Cataract blindness | The Fred Hollows Foundation NZ

Cataract blindness

Tekatoa was an I-Kiribati patient with dense cataracts in both eyes.

Tekatoa was an I-Kiribati patient with dense cataracts in both eyes.

Cataract is the leading cause of blindness in the world. While easily treated with surgery, most people affected by cataracts live in developing countries where eye health services are difficult to access, costly or are simply not available.

What are cataracts?

This patient had lost vision in her right eye due to cataract, Fiji. Photo: Sandy ScheltemaCataract blindness occurs when the natural lens of the eye becomes hard and cloudy; this interferes with the passage of light to the retina causing a gradual loss of vision and ultimately, blindness.

The effect on vision is like looking at a mirror in a bathroom that has become fogged up with steam. Early signs of cataracts are when your vision becomes blurry and it is hard to see. Colours become faded and seeing at night is increasingly hard, as well as when there is bright light or sunshine.

Often people are unable to continue on with their domestic duties or paid work as their vision worsens.

Advanced cataracts cause full blindness and the person often becomes dependent on others to go about their daily tasks.

Who does cataract affect?

Cataracts often cause vision loss and blindness among people 45 years and older, as the lens naturally hardens with age.

Almost everyone over the age of 60 years is affected by cataracts to some degree. Cataracts affect all genders and ethnicities, but lack of access to surgical services makes the effect of cataract more severe in developing nations. Awareness that it is a treatable problem is also lower.

There is a saying in the Pacific that “When your hair goes white, your eyes go white.”

Cataracts can also affect those who have experienced an eye injury, have diabetes, smoke, take steroids or who are constantly exposed to the sun’s harmful UV rays.

Children may be born with cataracts, of develop them in early life, especially if they have poor nutrition and health.

What is the magnitude of the problem?

On a global scale, cataracts are the leading cause of blindness.

Of the 39 million people who are blind worldwide, approximately 51% suffer from cataract blindness. In the Pacific region, cataracts account for over 70% of blindness.

Can cataract be prevented?

Cataracts are generally unable to be prevented.

However, some of the risk factors that can increase the chances of getting cataracts can be decreased by not smoking, preventing diabetes, avoiding eye trauma, and maintaining good nutrition.

It may also be useful to wear sunglasses to protect the eyes from the sun’s UV rays.

There is no known effective medical treatment which can prevent cataract from developing or slow its progress once it appears.

Can cataract be treated?

Cataract surgery - a small incision is made and the cataract removed. The IOL is inserted in its place.Cataract blindness is treatable. Cataracts can be removed in an operation performed under local anaesthetic. Fred Hollows, and later The Fred Hollows Foundation, championed the use of modern cataract surgery in developing countries using an implanted intraocular lens, a thin piece of clinical grade plastic.

The operation involves making a small incision, removing the clouded lens from the eye and leaving the thin lens capsule behind.

An intraocular lens is then implanted into the capsule and acts as a clear replacement lens. The operation takes around 20 minutes in the hands of a skilled surgeon and requires no sutures.

Despite studies showing that cataract surgery is among the most cost-effective of all health interventions, access to surgery in many developing countries is often both physically and financially difficult.

Cataract surgery in the developing world

Prior to the 1990s, most cataract operations in developing countries were traditionally done by removing the whole lens from the eye, including the capsule which contained it. Because the natural lens of the eye had been removed, the patient was left with no focusing mechanism and needed thick ‘coke bottle’ glasses. This solution provided poor outcomes for the patient.

Fred Hollows decided that the intraocular lenses produced in the developing world, and costing us much as $200, were too expensive so he raised funds to build lens factories in Nepal and then Eritrea.

By producing lenses in-country the market price was reduced to around $5 and more developing countries were able to afford to purchase them. Today, the laboratories have a combined manufacturing output of approximately 250,000 lenses annually and export to more than 40 countries.

Advances in surgical techniques

Professor Fred Hollows examines a patient while Dr Sanduk Ruit watches on. Nepal, 1992. Photo: Jonathan Chester/Extreme ImagesIn 1998, Dr Sanduk Ruit and his team at The Tilganga Eye Centre in Nepal (a partner of The Foundation) developed a new technique for cataract surgery called Small Incision Sutureless Cataract Surgery (SICS) that did not involve the use of sutures (thread for stitching), one of the most expensive components of the operation.

Not only is ‘sutureless surgery’ far less expensive, it is safer and faster (taking around half the time of the standard technique). Many of the training programs supported by The Foundation now train surgeons in the new sutureless technique, along with the standard Extracapsular Cataract Surgery (ECCE) + posterior chamber IOL implantation technique.

A new intraocular lens design has subsequently been developed to match the needs of sutureless surgery. Known as the FH105, the lens (which is smaller in diameter) fits snugly into the eye through a tighter incision.

In 2001, Tilganga Eye Centre developed a further refinement to its sutureless technique called ‘temporal’ section. An incision is made on the side rather than from the top of the eye. The ‘temporal’ section produces better post-operative results, reduces astigmatism and leads to earlier recovery of vision.

Note: This information is general in nature and is not a substitute for specialist medical advice. Have your eyes checked regularly every two years, even if you have not noticed any symptoms or changes.

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What we can do

Help keep Fred’s dream alive.

4 out of 5 people who are blind in the developing world don't need to be. Routine treatment costing as little as $25 can restore sight and hope.


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