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Cataract

Abstract

Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. The only treatment for cataract is surgery. Phacoemulsification is the gold standard for cataract surgery in the developed world, whereas manual small incision cataract surgery is used frequently in developing countries. In general, the outcomes of surgery are good and complications, such as endophthalmitis, often can be prevented or have good ouctomes if properly managed. Femtosecond laser-assisted cataract surgery, an advanced technology, can automate several steps; initial data show no superiority of this approach over current techniques, but the results of many large clinical trials are pending. The greatest challenge remains the growing ‘backlog’ of patients with cataract blindness in the developing world because of lack of access to affordable surgery. Efforts aimed at training additional cataract surgeons in these countries do not keep pace with the increasing demand associated with ageing population demographics. In the absence of strategie that can prevent or delay cataract formation, it is important to focus efforts and resources on developing models for efficient delivery of cataract surgical services in underserved regions. For an illustrated summary of this Primer, visit: http://go.nature.com/eQkKll

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Figure 1: Global prevalence of visual impairment due to cataract.
Figure 2: A model for the pathogenesis of adult-onset cataract.
Figure 3: Clinical presentation of cataract.
Figure 4: Simplified schematic diagram showing different technologies used for cataract surgery.
Figure 5: Management of complicated cataracts.

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Acknowledgements

The authors express their gratitude to E. X. Y. Liang for her contributions to technical editing and refining references.

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Introduction (S.K.R., V.R., D.L. and D.F.C.); Epidemiology (P.M. and J.J.); Mechanisms/pathophysiology (J.K., C.P.P. and V.R.); Diagnosis, screening and prevention (Y.L. and V.R.); Management (S.K.R., D.F.C., D.L., Y.L., V.R. and M.T.); Quality of life (J.J. and V.R.); Outlook (S.K.R., J.J., D.F.C., V.R., J.K. and D.L.); overview of Primer (D.L.).

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Correspondence to Dennis Lam.

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M.T. holds a patent on the BIL and ring caliper licensed to Morcher (Germany) which results in royalties. D.F.C. is a consultant for AMO Calhoun Vision Power Vision and LensAR. All other authors declare no competing financial interests.

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Lam, D., Rao, S., Ratra, V. et al. Cataract. Nat Rev Dis Primers 1, 15014 (2015). https://doi.org/10.1038/nrdp.2015.14

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