home Consultations Pathology of the lens (partial or complete opacification), change in shape and position. What disease is clouding of the eye lens a symptom of?

Pathology of the lens (partial or complete opacification), change in shape and position. What disease is clouding of the eye lens a symptom of?

Possible types cataracts
Symptoms and signs of the disease
Treatment of the disease
Traditional recipes against cataracts

Lens opacification is a pathology characterized by partial or diffuse opacification. The lens is a clear lens that is located inside the eye. It is responsible for displaying a precisely focused visible object on the retina. There are a huge number of prerequisites for the occurrence of cataracts. It can be congenital and acquired.

Very often, the occurrence of cataracts is observed in old age; the reasons for this are still not fully understood. It happens that clouding of the lens does not particularly affect visual acuity, but constant double vision, flickering of spots, stripes and streaks before the eyes significantly worsens the quality of life. Moreover, this disease tends to progress. Thus, it is worth starting treatment immediately. Next we will consider both traditional and traditional methods cataract treatment, as well as prevention methods.

Possible types of cataracts

They are observed in people with intrauterine pathologies of various etiologies. Layered (zonular) and polar cataracts are common. Symptoms include any visual impairment, often the pathology affects both eyes at once. The pupil is partially or completely darkened. Nystagmus is common.

Acquired cataracts are usually progressive. They develop when various types intoxication, under the influence of radiant energy, in old age and after various injuries. Cataracts can be a complication of diseases such as iridocyclitis, glaucoma, and high myopia.

Senile lens opacification develops mainly after 50 years. The reasons for its appearance during this period of human life are not fully understood. Main features senile cataract serves as a gradual decrease in vision to light perception with the correct projection of light. There are primary, immature and mature cataracts. At the initial stage, the transmitted light has darkening only near the equator in iradial or sector-shaped strokes, the wide base of which is directed towards the equator of the lens. With immature cataracts, the opacities intensify, forming a single whole, gradually blocking the pupil, but the anterior layers still remain transparent. The third stage of cataract occurs when all layers of the lens become cloudy. She is called mature. At this stage, the shadow of the iris is no longer visible in side lighting. Object vision is completely lost.

Traumatic cataract develops after a penetrating injury to the area, after blunt trauma. There is a cataract with common diseases body: diabetes mellitus, tetany, severe general infectious diseases, in case of large blood loss, during prolonged fasting.

Toxic cataracts are observed in workers industrial production at chronic poisoning industrial poisons. Radiation cataracts are observed in workers in hot shops (smelters, steelworkers, blacksmiths, glassblowers, etc.). This type of cataract is also called thermal cataract. Ionizing radiation (X-rays, alpha, beta and gamma rays, neutrons) also causes clouding of the lens.

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Symptoms and signs of the disease

As mentioned above, the main symptoms of the disease are blurred vision and changes in light sensitivity. People with cataracts have to change their glasses very often, as the disease tends to progress. The first sign of clouding of the lens is double vision, the appearance of “floaters” or spots in front of the eyes, visible objects have a sunny tint, and reading is difficult. At the early stage of the disease, visual acuity is practically not affected. But subsequently, as the cataract grows, vision begins to decline.

If you suspect a cataract, you should urgently consult an ophthalmologist (ophthalmologist). The doctor will conduct a diagnosis and determine visual acuity, visual field, intraocular pressure, and perform ultrasound and electrophysiological studies of the retina and optic nerve.

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Treatment of the disease

In advanced cases, treatment is carried out mainly surgically. For mature or almost mature cataracts, it is indicated surgical removal cloudy lens. The main indication for surgery is not the degree of its maturity, but the state of the visual function of both eyes. This method allows you to restore consistently high vision.

After cataract removal, the surgeon inserts strong convex lenses. IN modern world There is a wide variety of artificial lenses, which differ in their purpose, type, size, weight, color, method of fixation on the eye, etc. The surgeon’s task is only to select the appropriate model for a particular patient, for its implantation into the eye after removal of the lens.

When cataracts begin, in order to prevent its further development and progression, the doctor may prescribe general vitamin therapy (vitamins B1, B2, C, PP, E), instillation eye drops(riboflavin, ascorbic acid, distilled water, etc.). At the initial stage of the disease, treatment can be adjusted using special drugs, which influence material metabolism in the lens. Such drugs include catalin, oftan katachrome, taufon, quinax. The development of cataracts can be prevented by drugs such as vicein, vitaiodurol and vitafacol.

Massage has a good effect on cataracts. To do this, you need to sit comfortably and relax, massage your earlobes for 1 minute 2-3 times a day. Biologically located on the earlobes active points, affecting vision, as well as other internal organs person.

There is also an unconventional method of improving vision in the initial stage of the disease, called Su-jok therapy. The effect of this method is that it is necessary to place buckwheat grains or black peppercorns on the upper third of the pad of the thumb and fix it all with a plaster. Do not remove the patch for several days. This procedure must be carried out several times a month for a long time, only in this case the effect will be noticeable. Exactly on thumb In the upper third of the arm there are biologically active zones responsible for human vision.

In this article we will get acquainted with the answer to the question: what is eye cataract? In particular, attention will be paid to defining medical term. The treatment of cataracts, its diagnosis and symptoms will also be discussed. various stages factors causing the disease and some drops that are used in the fight against cataracts. Let's pay a little attention to historical data for general information.

Introduction

Eye cataract is a pathological condition that is associated with the eye lens, namely with its clouding. This disease leads to various disorders that manifest themselves to varying degrees, up to complete loss of vision. So, answering the question of what it is - cataract of the eye, we can define it as a disease that affects the lens.

Exists a large number of factors that can lead to cataracts. This may be a consequence of the influence of radiation, injury, or a number of diseases (for example, diabetes). The process of denaturation of the protein that makes up the eye, namely the lens, serves as a physical factor that causes clouding.

Over 90% of cases of the disease are a consequence of age. After 60 years, more than 50% of people begin to decrease the transparency of the lens, and after 80 and older - almost one hundred percent. Cataracts also serve main reason development of blindness (up to 50% of cases).

Symptoms and diagnosis

When answering the question of what it is - cataracts of the eye, it is impossible to ignore the point about the manifestations of this disease.

Among the possible symptoms of cataracts, the main one is decreased visual acuity. However, the place where the clouding begins causes two different phenomena, in one of which the deterioration in the abilities of the visual analyzers may not be observed (if the disease begins to affect the periphery of vision), and in the second it will be noticeable (if there is an effect on the central part of the lens). Vision degradation will noticeably increase as the cataract approaches the center of the eye. The disease can lead to myopia (if the lens nucleus is affected). This reason causes people with cataracts to frequently replace their glasses with to varying degrees"plus" on the lenses. If the disease is of the swelling type, then the lens will acquire an increasingly saturated white color.

With cataracts of the eye, there may be increased or decreased sensitivity to light. If the disease is congenital, then in a child it can lead to strabismus, the presence of white pupils, and a decline in visual abilities (the latter can be detected during the use of silent toys in the absence of a reaction to them).

When carrying out diagnostic procedures, the visual acuity indicator and the width of its field are checked. Intraocular pressure is also measured, and a series of ultrasound and electrophysiological studies of the retina and optic nerves are performed.

The use of slit lamps allows the doctor to determine the maturity of the cataract and the degree of clouding of the lens. Among other things, sometimes an additional examination is required to identify the presence of other possible visual impairment(retinal tissue detachment, glaucoma, etc.).

"Watch your eyes"

Signs of eye cataracts can vary among themselves and differ, which is due to the presence of several degrees of the disease, but the list of main ones should include:

Double vision in one eye as the other eye closes (an early sign that will disappear as the disease progresses).
Fuzzy display of the picture and blurring of images, which is not corrected by using glasses or lenses. There is a feeling of a veil covering everything around.
A person notices glare and/or flashes (most often observed at night).
Increased light sensitivity visual analyzer at night (the light source seems annoying and too bright).
When trying to look at a light source, a person may observe halos around it.
Impaired perception of colors (fading). The most difficult thing for a cataract patient to perceive is violet and blue colors, as well as their shades.
Temporary improvement in visual abilities. An example would be the refusal of glasses by a patient who previously wore them.
The constant need to change glasses may be another reason to think about cataracts.

Signs of specific types of disease

The doctor knows what to do with eye cataracts. However, first a specialist needs to establish an accurate diagnosis.

The first sign that the ophthalmologist pays attention to is the age of the patient who visited him. The clinical course of cataracts has many characteristic features, in particular, clouding of the lens. Most often it has a grayish color, less often with a shade of white. Cloudiness may begin to develop in different parts of the lens, which allows the doctor to draw conclusions about the type of cataract and its stage.

There is a relationship between the type of disease and clinical picture which will be observed by an ophthalmologist:

A white spot with clearly defined boundaries indicates the development of anterior cataract. If it takes on a pointed and extended shape, then it is called a pyramidal anterior.
Cloudiness in the area of the posterior pole of the lens, presented in the form of a white ball, indicates the presence of polar cataracts.
The characteristics of a central cataract are similar to those of a spherical cataract, but the opacities are located right in the center and reach 2 mm in diameter.
Fusiform cataracts are defined by their shape, which looks like a thin spindle located in the central part of the lens.
Congenital cataracts of the zonular type can be recognized by the characteristic cloudy core and the transparent layers located in it.
Dense soft cataracts are characterized by clouding of the entire lens and liquefaction of its masses. Subsequently, a “bag” is formed.
Diabetic cataracts are identified by the appearance of white opacities on the surface of the lens that take on the appearance of flakes. Often leads to changes in the iris.
Tetanic cataracts correspond to the characteristics of diabetic ones, but they are initially located under the lens capsule and subsequently spread into the thickness of the cortical layers (problems with the thyroid gland).
Toxic cataracts can be recognized by the appearance of opacities that are centralized under the lens capsule. In the future, they will begin to spread to the cortical layers.
The senile form of cataract can be determined by many signs, and it may depend on the level to which the disease has managed to reach.

The eye disease cataract is usually diagnosed using the information above. However, there are other features of the disease, which most often only a specialist knows about.

Ways to fight

How are eye cataracts treated and what is used during the procedures?

Currently, there is only one effective method for eliminating cataracts. It is a surgical intervention during which the clouded lens is removed. Every year, over twenty million operations of this kind are carried out around the world, and in Russia - about half a million. What does a specialist do for cataracts? The lens is the main object of manipulation. It will be replaced with a special one artificial lens intraocular type.

Phacoemulsification surgery is the most common and traumatic procedure today. It can be done even on an outpatient basis, but it should be done by a specialist with experience. Phacoemulsification has no age categories or restrictions.

All patients with diagnosed cataracts should be consulted by an ophthalmic surgeon. A specialist will help determine the time frame within which it is necessary to eliminate the problem. This procedure is safe and allows you to return to the usual way life right away.

Treatment of eye cataracts in uncomplicated cases involves local drip anesthesia without the use of acupuncture. Next, the surgeon makes a micro-incision (1.8-2.8 mm). The tip of the phacoemulsifier is inserted into the microincision space, which performs oscillatory movements at the speed of ultrasound. Using this procedure, the lens mass is converted into an emulsion liquid. Then it is withdrawn.

Replacement of the eye lens for cataracts is carried out at the next stage. Instead, it is implanted. The micro-incision is tightened independently without the use of sutures. The procedure is painless.

Modern technical capabilities allow a person not only to restore lost vision, but also to correct corneal astigmatism, as well as eliminate dependence on glasses.

How are eye cataracts treated, besides the above method?

There is also femtolaser surgery, which has only recently become widespread. Her methods make it possible to obtain predictable results. Currently, femtolaser surgery is a fairly expensive technology.

Treatment of eye cataracts in clinical trials using eye drops is carried out on animals. Such a drug would hypothetically slow down the rate at which the problem spreads. Active substance- lanosterol. It dissolves protein accumulations in the thickness of the lens. However, there are still no compelling reasons to be confident in the effectiveness of such a remedy.

Conditioning factors

There are many causes of eye cataracts. Among them are the following:

Diabetes factor.
Factor of smoking and drinking alcohol.
Some eye injuries.
Reception
Prolonged exposure to light rays on a surface eyeball.
The age factor leads to a decrease in antioxidant levels and a deterioration in the body's ability to fight natural toxins.
The phenomenon of retinal detachment, iridocyclitis, chorioretinitis, and some other diseases, as well as problems with metabolic processes occurring in the lens, can lead to cataracts.
Factor of severe infections. Examples include the following diseases: typhus, smallpox, malaria and others.
Anemia.
Poisoning with substances with toxic effects. Among them, for example, thallium or naphthalene.
Some skin diseases such as eczema, neurodermatitis, etc.
Third degree myopia.
Heredity factor.
Down's disease.
Labor activity in workshops with high temperatures.

Poor environment and radiation can also be factors that can lead to cataracts.

Transformation of the disease

Initial cataracts of the eye are often subtle, but if obvious symptoms appear, it is recommended to immediately consult an ophthalmologist. The doctor will be able to identify the level of complications that could develop in the fundus of the eye by using special drops. The pupil will first be dilated. Lack of proper treatment will allow the disease to progress, and in the future will lead to serious complications, up to the complete loss of the ability to see. Also, if cataracts are not treated, you may begin to suffer from increased intracranial pressure and the development of glaucoma. The optic nerve dies, and the nerve impulses entering the brain to analyze information are no longer radiated.

Statistics show that 12% of cataract patients are susceptible to rapid progression of the disease. This leads to complete clouding of the lens. About 15% of patients lose their vision within fifteen years. The majority of people require the intervention of an ophthalmic surgeon within 7-10 years. Replacing the lens of the eye for cataracts is a painless procedure, and fear of the upcoming operation is completely unfounded. For a trained doctor this is a simple manipulation.

Cataract includes the following stages:

Anterior and posterior capsular.
Perinuclear layered.
Nuclear.
Cortical.
Complete.

Cataracts may be immature. In this case, the cloudiness will be located in the imaginary central area of the lens. There is a loss of visual acuity. The movement of such a cataract is directed into the thickness of the central optical zone.

Overmature cataracts are characterized by a milky-white color of the lens, the discoloration of which occurs due to the liquefaction of the substance that forms it.

Possible complications

If eye cataracts are not diagnosed in time and are not eliminated, this can lead to the following problems:

Complete blindness, or amaurosis, which progresses slowly. Amaurosis is a state of absolute blindness.
Lens luxation is a complication characterized by displacement of the lens or its complete separation from the retentive ligament. There is a sharp deterioration in vision.
Phacolytic iridocyclitis is a disease manifested in inflammation of the tissues of the iris and ciliary body. At the same time, strong headaches and eye pain.
Phacogenic glaucoma - characterized by a secondary increase in intraocular pressure. This is caused by an increase in the size of the lens.
Obscurational amblyopia. This complication is more common in children and is a consequence of a congenital disease.

Eye cataracts and surgery are two inextricably linked phenomena. You should not delay visiting an ophthalmologist when the first symptoms indicating a disease occur.

History and modernity

For the first time, surgery to remove cataracts was performed by surgeon Jacques Daviel. He accomplished it in 1752. The first procedure to replace the lens with artificial analogues was carried out shortly after World War II. This work was done by a surgeon originally from England, Harold Ridley. The researcher noticed that eye plastic injuries did not always lead to complications or adverse reactions. Based on this observation, he decided to create artificial lenses that could be implanted. On February 8, 1950, the first operation of this kind was carried out. Cataracts of the eye were eliminated in 45-year-old nurse E. Atwood.

Scientists from China and the USA published in 2016 the results of their experiments on eliminating cataracts using stem cells. The technology involves growing another lens to replace the old one. Such cells can slow down the process of tissue necrosis and cause the restoration of new or damaged ones.

During the operation, the cataract of the eye is removed, followed by stimulation of stem cells. Having tested this protocol on several species of animals and obtained good results, doctors performed this procedure on twelve infants with congenital cataract. During the treatment, all children regained their lost vision.

Using drops

For cataracts in both eyes (or eyes), drops are often used to stop the development of the disease. They also prevent the development of complications after major operations. Any type of such medicine should be prescribed by an ophthalmologist. Trying to eliminate the disease on your own is not recommended.

"Oftan Katahrom" is a drug used to combat cataracts. It includes nicotinamides, as well as adenosine and some other compounds. The medicine normalizes metabolic processes and has a positive effect on oxidative and regenerative phenomena. Drops play the role of antioxidants. Their advantage is the rapid onset of the improvement effect, and they are not absorbed into the blood. They can be used during pregnancy.

Burning eyes are the most common side effect of the drug. The medicine has some restrictions on use due to individual intolerance to the components. It is not recommended to wear lenses while using drops.

For cataracts of the lens of the eye, Quinax drops are also used. They have a positive effect on the processes of resorption of protein masses formed in the lens of the gas. Also, "Quinax" activates some enzymes located in the cavity of the ocular anterior chamber, inside which a large amount of moisture is concentrated. The drops are different low level absorption and do not cause side effects. Do not interact with others medicines. Children and pregnant women are advised to consult a doctor before use.

"Taufon" is another drops used to prevent and combat cataracts. They also trigger regeneration processes in the tissues that form the lens of the eye. "Taufon" normalizes metabolic processes in the eyeball. Possible complication favors appearance allergic reaction. The product is used for almost any type of cataract.

Skulachev drops, otherwise called "Visomitin", are used to combat dry eye syndrome. They are often prescribed after operations. The duration of treatment is determined by the severity of symptoms, which must be determined by the doctor. The product can be used in conjunction with other similar medications, but it is necessary to make an interval of about five to ten minutes when taking it. "Visomitin" is not recommended for use during breastfeeding. Can only be used after 18 years of age.

Eye drops "999" for cataracts and glaucoma - a means for the prevention and treatment of the disease in question. Relieves eye strain, fights cataracts, tones the eyes. It is not recommended to use if there is severe eye pain.

It must always be remembered that the use medicines in most cases it does not replace surgical intervention. Therefore, you should not rely only on them. When identifying the first signs of cataracts, it is important to consult a doctor and strictly follow his recommendations to eliminate the problem.

We looked at how the lens of the eye is replaced during cataracts, and what symptoms this disease manifests.

Under the cataract understand all true lens opacities. Therefore, cataracts do not include the opalescence (optical heterogeneity) that is characteristic of the lens, due to its structure and the highest degrees of which are designated as a senile reflex.

Diagnosis of cataracts

More significant lens opacities are recognized already in daylight and are noticed even by non-doctors; gentle partial opacities can only be detected with precise research. For this purpose they use, first of all, side lighting.

Using this method, however, it is possible to recognize changes located in the area of the pupil and, moreover, not too deep. Therefore, it must be performed with artificial dilation of the pupil; Only then is the lens visible to a sufficient extent and one can get an idea of the distribution of opacities.

Very important for differential diagnosis between true and imaginary lens opacities has transmission through a flat mirror. With this method you can see a lot without dilating the pupil, since in a dark room the pupil dilates. With such a study, very deep-lying opacities are also clearly visible.

Only the equator of the lens cannot be examined by either of these two methods: it is always covered by the iris and, in its normal position, becomes visible only after iridectomy or iridodialysis.

As you can see the clouding of the lens

When examined with side lighting, lens opacities appear gray or white in varying intensity, very rarely bluish or completely sky blue;
Calcified cataracts are often yellowish-white in color; cataracts with a large hard nucleus are brownish-gray to dark brown.
Cholesterol crystals appear in the form of shiny, angular, rainbow-colored plates.
Most opacities appear matte; only with cat. intumescens there are sectors shiny like silk, and depending on the direction of the incident light, first one or the other sector shines.

Form of lens opacities

The shape of lens opacities varies greatly; Along with shapeless, cloudy opacities there are very sharply defined ones, then irregular shape, then having the form of dots, spots, stripes, sectors, circles or stars.

These shapes are related to the structure of the lens: stripes located mostly radially, and in this case they are called spokes.

Disks and stars located so that their centers coincide with the axis of the lens. The same is observed in relation to the finer structure of opacities, as it is perceived with a magnifying glass, for example, characteristic of sectors parallel banding and feathery pattern on the rays of the star.

Such opacities should be considered as located in the substance of the lens; They indicate that the fibrous structure of the lens substance is still preserved. If the rays of a star look wide gaping slits, then this indicates swelling of the lens substance in the deep layers.

If there is no indication of the relationship of the opacities to the structure of the lens, then the matter is either complete collapse substances of the lens or about opacification of the bag. For opacities last kind especially characteristic the presence of thin parallel folds.

Localization of lens opacities

The localization of opacities under lateral illumination is determined directly; when studying in transmitted light - by parallax.
Opacities located on the anterior surface in the plane of the pupillary margin belong to the anterior lens bag.
Opacities of the lens substance, even if they are very superficial, still lie noticeably deeper than the pupillary edge.
Opacities at the posterior pole are characterized by their slight parallax in relation to the corneal reflex.
For opacities that occupy the entire pupil, pay attention to the shadow cast by the iris.

If there is still a transparent medium in front of the cloudiness, then on the side from which the light falls a dark one appears type of sickle the shadow cast by the iris. This shadow is wider, the more obliquely the light falls and the deeper the cloudiness lies; it is sharply limited if the turbidity has a sharp border in front; it is blurry if the cloudiness gradually turns into a transparent medium.

The transparent medium in front of the opacities is either the transparent substance of the lens, as is the case with cat. perinuclearis and cat. senilis immatura, or chamber moisture, for example with wrinkled complete cataracts.

The question of which of these possibilities is at issue can be decided on the basis of accompanying phenomena, primarily the depth of the chamber.

Novice ophthalmologists often confuse the shadow falling from the iris with the pigment border of its edge, which in cases of cataracts is visible especially sharply; but the pigment border represents a sharp black line surrounding the entire pupil; in contrast, the shadow of the iris is observed only on the side from which the light falls, and its width can be changed at will by changing the direction of the incident light.

Volume The entire lens is subject to certain fluctuations during the formation of cataracts. For some time it increases due to impregnation with water (swelling), and then, due to the absorption of decay products, it decreases again (wrinkling).

Causes of cataracts

Since the lens is an epithelial formation, true inflammation of the lens does not occur. Only if the lens bag is damaged, exudate (pus) can form in its cavity, and later scar tissue.

Such damage to the lens bag can occur with the lens itself, or it can be corroded by pus located next to it. Pus that has penetrated into the bag destroys the substance of the lens even faster than chamber moisture; Granulation tissue, too, leads to absorption of the lens, as evidenced by the shaft of phagocytes that lies in front of it.

Senile cataract, however, is not amenable to this process. In this way the entire cortex may eventually be replaced by scar tissue, and the core will be surrounded on all sides by granulation tissue. But completely deprived of connection with the bag, the nucleus now acts only as foreign body. Typical giant cells appear in large numbers on its surface, gradually eating into its substance.

If the lens bag is damaged, chamber moisture has the opportunity to act on the substance of the lens and thus leads to the formation of opacities. But simple damage to the lens epithelium disrupts the diffusion process and leads to clouding of the lens. Inflammation of the surrounding parts obviously acts in the same way.

Toxic factors play a role in some poisons, in the action of metabolic products (), in disorders internal secretion(tetany).

Subjective symptoms of cataracts - lens opacities

Among the subjective symptoms of lens opacity, the first place is visual impairment.

Of course, if the clouding occupies only part of the pupillary area, if it is sharply limited, compact, then it causes little or no effect.

If it is gentle, transmits light and is not sharply limited, then it scatters the light very strongly and, as a result, disrupts it, even if there are still completely transparent areas next to it in the pupillary area.

For the same reason, it is very disturbing, although it actually does not represent opacities at all.

Next matters location of opacities.

Cloudiness located very peripherally (near the equator) does not interfere with vision at all, since it is always covered by the iris. If the turbidity approaches the middle, then its influence makes itself felt only when wide pupil: Hemeralopia appears.

On the contrary, if the clouding is located in the axial areas of the lens, then nyctalopia is observed, it will be better than near, since with convergence the pupil narrows, and if we are talking about stationary clouding, then in youth the vision will be better than in old age, when the pupil is already losing ability to expand.

The visual disorder is generally dioptric, i.e. it concerns color perception and not the field of vision. A decrease in visual acuity can lead to the destruction of quantitative vision (with mature complete cataracts).

Color perception can only be impaired due to the intense yellow color of the lens nucleus. However, this kind of disorder can occur in old people without the formation of cataracts.

The yellower the core of the lens, the warmer all the tones of colors seem to the patient; the entire color scale approaches that which the normal eye perceives under lamp lighting. Pure blue is the worst perceived color, but light yellow is also easily mistaken for white.

If color vision disorder goes beyond these limits if color perception to red and green colors, if a scotoma appears in color or other visual field disorders, this indicates a complication that is localized in the retina or optic nerve.

Research in this direction is of particular importance in cases where, due to cloudiness of the media, it is no longer possible to distinguish the details of the fundus.

If ophthalmoscopic examination is generally impossible, then the only criterion for judging the state of the sensory apparatus is the study of functions. They study, to the extent possible, using the smallest colored objects possible, the central color perception, and the boundaries of the visual field - using the perimeter or at least with the hand.

Symptoms of complete clouding of the lens - cataracts

If the lens opacification becomes complete, these tests are no longer possible. Such an eye, if it is healthy at all, must, however, also satisfy the following conditions:

1. The eye must still distinguish a candle flame in a dark room at a distance of 6 m, that is, whenever the candle flame is closed with his hand or opened again, he must immediately and without hesitation note this.

2. Him field of view when examined with a candle flame(projection) should be normal. The doctor stands in front of the patient, invites him to look straight ahead and first holds the candle behind the patient's head. Then he moves it forward, now from the side of the nose, now from the side of the temple, now from above the eye, now from below it. As soon as the first ray of light hits the patient’s pupil, the latter must indicate where the light source is without looking at it.

Many people cannot be forced to keep still: they move their eyes. If these eye movements are accurate and confident, if the patient immediately, and confidently, fixes the light in any direction, then this indicates good projection. But if these movements become searching, then the projection is bad even if it is finally found correct installation eyes and at the same time the correct localization of light.

3. Must be available color perception. If you place colored glass (red, green, blue) in front of the patient’s eye in a bright room, then he should correctly name the colors.

4. If the iris is normal, it can be used for diagnostic purposes and reaction to light, which in mature cataracts is especially lively and distinct. Due to the diffuse nature of the opacification, the incident light is scattered in all directions, so that a lot of light always reaches the pupillomotor region of the retina, even if the light falls from the side in the examination room.

Cataract treatment

Modern medicine offers only surgical treatment for cataracts with the destruction of the clouded lens with a laser and subsequent placement artificial lens.

In addition to decreased visual acuity, so-called monocular polyopia appears due to incorrect refraction, i.e. instead of one point of light you can see many of them. Many patients with incipient cataracts complain not so much of decreased visual acuity as of blindness.

A cataract is a clouding in the lens of the eye that causes vision problems. The most common type of cataract occurs in old age. More than half of all Russians aged 65 years and older have cataracts.

On early stages Intensive, non-invasive therapy can reduce vision problems caused by cataracts. However, at a certain point, surgery is the only option possible way cataract treatment. Today, cataract surgery is safe and very effective.

What is a lens?

The lens is the part of the eye that helps focus light onto the retina. The retina is the light-sensitive layer of the eye that sends visual cues into the brain. The lens is located just behind the iris, the colored part of the eye. When focusing, the eyeball changes shape. It becomes rounder as you look at nearby objects.

What is a cataract?

The lens of the eye is composed primarily of water and protein. The protein is designed to allow light to pass through it and focus on the retina. Sometimes the proteins aggregate and become concentrated in a small area of the lens. This is a cataract. Over time, cataracts can enlarge and cover more of the lens, making it difficult to see visual objects.

Although scientists continue to study cataracts, no one knows for sure what causes the condition. Scientists agree that there may be several reasons for this, including smoking and diabetes. Often the protein in the lens simply changes depending on the patient's age.

There is also some evidence that cataracts are associated with certain vitamin and mineral deficiencies. The National Eye Institute is conducting a study to find out whether the formation of cataracts is affected by vitamin deficiency.

Scientists know that cataracts will not spread from one eye to the other, although many people develop the disease in both eyes.

Symptoms of cataracts

The most common symptoms of cataracts are:

Cloudy or blurry vision.
Problems with light perception: headlights that seem too bright at night, glare from lamps or the sun, halo or haze around the lamp, various flickering.
Colors appear pale.
Double or multiple vision (this symptom disappears as the cataract grows).
Frequent change of glasses and contact lenses.

These symptoms may also be a sign of other eye problems. If you have any of these symptoms, contact your ophthalmologist.

When cataracts are small, you may not notice any changes in your vision. Cataracts tend to grow slowly, so vision deteriorates gradually. Some people with cataracts find that their ability to see objects at close range suddenly improves, but this is temporary. Vision will soon deteriorate as the cataract grows.

Types of cataracts

Age-related cataracts: Most cataracts are associated with aging.

Congenital cataracts: Some children are born with cataracts or develop them during childhood, often in both eyes. Usually these are children with congenital myopia and other vision pathologies.

Secondary cataracts: Cataracts are more likely to develop in people who have other health problems, such as diabetes. Additionally, cataracts are sometimes associated with steroid use.

Traumatic cataracts: Cataracts can develop soon after an eye injury or years later.

Diagnosis of cataracts

To detect cataracts, a ophthalmologist examines the lens.

A comprehensive eye examination usually includes:

Visual acuity test: This test shows how well you can see at different distances.
Pupil dilation: The pupil is dilated with atropine drops to allow the ophthalmologist to see better inner area eyes, which is necessary for accurate diagnosis.
Tonometry: This is a standard test to measure the pressure of fluid inside the eye. High blood pressure may be a sign of glaucoma.

Cataract treatment

For early cataracts, magnifying glasses and good indoor lighting can improve vision. If these measures do not help, surgery is the only option effective treatment. The surgeon removes the cloudy lens and replaces it with an artificial one.

Cataracts only need to be removed if they severely affect your vision and interfere with your daily activities. The decision to undergo surgery is made by the patient himself.

If you have cataracts in both eyes, the surgeon will not operate on both eyes at the same time. You will need to have surgery separately for each eye to avoid possible complications.

Sometimes cataracts are indicated for removal even if they do not bother you. For example, if the pathology interferes with the investigation or treatment of other eye problems, such as - age-related degeneration yellow spot or diabetic retinopathy. In these cases, the cataract must be removed surgically.

Is cataract surgery effective?

Surgical removal of cataracts is one of the most common eye surgeries performed in Russia today.

It is also one of the safest and effective methods treatment. More than 90% of people who have cataract surgery have improved vision and quality of life.

How are cataracts removed?

The eye lens is enclosed in a sort of "capsule", an outer covering that holds it in place. There are many different cataract surgery techniques, but they all fall into one of two main categories:

Extracapsular surgery: The eye surgeon opens the front of the capsule and removes the lens, leaving the back of the capsule in place. Sound waves (ultrasound) can be used to soften and break up the cloudy lens so it can be removed through a narrow, hollow tube. This is called phacoemulsification.

Intracapsular surgery: The entire lens, including the “capsule,” is removed. Although extracapsular surgery has largely replaced this technique in Russia, it is safe and effective and can be used in some cases, for example, if the eye cavity is too hard for phacoemulsification.

Currently, laser cannot be used to remove cataracts. Although scientists are working on methods to use laser surgery cataracts, the issue is still being studied.

Lens replacement methods

The lens of the eye is necessary for focusing vision. When it is removed, it must be replaced. There are three types of replacement lenses: intraocular lens, contact lens or special glasses. Today, about 90 percent of patients choose an intraocular lens (implant). Of these, about 90% take root, and the patient regains the ability to see clearly.

Intraocular lens

This is a clear plastic lens that replaces the affected lens; placed in the eye during cataract surgery. Patients who have undergone lens replacement surgery note that their vision has noticeably improved and they do not feel any discomfort.

Some people have increased sensitivity to the material from which the artificial lens is made, or for some reason the shape of the eyes is not suitable for wearing an implant, or patients have some other eye diseases. In these cases, surgery to replace the lens inside the eye cannot be performed.

Contact lenses

If it is not possible to replace the lens, soft or hard contact lenses can be used after surgery. These lenses can be worn all day and removed at night. At night, the lenses are placed in a special physical solution (your eye doctor tells you how to insert, remove, and clean your lenses.) When using all types of contact lenses, you must follow the instructions for wearing them. correct use and care.

Glasses for cataracts

Some people don't want to wear contact lenses or their eyes are too sensitive to wear them. For these people, cataract glasses may be best choice. Glasses for patients with cataracts affect vision differently than regular glasses. Their powerful magnification (20-35 percent) can complicate perspective vision and distort lateral vision. Until your eyes have adjusted to these changes, you need to be careful when you drive or do other activities.

What happens before surgery?

Before cataract surgery, your ophthalmologist will perform some tests. These may include tests to measure the curvature of the cornea (the clear, dome-shaped structure that protects the front of the eye) and the shape of the eye. For patients planning to wear contact lenses after surgery, this information will help the doctor choose the right type of lenses.

Other tests can help determine the condition of the retina and prepare the patient for surgery.

Many people choose to remain awake during surgery (local anesthesia), while others may have to use general anesthesia on a short time. If you have chosen local anesthesia, you will be given special medications that will temporarily make you unable to move your eyes.

What happens after surgery?

Most people who have cataract surgery can go home the same day. Others may have minor problems after surgery, such as bleeding. In these cases, they will have to stay in the hospital overnight or for several days.

Absolutely normal sensations after operation:

itching in the eye area;
sticky eyelids;
slight discomfort at the operation site.

Fluid retention also often occurs. In most cases, full recovery takes about 6 weeks.

If you feel discomfort, your eye doctor may suggest pain relief without aspirin every 4 to 6 hours (aspirin thins the blood and may cause bleeding). After 1-2 days, even moderate discomfort should disappear.

After surgery, your doctor will schedule exams to check your recovery progress. You may need to use eye drops to treat or prevent infection or inflammation. For a few days after surgery, you may also take eye drops or tablets to help control the pressure inside your eye. Ask your doctor to show you how to use them, when to take them, and what effects they may have.

Complications after cataract removal

Problems after surgery are rare, but they can occur. These may include:

infection,
bleeding,
increased pressure inside the eye,
inflammation (pain, redness, swelling),
retinal detachment.

With prompt medical attention, these problems can be treated.

Some signs postoperative complications may mean you need immediate attention from a surgeon. If you have any of the following symptoms, contact your eye care professional immediately:

unusual pain,
loss of vision,
flashing lights in front of the eyes (may indicate retinal detachment, which can lead to blindness).

When will vision be fully restored?

After surgery, you can read and watch TV almost immediately, but your vision may be blurry. The operated eye needs time to adapt, especially if the other eye has a cataract. The healing period may take many weeks. Your doctor can suggest ways to help improve your eye health during the recovery period.

How long it takes before you can see well usually depends on the condition of the other eye, the lens you choose for implantation, and your vision before surgery.

For example, after a lens transplant, you may notice that many shades have a bluish tint, and after being outside in bright sunlight, everything will turn reddish within a few hours. It won't take long to adjust to these changes.

What is secondary cataract?

Sometimes people who have extracapsular surgery develop secondary cataracts. When this happens, the back of the lens capsule becomes cloudy and prevents light from reaching the retina. Unlike cataracts, secondary cataracts are treated with laser.

In a technique called YAG capsulotomy, the eye surgeon uses a laser beam to create a tiny hole in the capsule that can let light through. This is a painless outpatient procedure.

What research is being done?

NEI conducts and supports a number of studies, such as the Age-Related Eye Disorders Study (AREDS). In this national clinical trial Scientists are studying how cataracts develop and what factors put people at risk for developing them. They also look at whether certain vitamins and minerals affect the development of cataracts.

Other research is focusing on new ways to prevent, diagnose and treat cataracts. In addition, scientists are studying the role of genetics in the development of cataracts.

Preventing Cataracts: What Can You Do to Protect Your Vision?

People over the age of 60 are at risk for many vision problems. If you are age 60 or older, you should have an eye exam through dilated pupils. This type of exam allows your eye care professional to check for signs of age-related macular degeneration, glaucoma, cataracts, and other vision problems.

– pathology of the light-refracting structure of the eye – the lens, characterized by its clouding and loss of natural transparency. Cataracts are manifested by blurred vision, deterioration of night vision, weakened color perception, sensitivity to bright light, and diplopia. Ophthalmological examination for cataracts includes visometry, perimetry, ophthalmoscopy, biomicroscopy, tonometry, refractometry, ophthalmometry, ultrasound scanning of the eye, electrophysiological studies. To slow the progression of cataracts, conservative therapy; Cataract removal is performed by microsurgical intervention with the replacement of the lens with an intraocular lens.

The lens is part of the dioptric (light-conducting and light-refracting) apparatus of the eye, located posterior to the iris, opposite the pupil. Structurally, the lens is formed by a capsule (bag), capsular epithelium and lens substance. The surfaces of the lens (anterior and posterior) are spherical in shape with different radii of curvature. The diameter of the lens is 9-10 mm. The lens is an avascular epithelial formation; nutrients enter it by diffusion from the surrounding intraocular fluid.

In terms of its optical properties, the lens is a biological biconvex transparent lens, the function of which is to refract the rays entering it and focus them on the retina of the eye. The refractive power of the lens is heterogeneous in thickness and depends on the state of accommodation (at rest - 19.11 diopters; in a state of stress - 33.06 diopters).

Any change in the shape, size, or position of the lens leads to significant impairment of its functions. Among the anomalies and pathologies of the lens are aphakia (absence of the lens), microphakia (reduction in size), coloboma (absence of part of the lens and its deformation), lenticonus (protrusion of the surface in the form of a cone), cataract. Cataract formation can occur in any of the layers of the lens.

Causes of cataracts

The etiology and mechanisms of cataractogenesis - the development of cataracts - are explained from the perspective of several theories, but none of them gives a comprehensive answer to the question of the causes of the disease.

In ophthalmology, the most widespread theory is free radical oxidation, which explains the mechanism of cataract formation from the point of view of the formation in the body of free radicals - unstable organic molecules with an unpaired electron that easily enter into chemical reactions and causing severe oxidative stress. It is believed that lipid peroxidation is the interaction of free radicals with lipids, especially unsaturated ones fatty acids, leads to the destruction of cell membranes, which causes the development of senile and diabetic cataracts, glaucoma, microcirculation disorders in brain tissue, and hepatitis. The formation of free radicals in the body is primarily promoted by smoking and ultraviolet radiation.

An important role in the mechanism of cataract development is played by an age-related decrease in antioxidant protection and a deficiency of natural antioxidants (vitamins A, E, glutathione, etc.). In addition, they change with age physical and chemical properties protein fibers of the lens, which make up over 50% of its structure. Disorders of lens metabolism and the development of opacities may be associated with changes in the composition of the intraocular fluid during recurrent inflammatory diseases eyes (iridocyclitis, chorioretinitis), as well as dysfunction of the ciliary body and iris (Fuchs syndrome), terminal glaucoma, pigmentary degeneration and retinal detachment.

In addition to age-related involution, deep general exhaustion after severe infectious diseases (typhoid, malaria, smallpox, etc.), fasting, anemia, excessive insolation, exposure to radiation, predispose to the development of cataracts. toxic poisoning(mercury, thallium, naphthalene, ergot). Risk factors for the development of cataracts are endocrinopathies (diabetes mellitus, tetany, muscular dystrophy, adiposogenital syndrome), Down's disease, skin diseases(scleroderma, eczema, neurodermatitis, Jacobi poikiloderma). Complicated cataracts can occur due to mechanical and contusive injuries to the eye, eye burns, eye surgeries, unfavorable heredity for cataracts in the family, high myopia, uveitis.

Congenital cataracts in most cases are caused by toxic effects on the embryo during the formation of the lens. Among the causes of congenital cataracts are infections suffered during pregnancy (influenza, rubella, herpes, measles, toxoplasmosis), hypoparathyroidism, taking corticosteroids, etc. Congenital cataracts can occur when hereditary syndromes and be combined with malformations of other organs.

Cataract classification

In ophthalmology, cataracts are divided into two large groups: congenital and acquired. Congenital cataracts, as a rule, are limited in area and stationary (do not progress); with acquired cataracts, changes in the lens progress.

Among acquired cataracts, depending on the etiology, there are senile (senile, age - about 70%), complicated (in case of eye diseases - about 20%), traumatic (in case of eye injuries), radiation (in case of damage to the lens by X-ray, radiation, infrared radiation), toxic (with chemical and medicinal intoxications), cataracts associated with common diseases.

Based on the location of the cloudiness in the lens, there are:

anterior polar cataract – located under the capsule in the area of the anterior pole of the lens; the cloudiness looks like round spot whitish and grayish color;
posterior polar cataract - located under the capsule of the posterior pole of the lens; similar in color and shape to anterior polar cataract;
fusiform cataract – located along the anteroposterior axis of the lens; has the shape of a spindle, in appearance it resembles a thin gray ribbon;
nuclear cataract – located in the center of the lens;
layered (zonular) cataract - located around the nucleus of the lens, with cloudy and transparent layers alternating;
cortical (cortical) cataract – located along the outer edge of the lens shell; has the appearance of whitish wedge-shaped inclusions;
posterior subcapsular - located under the capsule behind the lens;
complete (total) cataract - always bilateral, characterized by clouding of the entire substance and capsule of the lens.

Overmature cataracts can be complicated by phacogenic (phacolytic) glaucoma, associated with clogging of the natural outflow tracts of eye fluid with macrophages and protein molecules. In some cases, the lens capsule may rupture and protein detritus may enter the eye cavity, which entails the development of phacolytic iridocyclitis.

Cataract maturation can be rapidly progressive, slowly progressive, or moderately progressive. In the first option, 4-6 years pass from the initial stage to extensive clouding of the lens. Rapidly progressive cataract develops in approximately 12% of cases. Slow maturation of cataracts occurs over 10-15 years and occurs in 15% of patients. Moderate progression of cataracts in 70% of cases occurs over a period of 6-10 years.

Symptoms of cataracts

Expressiveness clinical manifestations depends on the stage of cataract. Visual acuity at initial cataract may not suffer. Early signs diseases may include double vision of objects (diplopia), flashing “spots” before the eyes, blurred vision (“like in a fog”), coloring of visible objects with a yellowish tint. Patients with cataracts report difficulty writing, reading, and working with small details.

Typical for a cataract clinic increased sensitivity eyes to light, deterioration of night vision, weakening of color perception, the need to use bright lighting when reading, the appearance of a “halo” when looking at any light sources. Vision with cataracts changes towards myopia, so patients with severe farsightedness sometimes suddenly discover that they can see perfectly well near without glasses. Visible image blurred before the eyes, but it is not possible to correct it with glasses or contact lenses, despite changing the diopter level.

In the stage of immature and especially mature cataracts, visual acuity sharply decreases, objective vision is lost, and only light perception is preserved. As the cataract matures, the color of the pupil becomes milky white instead of black.

Diagnosis of cataracts

Cataracts are identified by an ophthalmologist based on a number of standard and additional examinations.

Routine ophthalmological examination if a cataract is suspected, it includes visometry (visual acuity test), perimetry (visual field determination), color testing, tonometry (intraocular pressure measurement), biomicroscopy (examination of the eyeball using a slit lamp), ophthalmoscopy (examination of the fundus). Taken together, a standard ophthalmological examination allows us to identify such signs of cataracts as decreased visual acuity, impaired color vision; examine the structure of the lens, assess the localization and magnitude of opacification, detect dislocation of the lens, etc. If it is impossible to examine the fundus of the eye, with severe opacification of the lens, they resort to the study of entopic phenomena (mechanophosphene and the phenomenon of autoophthalmoscopy), which allows one to judge the state of the neuroreceptor apparatus of the retina.

TO special methods examinations for cataracts include refractometry, ophthalmometry, ultrasound scanning of the eye in A- and B-mode, ultrasound biomicroscopy, etc. Additional methods allow the ophthalmologist to calculate the strength of the intraocular lens (artificial lens) and determine the optimal operating technique.

For rate functional state Electrophysiological studies are carried out in the retina, optic nerve and central parts of the visual analyzer for cataracts: electrooculography (EOG), electroretinography (ERG), registration of visual evoked potentials (VEP).

Cataract treatment

In the initial stages of senile cataracts, conservative therapy is used, including instillation of eye drops (azapentacene, pyrenoxine, combination drugs with cytochrome C, taurine, etc.). Such measures do not lead to the resorption of lens opacities, but only slow down the progression of cataracts.

The meaning of the so-called replacement therapy consists of introducing substances, the deficiency of which leads to the development of cataracts. Therefore, the composition of eye drops includes amino acids, vitamins (riboflavin, a nicotinic acid, ascorbic acid), antioxidants, potassium iodide, ATP and other substances. The drug azapentacene has a different mechanism of action - due to the activation of proteolytic enzymes, it to some extent promotes the resorption of the opaque protein structures of the lens.

Conservative treatment of cataracts is ineffective, so the only method of eliminating the pathology and restoring vision is microsurgery - removing the altered lens and replacing it with an intraocular lens. The capabilities of modern eye microsurgery eliminate the need to wait for the cataract to fully mature before removing it.

Medical indications for surgical treatment include: intumescent cataract, overmature cataract, subluxation or dislocation of the lens, identification of secondary glaucoma, concomitant pathology fundus requiring treatment (diabetic retinopathy, retinal detachment, etc.). Additional indications to surgical treatment of cataracts are determined by professional and everyday needs to improve the quality of vision. For bilateral cataracts, the eye with lower visual acuity is operated on first.

In modern cataract surgery, several methods are used to remove a clouded lens: extracapsular and intracapsular cataract extraction, ultrasound and laser phacoemulsification.

The most serious prognosis for visual function associated with congenital cataracts, since in this case, as a rule, there are changes in the neuroreceptor apparatus of the eye. Surgery acquired cataract, in most cases leads to the achievement of acceptable visual acuity, and often to the restoration of the patient’s ability to work.

Prevention of congenital cataracts requires the prevention of viral diseases during pregnancy and the elimination of radiation exposure. To prevent the development of acquired cataracts, especially in at a young age, antioxidant protection of the body, earlier treatment of concomitant general and ophthalmological pathologies, prevention of eye injuries, and annual medical examinations by an ophthalmologist are necessary.