Cataract Definition: A cataract is a clouding of the lens of the eye; Cataracts are classified as one of three types : A subcapsular

lar cataract begins at the back of the lens. People with diabetes, high farsightedness or retinitis pigmentosa, or those taking high doses of steroids, may develop a subcapsular cataract. A nuclear cataract is most commonly seen as it forms. This cataract forms in the nucleus, the center of the lens, and is due to natural aging changes. A cortical cataract, which forms in the lens cortex, gradually extends its spokes from the outside of the lens to the center. Many diabetics develop cortical cataracts.

Anatomy and physiology:

Etiology The lens of the eye is normally clear. It acts like the lens on a camera, focusing light as it passes to the back of the eye. Until a person is around age 45, the shape of the lens is able to change. This allows the lens to focus on an object, whether it is close or far away.

As we age, proteins in the lens begin to break down and the lens becomes cloudy. What the eye sees may appear blurry. This condition is known as a cataract. Factors that may speed up cataract formation are: Diabetes Eye inflammation Eye injury Family history of cataracts Long-term use of corticosteroids (taken by mouth) or certain other medications Radiation exposure Smoking Surgery for another eye problem Too much exposure to ultraviolet light (sunlight)

Syptomatology Adult cataracts develop slowly and painlessly. Vision in the affected eye or eyes slowly gets worse. Mild clouding of the lens often occurs after age 60, but it may not cause any vision problems. By age 75, most people have cataracts that affect their vision.

Visual problems may include the following changes: Being sensitive to glare Cloudy, fuzzy, foggy, or filmy vision Difficulty seeing at night or in dim light Double vision Loss of color intensity Problems seeing shapes against a background or the difference between shades of colors Seeing halos around lights

Cataracts generally lead to decreased vision, even in daylight. Most people with cataracts have similar changes in both eyes, although one eye may be worse than the other. Many people with this condition have only mild vision changes. Other symptoms may include: Frequent changes in eyeglass prescription

Pathophysiology

Medical Management: Test: Asking you to read an eye chart (visual acuity test). A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment. Using a light and magnification to examine your eye (slit-lamp examination). A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification. The microscope is called a slit lamp because it uses an intense line of light a slit to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any tiny abnormalities. Dilating your eyes (retinal examination). To prepare for a retinal examination, your eye doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine the back of your eyes (retina). Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a cataract. Medications: Early stage: Early cataracts may be managed with the following measures: Stronger eyeglasses or contact lenses Use of a magnifying glass during reading Strong lighting Medication that dilates the pupil. (This may help some people with capsular cataracts, although glare can be a problem with this treatment.)

Progression cataract: Surgery:

Phacoemulsification. Phacoemulsification (phaco means lens; emulsification means to liquefy) is the most common cataract procedure performed in the United States.

The procedure generally involves: The surgeon makes a small incision. A thin probe that transmits ultrasound is then used to break up the clouded lens into small fragments. The tiny pieces are sucked out with a vacuum-like device. A replacement lens is then inserted into the capsular bag where the natural lens used to be. In most cases, this is an intraocular lens (IOL), which is foldable and slips in through the tiny incision. Because the incision is so small, it is often watertight and does not require a suture afterward, particularly if a foldable lens has been used. A suture may be needed if a tear or break occurs during the procedure or the surgeon inserts a rigid lens that requires a wider incision.

Nursing Diagnosis: High risk of injury related to loss of vitreous, intraocular hemorrhage, increased IOP Anxiety related to lack of knowledge. Acute pain related to trauma to the incision and increased IOP Risk for infection related to trauma to the incision Impaired vision Disturbed sensory perception:visual r/t altered sensory reception

Pathophysio
Cataract literally means a blockage or termination of natural flow. It is also refers to a disease condition that involves the opacification of the lens of the eye. The pathophysiology of this condition results either from direct blunt trauma, glaucoma from diabetes mellitus, or from the natural aging process. When the eye is accidentally bluntly hit or when a sharp object penetrates thru the cornea, the lens capsule and its matrix is affected causing a disruption of its lattice matter. Thereafter healing will occur with the lens opacifying starting at the point of injury then scattering towards the entire lens body. On the other hand, glaucoma produces increased intraoptic pressure and decreased perfusion to the lens capsule and body due to the high viscous content of the blood. Smoking and alcohol use may also contribute to cataracts as well as prolonged exposure to sunlight.The eye lens works similar to a camera lens, focusing light onto the retina in the rear of the eye for an image to record. The lens, made of water and protein, is arranged in a specific way such that the lens remains clear and light is able to pass through it. When people age, the protein may clump together and as a result a part of the lens gets clouded. Lenses become less flexible, less transparent and thicker during the aging process. This makes it more difficult to see overall or makes vision look blurry. Vision tends to get worse gradually as a result of slow "growing" of the cataract. The clear lens of the eye turns to a light brown shade which may cause a person's vision to appear slightly brown. Over time, the increased amount of tinting makes routine activities such as reading or identifying certain colors more difficult. Other possible cataract symptoms include difficulty with night

vision, sensitivity to glare or double vision. Surgery to replace a clouded lens with a fresh clear artificial lens corrects vision problems caused by cataracts.