The Importance of Nutrition

A cataract is a cloudy or opaque area in the normally clear lens of the eye. Depending upon its size and location, it can interfere with normal vision. Most cataracts develop in people over age 55, but they occasionally occur in infants and young children. Usually cataracts develop in both eyes, but one may be worse than the other.

The lens is located inside the eye behind the iris, the colored part of the eye. The lens focuses light on the back of the eye, the retina. The lens is made of mostly proteins and water. Clouding of the lens occurs due to changes in the proteins and lens fibers.

The lens is composed of layers like an onion. The outermost is the capsule. The layer inside the capsule is the cortex, and the innermost layer is the nucleus. A cataract may develop in any of these areas and is described based on its location in the lens:

• A nuclear cataract is located in the center of the lens. The nucleus tends to darken changing from clear to yellow and sometimes brown.
• A cortical cataract affects the layer of the lens surrounding the nucleus. It is identified by its unique wedge or spoke appearance.
• A posterior capsular cataract is found in the back outer layer of the lens. This type often develops more rapidly.

Types of Cataracts
Nuclear Cataract	Cortical Cataract	Posterior Capsular Cataract
Images courtesy of Eyemaginations™

Normally, the lens focuses light on the retina, which sends the image through the optic nerve to the brain. However, if the lens is clouded by a cataract, light is scattered so the lens can no longer focus it properly, causing vision problems.
Cataracts generally form very slowly. Signs and symptoms of a cataract may include:

• Blurred, hazy, or vision
• Reduced intensity of colors
• Increased sensitivity to glare from lights, particularly when driving at night
• Increased difficulty seeing at night
• Change in the eye’s refractive error

While the process of cataract formation is becoming more clearly understood, there is no clinically established treatment to prevent or slow their progression. In age-related cataracts, changes in vision can be very gradual. Some people may not initially recognize the visual changes. However, as cataracts worsen vision symptoms tend to increase in severity.

What causes a cataract?

Most cataracts are due to age-related changes in the lens. However, other factors can contribute to their development including:

• Diabetes mellitus - Persons with diabetes are at higher risk for cataracts.
• Drugs - Certain medications have been found to be associated with the development of a cataract. These include:
• Ultraviolet radiation - Studies have shown that there is an increased chance of cataract formation with unprotected exposure to ultraviolet (UV) radiation.
• Smoking - An association between smoking and increased nuclear opacities has been reported.
• Alcohol - Several studies have shown increased cataract formation in patients with higher alcohol consumption compared with people who have lower or no alcohol consumption.
• Nutritional deficiency - Although the results are inconclusive, studies have suggested an association between cataract formation and low levels of antioxidants (e.g. vitamin C, vitamin E, carotenoids). Further studies may show that antioxidants have a significant effect on decreasing cataract development.

Rarely, cataracts can be present at birth or develop shortly after. They may be inherited or develop due to an infection, i.e. rubella, in the mother during pregnancy. A cataract may also develop following an injury to the eye or surgery for another eye problem, such as glaucoma.

While there are no clinically proven approaches to preventing cataracts, simple preventive strategies include reducing exposure to sunlight through UV blocking lenses, decreasing or discontinuing smoking and increasing antioxidant vitamin intake through consumption of leafy green vegetables and nutritional supplements.

How is a cataract diagnosed?

Cataracts can be diagnosed through a comprehensive eye examination. This examination may include:

• Patient history to determine vision difficulties experienced by the patient that may limit their daily activities and other general health concerns affecting vision.
• Visual acuity measurement to determine to what extent a cataract may be limiting clear vision at distance and near.
• Refraction to determine the need for changes in an eyeglass or contact lens prescription.
• Evaluation of the lens under high magnification and illumination to determine the extent and location of any cataracts.
• Evaluation of the retina of the eye through a dilated pupil.
• Measurement of pressure within the eye.
• Supplemental testing for color vision and glare sensitivity.

Additional testing may be needed to determine the extent of impairment to vision caused by a cataract and to evaluate whether other eye diseases may limit vision following cataract surgery.
Using the information obtained from these tests, your optometrist can determine if you have cataracts and advise you on options for treatment.

How is cataract treated?

The treatment of cataracts is based on the level of visual impairment they cause.

If a cataract affects vision only minimally, or not at all, no treatment may be needed. Patients may be advised to monitor for increased visual symptoms and follow a regular check-up schedule.
In some cases, a change in eyeglass prescription may provide temporary improvement in visual acuity. Increasing the amount of light used when reading may be beneficial. The use of anti-glare coatings on clear lenses can help reduce glare for night driving.

When a cataract progresses to the point that it affects a person’s ability to do normal everyday tasks, surgery may be needed. Cataract surgery involves removing the lens of the eye and replacing it with an artificial lens. The artificial lens requires no care and can significantly improve vision. New artificial lens options include those that simulate the natural focusing ability of a young healthy lens.

Two approaches to cataract surgery are generally used:

• Small incision cataract surgery involves making an incision in the side of the cornea, the clear outer covering of the eye, and inserting a tiny probe into the eye. The probe emits ultrasound waves that soften and break-up the lens so it can be removed by suction. This process is called phacoemulsification.
• Extracapsular surgery requires a somewhat larger incision in the cornea and the lens core is removed in one piece.

Once the natural lens has been removed, it is replaced by a clear plastic lens called an intraocular lens (IOL). For situations where implanting an IOL is not possible because of other eye problems, contact lenses and in some cases eyeglasses may be an option to provide needed vision correction.

As with any surgery, cataract surgery has risks from infection and bleeding. Cataract surgery also slightly increases the risk of retinal detachment. It is important to discuss the benefits and risks of cataract surgery with your eye care providers. Other ocular conditions may increase the need for cataract surgery or prevent a person from being a cataract surgery candidate.
Cataract surgery is one of the safest and most effective types of surgery performed in the United States today. Approximately 90 percent of cataract surgery patients report better vision following the surgery.

Diabetic retinopathy is a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye. It is a serious sight-threatening complication of diabetes.

Diabetes is a disease that interferes with the body’s ability to use and store sugar, which can cause many health problems. Too much sugar in the blood can cause damage throughout the body, including the eyes. Over time, diabetes affects the circulatory system of the retina.

Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal tissue and clouding of vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.

Symptoms of diabetic retinopathy include:

• Seeing spots or floaters in your field of vision
• Blurred vision
• Having a dark or empty spot in the center of your vision
• Difficulty seeing well at night

In patients with diabetes, prolonged periods of high blood sugar can lead to the accumulation of fluid in the lens inside the eye that controls eye focusing. This changes the curvature of the lens and results in the development of symptoms of blurred vision. The blurring of distance vision as a result of lens swelling will subside once the blood sugar levels are brought under control. Better control of blood sugar levels in patients with diabetes also slows the onset and progression of diabetic retinopathy.

Often there are no visual symptoms in the early stages of diabetic retinopathy. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

Treatment of diabetic retinopathy varies depending on the extent of the disease. It may require laser surgery to seal leaking blood vessels or to discourage new leaky blood vessels from forming. Injections of medications into the eye may be needed to decrease inflammation or stop the formation of new blood vessels. In more advanced cases, a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous, may be needed. A retinal detachment, defined as a separation of the light-receiving lining in the back of the eye, resulting from diabetic retinopathy, may also require surgical repair.

If you are a diabetic, you can help prevent or slow the development of diabetic retinopathy by taking your prescribed medication, sticking to your diet, exercising regularly, controlling high blood pressure and avoiding alcohol and smoking.

What causes diabetic retinopathy?

Non-proliferative diabetic retinopathy (NPDR) is the early state of the disease in which symptoms will be mild or non-existent. In NPDR, the blood vessels in the retina are weakened causing tiny bulges called microanuerysms to protrude from their walls.

Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease. At this stage, new fragile blood vessels can begin to grow in the retina and into the vitreous, the gel-like fluid that fills the back of the eye. The new blood vessel may leak blood into the vitreous, clouding vision. Images courtesy of Eyemaginations, Inc.

Diabetic retinopathy is the result of damage caused by diabetes to the small blood vessels located in the retina. Blood vessels damaged from diabetic retinopathy can cause vision loss:

• Fluid can leak into the macula, the area of the retina which is responsible for clear central vision. Although small, the macula is the part of the retina that allows us to see colors and fine detail. The fluid causes the macula to swell, resulting in blurred vision.
• In an attempt to improve blood circulation in the retina, new blood vessels may form on its surface. These fragile, abnormal blood vessels can leak blood into the back of the eye and block vision.

Diabetic retinopathy is classified into two types:

1. Non-proliferative diabetic retinopathy (NPDR) is the early state of the disease in which symptoms will be mild or non-existent. In NPDR, the blood vessels in the retina are weakened causing tiny bulges called microanuerysms to protrude from their walls. The microanuerysms may leak fluid into the retina, which may lead to swelling of the macula.
2. Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease. At this stage, circulation problems cause the retina to become oxygen deprived. As a result new fragile blood vessels can begin to grow in the retina and into the vitreous, the gel-like fluid that fills the back of the eye. The new blood vessel may leak blood into the vitreous, clouding vision. Other complications of PDR include detachment of the retina due to scar tissue formation and the development of glaucoma. Glaucoma is an eye disease defined as progressive damage to the optic nerve. In cases of proliferative diabetic retinopathy, the cause of this nerve damage is due to extremely high pressure in the eye. If left untreated, proliferative diabetic retinopathy can cause severe vision loss and even blindness.

Risk factors for diabetic retinopathy include:

• Diabetes — people with Type 1 or Type 2 diabetes are at risk for the development of diabetic retinopathy. The longer a person has diabetes, the more likely they are to develop diabetic retinopathy, particularly if the diabetes is poorly controlled.
• Race — Hispanic and African Americans are at greater risk for developing diabetic retinopathy.
• Medical conditions — persons with other medical conditions such as high blood pressure and high cholesterol are at greater risk.
• Pregnancy — pregnant women face a higher risk for developing diabetes and diabetic retinopathy. If gestational diabetes develops, the patient is at much higher risk of developing diabetes as they age.

How is diabetic retinopathy diagnosed?

Diabetic retinopathy can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on evaluation of the retina and macula, may include:

• Patient history to determine vision difficulties experienced by the patient, presence of diabetes, and other general health concerns that may be affecting vision
• Visual acuity measurements to determine the extent to which central vision has been affected
• Refraction to determine the need for changes in an eyeglass prescription
• Evaluation of the ocular structures, including the evaluation of the retina through a dilated pupil
• Measurement of the pressure within the eye

Supplemental testing may include:

• Retinal photography or tomography to document current status of the retina
• Fluorescein angiography to evaluate abnormal blood vessel growth

How is diabetic retinopathy treated?

reatment for diabetic retinopathy depends on the stage of the disease and is directed at trying to slow or stop the progression of the disease.

In the early stages of Non-proliferative Diabetic Retinopathy, treatment other than regular monitoring may not be required. Following your doctor’s advice for diet and exercise and keeping blood sugar levels well-controlled can help control the progression of the disease.

If the disease advances, leakage of fluid from blood vessels can lead to macular edema. Laser treatment (photocoagulation) is used to stop the leakage of blood and fluid into the retina. A laser beam of light can be used to create small burns in areas of the retina with abnormal blood vessels to try to seal the leaks.

When blood vessel growth is more widespread throughout the retina, as in proliferative diabetic retinopathy, a pattern of scattered laser burns is created across the retina. This causes abnormal blood vessels to shrink and disappear. With this procedure, some side vision may be lost in order to safeguard central vision.

Some bleeding into the vitreous gel may clear up on its own. However, if significant amounts of blood leak into the vitreous fluid in the eye, it will cloud vision and can prevent laser photocoagulation from being used. A surgical procedure called a vitrectomy may be used to remove the blood-filled vitreous and replace it with a clearfluid to maintain the normal shape and health of the eye.

Persons with diabetic retinopathy can suffer significant vision loss. Special low vision devices such as telescopic and microscopic lenses, hand and stand magnifiers, and video magnification systems can be prescribed to make the most of remaining vision.