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Dear Readers,
Cataract was a significant global problem at the beginning of the last century, but not widely recognized as such. Today, it is a greater problem, the significance of which is better understood. According to the latest assessment, age related cataract is responsible for 48% of world blindness, which represents about 18 million people. Although cataracts can be surgically removed, in many countries surgical services are inadequate, and cataract remains the leading cause of blindness.The priorities for VISION 2020 are based on the facts that 75% of blindness and visual impairment occurs in the poor and very poor communities of the world, and that 75% of blindness and visual impairment is a result of five preventable or treatable conditions (cataract, refractive errors and low vision, trachoma, onchocerciasis, and a specific group of causes of blindness).

This issue Introduces you to the types of cataract, talks about epidemiology, risk factors and cataract surgery that enables you in understanding the problems. It also discusses about various surgical interventions, barriers and guidelines .

The organization, which we are featuring, is an Association of ASCRS , International Organization and the featured personality is Dr. CHARLES D. KELMAN, an ophthalmologist and a pioneer in cataract surgery. You would know about the history of cataract. We would wish you an experience of learning that is very practical. Your feedback will let us know how we can improve. Please send in your feedback at eyesite@aravind.org. We wish you happy reading and do look forward to receiving your feedback.

Regards,

Vision 2020 e-resource team
The Issue Features...
TYPES OF CATARACT
Vol. 6 No.6 June 2010
•   Introduction
•   Types of Cataract
•   Epidemiology of Cataract
•   Risk Factors
•   Surgical Interventions
•   Types of Cataract Surgery
•   Understand the Problem
•   Barriers
•   History of Ophthalmology
•   Featured Personality
•   Featured Organisation
•   Talk to Us
•   Past Issues

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The Meaning of Cataract:
A literal meaning of cataract is a curtain. A curtain, as we all know prevents the visualization of objects behind it. Similarly the cataract acting like a curtain inside our eye hampers vision. And as per the wordweb dictionary it is an eye disease that involves the clouding or opacification of the natural lens of the eye.

What is Cataract:
A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus to let us see things clearly.

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But due to the aging changes, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

  • CATARACT INTRODUCTION

  • This article provides brief information about cataract, types of cataract, cataract global problem, risk factors for cataract, complications of cataract surgery, post-operative endophthalmitis and use of IOL.

  • VISION 2020: THE RIGHT TO SIGHT: CATARACT

  • This article deals with the latest assessment of world blindness, which represents about 80 million people. The priorities of Vision 2020 are based on the facts that 75% blindness and visual impairment occurs in the poor and very poor communities of the world.

  • CATARACTS

  • Cataract is the most common cause of blindness in the world today. It is, however, treatable with highly effective surgery. This article provides brief information on types of cataract, common reasons of cataract to develop, symptoms of cataract, suggestion to avoid, diagnosis, treatment and procedure to be followed after surgery.

  • FACTS ABOUT CATARACT

  • This information was developed by the National Eye Institute to help patients and their families search for general information and facts about cataract. It also describes briefly causes and risk factors, symptoms and detection, treatment and current research regarding cataract.



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TYPES OF CATARACT
It explains about the various types of cataracts. Cataract is an eye disorder which is caused due to myriad of factors. There are other types also, which are caused due to rare diseases or as a result of local eye injuries or inflammation. The various types of cataract are:
  • AGE-RELATED CATARACTS
    • a.Cortical senile cataract
    • b.Senile nuclear cataract
  • 2.CONGENITAL CATARACT
    • a.Sutural cataract
    • b.Lamellar cataract
    • c.Zonular cataract
    • d.Total cataract
  • 3.SECONDARY CATARACTS
  • 4.TRAUMATIC CATARACTS
    • a.Blunt trauma (capsule usually intact)
    WHAT ARE CATARACTS? TYPES OF CATARACTS

    1. AGE-RELATED CATARACT
    About 90% of all cataracts are age related and start developing after age 40. Usually, there is no other demonstrable cause, and the only relevant history may be a familial occurrence.

  • AGE-RELATED CATARACT

  • This article focuses on age-related cataract as the leading cause of visual impairment worldwide. The continued increase in life expectancy, along with the growth of the worlds population, will ensure that cataract continues to be a major public health problem in the years to come. And due to aging, many changes occur in the lens, these can be grouped and explained under the following headings-structural, optical, metabolic, and molecular.

    a.SENILE CORTICAL CATARACT
    If nuclear changes are associated with changes in the cortex, as is often the case, the diagnosis of cataract is apparent.

  • COMPARATIVE STUDY OF SERUM NA+ AND K+ LEVELS IN SENILE CATARACT PATIENTS AND NORMAL INDIVIDUALS

  • This study focuses on serum level of Na+ and K+ in senile cataract patients and normal individuals. Many factors such as aging, changes in blood electrolytes levels, and possibly family history are involved in senile cataract formation. Changes in serum electrolytes levels can induce changes in aqueous electrolytes levels and effect on lens metabolism and probably cataract formation.

    b.SENILE NUCLEAR CATARACT
  • OXIDATIVE CHANGES IN HUMAN LENS PROTEINS DURING SENILE NUCLEAR CATARACT FORMATION

  • This abstract focuses on the oxidative of proteins in the Senile nuclear cataract formation.

    2. CONGENITAL CATARACTS
    Congenital cataracts may be hereditary or due to prenatal exposure to drugs, infection, radiation, or trauma.

  • CONGENITAL CATARACTS - FACIAL DYSMORPHISM - NEUROPATHY

  • This deals with congenital cataract, facial dysmorphism and hypogonadism neuropathy syndrome. Over 100 patients have been diagnosed. Developmental abnormalities include congenital cataracts and microcorneae, primary hypomyelination of the peripheral nervous system, impaired physical growth, delayed early motor and intellectual development, mild facial dysmorphism and hypogonadism.

    a.SUTURAL CATARACT
  • SUTURAL CATARACT ASSOCIATED WITH A MUTATION IN THE FERRITIN LIGHT CHAIN GENE (FTL) IN A FAMILY OF INDIAN ORIGIN.

  • This deals with molecular characterization of congenital suture cataract. Authors have come across a four generation family affected with bilateral congenital cataract at the Dr. Daljit Singh Eye Hospital, Amritsar, India. A genome-wide scan by two-point linkage analysis using more than 400 microsatellite markers and further multipoint and haplotype analysis placed the cataract locus within a 5.0 cM region between markers D19S902 and D19S867 on chromosome 19q13. Since FTL lies within the mapped interval, and because of its association with HHCS, hematological tests were performed in two patients. These indicated high levels of ferritin in the serum without iron overload. Sequencing of FTL showed a G>A change in the 5'-UTR at position 32 from the transcription start site, in a highly conserved three-nucleotide motif that forms the IRE bulge. This is the first report of HHCS in a family of Indian origin.

    b.LAMELLAR CATARACT
  • LAMELLAR CATARACT

  • Lamellar Cataract is a form of cataract, where the opacity only affects some of the layers of the eye lens i.e. the layers outside the nucleus. More detailed information about the symptoms, causes, and treatments of Lamellar Cataract is available in this page.

    C.ZONULAR CATARACT
  • ZONULAR CATARACT AND NYSTAGMUS

  • This deals with Zonular cataract and nystagmus, that affect only certain layers of the lens. More detailed information about the symptoms, causes, and treatments of Zonular cataract and nystagmus is available in this page.

    d.TOTAL CATARACT
  • CONGENITAL TOTAL CATARACT-POSSIBLY RECESSIVE*


  • 3. SECONDARY CATARACT
  • A RETROSPECTIVE COMPARISON OF TECHNIQUES TO PREVENT SECONDARY CATARACT FORMATION FOLLOWING POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION IN INFANTS AND CHILDREN*

  • This study deals with the effect of various methods in the management of posterior capsule opacification with children with implanted IOLs. Authors have reviewed the charts of 20 eyes of 15 children (1.5 - 12 years) who underwent primary cataract surgery with PC IOL in the last 5 years. The posterior capsule and anterior vitreous were managed in a variety of ways: in 5 eyes the posterior capsule was left intact, and 15 eyes underwent posterior continuous curvilinear capsulorhexis (PCCC) - nine cases without and 6 with anterior vitrectomy. In 8 eyes posterior optic capture was performed, 3 with and 5 without vitrectomy. The follow-up ranged from 1 to 4.5 years (mean: 2 years).

    4. TRAUMATIC CATARACT
  • SURGICAL MANAGEMENT OF THE TRAUMATIC CATARACT

  • This deals with surgical management of traumatic cataract. Besides cataract, ocular trauma can also induce lens sublaxation and dislocation, and cause injuries to the cornea, iris, vitreous, and retina. In the case of blunt trauma, coup and contrecoup forces on the lens could cause rapid anterior-posterior shortening, leading to abrasion or rupture of the lens capsule with subsequent cataract genesis.

    a.BLUNT TRAUMA (CAPSULE USUALLY INTACT)
  • ANNULAR PIGMENT BAND ON THE POSTERIOR CAPSULE FOLLOWING BLUNT OCULAR TRAUMA: A CASE REPORT

  • This case report describes an unusual presentation of an annular pigment band on the posterior capsule following blunt ocular trauma in a 28-year old male patient. Repeat examinations revealed no evidence of other signs of blunt ocular trauma or pigment dispersion syndrome in either eye.



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Age and heredity are the most important risk factors associated with the different types of cataract. Apart from that some causal effects Smoking, UV-B exposure, Diabetes, use of steroids and Alcohol are also the risk factors in the development of Cataract.

  • RISK FACTORS FOR CATARACTS

  • This Consumer Reports listed out the Risk factors of Cataract.

  • SMOKE EXPOSURE AND CATARACT

  • Uniteforsight article reviews research on the association between smoke and cataract, with a specific focus on cigarette smoke and smoke from cooking.

  • RISK FACTORS FOR CATARACT

  • This Clinical guide points out the Risk factors for the development of cataracts include lifestyle behaviors such as smoking and the excessive use of alcohol and Long term use of corticosteroids and Prolonged exposure to UV-B radiation etc

  • CATARACT BLINDNESS CHALLENGES FOR THE 21ST CENTURY

  • This article points out the risk factors of Cataract. Causes of Cataract Blindness and the challenges are to prevent or delay Cataract formation and cure that which does occur, Preventive interventions, changes in government policy and legislation, and modification of community and individual behavior.



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At present the only treatment for cataract is surgery to remove it. Many other remedies for cataracts have been attempted. These have included medications, eye drops, vitamins, changes in diet, and resting the eyes. Unfortunately, none of these has proven successful in dissolving or clearing cataracts. Fortunately, there have been tremendous advances in cataract surgery in the past several years. The chances for recovering good vision after surgery are now excellent.



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This article deals with various aspects of following surgical method for cataract as:
  • INTRACAPSULAR CATARACT EXTRACTION (ICCE)
  • EXTRACAPSULAR CATARACT SURGERY (ECCE)
  • SMALL INCISION CATARACT SURGERY (SICS)
  • PHACOEMULSIFICATION


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Cataract is a major cause of blindness in Asia. Poverty, lack of awareness, distance from clinics and hospitals, fear of treatment, sex related and Cultural beliefs are the major barriers of cataract treatment.

  • ELIMINATING CATARACT BLINDNESS _ HOW DO WE APPLY LESSONS FROM ASIA TO SUB-SAHARAN AFRICA?

  • This paper explores the factors that lead to success at Aravind, and compares and contrasts the conditions in India with those found in much of sub-Saharan Africa.

  • TREATING CATARACTS IN INDIA

  • This report provides information on the major achievements of the Cataract Blindness project in India. According to this report overall population prevalence of cataract blindness declined by 26 percent, from 1.5 percent at baseline to 1.1 percent. Based on an estimated 3.5 million cataract surgeries each year, about 320,000 people were saved from blindness annually.

  • RECOGNISING AND REDUCING BARRIERS TO CATARACT SURGERY

  • This article determines patient-related barriers to cataract services in the region and their resolution. It is concluded that further expansion of outreach services, coupled with a more intensive health education is needed to overcome these barriers.



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In the first authentic document on the subject, the writing of Celsus, there is a complete teaching on the pathology and treatment of cataract. The preceding Hippocratic writings are silent on the subject, so that the Alexandrian school must have developed the teaching to the advanced level seen in Celsus. What exactly the Alexandrians did and where they found the basis for their studies is a matter of conjecture. It is possible that the operation for depression was known in India since early days, but the evidence that it was known in Egypt and Babylon is more than doubtful. Celsus' account of cataract and its treatment was indeed the teaching that persisted till the 18th century with hardly any modification. The sudden eruption of a complete system of pathology and treatment from out of a historical void is but one of the many strange things in the history of cataract.

Reference:http://www.mrcophth.com/Historyofophthalmology/cataracthistory.htm


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Dr. CHARLES D. KELMAN

Charles D. Kelman (May 23, 1930 June 1, 2004) was an ophthalmologist and a pioneer in cataract surgery. Charles D. Kelman (May 23, 1930 June 1, 2004) was an ophthalmologist and a pioneer in cataract surgery. Kelman was born in Brooklyn, New York to David and Eva Kelman. He grew up in Queens where he attended Forest Hills High School. After graduation, he attended Boston's Tufts University, where he earned a B.S. degree, and then studied medicine at the University of Geneva were he obtained his M.D. degree. After interning at Kings County Hospital, he worked as an ophthalmologist at the Manhattan Eye, Ear and Throat Hospital in New York.

One of the cataract surgery techniques that Kelman developed, phacoemulsification, has become today's standard. Inspired by his dentist's ultrasonic tools, in 1967 Kelman introduced the technique that uses ultrasonic waves to emulsify the nucleus of the eye's lens to remove the cataracts without a large incision. This new surgery removed the need for an extended hospital stay and made the surgery less painful. It has helped 100 million people nation-wide. "Dr. Kelman, who received the National Medal of Technology from President George H.W. Bush in 1992, was inducted [in February 2004] into the National Inventors Hall of Fame in Akron, Ohio.

Neurosurgeons have improved upon the technique and used it to remove tumors from the brain and spinal cord." (Boston Globe) In 2004, Kelman died of lung cancer in Boca Raton, Florida. He was survived by his wife, Ann, as well as five children, Jennifer, Lesley, Jason, Seth, and Evan Kelman.



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THE AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY (ASCRS)

The American Society of Cataract and Refractive Surgery (ASCRS) is an independent non-profit organization founded in August of 1974 to disseminate information about anterior segment ophthalmic surgery. Since 1974, ASCRS has seen anterior segment surgery develop into a highly sophisticated form of ophthalmic treatment. Through its educational programs and services, ASCRS has become the physicians' primary source of up-to-date information on scientific developments within the field, as well as the regulatory decisions that affect ophthalmic practices.

MISSION:
The mission of the American Society of Cataract and Refractive Surgery is to advance the art and science of ophthalmic surgery and the knowledge and skills of ophthalmic surgeons. It does so by providing clinical and practice management education and by working with patients, government, and the medical community to promote the delivery of quality eye.



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