Nyctalopia in the context of "Cataracts"

A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading and recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. In 2020 Cataracts caused 39.6% of all cases of blindness and 28.3% of visual impairment worldwide. Cataracts remain the single most common cause of global blindness.

Cataracts are most commonly due to aging but may also be due to trauma or radiation exposure, be present from birth or occur following eye surgery for other problems. Risk factors include diabetes, longstanding use of corticosteroid medication, smoking tobacco, prolonged exposure to sunlight and alcohol. In addition, poor nutrition, obesity, chronic kidney disease and autoimmune diseases have been recognized in various studies as contributing to the development of cataracts. Cataract formation is primarily driven by oxidative stress, which damages lens proteins, leading to their aggregation and the accumulation of clumps of protein or yellow-brown pigment in the lens. This reduces the transmission of light to the retina at the back of the eye, impairing vision. Additionally, alterations in the lens's metabolic processes, including imbalances in calcium and other ions, contribute to cataract development. Diagnosis is typically through an eye examination, with ophthalmoscopy and slit-lamp examination being the most effective methods. During ophthalmoscopy the pupil is dilated and the red reflex is examined for any opacities in the lens. Slit-lamp examination provides further details on the characteristics, location and extent of the cataract.

Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissues. It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. Vitamin A plays a major role in phototransduction, so this deficiency impairs vision, often presenting with nyctalopia (night blindness). In more severe VAD cases, it can progress to xerophthalmia, keratomalacia, and complete blindness.

Vitamin A deficiency is the leading cause of preventable childhood blindness worldwide and is a major cause of childhood mortality. Each year, approximately 250,000 to 500,000 malnourished children in the developing world go blind from a VAD, with about half of whom dying within a year of losing their sight. Addressing VAD has been a critical focus of global health initiatives, including Sustainable Development Goal 2: to end hunger, achieve food security and improved nutrition and promote sustainable agriculture.