Treatment of cataract abroad
Cataract is a lens opacity that leads to the eventual loss of one’s vision. This condition is common among elderly people. The risk of the lens opacity is 60-90% after the age of 60 according to different authors.
Approximately 50% of all cases concerning blindness are caused by the cataract. 35% of all the ophthalmic surgeries in the world are performed regarding the cataract.
Causes of cataract
Cataract can be congenital and acquired. Acquired cataract is subdivided into several types according to its cause:
- Senile (age-related) cataract develops with age
- trauma injury is the result of penetrating wounds of the eyeball
- Radiation is the consequence of radiation exposure
- Complications occur along with the presence of other eye diseases (uveitis, myopia)
- Toxicity is the one caused by chemical compounds (naphtholanic acid)
- endocrine occurs by hormonal imbalance processes in the body (usually it is diabetes mellitus)
Lens opacity occurs due to the protein denaturation. The development of the illness is greatly influenced by dehydration, disturbance of the ion balance, oxidation-reduction processes, exchange of sugars and cholesterol.
Causes of the congenital cataract are:
- Chromosomal or genetic mutations
- Rubella in the first trimester of pregnancy
- Alcoholism of a pregnant woman
- The effect of radiation on the foetus during fetal development
- Deficiency of vitamins A, E, and folic acid during pregnancy
- Taking contraceptive medications by the mother during pregnancy
Cataract makes up 60% of all the congenital vision defects and is the most common reason of blindness.
Symptoms of cataract
The main sign of the cataract is progressing vision loss. Peculiarities of the clinical picture depend on the primary location of the pathological process. Opacity can start in different parts of the lens.
Cortical cataract. Vision clarity doesn’t decrease during the initial stage. The patient first complaints of seeing spots, double vision and spots in the eyes. A patient can see several subjects at the same time instead of one, especially when it’s light. After a few years, opacity becomes uniform as the disease progresses. A person loses the ability to distinguish objects and a sense of light remains. The patient can also distinguish colours.
Nuclear (hard) cataract is characterised by the decreased vision acuity. A strong myopia develops in the process and reaches up to 10-12 diopters. This happens due to a change in the lens refractive force of light rays.
Subcapsular cataract. This form of the disease is characterised by an unfavourable course. Visual acuity decreases early and the lens opacity rapidly progresses.
Diagnostics of cataract
The physician identifies cataract during examination of the eyes, which is carried out with passing light on a wide pupil. If there are some signs of cataract, pupils become black under pink light, since the reflected rays are partially absorbed by the opalescent fibres of the lens.
A biomicroscopic study using a slit lamp makes it possible to determine the location of the opacity foci as well as their prevalence. This diagnostic procedure allows the doctor to determine the degree of decay of the lens fibre.
Following techniques assist a doctor while establishment, refinement and differential diagnostics:
- Assessment of vision acuity
- Tonometry (measurement of intraocular pressure)
- Keratometry (measurement of the cornea anterior surface curvature)
- Ophthalmoscopy (examination of the fundus)
- Perimetry (definition of visual fields)
A specialist may also prescribe some other procedures in certain clinical cases such as:
- Electrophysiological examination of the optic nerve
- Endothelial microscopy
- Definition of retinal visual acuity
Treatment of cataract abroad
Conservative techniques aimed to slow down the process of lens opacity are constantly being developed. But, taking into account the fact that cataract is able to progress within decades, there were no conclusive evidence proving the effectiveness of some medicines yet.
Treatment is based on the surgery performance. It is necessary to remove the affected lens and switch it with the artificial one to preserve vision. The following interventions are applied:
Extracapsular extraction of a cataract is a classic operation that has been used for many years. It is still used in the developing countries, although it has already been displaced in countries with more progressive healthcare and surgical techniques. The lens is removed together with the capsule, and then the intraocular lens (artificial lens) is inserted into its place.
Phacoemulsification of the lens isthe most common operation for the cataract treatment in developed countries. It has a much lower risk of complications and higher efficacy. Intracapsular lens removal is performed. The doctor shreds it with an ultrasound and sucks up the liquid with a special device (phacoemulsifier). Then, the intraocular lens is inserted instead of the damaged one.
Benefits of such a surgery are:
- No sutures are required
- Slitation period
- Performed under local anaesthesia
- Short duration of the operation
- Low risk of complications
Innovative treatment of cataract
Until recently, doctors had the opportunity only to install artificial intraocular lenses instead of affected ones. This was the essence of cataract surgical treatment, regardless of what kind of operation is carried out by an ophthalmologist.
Research was completed successfully in 2016 on growing own human lens from stem cells. This technique gives a chance to effectively treat congenital cataract in the newborns. It has not been applied for the senile cataract treatment, but it is going to be for sure.
The core of the technique is that damaged lens is removed and a new one is grown instead. Lens is grown from the stem cells which are located at the same spot, inside the lens. Specialists had to change the way they performed a surgery of its extraction, as stem cells were removed together with the lens before.
Newborns had their vision completely restored within 3 months after the conducted surgeries. Rejection of such a lens does not occur, because it is grown from autologous, genetically native cells.
Prognosis for cataract
If you are not going to treat the disease, the prognosis is unfavourable. Vision disorders progress further and further and a person will become blind sooner or later. The question is how much time will pass before there is complete vision loss: several years or decades.
Prognosis is favourable if qualitative surgical treatment was performed. Vision restores in 95% of patients.
Positive prognostic factors that ensure a high chance of regaining vision after the surgery are:
- The patient can find sources of light
- The patient distinguishes between colours
- Female sex
- Absence of complications after surgery
It is also less risky to have surgery in a first world country with an excellent healthcare system, such as Germany. 1% of patients are observed to have corneal edema, but it is completely reversible. 0,4% of patients have retinal detachment. 0,1% of patients have endophthalmitis (inflammation of the internal anatomical structures of the eye).
Risk of complications after extracapsular extraction of cataracts can reach up to 20% in the developing countries.