‘CATARACTA’(LATIN)MEANING ‘WATERFALL’

• The human eye contains a

translucent lens inside it.
• This lens focuses the rays of
light entering the eye on to
the retina rather like rays of
sunshine being focused by a
magnifying glass.
• The retina converts this light
into neurological messages
that are then transmitted to
the brain by the optic nerve.
 Definition of catract
• defined as one where the transparency of
the lens has been reduced sufficiently to
disturb vision (Gregory and Talamo, 1996)
• Cataract: A cataract is a lens opacity or
cloudiness .(WHO)
• Cataract is a condition in which the normally
clear lens of the eye becomes cloudy and
clear change.
DEFINITION:

Cataract is caused by opacification and

degeneration of lens fibres already
formed, the formation of abberent lens
fibres or deposition of other materials in
their place.
If this ocular lens becomes cloudy or hazy it is
called a cataract. The light focused on the retina
is then no longer sharply focused, and the
patient's vision becomes blurred in this eye
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 CAUSES
• Advancing Age
• Radiation exposure
• Long term exposure to ultraviolet radiation
• Drugs
• Congenital (e.g. congenital cataract)
• Smoking Obesity Eye injuries UV
Malnutrition Family history. Metabolic
problems, such as diabetes. Aging (most
common). cataracts
• Autosomal dominant inheritance: manifests in the
heterozygous state In this male and female both
are affected. Mutation in one allele is enough to
express the disease. This is vertical transmission.
The offspring's have 50% chances to have the
disease.
• 19. 2. Autosomal recessive inheritance:
only manifest when mutant allele is
present in homozygosity. Individuals
heterozygous for such mutant alleles show
no features of the disorder and are
healthy, i.e. they are carriers.
• X-linked inheritance: When a gene for
particular disease/trait lies on the X
chromosome it is X-linked Males = XY
(X from mother, Y from father) Females
= XX (1 X from mother, 1 X from father)
X-linked genes are NEVER passed from
father to son In an affected family
affected females must have an affected
father Males are hemizygous for x-
linked traits Males are never carriers
• Locus Inheritance Candidate Genes
Cataract Type 1q22-30 AD Connexin 50
Pulverulent 2q33-35 AD γ-crystallin cluster
Pulverulent, nuclear 13q11-12 AD
Connexin 46 Nuclear pulverulent 17q AD
α-crystallin cluster Lamellar, zonular
nuclear 22q AD β-crystallin cluster
Caerulean, pulverulent 6p24 AR ?
Congenital Xp22.3-21.1 X ? Congenital
Gene locations and candidate genes
• currently about 45 genetic loci to which
cataracts have been mapped with specific
genes identified is 38, although the
number is constantly increasing. The
genes linked to cataract will be considered
under the following headings: a)Those
linked to the genes coding for connexin
proteins b)Those linked to the crystallins of
the lens c) Those linked to currently
unidentified genes
• Chromosome/Genes/Loci Cataract Type
Chromosome 19q13 Autosomal Recessive
Congenital Nuclear Cataracts Exon 11 of
HSF4 Autosomal Recessive Cataract
Chromosome 7q21.11-q31.1 Autosomal
Recessive Congenital Cataract FYCO1
Autosomal Recessive cataract EPHA2
Autosomal Recessive Congenital
Cataracts LCA5 Cataracts Chromosome
2p12 Autosomal Dominant Nuclear
ETIOLOGY:
•Eye injury / Physical Trauma
•Sun exposure
•Smoking
•Hypertension
•Kidney disorders
•Diabetes milletus
•Long term use of steroids
•Toxic substances
•Hereditary
PATHOGENESIS:
•DEGENERATION
•OPACIFICATION
•DEPOSITION OF OTHER MATERIAL
•ABNORMALITY OF LENS PROTEIN
•DISORGANISATION OF FIBRES
BLURRED VISION DUE TO SCATTERING
OF LIGHT ON THE RETINA
CLASSIFICATION :
BASED ON :
•MORPHOLOGY
•AGE OF ONSET
•MATURITY
•ETIOLOGY
MORPHOLOGIC:
1.CAPSULAR CATARACT
-ANTERIOR CAPSULAR CATARACT
-POSTERIOR CAPSULAR CATARACT
2.SUB CAPSULAR CATARACT
-ANTERIOR SUBCAPSULAR CATARACT
-POSTERIOR SUBCAPSULAR CATARACT
3.NUCLEAR CATARACT
4.CORTICAL CATARACT
5.LAMELLAR/ZONULAR CATARACT
6.SUTURAL CATARACT
-POSTERIOR SUBCAPSULAR CATARACT
-CORTICAL CATARACT
-NUCLEAR CATARACT
-MATURE CATARACT
AGE OF ONSET:
1.CONGENITAL
2.INFANTILE
3.JUVINILE
4.PRE-SENILE
5.SENILE
 SIGNS AND SYMPTOMS
• Blurry vision
• Glare from car headlights especially at night.
• Sunlight or indoor overhead lighting may seem
to be seem too bright or cause glare.
• Bright colors may appear dulled.
• Sometime cataracts can cause double vision,
• Frequently changing contact or eyeglasses
prescriptions.
 TYPES OF CATARACT
• CLASSIFIED BY LOCATION OF
OPACITY WITHIN LENS STRUCTURE
• Nuclear
• Posterior cortical cataract
• Posterior polar cataract (importance lies in
higher risk of complication - posterior
capsular tears during surgery)
• Posterior subcapsular cataract
• Anterior cortical cataract
INFANTILE AND JUVINILE CATARACT
MATURITY:
1.INTUMESCENT CATARACT
2.IMMATURE CATARCT
3.MATURE CATARACT
4.HYPERMATURE CATARACT
5.MORGAGNIAN CATARCT
MATURE AND IMMATURE CATARACT
IMMATURE CATARACT
ETIOLOGIC:
1.TRAUMATIC CATARACT
2.METABOLIC CATARACT
3.TOXIC CATARACT
4.COMPLICATED CATARACT
5.INTRA UTERINE CATARACT
6.HERIDITARY CATARACT
7.RADIATIONAL CATARACT
8.ELECTRIC CATARACT
9.CATARACT ASSOSCIATED WITH
SKIN DISEASES-ICHTHYOSIS,ATOPIC
DERMATITIS
10.CATARACT ASSOSCIATED WITH
OSSEOUS DISEASES-PARATHYROID
TETANY
11.CATARACT WITH MISCELLANEOUS
DISEASES-DYSTROPHIA
MYOTONICA,ALPORTS
SYNDROME,DOWNS SYNDROME
AFTER CATARACT
SUBJECTIVE
CLASSIFICATION:
• GRADE 0: CLEAR LENS
• GRADE 1: SWOLLEN FIBRES AND SUB
CAPSULAR OPACITIES
• GRADE 2: NUCLEAR CATARACT AND
VISIBLE LENS FIBRES
• GRADE 3: STRONG NUCLEAR CATARACT
WITH PERINUCLEAR AREA OPACITY
• GRADE 4: TOTAL OPACITY
Top Left Top Right
This is a posterior subcapsular cataract. Such Cortical cataract as seen against the reflection
cataracts often cause difficulty in reading, and a of the retina. This is a very common type of
disabling glare in bright light. cataract causing glare and blurring of vision.
Bottom Left
Nuclear cataract is another common type. This Bottom Right
is an opacity in the central nucleus of the lens A mature cataract. These are now rare in
which tends to cause refractive changes and developed countries.
blurring of vision.
• Clinical features:
– Symptoms: glare and decreased visual acuity
especially during bright sunlight, but see well in dim
illumination.
– Signs: granular opacities in the posterior pole of
cortex adjacent to the posterior capsule.
• May be age-related or occur as a complication
of other conditions such as intraocular
inflammation (e.g. chronic uveitis), steroid
administration, vitreoretinal surgery and trauma.
• May also be related to irradiation and systemic
conditions such as diabetes mellitus.
SUBJECTIVE CLASSIFICATION
• No-stitch/small incision surgery are
techniques used to restore vision loss due
to cataracts.
• The cloudy lens is removed and replaced
with a plastic lens (IOL) implant.
• Ultrasound technology
(phacoemulsification) is often used to
remove the cataract.
• A special lens can then be implanted
through a smaller incision than is required
in traditional cataract surgery.
Phacoemulsification
INSERTION OF INTRAOCULAR LENS
What are the Advantages of this
procedure?
• Faster recovery of good vision
• Faster return to normal activities
• Good vision in a matter of days instead of
weeks or even months
• Return home within hours of the procedure
• No need for an overnight hospital stay
• Reduces the chance of surgically induced
astigmatism or ruptured sutures
 PREVENTION
• controlling diseases that increase the risk
of a cataract, and avoiding exposure to
factors known to promote cataract
formation.
• Wearing sunglasses when you are outside
during the day can reduce the amount of
UV light your eyes are exposed to.
• Some sunglasses do not filter out the
harmful UV. An optician should be able to
tell you which sunglasses filter out the
 Nursing Assessment
• The nurse should assess:
• Recent medication intake. It is a common practice to withhold any anticoagulant therapy to
reduce the risk of retrobulbar hemorrhage.
• Preoperative tests. The standard battery of preoperative tests such as complete blood count,
electrocardiogram, and urinalysis are prescribed only if they are indicated by the patient’s medical
history.
• Vital signs. Stable vital signs are needed before the patient is subjected to surgery.
• Visual acuity test results. Test results from Snellen’s and other visual acuity tests are assessed.
• Patient’s medical history. The nurse assesses the patient’s medical history to determine the
preoperative tests to be required.
•
• ased on assessment data, the nursing diagnoses for the patient
include:
• Disturbed visual sensory perception related to altered sensory
reception or status pf sense organs.
• Risk for trauma related to poor vision and reduces hand-eye
coordination.
• Anxiety related to threat of permanent loss of vision/independence.
• Deficient knowledge regarding ways of coping with altered abilities
related to lack of exposure or recall, misinterpretation, or cognitive
.
limitations
• Activities. Activities to be avoided are instructed by the nurse.
• Protective eye patch. To prevent accidental rubbing or poking of the eye, the patient
wears a protective eye patch for 24 hours after surgery, followed by eyeglasses worn
during the day and a metal shield worn at night for 1 to 4 weeks.
• Expected side effects. Slight morning discharge, sone redness, and a scratchy
feeling may be expected for a few days, and a clean, damp washcloth may be used
to remove slight morning eye discharge.
• Notify the physician. Because cataract surgery increases the risk of retinal
detachment, the patient must know to notify the surgeon if new floaters in vision,
flashing lights, decrease in vision, pain, or increase in redness occurs.
• ndividual findings, noting specific deficit and associated symptoms, perceptions of client/SOs.
• Assistive devices needs.
• Use of safety equipment or procedures.
• Environmental concerns, safety issues.
• Level of anxiety and precipitating/aggravating factors.
• Description of feelings.
• Awareness and ability to recognize and express feelings.
• Plan of care.
• Teaching plan.
• Client involvement and response to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes.
• Modifications to plan of care.
• Long term needs.