Cataract Surgery

Excerpt

Cataracts are the world’s leading cause of remediable blindness. While some cataracts, may be congenital, secondary to trauma, or drug-induced, most cataracts are age-related. Age-related cataracts are due to the opacification of the lens. The crystalline lens is a biconvex structure that focuses light on the retina. It is transparent with a diameter of 10 mm and an axial length of around 4 mm. The lens consists of fibers that are derived from lens epithelium, a thin surrounding capsule, and zonular fibers that allow for accommodation in conjunction with the ciliary body. With age, the lens stiffens, leading to farsightedness known as presbyopia. While one of the main functions of the lens is to focus light, it is not a passive optical element. In order to maintain transparency, the lens has a microcirculation pathway driven by sodium channels that deliver nutrients to deeper fibers through extracellular inward flow. Intracellular outward flow is maintained through gap junctions and is used to remove waste. The lens also serves as a UV filter that protects the retina. Finally, the lens acts as an oxygen sink with some of the highest concentrations of the antioxidant glutathione (GSH) in the body. Glutathione scavenges reactive oxygen species, is a co-factor for repair enzymes, and is thought to be released into the aqueous humor to be used by the avascular tissues such as the cornea and trabecular network. With age, oxidative damage can accumulate, causing an opacification of the lens.

Regardless of the etiology, the treatment is cataract surgery when the visual function is affected. Cataract has secondary complications such as glaucoma and uveitis when it is allowed to progress on its natural course. With newer and well-developed techniques, cataract surgery is one of the most successful clinical managements in medicine with direct improvements in visual acuity as well as large improvements in activities of daily living and decreased mortality. While as many as 95% of patients will have improved visual acuity, cataract surgery does have complications. The most common include posterior capsule opacification and cystoid macular edema. Rare but serious complications include endophthalmitis and retinal detachment.

Cataracts are one of the most common ophthalmic pathologies characterized by the opacification of the lens. In 2013, the United States had more than 22 million people who had cataracts. In 2020, that number is expected to reach 30.1 million. Incidence increases with age; 43-year-old to 54-year-old patients have an incidence of 8.3%, while patients over 75 have an incidence as high as 70.5%. Women are slightly more affected, with an average incidence of 26% and men 22.6%. In 2015, 3.7 million cataract surgeries were performed in the United States with data suggesting that the incidence of cataract surgery will continue to increase.