Introduction

Definition of cataracts

Cataracts are the primary cause of preventable blindness globally. While some cases of cataracts may be congenital, caused by trauma, or medication-induced, the majority are associated with ageing. A cataract is when the clear lens of the eye becomes cloudy. This cloudiness can block light from passing through the lens to the retina, which is the part of the eye that helps us see.¹ Cataracts can affect a person's quality of life and their productivity. Most cases of cataract-related blindness can be prevented through surgery by removing the cataract and placing an artificial lens, which can successfully restore vision.²

Overview of Cataracts and Common Eye Health Issues

Causes and development of cataracts

Cataracts usually form when the eye's lens tissue changes due to ageing or injury, causing the proteins and fibres in the lenses to start breaking down. This makes your vision look blurry or unclear.

Several factors besides ageing can increase the chances of developing cataracts, including:

• A family history of cataracts
• Diabetes
• A major eye injury
• Eye surgery to help with glaucoma or other eye problems
• Steroids- medications that help treat certain health issues, such as arthritis or allergies.
• Radiation therapy for cancer and other illnesses

Factors that may speed up the formation of cataracts include:

• Smoking
• Consuming excessive amounts of alcohol
• Being in the sun for a long time, especially without wearing sunglasses

Common eye health conditions impacted by cataracts

Cataracts can make it more difficult to manage various existing eye conditions, which are already tough to deal with. The most commonly encountered among these are:

• Glaucoma: a condition characterised by elevated pressure within the eye, which can harm the optic nerve and result in a loss of vision³
• Diabetic retinopathy: a complication associated with diabetes that harms the blood vessels in the retina, leading to vision problems
• Age-related macular degeneration (AMD): a condition that affects central vision, mainly impacting those over 50 years old⁴

How cataracts impact vision

Cataracts typically lead to a gradual blurring of vision, heightened sensitivity to light, diminished colour perception, and challenges with night vision. The symptoms occur because the clouded lens scatters incoming light, reducing the sharpness of the focus on the retina. As cataracts develop, they can increasingly blur vision, making it more challenging to carry out daily activities like reading, driving, or identifying faces. When combined with other eye conditions, these symptoms can complicate the management of vision and impact overall quality of life.

Impact of cataracts on glaucoma

How cataracts affect intraocular pressure (IOP)

Cataracts don’t increase intraocular pressure (IOP), but they can make it trickier to manage eye pressure in people with glaucoma. As cataracts get worse, they can make the lens thicker, which might decrease the space in the front part of the eye. In patients with angle-closure glaucoma, this can make it harder for eye fluid to drain, which can lead to problems with higher IOP. Cataracts can complicate the monitoring and management of eye pressure by blocking the drainage area of the eye, thereby affecting the effectiveness of glaucoma treatments.

Visual field narrowing

Cataracts worsen vision clarity, exacerbating the central and peripheral vision loss caused by glaucoma. Patients may find it harder to handle everyday activities like walking safely, reading, and driving, since both central and peripheral vision can be impacted. Cataracts and glaucoma together lead to a greater loss of vision and the visual field.

Surgical risks and complications

Individuals with glaucoma encounter specific challenges during cataract surgery, as fluctuations in pressure after the procedure can have temporary or lasting impacts on the optic nerve. It's important to manage these fluctuations to maintain eye health, and surgeons frequently employ specialised techniques to stabilise intraocular pressure during surgery. Moreover, after surgery, glaucoma patients might need more careful observation to address potential issues like inflammation or fluid accumulation that could affect the outcome of the procedure.

Impact of cataracts on diabetic retinopathy

Compounding vision loss

Cataracts and diabetic retinopathy (DR) both contribute to worsening vision in people with diabetes, making the symptoms of each condition even more challenging. People with diabetes are more likely to develop cataracts because of changes in their metabolism that can lead to cloudiness in the lens of the eye.⁵ Blind spots and floaters can result from diabetic retinopathy, and the addition of cataracts can further blur vision, making it more difficult to see small details.

Difficulty in monitoring diabetic retinopathy

Cataracts can block the view of the retina, which makes it more difficult for eye doctors to see and track changes in diabetic retinopathy. This clarity is important for monitoring how diabetic retinopathy is developing and for deciding on the best treatment options.

Impact of Cataracts on Age-Related Macular Degeneration (AMD)

Worsening of central vision loss

Cataracts and age-related macular degeneration (AMD) are common causes of reduced vision and blindness in people over the age of 50.⁶ When both conditions are present, the overall vision impairment becomes more pronounced, as each one impacts vision quality in distinct ways. Cataracts cause vision to become cloudy, especially in low-contrast situations, whereas age-related macular degeneration mainly impacts central vision.

Contrast sensitivity and colour perception

Cataract surgery can improve vision for patients with age-related macular degeneration (AMD), particularly when cataracts have progressed to a point where they negatively impact vision on their own, separate from AMD.⁷ People with mild AMD may find that cataract removal enhances their brightness and colour perception, which can help with peripheral vision. It’s important to understand that in severe cases AMD, cataract surgery may not fully restore central vision. However, it can still enhance quality of life by improving peripheral vision or contrast sensitivity.

Challenges in AMD treatment

Cataract surgery is usually considered safe for patients withAMD, but researchers are continuing to investigate any potential risks that may be associated with the progression of AMD following the procedure. Recent research indicates that cataract surgery typically does not hasten the progression of AMD in the majority of cases.⁸ However, after surgery, patients may perceive a progression, which they can attribute to the natural prognosis of the condition itself. Monitoring before and after surgery is crucial, particularly for individuals with late-stage AMD. This approach allows for the tracking and management of any changes in the condition. Additionally, taking precautions, such as minimising light exposure during procedures, can help reduce the risk of phototoxicity.

Strategies for managing cataracts with coexisting eye conditions

Taking care of cataracts alongside other eye conditions requires attentive management and a forward-thinking strategy. Here’s what you need to know to make informed decisions about your eye health.

Regular eye exams and monitoring

When you have multiple eye conditions, like cataracts and glaucoma or diabetic retinopathy, it's essential to have regular eye exams. Your eye doctor uses these exams to monitor even the slightest changes in your vision and make necessary adjustments to your treatment. Advanced imaging tools, such as optical coherence tomography (OCT), enable doctors to closely observe the structures in your retina or optic nerve. This can help if you're at risk of vision loss from various conditions. This technology provides your doctor with a clear view of your eyes, helping to identify complications early and ensuring your treatment stays on course.

Personalised treatment approaches

Every eye condition impacts your vision in unique ways, making it crucial to have a personalised treatment plan that suits your specific needs. If you have both cataracts and glaucoma, your doctor may suggest a combined surgery. This approach can help reduce eye pressure while simultaneously enhancing your vision clarity. For individuals with diabetes, it's important to maintain stable blood sugar levels before and after cataract surgery, since elevated glucose levels can affect the healing process of your eyes. A tailored approach takes into account all facets of your health, resulting in safer and more effective treatment results.

Patient education and awareness

It's important to grasp the essentials of your eye health and the steps you can take to prevent problems with it. Being aware of warning signs of complications, such as sudden changes in vision, helps you to seek assistance promptly. It is important to manage your overall health, like blood sugar and blood pressure, especially if you have conditions such as diabetes or hypertension. Understanding your eye conditions and what to anticipate during treatment empowers you to make decisions that support your long-term eye health. A healthcare team, which may consist of various specialists, can offer additional support to help you manage not just your eye health, but also any related health issues that impact your vision.

Taking these proactive steps can significantly change how you manage cataracts and other eye conditions, ensuring you maintain your vision and protect your eye health for the long term.

Summary

Cataracts make the lens of the eye cloudy, resulting in blurry vision and affecting everyday activities, especially for older people. These conditions can make it more challenging to manage glaucoma, diabetic retinopathy, and age-related macular degeneration by blocking the view of the retina, which hinders doctors' ability to keep track of these issues. Regular eye exams and timely intervention are essential for effectively managing these eye problems. Focusing on regular eye care can support your vision and overall eye health, leading to an improved quality of life.