The primary functions of the crystalline lens are to transmit incident light and to focus it on the retina. This requires that the lens is transparent, a condition dependent on the highly regular organization of the cells of the lens and the high degree of order of the proteins in the lens cytoplasm. The protein concentration in lens fibre cells is extremely high, resulting in an index of refraction significantly greater than that of the surrounding fluids, and so enabling the lens to refract incident light. Cataract occurs when the lens loses its transparency by either scattering or absorbing light such that visual acuity is compromised. Cataracts can result from genetic, metabolic, nutritional or environmental insults, or they may be secondary to other ocular or systemic diseases such as diabetes or retinal degenerative diseases (see box). By far the most important risk factor is age; aging-related cataract constitutes the great majority of all cataracts and is a major public health problem worldwide. In developing countries, where the availability of surgical facilities is limited, aging-related cataract is the leading cause of blindness. Because at present there is no efficacious non-surgical therapy for cataract, the problem is expected to increase in magnitude in coming decades as the world population becomes progressively older.

Causes of cataracts

• Aging
• Inheritance
• Metabolic disorders, e.g. Lowe’s syndrome, hypocalcaemia
• Diabetes
• Toxicity, e.g. drug-induced (steroids, amiodarone), chemical, metal ions
• Nutrition
• Physical dehydration
• Trauma
• Radiation
• Eye disease, e.g. glaucoma, uveitis, post-vitrectomy
• Systemic disease, e.g. atopy, renal failure

Lens growth

Although the lens grows throughout life, none of the cells are cast off. Component cells are added to the lens as time goes by, with those in the centre being as old as the individual. The lens grows by regular addition of fibres to the lens mass. Growth rate is not uniform throughout the human lifespan, and it appears to be maximal in foetal life. Foetal lens mass increases by about 180 mg/year (lens mass is 90 mg at birth), but the growth rate drops significantly after birth and is 1.3 mg/year between 10 and 90 years of age. Estimates of average lens density suggest that protein content remains relatively constant at around 33% of the wet weight over the age span. The dimensions of the lens change in a complex manner as the lens grows. In early foetal life, the lens is almost perfectly spherical, but by birth the sagittal profile is ellipsoidal as equatorial growth outstrips growth in the sagittal plane. At birth, equatorial lens diameter is about 6.5 mm while sagittal width is about 3 mm. By the age of 90 years, this changes to about 10 mm in the equatorial plane and 6 mm in the sagittal plane.

Classification of cataracts

There appears to be three major types of ageing-related cataracts:

• cortical,
• nuclear,
• posterior subcapsular.

Which differ both in the location in which the opacity initially appears and in the pathology underlying the opacification.

Many risk factors may be common to all three types of ageing-related cataracts, and although cataracts often begin as a pure type, as they mature they typically become mixed cataracts. The main types of cataracts seen in clinical practice are summarized in the box below. Objective classification schemes (see box) use photographic standards to subdivide each major type into grades. These grades are based on density and colour (in the case of the nucleus) or according to the anatomical area of the cataract (in the case of the cortical and posterior subcapsular areas). One may directly compare a patient’s lens as seen on the slit lamp with a photographic copy of the various standard grades, as set up in the various classification schemes (clinical grading), or one may take photographs of the lens being studied and later grade the photographs according to the classification scheme used (photographic grading).

Types of cataracts

• Cortical
• Nuclear
• Posterior subcapsular
• Mixed
• Mature and hypermature
• Capsular
• Anterior subcapsular
• Retrodots
• Congenital and juvenile-total or partial
• Traumatic

Objective classification schemes for cataracts

• Lens Opacities Classification System II and III (LOCS II and LOCS III)
• Oxford Cataract Classification System
• Beaver Dam Eye Study

How many times have you been in that local upscale mall shopping for the latest designer handbag or the newest cut of blue jeans. Frustrated that the slacks you tried on didn’t fit correctly, you happen to look into the window of that high end optical store and spot the perfect set of eyeglass frames. You walk inside and ask to try them on. The Heavens open up and Angels begin to sing; it is love at first sight. It is the perfect color, the perfect size, and the perfect shape and you will not be denied.

Your pulse begins to race; the excitement builds as you fumble around in your purse or wallet for your vision insurance card. That is when the optical professional then smugly informs you that their store does not take your vision insurance. Utterly defeated, you sadly hand over the perfect set of frames back to the sales person and walk out of the store. You then continue your search for that perfect frame going to this store and that, but not quite ever finding that perfect piece again. All because the optical store did not take your vision insurance.

This exact scenario is the problem that plays itself out on a daily basis in hundreds of optical stores throughout the country. The one question is WHY? Why do we as a community allow this to happen? Only because you the consumer do not know your vision insurance policy inside and out. Our medical lives have been virtually altered to select doctors and procedures directly based upon whether our favorite general practitioner, our favorite dentist, gynecologist, etc. is in or out of our approved network. So why not our local, favorite optical shop.

Does your vision insurance carrier really have that much power over your decision-making skills to dictate where you can and cannot purchase that perfect frame? Absolutely not!

Every optical store that does not take your vision insurance directly is always considered an out-of-network provider by your vision carrier. Want more? Some of those vision insurance companies will ACTUALLY reimburse you for your frame and lens purchase up to a certain set amount. Who Knew?

You just don’t have to settle anymore; you just have to know your vision plan. And that’s the moral: be sure to know the details of your optical insurance plan before you settle on that perfect pair. You’ll be glad you did!

Eyelid surgery is a simple procedure that addresses those sagging or puffy eyelids. Increasingly as we age our eyelids begin to sag down over our eyes. Generally, this is genetically linked, as some people suffer more than others from this frustrating occurrence.

If you suffer from eyelids that show your age, alter your appearance or even hinder your vision, eyelid surgery is an easy way to address the issue. It is a simple procedure that can do wonders when it comes to making you look younger. Unlike facelifts, surgical procedures on your eyes have a relatively quick turn around time. Depending on how much tissue is taken from your eyes, you could be back to work in a couple of days.

It is important to note that the procedure is not just limited to the tissue above your eyes. Some patients will have tissue removed from below their eyes as well. Normally, removing the extraneous under eye tissue can be done by the same doctor during the initial procedure. So, if you are one of those people with very puffy under eyes, address this with your surgeon as well.

The surgical procedure on your eyes is a very subtle way of making yourself look younger. When you choose to have the puffiness or sagginess or your eyes addressed, you are merely updating your look. With reconstructive procedures and some brow or facelifts, you may feel you are altering your appearance. Looking like a different person is not what you are going for by updating your eyes.

The procedure merely takes away years of sun damage and stress by removing the tissue or weight that has gathered around your eye. Over many years, the skin around your eyes becomes weaker and less elastic. Eventually creams and special eye make-up do nothing to affect the puffiness. Yet, surgical procedures can reverse the aging, stress and sun damage very quickly.

If you are curious about how eyelid surgery may affect your life, chat with your doctor to get a referral to a local plastic surgeon. They should be able to recommend a quality surgeon known for updating eyes. Talk with the surgeon about cost and what to expect from the procedure. They will be able to go through the process with you step-by-step.

Your doctor may tell you that you need the procedure for other reasons beyond updating your appearance. If sagging eyelids are hindering your vision, then having the surgical procedure done becomes less elective and more necessary. If your eyelids are affecting the way you drive, read or work, the procedure should become a top priority. In fact, in some cases, if you can prove the procedure is for medical reasons, you can receive help from your insurance company to cover the cost.

Eyelid surgery doesn’t have to be a face altering or life changing experience. It is an easy way to address those frustrating, saggy eyes.

Everyone has seen the specs, but not everyone wears them from morning until evening.

How nice and helpful eyewear is – this is debatable – many are bored with their helplessness without them, others by the inconvenience during sports and other mobile activities, but when your vision depends on them, you must not be capricious. Or maybe you do?

For a long time on the market, there are small and inconspicuous substitutes for glasses – contact lenses. They are divided into two main types – soft and hard. Soft lenses have a much greater application in eye practice because they are physiological.

Their selection should not be done indiscriminately, as it is necessary to adhere to several indicators – radius, diameter, diopter, and the type of material. Last but not least contacts comply with the occupation of the patient. Lenses should not be over worn. In general, the patient must comply with several rules when wearing lenses, and also follow the doctor’s instructions.

In one year of use the lenses need to be properly cared for: disinfected and cleaned by a special solution. The main problem occurs if there was no good maintenance or one of them stop “working” properly.

For the last 5 years the range of parameters of these lenses has grown. The lenses have acquired other qualities – UV protection, corrections astigmatism, huge selection of colors, and lenses with unusual views – Crazy and Wild eyes.

The advantages of lenses compared to glasses are that they provide much better visual acuity and no field restriction. Having in mind the quality and materials which they are produced from, the contact lenses provide a significant comfort. Glasses naturally remain in practice, they also have their place, but contact lenses are preferred mostly by young people, ones with high diopter and those who have a significant difference in vision between both eyes, which cannot be corrected with glasses, as they raise separation of images from both eyes in the cerebral cortex.

What to choose – glasses or contact lenses? Everything depends on the patient’s age, on his/her profession, and are there any medical indications for wearing contact lenses. If the one in need of a means of vision correction is an athlete for example, of course, the contact lenses are better than glasses. Lenses are not recommended for people with certain eye diseases or when their side effects have already occurred – allergic reactions and others. Of course, everyone who uses contact lenses should have a pair of glasses – as a backup.

The reasons for which we give up on glasses and try contact lenses are various. Some people are unsatisfied by their appearance or they try to make their life more convenient. Others are willing to change their look and attract other people’s attention. Whatever the causes are to resort to the lens, the glasses have their advantages. They make us look more intelligent and charming.