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A cataract
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is the clouding or opacity that develops in the eye's lens. The crystalline lens is comprised primarily of
protein and water. Normally, the protein is bonded in a way that allows light to pass through it. A cataract
forms when bonding changes and protein molecules clump together. Eventually, these clumps cloud the lens and
block light. If left untreated, cataracts may eventually cause blindness.
Incidence and Prevalence
In the United States, about 50% of those between the ages 65 and 74, and 70% of those over age 75 have a
cataract. Women are affected more frequently than men. African Americans lose their vision from cataracts and
glaucoma at twice the rate of Caucasian Americans, primarily due to lack of treatment.
One in every 10,000 babies is born with congenital cataracts. In some cases, it is related to the mother having
an infectious disease or engaging in alcohol or drug abuse during pregnancy.
Types
The lens consists of three parts: the nucleus (center of the lens), the lens cortex (periphery), and the capsule
(membrane that envelops the lens). Cataracts can form in any of these parts.
Causes and Risk Factors
Aging is the primary risk factor for cataracts. Other factors determine overall risk for and severity of the
condition. When cataracts occur in younger patients, they are usually caused by a chronic medical condition,
eye trauma, or prescription drug.
Medical conditions such as diabetes, myotonic dystrophy, or Wilson's disease increase the risk for cataracts,
regardless of age. Slowly progressing cortical cataracts are common in diabetics. Diabetic patients or those
who take high doses of steroids are more at risk for sub capsular cataracts.
Certain drugs can stimulate cataract development. These include the following:
- Amiodarone (Cordarone®), heart medication
- Chlorpromazine (Largactil®), sedative
- Corticosteroids (e.g., prednisone), used to treat inflammation in many acute and chronic illnesses
- Lovastatin (Mevacor®), cholesterol-lowering drug
- Phenytoin (Dilantin®), antiseizure drug used to treat epilepsy
Fetal exposure to infection, radiation, steroids, alcohol, and other substances of abuse during pregnancy are risk
factors for congenital cataracts.
Smoking and alcohol abuse increase the risk for cataracts. Individuals who smoke 20 or more cigarettes a day have twice
the risk of nonsmokers for developing cataracts. Long-term alcohol abuse leads to vitamin deficiencies that may lead
to development of the condition.
Deficiencies in vitamins C and E, selenium, beta carotene, and lycopene may be linked to cataract development. These
antioxidants protect the body from free radicals that cause damage to cell walls and other cell structures, as well
as the genetic material within cells.
African Americans may be at higher risk for cataracts, possibly because of this group's higher risk for some chronic
conditions (e.g., diabetes) that increase the risk for cataracts.
Prolonged exposure to sunlight, specifically ultraviolet B (UVB), is a risk factor for cataracts. The longer the exposure,
the greater the risk. However, even a low level of exposure increases risk.
An eye injury may increase the risk for a cataract.
Eye disease (e.g., uveitis) or infection can lead to cataracts. A tumor can also cause changes that may lead to the development
of cataracts.
Signs and Symptoms
Symptoms depend on the cataract's location in the lens and the amount of clouding. Cataracts are painless and often progress slowly,
so many years may pass before a patient experiences symptoms. If only one eye develops a cataract, the patient may never experience
symptoms, as long as sight in the other eye remains stable.
Common symptoms of cataracts include:
- Blurry vision
- Colors appear faded
- Frequent changes in prescription eyeglasses or contacts
- Poor night vision
- Seeing a halo around lights
- Sensitivity to bright sunlight or headlight glare at night
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