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The lens is a transparent structure inside the eye that allows objects to be correctly focused at different distances. The lens is shaped like a biconvex lens, resembling a flattened sphere. It is located just behind the pupil and its main function is to focus images regardless of their distance. Essentially, the lens is an ocular structure necessary for proper vision.
The lens's ability to focus is achieved thanks to the elasticity of its collagen fibers. However, it loses this quality as we age, leading to a loss of visual acuity. This is how presbyopia manifests itself.
This condition generally appears after the age of 40 due to the normal aging process. However, the age of onset varies and is due to genetic factors and the presence of other refractive errors such as myopia or hyperopia.
The lens is transparent. Eye injuries, prolonged exposure to UV rays, aging, and diseases such as diabetes can cause it to lose that transparency and become opaque. This is how cataracts appear.
The main symptoms of cataracts are blurred vision, difficulty seeing in low light, and loss of brightness and contrast of objects and colors. Cataracts make us see as if we were standing behind a fogged-up window.
When cataracts impair vision, surgery is necessary. During the procedure, the lens is removed and replaced with an artificial lens known as an intraocular lens.
Let's learn more about the most common diseases:
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We all have a natural lens inside the eye called the crystalline lens, which is named for its transparency. Thanks to it, we can focus clearly when looking at different distances.
With age, this lens becomes cloudy due to natural causes, leading to a decrease in the quality and quantity of vision. Other causes of clouding include trauma, congenital abnormalities, metabolic diseases such as diabetes, or chronic use of medications such as corticosteroids.
Any opacity in the lens is known as a cataract, and the only treatment is surgery. In this surgery, the opaque lens is removed and replaced with an acrylic lens that will be housed in the site where the cataract was located and will remain there (inside the eye) for life.
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The most common cataract in our area is senile cataract, caused by aging and deterioration of lens proteins due to age. However, there are other causes of this disease: metabolic, traumatic, inflammatory, congenital, etc.
Some diseases:
- Age-related cataracts
- Presbyopia
- Cataract due to trauma
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The symptoms of cataracts vary greatly from person to person, but we can identify a series of common symptoms:
More intense glare with light: A person suffering from cataracts is more sensitive to light, to the point of being bothered by it, even when driving at night.
Improved vision: Sometimes patients with cataracts report that their near vision has improved significantly. This situation is due to the beginning of the formation of the cataract, the eye is becoming myopic, which causes an improvement in the patient's near vision.
Blurred vision: This is one of the most common symptoms of cataracts. The patient experiences a cloudy appearance that impedes proper vision, interfering with everyday activities such as watching television or driving. At this point, it is essential to see a specialist, as failure to do so can lead to more advanced vision loss.
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The only definitive treatment available today for cataracts is surgery.
Regular eye exams allow for early detection of cataracts, which prevents the problem from progressing and facilitates treatment.
Currently, cataract surgery is usually performed by microincision (i.e., 2.5 mm hand incisions that do not require sutures) using equipment known as a phacoemulsifier that vibrates at ultrasonic speed to pulverize and aspirate the cataract.
After removing the cataract, the intraocular lens, which is always necessary, is introduced into the eye.
There are many types of intraocular lenses. Spherical lenses allow patients with a high risk of developing good distance vision, but they require glasses after surgery to read. When a condition called corneal astigmatism exists, a toric lens is needed to correct it.
Multifocal intraocular lenses are now also available. They allow adequate vision for both distances and near vision, thus offering patients independence from glasses for both distances (which is achieved with this type of lens in more than 90% of cases). However, not all patients are good candidates for this type of lens, and therefore, careful evaluation is required before surgery.
Furthermore, given the efficacy and safety of modern cataract surgery, you don't necessarily need to have a significant cataract to be a candidate for one of these lenses. In those over 50 or 55 years of age who have significant myopia or hyperopia, even when the lens opacity is incipient, they could be good candidates for a procedure called phacorefractive surgery, which seeks to remove the lens to place a multifocal intraocular lens (using the same technique as cataract surgery) but performed to achieve independence from glasses, in cases where refractive surgery treatment with Excimer laser is not the best option.
To accurately evaluate each case and make decisions regarding the aforementioned procedures, it is important to conduct a complete medical history, perform state-of-the-art diagnostic tests, and provide a comprehensive approach to the patient by the ophthalmologist. Remember that each surgery has specific indications, and you should receive sound advice before implanting an intraocular lens.
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In order to focus on nearby objects, the human eye automatically changes the magnification of the eye's internal lens (called the crystalline lens) in a process called accommodation.
Starting at age 40, the elasticity of the lens decreases, leading to a decrease in the ability to clearly see close objects. This natural process, called presbyopia, occurs with age in everyone, although it may appear later in some.
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The main symptom is poor near vision, which manifests when the patient begins to move close objects away in order to obtain a clear image.
This can lead to visual fatigue or eyestrain, presenting red eyes, itching, heavy eyes, headaches.
Initially, patients can read by moving the text away from their eyes, but eventually, glasses will be required to read comfortably. Glasses have no effect on the deterioration of near vision, as this is determined simply by age.
There is still no proven medical treatment that can prevent or correct presbyopia.
There is also no surgical treatment that can completely correct it, however, there are alternatives thatThey allow the patient to perform almost all of their activities without glasses, but appropriate case selection is required.
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In patients under 50 to 55 years of age, the possibility of excimer laser surgery can be evaluated in an alternative known as "monovision," in which one eye is corrected so that it focuses for distance vision and the other for near vision. A test should always be performed before surgery, with a simulation of the correction that will be performed with the surgery, using contact lenses. This way, it will be known with certainty whether the patient will feel comfortable with this type of surgery. A patient who feels comfortable with the vision achieved in the monovision test will most likely feel equally well after laser surgery.
For patients over 55 to 60 years of age, surgery may be considered for a special intraocular lens that allows for focusing both near and far (such as the Panoptix lens). This surgery is the same as that performed for cataract surgery and involves removing the eye's natural lens (the crystalline lens) and implanting the intraocular lens.
The results of lens extraction surgery with multifocal intraocular lens implantation are generally very good (approximately 90% of patients do not require glasses for either distance or near vision). However, it is important to understand that these lenses do not function exactly like the natural lens, and therefore, there are some details that must be taken into account. Reading requires slightly more light, and very small text can be difficult to read.
Additionally, some patients may experience halos around lights at night. These types of nighttime visual symptoms generally subside within a few months and almost never cause severe discomfort, but they do in a few cases. Therefore, if the patient's activity requires a lot of nighttime driving, especially on the highway, they may not be an ideal candidate for this type of surgery.
The most effective is the replacement of the crystalline lens with multifocal intraocular lenses (three distances: far, intermediate and near) allowing us to correct presbyopia and any other associated graduation defect such as myopia, hyperopia or astigmatism.
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