Congenital and developmental cataracts occur due to some disturbance in the normal growth of the lens. When the disturbance occurs before birth, the child is born with a congenital cataract. Therefore, in congenital cataract, the opacity is limited to either embryonic or foetal nucleus
• A developmental cataract may occur from infancy to adolescence. Therefore, such opacities may involve infantile or adult nucleus, deeper parts of cortex or capsule.

Acquired cataract

• In acquired cataract, opacification occurs due to degeneration of the already formed normal fibres

Age-related cataract

• Is the commonest type affecting either sex usually above the age of 50 years
• Usually bilateral, but almost always one eye is affected earlier than the other

Morphologically, the senile cataract occurs in two Forms

• Cortical (soft cataract) 
• Nuclear (hard cataract)

The cortical senile cataract may start as 

• Cuneiform (more commonly)
• Cupuliform—Posterior Sub Capsular (PSC) cataract

Stages of Maturation

Maturation of the cortical type of senile cataract

• Stage of lamellar separation- The earliest senile change is the demarcation of cortical fibres owing to their separation by fluid. This can be demonstrated by slit-lamp examination only. These changes are reversible
• Stage of incipient cataract - In this stage, early detectable opacities with clear areas between them are seen. Two distinct types
• Cuneiform senile cortical cataract - wedge-shaped opacities with clear areas in between
• Cupuliform senile cortical cataract - saucer-shaped opacity develops just below the capsule
• Immature senile cataract (ISC) - Opacification progresses further. The lens appears greyish white but clear cortex is still present and so iris shadow is visible. In some patients, at this stage, the lens may become swollen due to continued hydration. This condition is called ‘intumescent cataract’
• Mature senile cataract (MSC) - Opacification becomes complete, i.e. the whole of the cortex is involved. The lens becomes pearly white in colour 
• Hyper mature senile cataract (HMSC)-  May occur in any of the two forms
• Morgagnian hypermature cataract
• Sclerotic type hyper mature cataract

Congenital and developmental cataracts

• Idiopathic
• Heredity
• Maternal factors

• Malnutrition during pregnancy
• Infections- Maternal infections like rubella toxoplasmosis and cytomegalic inclusion disease
• Drugs ingestion
• Radiation
• Foetal or infantile factors
• Deficient oxygenation (anoxia) owing to placental haemorrhage
• Birth trauma
• Metabolic disorders
• Malnutrition in early infancy

Age-related cataract

• Age- By the age of 70 years, over 90% of the individuals develop a senile cataract
• Sex-prevalence of cataract is greater in females than males at all ages
• Heredity
• Ultraviolet irradiations
• Dietary factor -Diet deficient in certain proteins, amino acids, vitamins (riboflavin, vitamin E, vitamin C), and essential elements
• Smoking

Symptoms

• Reduced visual acuity
• Glare
• Uniocular polyopia (i.e. doubling or trebling of objects)
• Coloured halos
• Black spots in front of eyes
• Image blur, distortion of images and misty vision

• Visual acuity­– Diminished visual acuity from 6/9 to PL+
• Ophthalmoscopy - Dark areas against the red fundal glow
• Slit-lamp examination - Lenticular Opacity

NON-SURGICAL MEASURES

• Treatment of the cause of cataract
• Measures to delay progression
• Topical preparations containing iodide salts of calcium and potassium
• Measures to improve vision
• Prescription of glasses refractive status

SURGICAL MANAGEMENT

• Intracapsular cataract extraction (ICCE)
• Extracapsular cataract extraction
• Manual small incision cataract surgery (SICS)
• Phacoemulsification

Ayurvedic Treatment

DIETARY MODIFICATIONS

• Triphala - can be used in preventive and curative aspect
• Avoid sour and spicy foods

Internal medicines

For IMSC

• Triphala gritha + Triphala choorna + honey
• Patoladi ghritam + Triphala choorna + honey – If associated with Diabetic Retinopathy­­
• Sapthamrutha lauha

Procedures

• Netraseka - Chakshushya drugs ( Darvi, Yasti, Triphala etc) - in Burning sensation
• Jaloukavacharana- either forhead or eyelid at regular intervals
• Pratimarsha Nasya - Anutaila
• Nasya - Ksheerabala avarthi or Dhanwanthara taila
• Anjana - Elaneerkuzhambu, Pasupatha varti, Kachayapanam kuzhambu
• Sirolepa - Chakshushya drugs
• Tarpana – Jeevaneeya gana ghritha
• Putapaka for 1 or 2 days

MSC and HMSC

• Cataract surgery indicated