- By Unknown
-
Postado Friday, 16 September 2011
at 00:48
What are the methods of treatment for childhood cataract?
The treatment options are:
• No surgery with periodic follow up
• Cataract removal without intraocular lens implant
• Cataract removal with intraocular lens implant
What factors decide the treatment option and the timing of surgery?
The treatment option and the timing of surgery will be decided by the ophthalmologist, based on the following factors:
• Age of the child
• Density of cataract
• Whether cataract involves one eye or both eyes
If the cataract is not very dense and the child is able to see through it, then the surgery may not be required or it may be deferred till the child reaches a age where a cataract surgery with lens implant can be done safely.
Generally the lens implantation is not preferred in a child below 2 years of age because these eyes are still in growing stage, moreover there is a tendency for severe inflammation (uveitis) in these young children and the chances of aftercataract (opacification of the capsule of lens) is almost 100%.
Cataract involving only one eye has to be treated more urgently because the chance of amblyopia is greater in these cases.
What are the complications of surgery?
Cataract surgery is very safe, but as in any surgery, complications are possible. There is a very small risk of serious bleeding or infection after the surgery. If a lens has been implanted, there is a very high chance of aftercataract formation, which may require laser treatment or even a small surgery. Even years after surgery, related eye problems such as retinal detachment can develop and threaten sight. For this reason it is very important to have a regular follow up even after the surgery is done. To examine the eye properly in an uncooperative young child after cataract surgery, the ophthalmologist may occasionally give sedative medicine or even general anesthesia.
What to do after surgery?
The care of the eye after surgery is the most important part of treatment. As we remove the lens of the eye, the refractive power of the same has to be compensated in some form to enable the eye to see properly. Also, because the lens is not there, the eye can not change the power for near work (accommodation). For this reason, the child will require to wear an additional near addition (like in presbyopia) for doing near work. The various options available for this purpose are:
• Glasses
• Contact lens
• Intraocular lens implant
The advantages of glasses are that they are very convenient and simple to use and there is no chance of harming the eye. The disadvantages are that they are very thick and heavy, and the child (especially teenagers) may not like to wear them because of poor appearance and because it hampers in sports. Moreover, they are unsuitable for children who have cataract in only one eye, because the vision from the two eyes cannot be properly combined in the brain, when one eye focuses in the normal way and the other looks through a very strong spectacle lens.
Contact lenses provide both vision and appearance that is normal. But the main disadvantage is that they have to be properly cleaned and maintained, or else there is a small risk of infection. It may be difficult to place them in the eye and to remove them for cleaning especially in small children between 1 to 5 years of age. Also the chances of losing the contact lens is also very high in this age group.
Intraocular lenses are a very good option, as they do not require any maintenance. But these are not preferred in children below 2 years of age. They also have a higher chance of developing aftercataract.
The best form of visual rehabilitation for child is a very complex decision and the ophthalmologist will decide after discussing these issues with the parents.
Amblyopia therapy: In some cases of cataract in children below 5-6 years of age, especially in those where only one eye is involved, the child may have to be treated for amblyopia.
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What is cataract?
Cataract is a clouding or opacity of the normally transparent lens inside the eye. Cataract is a common cause of poor vision in older adults, but it may also occur uncommonly in infants and children.
What causes cataract in children?
The child may either be born with cataract or may develop cataract early in life after birth. It may be caused due to some disease in mother during pregnancy or due to some problem with child's general health, or injury to the eye. Sometimes it may be hereditary, being passed to the child, usually from a parent who has the same problem. The ophthalmologist or pediatrician generally runs a few tests to find out the cause of cataract. In many cases, though, no cause may be found.
How to know if one's child has a cataract?
The child may have cataract in both the eyes or in only one eye. At birth, each child is examined by the pediatrician to rule out any congenital abnormality, including cataract. If the child has significant cataract in both the eyes, the family members can usually notice that the child does not see well. The child may not be able to recognize mother (normally recognizes by 2 months of age), may not respond to visual stimuli etc. Sometimes when it involves only one eye, it may be difficult to detect, as the child may be seeing normally. The cataract may make the black pupil of the eye look white or gray. Sometimes the eye with cataract may wander out of line causing squint, or may show a jiggling movement (nystagmus). Presence of nystagmus and squint are poor signs in cataract, as they may signify that vision may not return fully after surgery.
Note that the child may have poor vision due to other reasons also besides cataract. Moreover, cataract in child may be associated with other diseases of the eye as well. Therefore it is mandatory to see an ophthalmologist in case you notice the child has any of the above problems.
My child has a cataract. Would he be able to see?
It is very important to treat this condition as soon as possible to get the best results. Most children who are treated for cataract at the right time end up seeing well. Though there might be certain conditions in which the vision is low even with the best possible treatment. Your ophthalmologist will keep you informed about this.
Why is it important to treat childhood cataract early?
The presence of cataract in a child does not let the eye get proper visual stimulus to develop. This prevents the normal development of the eye, especially if the cataract is present in only one eye. This condition is known as amblyopia or lazy eye. Therefore it is important to treat this condition at the earliest to prevent and to treat amblyopia.
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What are the complications of cataract surgery?
Cataract surgery is one of the most successful surgeries. Over 90% of patients operated for cataract gain a useful vision. But like any other surgery, problems may develop occasionally. If any of these complications occur, you should contact your surgeon immediately.
• Infection following cataract surgery is very uncommon but can be serious. There may be decrease in vision and the eye may become red and painful. This is an emergency, and you must contact your ophthalmologist immediately.
• Inflammation of the eye: This is called uveitis. The eye may become red and aching. This can be treated with drops.
• An accumulation of fluid in the retina may occur causing blurring of the central vision - this is known as cystoid macular edema. This usually resolves itself within a couple of weeks using drops.
• The implanted lens may occasionally move from its original position causing distorted vision. If this happens, further surgery may be needed to reposition the displaced lens.
• The retina may become separate from the inner wall of the eye. This is referred to as a retinal detachment and may require surgery. If you notice a shadow in your field of vision, floaters or flashing lights, immediately report to your surgeon.
• Thickening of the membrane behind the new lens can occur in the months following surgery. This is referred to as capsular opacity or 'aftercataract'. Although the vision becomes blurred it can be treated with laser.
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What are the precautions to be taken after surgery?
Use the eye drops and medicines as prescribed
Avoid rubbing or squeezing your eye
Protection: As advised by your doctor, you may wear the protective eye shield at night for first week. Dark eyeglasses may be worn during the daytime, especially outdoors, to avoid any discomfort that you may have from bright light and also to prevent any injury to eye.
Face wash: For the first few days, avoid splashing water directly into the eye. You may use a clean, soft, wet towel to wipe your face.
Shaving: Shaving of the beard is permitted after the operation.
Bathing: Body bath (below the neck) may be resumed after the first day, but avoid taking a shower or a bath in the bathtub for the first week after surgery.
Head bath: One may wash the hair with the head tilted backwards to avoid any water splashing into the eye.
Games: Normal daily activities including walking, reading and watching television may be resumed soon after the operation. However avoid strenuous activities like jogging, lifting weights, swimming, gardening, aerobics, contact sports etc. for 1-2 months.
Sex: You can resume your sex life a week or two after the operation after consulting your doctor.
Makeup: Avoid eye makeup for 6 weeks.
Diet: There are no dietary restrictions and you may take your routine diet. However, the restrictions as per you pre-existing medical problems, if any, are to continue. Avoid constipation by taking high fiber diet and plenty of fluids.
Driving: Avoid driving unless the surgeon permits you.
Job: You may get back to your job in 1-4 weeks after surgery depending on your profession. Ask your surgeon about this.
Normal symptoms: The following symptoms are normal and are not a cause for alarm. These are slight redness, mild watering, mild irritation, glare and slight drooping of upper eyelid. These will remain to some extent for 6-8 weeks.
Alarming symptoms: In case of any pain, injury, decrease in vision or flashes of light in the operated eye, contact your surgeon immediately.
How to apply eye drops?
Wash hands
Tilt your head back and look at the ceiling
Gently pull the lower eyelid down until it forms a small pocket, or pouch.Squeeze the bottle or the dropper to release a single drop into the eye. Take care not to touch the eye or eyelid with the nozzle of the bottle.
Release the lower lid and close eyelid for 30 seconds. Dab excess with tissue.
Special precautions:
In order to keep the eyedrops clean:
do not allow the nozzle to touch the eye or anything else
do not allow other people to use your eyedrops
replace the cap of the eyedrops immediately after use
discard the eyedrops four weeks after first opening
If you are using more than one kind of eyedrop in the same eye, wait five minutes between drops.
If you are using both drops & ointment in the same eye, always use the drops first and wait five minutes before applying the ointment.
If you wear contact lenses, you should stop wearing them for the duration of your treatment unless otherwise directed by your doctor.
How to apply eye ointment?
Wash hands.Tilt head back and look at ceiling.
Gently pull the lower eyelid down until it forms a small pocket, or pouch.
Hold the tube parallel to the eye to avoid injury. Squeeze a line of approximately ½ cm (¼ inch) of ointment into the pouch without touching the eye, lid or lashes.
Release the lower lid and allow to blink. Wipe away the excess ointment with a tissue.
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- By Unknown
-
Postado Thursday, 15 September 2011
at 23:49
What checkups will be done on me before cataract surgery?
At the outpatient clinic, an ophthalmologist (eye doctor) will examine your eyes. You will have a sight test and then a full eye examination. Often eye drops are put in your eye to make the pupil (hole in the iris) bigger. This helps the ophthalmologist to examine your eye fully. The effect of these drops will wear off after a few hours, however your near vision will be blurred initially. For this reason you should not drive to appointments and you must be careful that you do not miss your footing and fall e.g. down steps.
Once you and your ophthalmologist have decided that you will have your cataract removed, a physical examination is necessary so that he or she may be alerted to any special medical risks. Ask your ophthalmologist if you should continue your usual medications. Your eye will be measured to determine the proper power of the intraocular lens (IOL) that will be placed in your eye during surgery.
What should I do on the day before surgery?
Follow the instructions and medications as advised by your ophthalmologist. Continue to take your usual medicines for systemic conditions like hypertension, unless advised otherwise by your doctor. Take a thorough bath, including your head bath, with soap and water. Do not apply any cosmetics in and around the eye.
On the morning of the day of surgery, you may take a bath, wash your face with soap and water or shave.
What happens to me in the hospital when I go for surgery?
Most operations for cataract are performed on a day care basis. This means that you are admitted to hospital, have your operation and are discharged home all in the same day. You do not stay overnight in hospital. You may be asked to skip breakfast, depending on the time of your surgery.
Before the operation you will be given eye drops, and perhaps medications to help you relax. Normally cataract surgery is performed with a local anesthetic and some sedation. The local anesthetic numbs the area that is being operated on. Though you may see light and movement, you will not be able to see the surgery while it is happening.
As the operation is done under local anesthesia, your cooperation is very important for the surgical success. Do not move your head during the operation and follow the instructions given to you from the surgeon.
The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your head. The operation is performed with the aid of a microscope through a small cut in the top of the eye. This is closed using small stitches at the end of the operation. The operation generally takes up to 45 minutes. At the end of the surgery, a pad or shield will probably be put over your eye to protect it from accidental rubbing and bumping after the operation. After a short stay in the outpatient recovery area, you will be ready to go home. You should plan to have someone else drive you home.
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When should I have the surgery?
Usually, you can decide if, and at what stage to have the operation. The cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for a while. If visual impairment interferes with your ability to read, to work, or to do the things you enjoy then you will probably want to consider surgery.
In the past, eye specialists often waited until the cataract became 'ripe' before suggesting you had it removed. Nowadays, with modern surgery the operation can be carried out at any stage of the cataract's development, and in fact, is a little safer to do before the cataract becomes 'ripe'.
What are the surgical options?
Majority of cataracts today are removed by Extracapsular surgery, in which the posterior capsule of the natural lens is left in place to support the IOL, which is implanted at the time of surgery. There are two types of extracapsular surgery.
Conventional extracapsular surgery: The nucleus of the lens, which is too hard to simply remove by aspiration, is taken out in one piece, and the softer parts of the lens are then aspirated. The surgeon makes an incision (10-12 mm in size) where the cornea and sclera meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the capsule and removes the hard center, or nucleus, of the lens. Using a microscopic instrument, the surgeon then suctions out the soft lens cortex, leaving the capsule in place.
Phacoemulsification: It is a form of extracapsular surgery. In phacoemulsification, the hard nucleus is broken up by ultrasonic fragmentation (using sound waves) within the eye, and can then be aspirated. This allows a smaller incision (3 mm in size) to be used.
The other way of removing cataract is Intracapsular surgery, in which the whole lens is removed in a single piece, without leaving the posterior capsule behind. The patients are rehabilitated with glasses or contact lenses. This form of surgery is being done in a few villages and camp surgeries in India.
What is lens implantation?
The function of the normal lens is to focus the image on the back of the eye (retina) so that it forms a sharp image. Once the opaque lens (cataract) is removed, an artificial plastic lens is implanted inside the eye for this function. This lens is known as Intra-Ocular Lens (IOL).
Lens implants have certain advantages. They usually eliminate or minimize the problems with image size, side vision and depth perception noted by people who wear thick eyeglasses after cataract surgery without IOL implantation. They are also more convenient than contact lenses because they remain in the eye and do not have to be removed, cleaned, and reinserted.
Occasionally the doctor will decide that someone's eye is not suitable for a lens implant. In these cases contact lenses or special glasses will be prescribed instead.
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What are the symptoms of cataract?
Blurring of Vision- Cataract leads to a painless, progressive blurring or dimming of vision. The things may seem blurred around the edges, or your glass may seem dirty or scratched. The opacity affecting the central part of the lens may cause poor vision in bright light.
Frequent change of glasses - Some forms of cataract lead to a change in refractive power of your lens and thus cause frequent changes in power of your glasses. Because of this, some patients may no longer need the reading glasses for near work, this phenomenon is known as 'second sight'.
Glare - Cataract may also lead to sensitivity to light and glare, especially in bright sunlight or while driving at night.
Double Images - The cloudiness in the lens may occur in more than one place, so that the light rays that reach the retina are split, causing a double image.
Change in color vision - Cataract may also cause change in color vision. As the cataract develops its center becomes more and more yellow, giving everything you see a yellowish tinge.
What is the treatment? Can it be cured by medicines?
There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. Surgery is the only way to remove a cataract. Cataracts cannot be removed with a laser, only through a surgical incision. In cataract surgery, the cloudy lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.
When should I have the surgery?
Usually, you can decide if, and at what stage to have the operation. The cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for a while. If visual impairment interferes with your ability to read, to work, or to do the things you enjoy then you will probably want to consider surgery.
In the past, eye specialists often waited until the cataract became 'ripe' before suggesting you had it removed. Nowadays, with modern surgery the operation can be carried out at any stage of the cataract's development, and in fact, is a little safer to do before the cataract becomes 'ripe'.
What are the surgical options for cataract surgery, and which one is the best?
Today there are so many options in cataract surgery, e.g., routine extracapsular surgery with lens implant, phacoemulsification with a foldable or non-foldable lens implant, with or without stitches. The best procedure for a patient is usually the one with which his or her ophthalmologist feels the most comfortable, since these variations of cataract surgery are all quite effective. The patient should discuss the options with his or her ophthalmologist and the decision should be made on the basis of the requirements of the patient and expertise of the ophthalmologist.
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What is cataract?
Cataract ('safed motia') is a clouding or opacity of the normally transparent lens inside the eye. To understand why this leads to loss of vision, it is important to understand the functioning of a normal eye.
Inside the eye, behind the colored part of the eye (iris) with the black hole in the center (pupil) is a lens. In the normal eye the lens is clear or transparent. It helps to focus light rays on to the tissue at the back of the eye (retina). When cataract develops the lens becomes cloudy and prevents the light rays passing into the retina. The picture that the retina receives becomes dull and fuzzy. Cataract usually forms and progresses slowly and therefore leads to a gradual blurring of vision.
What causes cataract?
Most forms of cataract develop in adult life. The normal process of aging causes the lens to harden and become cloudy (opaque). This is called age-related cataract and it is the most common type. It can occur anytime after the age of 40. In younger people they can result from an injury, certain drugs, long-standing inflammation or illnesses such as diabetes. Babies can be born with this condition. This is called congenital cataract.
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