AGE RELATED CATARCT.pptx

BIPIN KOIRALA
HIMALAYA EYE INSTITUTE
MASTER’S OF OPTOMETRY
1

anup.subedi10@gmail.com
 INTRODUCTION
 PATHOPHYSILOLOGY
 TYPES AND GRADING
 TREATMENT
 SUMMARY
2

 The crystalline lens is a transparent structure.
 Its transparency may be disturbed due to
degenerative process leading to opacification of
lens fibers.
 Development of an opacity in the lens is known
as cataract.
3

 In 2020, worldwide an estimated 15.2 million
(12.7-17.9) people aged 50+ years were blind,
 A further 78.8 million (67.2-91.4) had Severe
Visual Impairment, due to cataract.
 In Nepal cataract occupies 65 percent of total
burden of blindness
4
Cataract-related blindness and vision impairment in 2020 and trends over time in relation to VISION 2020: the Right to
Sight: an analysis for the Global Burden of Disease Study.
Konrad Pesudovs; Van C Lansingh; John H Kempen; Jaimie D Steinmetz; Paul S Briant; Rohit Varma; Ningli Wang; Jost
Jonas; Serge Resnikoff; Hugh R Taylor; Tasanee Braithwaite; Maria Vittoria Cicinelli; Theo Vos; Rupert R A Bourne

 Also called as ‘SENILE CATARACT ’
 This is the commonest type of acquired cataract
 Affecting equally persons of either sex usually
above the age of 50 years.
 By the age of 70 years, over 90% of the
individuals develop senile cataract.
 The condition is usually bilateral, but almost
always one eye is affected earlier than the other.
6

Senile
Cataract
Cortical
Cataract
Cupuliform
Cueniform
Nuclear
Cataract
7

 It is very common to find nuclear and cortical
senile cataracts co-existing in the same eye
 In general, the predominant form can be given
as
1. Cuneiform (70 %)
2. Nuclear (25 %)
3. Cupuliform (5 %)
8

 Senile cataract is essentially an ageing process.
 Though its precise etiopathogenesis is not clear,
9

 Heredity. It plays a considerable role in the
incidence, age of onset and maturation of senile
cataract
 Ultraviolet irradiations. More exposure to UV
irradiation from sunlight have been implicated
for early onset and maturation of senile cataract
10

 Dietary factors. Diet deficient in certain proteins,
amino acids, vitamins (Riboflavin, vitamin E,C),
and essential elements have also been blamed
for early onset and maturation of senile cataract.
 Dehydrational crisis. Severe dehydrational crisis
(due to diarrhoea, cholera etc.)
11

 Smoking has also been reported to have some
effect on the age of onset of senile cataract.
 Smoking causes accumulation of pigmented
molecules—3 hydroxykynurinine and
chromophores, which lead to yellowing.
 Cyanates in smoke causes carbamylation and
protein denaturation causing opacified fibers
production
12

 When ???
 What are the causes???
13

 Pre senile cataract is the cataractous changes
similar to senile cataract occur before 50 years of
age.
 Myotonic dystrophy
 Diabetes
 Atopic dermatitis
 Genetic / family history
14

 Cortical Senile Cataract.
 Its main biochemical features are decreased
levels of total proteins, amino acids and
potassium
 Associated with increased concentration of
sodium and marked hydration of the lens
 Followed by coagulation of proteins.
15

 Nuclear Senile Cataract.
 In occurs due to usual degenerative changes and
agerelated nuclear sclerosis associated with
dehydration and compaction of the nucleus
 There is significant increase in water insoluble
proteins.
17

 The total protein content and distribution of
cations remain normal.
 May or may not be associated deposition of
pigment urochrome and/or melanin derived
from the amino acids in the lens
18

 Stage of lamellar separation.
 Stage of incipient cataract
 Immature senile cataract (ISC).
 Mature senile cataract (MSC)
 Hypermature senile cataract (HMSC)
19

 The earliest senile change is demarcation of
cortical fibres owing to their separation by fluid.
 This phenomenon of lamellar separation can be
demonstrated by slit-lamp examination only.
 These changes are reversible
20

 In this stage early detectable opacities with clear
areas between them are seen
 Two distinct types of senile cortical cataracts can
be recognized at this stage:
1. Cuneiform senile cataract
2. Cupuliform senile cataract
21

 Cupuliform cataract lies right in the pathway of
the axial rays and thus causes an early loss of
visual acuity
23

 In this stage, opacification progresses further.
 The cuneiform or cupuliform patterns can be
well recognised.
 Lens appears greyish white but clear cortex is
still present and so iris shadow is visible.
24

 Lens may become swollen due to continued
hydration. This condition is called ‘intumescent
cataract'.
 Due to swollen lens anterior chamber becomes
shallow.
25

 In this stage, opacification becomes complete,
i.e., whole of the cortex is involved.
 Lens becomes pearly white in colour. Such a
cataract is also labelled as ‘ripe cataract’
26

 When the mature cataract is left in situ, the
stage of hypermaturity is seen and can be of 2
types:
1. Morgagian cataract
2. Sclerotic type hypermature cataract
27

 The lens becomes inelastic and hard, with
decrease in its ability to accommodate and
obstructs the light rays.
 The nucleus may become diffusely cloudy
(greyish) or tinted (yellow to black) due to
deposition of pigments.
 In practice, the commonly observed pigmented
nuclear cataracts are either amber, brown
(cataracta brunescens) or black (cataracta nigra)
29

31
Brown Cataract Black Cataract

Symptoms
 Glare
 Uniocular polyopia
 Coloured halos
 Black spots in front of eyes.
 Image blur, distortion of images
 Loss of vision.
32

 Day blindness
 Second sight with nuclear sclerosis
33

 Visual acuity testing.
 Oblique illumination examination (reveals colour
and appearance of the lens in pupillary area)
 Test for iris shadow
 Distant direct ophthalmoscopic examination
 Slit-lamp examination
34

 Based on extension especiallly in vertical
diameter
39

 Phacoanaphylactic Uveitis.
 A hyper mature cataract may leak lens proteins
into anterior chamber.
 These proteins may act as antigens and induce
antigenantibody reaction leading to uveitis.
44

 It may occur by different mechanisms:
 Due to intumescent lens (phacomorphic
glaucoma)
 leakage of proteins into the anterior chamber
from a hypermature cataract (phacolytic
glaucoma).
45

 It may occur due to degeneration of zonules in
hypermature stage
46

 Non-surgical measures
1. Potassium iodide Drop
2. Glass to avoid photophobia
3. Mild pupillary dilator for PSCC
 Surgical management
47

 General medical examination diabetes mellitus;
hypertension and cardiac problems, septic gums
 Ocular examination. slit-lamp biomicroscopy is
desirable in all cases.
48

 Light perception (PL)/ Projection of rays (PR)
 RAPD examination to rule out ON anomalies
 Two-light discrimination test.
 Maddox rod test.
 Colour perception.
 Entoptic visualisation.
 Laser interferometry
 Visiometry
49

 Rule out infections like conjunctival infections,
meibomitis, blepharitis and lacrimal sac infection.
 Lacrimal syringing should be carried out in each
patient with history of watering from the eyes.
 Anterior segment evaluation by slit-lamp
examination.
 Evaluate status of endothelium
 Intraocular pressure (IOP) measurement.
50

 A.K. Khurana Comphrenshive Ophthalmology
 J.J Kanski Clinical ophthalmology
 Thank you
55

AGE RELATED CATARCT.pptx

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