- What is Cataract
A cataract is an opacification of the eye’s natural lens that prevents the light rays from reaching the retina, leading to visual impairment. The lens becomes less flexible, less transparent, and thicker causing loss of vision1. Proteins and fibers within the lens build up, break down, and clump together, clouding the lenses,2. Cataracts are the leading cause of blindness in the world3.
- Types of Cataracts, if there are any
Nuclear sclerosis cataract: involves the “nuclear” part of the lens. This eventually becomes hard or sclerotic and can progress slowly over many years before it begins to affect the vision.
Cortical cataract: involves the lens cortex (the outer layer). Fluid-filled cavities between lens fibers are seen as white spikes extending from the edge of the lens toward the center. It only creates symptoms if the visual axis is involved.
Posterior subcapsular cataract: involves the back of the lens which is adjacent to the capsule in which the lens sits. Opacities are seen in the posterior central portion of the lens and can cause a significant reduction in vision due to the central position occupying the visual axis2.
- Symptoms of Cataract
Cataracts can cause clouded and blurred vision. During the very early stages of cataract development, many notice that they become increasingly sensitive to bright light and glare and see “halos” around lights, especially when driving at night. Later, frequent changes in prescription glasses, and the risk of progressive myopia, monocular diplopia, and fading or yellowing of colors may apper2.
- Causes of Cataract
Senile cataract: The most common factor that increases the risk of cataracts is aging. Congenital cataract: Some are born with cataracts or develop it during childhood. It is usually genetic, or due to serious complications during pregnancy, or illness during childhood.
Traumatic cataract: Blunt force or penetration of the lenses causes damage to the fibers and cataracts can develop within a few days.
Complicated and Consecutive cataract: Cataract secondary to other pathological conditions of the eye, mainly intraocular inflammatory conditions. Cataract due to other diseases outside the eye, e.g. diabetes mellitus and downs syndrome. Cataracts due to previous eye surgery, prolonged use of corticosteroid medications, smoking, ultraviolet light, and radiation treatment1.
- Traditional treatment
Cataract surgery is the only way to treat and remove cataracts and correct the visual impairment associated with cataracts. In cataract surgery, the opaque nucleus of the lens is removed and, in most cases, replaced with an artificial intraocular lens (IOL). Cataract surgery is quick and painless and in most cases an outpatient procedure that does not require general anesthesia. Some patients see well a few days after cataract surgery, but full recovery and stabilization of vision can take a couple of months1, and may require additional correcting glasses for optimal result, as surgery with IOL insertion typically allows good vision at only one distance, and so reading glasses are often required.
- The person who has Cataract can also be affected with other diseases that we are treating in the project, and if yes, which ones and why
Glaucoma: The thickness of the lens increases throughout life. This pushes the iris forward and the anterior chamber flattens. This predisposes to acute angular-closure glaucoma in particularly farsighted people who have short eyes and thereby already a narrow anterior chamber4.
Presbyopia: Almost everyone (with a natural lens) experiences some degree of presbyopia after the age of 40, as a natural part of aging. As a result, a person >40 years who have cataracts is likely to also have some degree of presbyopia5.
- Is it caused by ageing
Yes, most cases of cataracts are related to the aging process. Occasionally children can be born with the condition, or develop after eye injuries, inflammation, and some other eye diseases1.
- How does this disease influence our working life
People with cataracts have decreasing or blurriness of vision, which can make it difficult to see presentations, view the computer screen, and operate heavy machinery. Change in color perception can also occur with cataracts, which makes some professions – in which a flawless color vision is essential – difficult to perform (e.g. armed service such as military and police work), civil aviation, railways, sailing industry, fire service officers, laboratory and pharmacists)6. Vision impairment also increases the risk factors of social withdrawal and depression, absenteeism, early retirement. and occupational injuries. It increases the risk of falls, and fear of falling can lead to general uncertainty, dependency, feeling unsafe, reduced social participation, and difficulties carrying out daily activities such as working life7.
- Can Cataract be resolved with the surgery
Yes, see “5. Traditional treatment”.
- The Covid 19 influenced treatments and scheduled appointments
COVID-19 has caused significant changes in ophthalmic practice. At the beginning of the pandemic, most ophthalmologists restricted their practice to visiting only urgent cases. On March 11th 2020, American Academy of Ophthalmology (AAO) recommended ophthalmologists to stop all routine activities and restrict their treatment only to urgent and emergent cases8. Later AAO recommended that clinical activities could be performed with continued caution in compliance with local regulations.
The known cases of COVID-19 should be quarantined at home and defer their ophthalmologic examination. In the case of urgent patients, strict precautions should be considered to take them directly to the examining room without any contact with others. Cataracts that interfere with the ability of patients to drive, work or see their medications or cataracts which cause an increased risk of falling down or annoying anisometropia is considered semi-urgent and could be performed within days to weeks according to AAO recommendations. Non-acute operations may have been delayed during certain periods due to Covid-19 9. With the new mutations again putting the health care system under pressure, elective cataract surgeries are again being postponed in many facilities.
- How important is the image analysis in this disease
As the lens becomes opaque, it can be difficult to take images through the lens. Furthermore, image analysis is intended for the retina, why it will only be relevant if the cataract is accompanied by other conditions that affect the retina.
- What are the benefits for the patient and why do we propose the See Far glasses to be used?
People with cataracts present blurred vision, glare, and color vision changes. The See Far smart glasses, adapts to the needs of users and optimize their vision through the use of a personalized visual assistant that captures the condition of the eye, detect the problem, and provides the appropriate adjustment through the integration of reality technologies. The See Far smart glasses can increase the contrast of texts and images, filter light to improve color vision, increase the lighting of specific areas, and magnify texts and images. Augmented reality technology can also be used for recognition of warning of obstacles or dangers during walking around.
Through the notifications offered by the See Far mobile application, the user will receive specific reminders about the most appropriate diet for the specific pathology, as well as recommendations for healthy living. The See Far smart glasses are aimed at workers with visual impairments due to impairments associated with aging such as cataracts. It will allow the user to remain active in their professional and personal life, to remain independent, active, and healthy.
Sources
1: The International Agency for the Prevention of Blindness https://www.iapb.org/learn/knowledge-hub/eye-conditions/cataract/
2: Mayo Clinic, “Cataracts”, https://www.mayoclinic.org/diseases-conditions/cataracts/symptoms-causes/syc-20353790
3: Light for the world, “Common cause of vision impairment and eye diseases”, https://www.light-for-the-world.org/our-work/eye-sight/saving-eyesight/
4: WebMD, https://www.webmd.com/eye-health/acute-angle-closure-glaucoma
5: The International Agency for the Prevention of Blindness, “Position Paper on Presbyopia”, https://www.iapb.org/learn/resources/position-paper-on-presbyopia/
6: Colour vision in the workplace, “Employees with colour vision impairment” Infographic, https://www.theiet.org/media/5145/colour-vision-in-the-workplace.pdf
7: NCBI, “Sensory impairments in community health care: a descriptive study of hearing and vision among ederly Norwegians living at home” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045259/
8: American Academy of Ophthalmology, “Recommendations for urgent and nonurgent patient care”, https://www.aao.org/headline/new-recommendations-urgent-nonurgent-patient-care
9: IJO, “Ophthalmic practice during COVID-19 pandemic”, http://ies.ijo.cn/gjyken/ch/reader/view_abstract.aspx?file_no=20210501&flag=1
Author Marie Heilskov / Partner AUH
