The symptoms of cataracts include:

1. Blurry or Clouded Vision: The most common symptom, where vision becomes increasingly hazy or foggy.
2. Difficulty with Night Vision: Trouble seeing in low light or at night.
3. Sensitivity to Light: Increased sensitivity to sunlight or bright lights, often accompanied by glare.
4. Fading or Yellowing of Colours: Colours may appear less vibrant or more yellow.
5. Frequent Changes in Prescription Glasses: Needing stronger glasses or contact lenses more frequently.

In low-income settings, clinical findings of cataracts often include advanced lens opacification due to delayed diagnosis and treatment. Patients commonly present with significant visual impairment or blindness, as access to routine eye examinations and surgical interventions is limited. Observable signs may include:

1. Visible Clouding of the Lens: Advanced opacification visible to the eyes, pen-torch examination and upon detailed slit-lamp examination.
2. Reduced Visual Acuity: Marked decrease in vision, often to the level of legal blindness.
3. Absent Red Reflex: Diminished or absent red reflex when using an ophthalmoscope.
4. Glare and Light Sensitivity: Increased glare and difficulty seeing in bright light.
5. Pupil Reflex Abnormalities though not common may be seen in advanced cataracts which have become complicated.

The differential diagnoses for cataracts include a range of other conditions that can cause similar symptoms of visual impairment or lens opacification. These conditions include:

1. Corneal Opacities: Scarring or clouding of the cornea from infections, injuries, or other diseases, resulting in decreased vision.
2. Refractive Errors: Conditions like myopia (near-sightedness), hyperopia (farsightedness), and astigmatism, which cause blurred vision but are corrected with glasses or contact lenses.

3 An old retinal Detachment: This can mimic cataract separation of the neurosensory retina from the retina pigment epithelium, leading to sudden vision loss and potential blindness if not treated promptly.

4. Glaucoma: A group of eye conditions that damage the optic nerve, often associated with increased intraocular pressure, leading to peripheral vision loss. This often coexist with cataracts.
5. Leukocoria could be found in the young.

Cataract investigations include a basic eye examination with a pen torch then with a slit-lamp to assess the level of lens opacity. Visual acuity tests determine vision loss severity. A dilated eye exam checks the retina and optic nerve. These fundamental tests help diagnose cataracts where resources are limited such as in the rural settings.

Primarily involves surgical intervention, usually through manual small-incision cataract surgery (MSICS) or phacoemulsification (where available).

Efforts focus on increasing access to affordable surgeries and training local healthcare providers. Outreach programs and mobile eye clinics are vital in reaching remote areas. Post-operative care and follow-up are essential to ensure successful outcomes. Addressing barriers like cost, transportation, and awareness is crucial for effective treatment.

Reviewer’s Reflection

From my experience in Nigeria, having an efficient system can contribute to reducing the burden of cataract blindness. We did over 11000 cataract surgeries in 2023 at Tulsi Chanrai Foundation Hospital with over half of that being done for free amongst 6 surgeons. It’s the cheapest and most affordable private health enterprise at the heart of Abuja. (This is a comment to give perspective of what can be done to address cataract blindness)

At TCF Abuja, we have outreach centres in mainly 2 neighbouring states. Our buses bring indigent patients daily from Monday to Friday and they all have their cataract surgery done at no cost. We cover the cost from those patients who pay for their regular appointment and pay for their surgeries. Even then we don’t charge those who pay for their treatment high fees. We have paying patients and non-paying patients. If we don’t charge high fees from regular patients, how are we able to cover the cost for patients who have free surgery?? It’s from the high turnover of patients we see at the outpatients. In 2023, we saw over 76000 patients at the outpatient. This is a very efficient model that can help to address the burden of cataract blindness. Others can replicate this model. We have very very low complications because the surgeons are so good.

After cataract treatment, follow-up involves regular post-operative visits to monitor healing and visual recovery (we see our patients 1 months after surgery and then 6 months after. No need for regular follow-ups once you have done a good job. For the free patients they’re followed up 1 month after surgery at the outreach centre, they don’t come back to the main hospital). These visits also assess for any complications such as infection or inflammation. Adjustments to prescription glasses or contact lenses may be made to optimize vision. Patient education on post-operative care, including the use of prescribed eye drops, is essential. Long-term monitoring ensures ongoing eye health and early detection of any potential issues like posterior capsular opacification.

In Sub-Saharan Africa, preventing and controlling cataracts involves promoting eye health awareness, improving nutrition, ensuring access to affordable surgeries, implementing community outreach programs, and advocating for policies supporting eye care initiatives. These efforts aim to reduce cataract prevalence and enhance vision health across the region.