Health Watch

Save your eyes! :

Cataract-causes and treatment

Nipuni WIMALAPALA

The main cause for 48 percent of loss of vision is due to cataract according to the recent research data of World Health Organization. In an interview with the Daily News Health watch Dr. Madhuwanthi Dissanayake, Consultant Eye Surgeon and Senior Lecturer, Faculty of Medicine, Colombo explains what causes cataract, its symptoms and methods of treatment.

As Dr. Dissanayake mentioned, the human lens is a naturally clear structure located behind the iris and is supported by the zonules. The lens does not have blood vessels or nerves. The basic lens consists of a central nucleus surrounded by the cortex contained within the lens capsule. When light passes through the pupil it is focused by the lens to produce clear sharp images on the retina, the light sensitive membrane of the back of the eye which functions like the film of a camera. When this arrangement is disturbed in any way, the clear vision is lost. As a result of scattering of light, blurring of the image will occur. This is what happens in cataract.

“The human lens is made mostly of water and protein fibers which are arranged in a precise manner to make the lens clear and allow light to pass through without interference. With ageing the composition of lens undergoes changes and the structure of the protein fibers breaks which results in creating clouding areas of the lens and leading to the loss of transparency. This loss of transparency or opacity formation is called a cataract Dr. Dissanayake explained further.

According to Dr. Dissanayake, Cataract creates gradual, painless and progressive loss of vision which takes place slowly. Patients are not aware of it at the beginning since there is no pain, abnormal tearing or any visible symptom. But as the cataract develops gradually the final out come is loss of vision. In the early stages gradual loss of vision can be seen. Vision becomes misty and blurred. It commonly affects distance vision and also causes problems with glare. In early stages stronger light and eyeglasses can help to deal with the vision problem temporarily. Patients face difficulties when reading and driving. They describe it as looking through a fogged-up window.

The main symptoms are;

* Blurred vision.
* Increasing difficulty with vision at night.
* Glare, especially at night.
* Halos around lights.
* Need of brighter light when reading.
* Double vision in a single eye.
* Fading or yellowing of colours.

Pain, redness and discharge are not the symptoms of cataract, but when it is in the late stage these symptoms also can occur.

There are 3 main types of cataracts according to the site of the opacity.

Subcapsular Cataract

This starts as a small opaque area just under the capsular shell, usually at the back of the lens, right in the path of light on its way to the retina. This type of cataract may occur in both eyes but can rather develop in one eye earlier than in the other. This often interferes in reading vision, reduces vision in bright light and causes glare or halos around lights in the night.

Cortical Cataract

This begins as whitish, wedge-shaped streaks on the outer edge of the lens cortex. As it slowly progresses the streaks extend to the centre and interfere with light passing through the nucleus. Both near vision and distance vision can be impaired. Patients have problems with glare and loss of contrast.

Nuclear Cataract

Nuclear cataract occurs in the centre of the lens. In its early stages the patient become more near sighted or even experience a temporary improvement in reading vision. This so-called “second sight” will disappear as the lens gradually turns yellow and begins to cloud the vision. Seeing in dim light and driving at night may be especially troublesome.

“According to the density of the cataract the classification goes as early, moderate, mature and hypermature cataract. The danger of a late stage cataract is can cause severe eye pain, redness (inflammation) and headache. This is a relatively rare but an extremely painful situation and needs surgical removal of the lens. When you consider the age of onset of cataract, the congenital cataracts are extremely important which is responsible for most of child patients who suffer from cataract. This type basically has a family history of cataract or is genetic. Infections like Rubella and toxoplasmosis are other causes. When it comes to infants suffering from cataract, surgery must be done as soon as possible. Otherwise after the maturation period of the brain -eye development is over, it is really difficult to recover the vision perfectly”, said Dr. Dissanayake.

Main cause

As she stated, the main cause for cataract is ageing. And also there are some other reasons such as usage of drugs (eg. Steroids) or medicines for a long time without being properly monitored by a doctor. Suffering from diabetes also causes cataract. Exposure to sunlight, cigarette smoking, trauma (blunt or penetrating), family history of cataract, corticosteroid therapy, radiation exposure, electrical injury, myotonic dystrophy and uveitis ocular inflammation may also cause cataract.

Dr. Dissanayake stressed that the definitive solution or the treatment for cataract is surgery. Cataract surgery should be considered when changes in eye glasses help no longer, quality of life is jeopardized and cataract removal is likely to have an impact on vision. No medication can heal cataract, but can control the associated factors. The main outcome of surgery is improvement of vision.

During the post operative period, the patient must take good care of the eye. Patients should avoid dusty, crowded places and trauma and should use the medications in the prescribed manner. If there is any pain or redness of the eye, the patient should immediately contact the surgeon and take advice.

Hemorrhoids and modern dietary patterns

H M P S Herath,

Department of Applied Nutrition, Wayamba University of Sri Lanka.

Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. The rectum is the last part of the large intestine leading to the anus. The anus is the opening at the end of the digestive tract where bowel contents leave the body. There are two types of hemorrhoids, called as internal and external. Internal hemorrhoids develop in the lower rectum and they may protrude through the anus. Most protruded hemorrhoids shrink back inside the rectum their own. External hemorrhoids are located under the skin around the anus.

Identification

The most common symptom of internal hemorrhoids is bright red blood or stool, after a bowel movement. Internal hemorrhoids that are not protruded are usually not painful. Protruded hemorrhoids often cause pain, discomfort and anal itching. Blood clots may form in external hemorrhoids. A blood clot in a vein is called a thrombosis.

Thrombosed external hemorrhoids cause bleeding, painful swelling around the anus. When the blood clot dissolves, extra skin is left behind.

This skin can become irritated. Excessive straining, rubbing or cleaning around the anus may make symptoms.

Hemorrhoids are not dangerous or life threatening. Symptoms usually go away within a few days. But, hemorrhoids are painful and irritated. Therefore it can be a problem for the day to day activities of the people.

Causes of hemorrhoids

Swelling in the anal or rectal veins causes hemorrhoids. Several factors may cause this swelling.

1) Chronic constipation
2) Straining during bowel movement
3) Sitting on toilet for long periods of time
4) Lack of fiber in the diet
5) Ageing & pregnancy

Constipation

Difficult defecation with straining and hard or infrequent stools are symptoms most often associated with constipation. Other symptoms sometimes associated with constipation include, no urge to have bowel movements, a sense of incomplete evacuation, anal and perennial pain, soiling of cloths and discomfort.

Intestinal transit rate is the main factor that affects the constipation. Slower intestinal transit rates responsible for increased likelihood of constipation.

Other physiological factors that may contribute to constipation are failure of relaxation of the anal sphincter, diminished rectal sensation and disease such as hyperthyroidism, diabetes mellitus, Parkinson’s disease, multiple sclerosis and spinal cord injuries.

Behavioural factors

Some behavioural factors may affect the hemorrhoids. Excessive straining during the bowel movements and sitting on toilet for long period of time will increase the pressure in the abdomen it will cause hemorrhoids.

Aging and pregnancy

Weakening of the connective tissue in the rectum and anus occurs with age and it may lead to the increased hemorrhoids during elderly ages.

Pregnancy can cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus.

For most women, hemorrhoids caused by pregnancy, disappear after child birth.

To be continued

To avoid diabetes

At present main killer disease in Sri Lanka next to heart ailments is diabetes. Regrettably people do n ot realize the danger. This is not a rich man’s disease but even estate people are also suffering from diabetics. Diabetes is a life time disease which cannot be cured but could be controlled. The following are the cause of diabetes.

1. Hereditary
2. Obesity
3. Lack of exercise - rest both body and mind etc.
4. Mental Depression
5. Intake of too much of salt
6. Intake of strong drugs - side effects

The following suggestions are made
1. Consult your doctor and have a proper diet programme
2. Lead a balanced life - Exercise, rest, sleep etc.
3. Eat regularly
4. Please do not fast if you have diabetic
5. Check your body weight regularly
6. Take suggested drugs regularly under medical supervision - Please do not select drugs from advertisement
7. Avoid salty, sweet and starchy foods.
8. There are items called sugar free food, but it may cause side effects
9. Intake of boiled vegetable, fish acceptable.

Diabetes could be controlled by flowing medication

1. Injection
2. Tables

Please ensure that these are taken under the supervision of a doctor. It is always better to go for a medical checkup every 6 months.

S R Balachandran
B.Sc., FCA, FCMA (Sri Lanka)
Council Member - The National Chamber of Commerce of Sri Lanka