Senile Cataract

PATHOLOGY

The cataract linked to old age is known as senile cataract and usually appears after 60-65 years of age. The senile cataract can appear in one eye only or in both eyes and develop with a very variable speed between the two eyes and from individual to individual. Other than other types of cataract, the senile cataract progresses gradually over time but the speed of its evolution cannot be exactly predicted. It is appropriate to remember that the cataract is not a condition that can be transmitted from one eye to the other ort from person to person. No pharmacological remedies, eye drops, eye exercises or lenses that can slow-down, block or cause the regression of the process related to the loss of transparency of the  lens. However, it is true that protecting the eyes from  the UV rays by regularly wearing, since very young age, sunglasses or clip-on filtered lenses can help to prevent or delay the process that leads to the formation of the cataract in older age.

 DIAGNOSIS

The senile cataract can have several stages of evolution. At the initial stage (incipient) the cataract is often asymptomatic. In some cases, however, the lens can be subject to a variation in the refraction index, which determines the appearance of refractive defects, such as light hypermetropia or a generally progressive shortsightedness (index myopia). In these cases the prescription of eye glasses can be sufficient to solve the problem. As the cataract progresses, a few additional symptoms appear such as blurring of vision, faded vision, altered perception of colors, loss of contrast, increased sensibility to light, glare, difficulty in the night vision, need of a better lighting while reading, double image while viewing. Such symptoms worsen over time together with the cataract. At a more advanced stage (brunescent), the opacification degree of the lens becomes such as to determine a significant impediment to the passage of the light to the inside of the eye, which can further evolve (black cataract) and determine a condition of real blindness.

The instrumental tests that are necessary during an in-depth eye examination in order to diagnose and, should it be the case, determine the right time for submitting to a cataract surgery are: the IOL Master that provides several anatomic parameters such as the length of the eyeball and the depth of the anterior chamber (i.e. the distance between the cornea and the lens), which can be accessed with surgical instruments during surgery; the Pentacam (topography, pachimetry, no-contact biometry) which measures the thickness, curvature of the cornea and the angular anatomic structure,  the A-scan Ultrasonography that is useful to evaluate the size and hardness of the lens, the high resolution Optical Coherence Tomography (OCT) that analyzes each individual retinal layer in order to  see whether there are retinal pathologies before the surgery, which might cause complications in the after-surgery time because of an inflammatory effect linked to its execution, and finally the B-Scan Ultrasonography, which shows whether the lens is well positioned and adherens for all the 360° of the suspending apparatus  (zonula) of the ciliary body and whether any retinal tractions exist at the time of the surgery, such as to represent an ancillary risk factor.

TREATMENT

Thanks to the continuous progress of technologies, the loss of vision caused by the cataract is today easily reversible thanks to a surgery performed with laser (femtolaser) or ultrasounds (phacoemulsification) that provides for the removal of the opaque lens and its replacement with a perfectly transparent artificial lens (IOL). It is advisable to avoid that the cataract evolves to such a point as to determine blindness; it must be avoided as soon as it starts interfering with the normal performance of the daily working activities. It is always advisable not to wait that the cataract reaches the more evolved stage also because, as the opacification increases, the lens acquires a particularly high hardness and this may prevent the use of last generation techniques and favor the arising of complications during the surgery.

The cataract surgery can take place in day hospital facility, lasts a few minutes (usually 10-15 minutes) and its execution is minimally invasive and absolutely painless. Various types of anesthesia exist: we suggest a “blended anesthesia”, which consists in the administration of local anesthetic eye drops and a mild intravenous sedation that is regulated from time to time in function of the status of anxiety of the patient. The after surgery time is without particular inconveniences and is rather short (few days).  The cataract surgery gives excellent results, restoring in the vast majority of cases a perfectly clear vision. Moreover, there is the possibility during the check up before surgery, after performing all the necessary instrumental tests before the cataract surgery, to correct also great refractive defects (such as shortsightedness, hypemethropy, astigmatism or  presbyopia), implanting different  types of artificial lenses  (IOL) depending on the needs pointed out by the patient (yellow, toric or multifocal lenses).

The contraindications are really very rare, but it is appropriate to keep in mind that the risk of complications or less satisfactory results is possible, in particular in patients suffering from severe corneal, retina or optic nerve pathologies.  For this reason, before submitting to a cataract surgery, it is very important to ask for an in-depth eye examination and evaluate together with one’s own ophthalmologist how to obtain the maximum benefit.

WE CAN HELP YOU

If you believe that you are suffering from this pathology or you have any doubts that you wish to be clarified you can contact us.

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