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Cataract

A cataract is a clouding of the eye's natural lens — the transparent structure that sits just behind the pupil and focuses light onto the retina. As the lens gradually becomes less clear, light is scattered rather than focused sharply, leading to a progressive deterioration in vision. Cataracts are the leading cause of reversible blindness worldwide, and the surgical treatment for them is one of the most commonly performed and successful operations in medicine.

Causes

The overwhelming majority of cataracts are age-related, resulting from the gradual chemical changes that occur in the proteins of the lens over a lifetime. By the age of 75, most people have some degree of lens opacification, though the extent to which it affects vision varies considerably. Other causes include prolonged exposure to ultraviolet light, smoking, diabetes, prolonged use of corticosteroid medications, previous eye injury or surgery, radiation exposure, and certain inherited conditions. Congenital cataracts — present at birth or developing in early childhood — are less common but require prompt attention to prevent amblyopia (lazy eye).

Symptoms

Vision with cataracts is often described as looking through a frosted or fogged-up window. Common complaints include blurred or hazy vision, increased sensitivity to glare and bright lights (particularly at night when driving), faded or yellowed colour perception, difficulty reading even with glasses, frequent changes in glasses prescriptions, and sometimes a phenomenon called monocular diplopia — seeing double in one eye.

Diagnosis and treatment

Cataracts are diagnosed during a routine eye examination, which includes visual acuity testing and examination of the lens using a slit lamp. Treatment is surgical and highly effective. Phacoemulsification — the standard modern technique — involves making a tiny incision in the eye, breaking up the cloudy lens using ultrasound, removing it, and inserting a clear artificial intraocular lens implant. The procedure is typically performed under local anaesthesia as a day case, takes around 15 to 20 minutes, and most patients notice a dramatic improvement in vision within days.

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