Cortical Cataract: Symptoms, Diagnosis, Treatment & Recovery

What is Cortical Cataract?

A cortical cataract is a type of cataract that affects the lens of the eye, specifically the cortex, which is the outer part of the lens. This condition involves the clouding of the lens, disrupting the clarity of vision. 

Unlike other types of cataracts, cortical cataracts are characterised by white, wedge-like opacities that start in the periphery of the lens and work their way to the centre in a spoke-like fashion. These opacities are due to changes in the water content and fibre structure within the lens, leading to the scattering of light as it passes through, which results in blurred and distorted vision.

The progression of a cortical cataract can vary, starting subtly and often not noticed until it begins to encroach on the central axis of the lens. One of the distinguishing features of this type of cataract is the problems it causes with glare and the contrast of vision, especially in bright conditions. The gradual development of this cataract type makes early detection and monitoring crucial.

Regular eye examinations are recommended to assess and manage the progression effectively, maintaining the best possible vision. This condition primarily affects adults, particularly as they age, making it a significant concern for elderly populations globally.

What Causes Cortical Cataracts?

Cortical cataracts develop due to a variety of factors that alter the lens structure in the eye. Here are some of the causes & complications:

• Ageing: The primary cause of cortical cataracts is ageing, which leads to natural biochemical changes in the lens, degrading its proteins and fibre cells, making them more opaque.
• Genetic Factors: Inherited genetic traits can predispose individuals to cataract development, including cortical cataracts, often influencing the age of onset and progression rate.
• Diabetes: Prolonged high blood sugar levels can cause changes in the eye’s lens through glycation, which affects lens transparency and accelerates cataract formation.
• Ultraviolet Radiation: Frequent exposure to UV radiation can damage the lens cells, increasing the risk of cataract formation.
• Smoking: The harmful chemicals in tobacco smoke interfere with the antioxidant capabilities in the lens, leading to oxidative stress and tissue damage.
• Medication Use: Certain medications, particularly corticosteroids, have been linked to an increased risk of developing cataracts.
• Nutritional Deficiencies: Poor diet lacking in antioxidants like vitamins C and E can contribute to earlier and more severe cataract development.
• Eye Injury: Physical trauma can disrupt the lens structure, accelerating cloudiness and cataract formation.

Types of Cortical Cataract

Different stages and characteristics define the types of cortical cataracts, each affecting vision in unique ways:

• Incipient Cortical Cataract: This initial stage features small opacities on the lens’s outer edges, which may cause slight vision disturbances.
• Immature Cortical Cataract: As the condition progresses, the opacities become larger and more numerous, encroaching on more of the lens and impacting vision more significantly.
• Mature Cortical Cataract: This advanced stage is characterised by significant cloudiness covering most of the lens, causing noticeable vision loss and difficulty seeing in low light.
• Hyper-mature Cortical Cataract: In this final stage, the lens becomes completely opaque, leading to substantial vision impairment and potentially contributing to complications like phacomorphic glaucoma.

Symptoms of Cortical Cataract

The symptoms of cortical cataracts can vary depending on the stage of the cataract, but typically include:

• Glare and Halos: One of the earliest and most common symptoms, individuals may notice significant glare and halos around lights, which becomes especially problematic when driving at night.
• Blurred Vision: Vision may gradually become foggy or blurred, affecting the clarity of images and making it difficult to read or recognize faces.
• Decreased Colour Perception: Colours may appear faded or yellowish as the cataract filters the light entering the eye.
• Frequent Prescription Changes: Those with cortical cataracts might find that they need frequent changes in their eyeglass or contact lens prescriptions.
• Difficulties with Contrast Sensitivity: It becomes challenging to discern between different shades or textures, affecting tasks like driving or reading.
• Monocular Diplopia: In advanced cases, the affected eye may perceive double images, complicating daily activities.

Diagnosis and Evaluation of Cortical Cataract

Diagnosing cortical cataracts involves several steps to ensure an accurate assessment:

• Visual Acuity Test: This basic eye test uses an eye chart to measure how well you see at various distances.
• Slit-lamp Examination: The slit lamp allows the doctor to see the structures at the front of your eye under magnification. It’s crucial for identifying the location and extent of the cataract.
• Retinal Examination: After dilating your pupils, the eye doctor examines the retina and other structures at the back of your eye using a slit lamp or an ophthalmoscope.
• Tonometry: This test measures the pressure inside your eye, important for assessing the risk of glaucoma, which can be associated with cataracts.
• Pupil Dilation: Dilation of the pupils allows for a more thorough examination of the internal structures of the eye, crucial for detecting cataracts.
• Assessment of Symptoms: Discussion of symptoms such as changes in vision, difficulty with glare, and other related issues helps correlate the physical findings with the patient’s experience.

Each of these diagnostic steps provides crucial information, helping to form a comprehensive picture of the health of the eye and the impact of the cataract.

How Can Cortical Cataract Be Treated?

Treatment for cortical cataracts primarily involves surgery, which is recommended based on the degree of vision loss and the impact on daily activities. Here are the general steps:

• Surgical Removal: The clouded lens is surgically removed and replaced with a clear, artificial lens. This is typically done through a process called phacoemulsification, where the lens is emulsified with an ultrasonic handpiece and aspirated from the eye.
• Lens Replacement: A plastic or silicone intraocular lens is implanted in the eye to restore vision. This lens can be multifocal, providing different focusing zones to reduce dependency on glasses.
• Postoperative Care: After surgery, patients may need to use eye drops to prevent infection and control eye pressure. Regular follow-up visits are necessary to monitor the healing process.

When is Cortical Cataract Considered Serious?

A cortical cataract is considered serious when it significantly impairs vision and affects daily activities. Here are some scenarios:

• Significant Vision Loss: When vision cannot be corrected to better than 20/40 with glasses, impacting tasks like reading or driving.
• Glare Sensitivity: Severe difficulty with glare and light, affecting the ability to navigate bright environments.
• Rapid Progression: Quick worsening of the cataract that leads to swift declines in visual acuity.
• Complications: Development of complications like phacomorphic glaucoma or significant inflammation inside the eye.

Prevention of Cortical Cataracts

While it’s difficult to completely prevent cortical cataracts, risk reduction is possible. Here are some strategies:

• UV Protection: Wearing sunglasses that block UV rays can help protect the eyes from damage that may lead to cataract formation.
• Quit Smoking: Avoiding tobacco smoke can reduce the risk of cataracts, as smoking increases oxidative stress in the eye.
• Manage Health Conditions: Keeping conditions like diabetes under control can prevent complications that might accelerate cataract development.
• Nutritional Supplements: Some evidence suggests that antioxidant vitamins such as vitamins C and E might reduce cataract risk.

Regular eye examinations are essential for early detection and management of cataracts, allowing for timely intervention and better visual outcomes. If you suspect any changes in your vision or eye health, consulting an eye care professional is crucial.

Myths and Facts About Cortical Cataract

Here are a few myths and facts about cortical cataract:

• Myth 1: Only the elderly develop cataracts.
  Fact: While age is a significant risk factor, cataracts can develop at any age, including infancy. Factors like trauma, certain medications, and other health conditions can precipitate their onset.
• Myth 2: Cataracts are growths that form inside the eye.
  Fact: Cataracts are not growths but rather the clouding of the eye’s natural lens caused by protein clumping in the lens.
• Myth 3: Lifestyle changes can cure cataracts.
  Fact: While healthy lifestyle choices may slow the progression, cataracts can only be effectively treated through surgery.
• Myth 4: Cataract surgery is risky and painful.
  Fact: Cataract surgery is generally very safe and involves minimal discomfort, thanks to advances in surgical techniques and anaesthesia​.
• Myth 5: Cataracts can regrow after surgery.
  Fact: Once removed, cataracts do not regrow. However, some patients may experience a condition called posterior capsule opacification, which can blur vision and may require a simple laser treatment​.

When to Consult a Doctor for Cortical Cataract?

Consulting an ophthalmologist is recommended if you experience any signs of a cortical cataract, such as gradual vision blurring, difficulty seeing in bright light, or perceiving halos around lights. 

If these symptoms affect your daily tasks, like driving or reading, it’s important to seek professional advice. An ophthalmologist, a specialist in eye care, can provide a thorough diagnosis using advanced imaging techniques. 

Early consultation can lead to timely intervention, potentially preserving more of your vision. It’s particularly crucial for individuals over the age of 60 or those with risk factors like diabetes or a history of eye injuries to have regular eye examinations, ensuring any changes in eye health are promptly addressed.

Questions to Ask Your Doctor About Cortical Cataract

Being well-informed about your health condition empowers you to make the best decisions for your care. When consulting with your doctor about cortical cataract, it’s essential to have a list of specific questions that can help you understand your diagnosis, treatment options, and what to expect in the future. Here are a few ones for you:

1. What are the signs that my cortical cataract is progressing?
2. How frequently should I have my eyes examined as the cataract develops?
3. What are the potential risks and benefits of cataract surgery?
4. Are there different types of intraocular lenses available, and which might be best for my situation?
5. What should I expect during the recovery period after cataract surgery?
6. Are there activities or medications I should avoid to prevent the progression of my cataract?
7. How will we monitor for potential complications after surgery?
8. Is there a possibility that my other eye might develop a cataract soon?
9. What improvements in vision can I realistically expect post-surgery?
10. Are there new treatments on the horizon for cortical cataracts?

These questions can help ensure that you are well informed about your condition and the treatment options available, allowing for better decision-making and management of cortical cataract.