Senile (Age-Related) Cataract

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import Image as RLImage
import urllib.request
import io
import os

OUTPUT = "/home/daytona/workspace/senile-cataract/Senile_Cataract.pdf"

# ── Download images ──────────────────────────────────────────────────────────
IMG_ANATOMY = "https://cdn.orris.care/cdss_images/a2674d6ec496b5de9e01cd831d3b38fad72b4369b523c13cca36a6fd099d9385.png"
IMG_TYPES   = "https://cdn.orris.care/cdss_images/29451237b3f1b4220de6fc97dc359b8089c1b6b5647538ce70183e87ed5d4d85.png"

def download_image(url, filename):
    path = f"/home/daytona/workspace/senile-cataract/{filename}"
    if not os.path.exists(path):
        urllib.request.urlretrieve(url, path)
    return path

anatomy_img = download_image(IMG_ANATOMY, "anatomy.png")
types_img   = download_image(IMG_TYPES,   "types.png")

# ── Document setup ────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2.2*cm, bottomMargin=2.2*cm,
    title="Senile Cataract",
    author="Orris Medical AI"
)

W, H = A4
TW = W - 4*cm  # text width

# ── Styles ────────────────────────────────────────────────────────────────────
BASE = getSampleStyleSheet()

TITLE = ParagraphStyle("TITLE", parent=BASE["Title"],
    fontSize=22, textColor=colors.HexColor("#1a3a5c"),
    spaceAfter=4, leading=26, alignment=TA_CENTER)

SUBTITLE = ParagraphStyle("SUBTITLE", parent=BASE["Normal"],
    fontSize=11, textColor=colors.HexColor("#4a6fa5"),
    spaceAfter=14, alignment=TA_CENTER, italic=True)

H1 = ParagraphStyle("H1", parent=BASE["Heading1"],
    fontSize=13, textColor=colors.white,
    backColor=colors.HexColor("#1a3a5c"),
    spaceBefore=14, spaceAfter=6,
    leftIndent=-0.5*cm, rightIndent=-0.5*cm,
    borderPad=5, leading=18)

H2 = ParagraphStyle("H2", parent=BASE["Heading2"],
    fontSize=11, textColor=colors.HexColor("#1a3a5c"),
    spaceBefore=10, spaceAfter=4, leading=16,
    borderPad=2)

H3 = ParagraphStyle("H3", parent=BASE["Heading3"],
    fontSize=10.5, textColor=colors.HexColor("#2e6da4"),
    spaceBefore=8, spaceAfter=3, leading=14, bold=True)

BODY = ParagraphStyle("BODY", parent=BASE["Normal"],
    fontSize=9.5, leading=14, spaceAfter=4, alignment=TA_JUSTIFY,
    textColor=colors.HexColor("#222222"))

BULLET = ParagraphStyle("BULLET", parent=BASE["Normal"],
    fontSize=9.5, leading=13, leftIndent=14, spaceAfter=2,
    bulletIndent=4, textColor=colors.HexColor("#222222"))

CAPTION = ParagraphStyle("CAPTION", parent=BASE["Normal"],
    fontSize=8.5, textColor=colors.HexColor("#555555"),
    alignment=TA_CENTER, spaceAfter=8, italic=True)

HIGHLIGHT = ParagraphStyle("HIGHLIGHT", parent=BASE["Normal"],
    fontSize=9.5, leading=13, leftIndent=12,
    backColor=colors.HexColor("#eaf2fb"),
    borderPad=6, spaceAfter=6,
    textColor=colors.HexColor("#1a3a5c"))

SOURCE = ParagraphStyle("SOURCE", parent=BASE["Normal"],
    fontSize=8, textColor=colors.HexColor("#888888"),
    alignment=TA_CENTER, spaceBefore=20, italic=True)

def h1(text):
    return Paragraph(f"  {text}", H1)

def h2(text):
    return Paragraph(text, H2)

def h3(text):
    return Paragraph(text, H3)

def body(text):
    return Paragraph(text, BODY)

def bullet(text):
    return Paragraph(f"•  {text}", BULLET)

def highlight(text):
    return Paragraph(text, HIGHLIGHT)

def sp(n=6):
    return Spacer(1, n)

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#cccccc"), spaceAfter=4)

# ── Build content ─────────────────────────────────────────────────────────────
story = []

# Title block
story.append(sp(10))
story.append(Paragraph("Senile (Age-Related) Cataract", TITLE))
story.append(Paragraph("Based on Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Edition", SUBTITLE))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#1a3a5c"), spaceAfter=14))

# ── DEFINITION ───────────────────────────────────────────────────────────────
story.append(h1("1. Definition"))
story.append(body(
    "<b>Cataract</b> is opacification of the crystalline lens. "
    "<b>Senile (age-related) cataract</b> refers to lens opacity that occurs as a consequence of normal ageing. "
    "It is the <b>commonest cause of reversible visual disability in the world.</b>"
))
story.append(highlight("⚠ There is NO medical treatment to prevent the development or progression of cataract. "
    "Phacoemulsification with IOL implantation is the definitive treatment."))
story.append(sp())

# ── ANATOMY ──────────────────────────────────────────────────────────────────
story.append(h1("2. Lens Anatomy"))
story.append(body(
    "The lens is a biconvex, transparent structure held in place by <b>zonules</b> arising from the ciliary body. "
    "Its primary function is to focus light on the retina."
))
bullet_items = [
    "<b>Capsule</b> – acellular membrane enclosing the lens",
    "<b>Epithelial cells</b> – cuboid cells beneath the anterior capsule; <b>germinative zone</b> cells divide continuously and differentiate into lens fibres",
    "<b>Cortex</b> – peripheral lens substance made of newer lens fibres",
    "<b>Nucleus</b> – central, denser older lens fibres",
]
for b in bullet_items:
    story.append(bullet(b))

story.append(sp(8))
img = RLImage(anatomy_img, width=TW*0.85, height=TW*0.85*0.42)
story.append(img)
story.append(Paragraph("Fig. 10.1 – (A) Cross-sectional anatomy of the anterior segment; (B) Histological cross-section of the lens showing zones", CAPTION))
story.append(sp())

# ── EFFECT ON VISION ─────────────────────────────────────────────────────────
story.append(h1("3. Effect on Vision"))
story.append(body(
    "Cataracts develop slowly and in early stages alter vision subtly. "
    "The effect depends on: (a) type of cataract, (b) extent of opacification, (c) position of opacification."
))

symptoms_data = [
    ["Symptom", "Mechanism"],
    ["Reduced visual acuity", "Progressive opacification; initially correctable with glasses"],
    ["Loss of contrast sensitivity", "Light scattering within the lens"],
    ["Change in colour perception", "Difficulty perceiving blue colours (urochrome pigment)"],
    ["Glare", "Light scattering; worse at night (e.g. oncoming car headlights)"],
    ["Monocular diplopia", "Especially with point light sources"],
    ["Poor night vision", "Reduced light transmission through opaque lens"],
]
t = Table(symptoms_data, colWidths=[TW*0.4, TW*0.6])
t.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3a5c")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f0f5fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#bbbbbb")),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(t)
story.append(sp())

# ── TYPES ─────────────────────────────────────────────────────────────────────
story.append(h1("4. Types of Age-Related Cataract"))

story.append(sp(8))
img2 = RLImage(types_img, width=TW*0.9, height=TW*0.9*1.18)
story.append(img2)
story.append(Paragraph(
    "Fig. 10.2 – Age-related cataract: (A) Posterior subcapsular; (B) PSC on retroillumination with Wedl cells (arrow); "
    "(C) Nuclear sclerosis; (D) Nuclear sclerosis on retroillumination – nucleus-cortex demarcation (arrow); "
    "(E) Cortical cataract; (F) Cortical spokes on retroillumination; (G) Christmas tree; (H) Christmas tree on retroillumination",
    CAPTION))
story.append(sp())

# Type 1
story.append(h3("4.1 Posterior Subcapsular Cataract (PSC)"))
for b in [
    "Located just in front of the <b>posterior capsule</b>",
    "Granular or plaque-like on oblique slit lamp; <b>black and vacuolated on retroillumination</b>",
    "Vacuoles = swollen migratory lens epithelial cells (<b>Bladder cells / Wedl cells</b>)",
    "Located at the <b>nodal point</b> of the eye → even small opacity causes profound visual loss",
    "Characteristic symptom: <b>glare</b> from oncoming headlights",
    "Symptoms worsen with <b>miosis</b> (near tasks, bright sunlight)",
]:
    story.append(bullet(b))

story.append(sp(4))

# Type 2
story.append(h3("4.2 Nuclear Sclerotic Cataract"))
for b in [
    "Exaggeration of normal ageing change",
    "Causes <b>myopia</b> due to increased refractive index of nucleus",
    '<b>"Second sight of the aged"</b> – elderly patients can read without glasses again',
    "<b>Yellowish hue</b> due to deposition of <b>urochrome pigment</b>",
    "Best assessed with <b>oblique slit lamp beam</b>",
    "When advanced: nucleus appears <b>brown (brunescent)</b>; rarely <b>black (nigra)</b>",
]:
    story.append(bullet(b))

story.append(sp(4))

# Type 3
story.append(h3("4.3 Cortical Cataract"))
for b in [
    "Involves anterior, posterior or equatorial cortex",
    "Begins as <b>clefts and vacuoles</b> between lens fibres due to cortical hydration",
    "Progresses to <b>cuneiform (wedge-shaped) or radial spoke-like opacities</b>",
    "Often initially in the <b>inferonasal quadrant</b>",
    "<b>Glare</b> is a common symptom",
]:
    story.append(bullet(b))

story.append(sp(4))

# Type 4
story.append(h3("4.4 Christmas Tree Cataract"))
for b in [
    "Polychromatic, needle-like crystalline deposits",
    "Multicoloured sparkling appearance (like a Christmas tree)",
    "Seen on direct illumination and retroillumination",
]:
    story.append(bullet(b))

story.append(sp())

# ── MATURITY ──────────────────────────────────────────────────────────────────
story.append(h1("5. Cataract Maturity (Stages)"))

maturity_data = [
    ["Stage", "Description"],
    ["Immature", "Lens partially opaque; red reflex still present"],
    ["Mature", "Lens completely opaque; red reflex absent"],
    ["Hypermature", "Shrunken, wrinkled anterior capsule due to water leakage out of the lens"],
    ["Morgagnian", "Hypermature cataract with liquefied cortex; nucleus sinks inferiorly"],
]
t2 = Table(maturity_data, colWidths=[TW*0.25, TW*0.75])
t2.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#2e6da4")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f0f5fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#bbbbbb")),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(t2)
story.append(sp())

# ── SYSTEMIC ASSOCIATIONS ─────────────────────────────────────────────────────
story.append(h1("6. Cataract in Systemic Disease"))

story.append(h3("6.1 Diabetes Mellitus"))
for b in [
    "Hyperglycaemia → high aqueous glucose → diffuses into lens",
    "Glucose metabolized to <b>sorbitol</b> (aldose reductase) → osmotic overhydration",
    "Refractive fluctuation with plasma glucose: hyperglycaemia = <b>myopia</b>",
    "Classic <b>snowflake cortical opacity</b> – rare; young diabetics; may mature within days",
    "Age-related cataract occurs <b>earlier</b> in diabetics; nuclear sclerosis rapid",
    "~1 in 5 cataract surgery patients have diabetes",
]:
    story.append(bullet(b))

story.append(sp(4))
story.append(h3("6.2 Other Systemic Associations"))
for b in [
    "Chronic steroid use → posterior subcapsular cataract",
    "Myotonic dystrophy",
    "Neurofibromatosis type 2",
    "Down syndrome",
    "Galactosaemia (in children)",
]:
    story.append(bullet(b))

story.append(sp())

# ── SECONDARY CATARACT ────────────────────────────────────────────────────────
story.append(h1("7. Secondary (Complicated) Cataract"))
story.append(body(
    "Develops as a result of primary ocular disease."
))

secondary_data = [
    ["Cause", "Features"],
    ["Chronic anterior uveitis", "Most common cause; both inflammation and steroid therapy causative; polychromatic lustre at posterior pole earliest sign"],
    ["Acute angle closure glaucoma", "Glaukomflecken – small grey-white subcapsular opacities (focal lens epithelial infarcts); pathognomonic"],
    ["High myopia", "Posterior subcapsular opacity + early nuclear sclerosis"],
    ["Hereditary fundus dystrophies\n(RP, Leber, gyrate atrophy, Stickler)", "Usually posterior subcapsular opacity"],
]
t3 = Table(secondary_data, colWidths=[TW*0.38, TW*0.62])
t3.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3a5c")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f0f5fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#bbbbbb")),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(t3)
story.append(sp())

# ── MANAGEMENT ────────────────────────────────────────────────────────────────
story.append(h1("8. Management"))

story.append(h3("8.1 Indications for Surgery"))
for b in [
    "Cataract significantly impairs quality of life or daily activities",
    "Secondary complication (e.g. phacomorphic glaucoma, phacolytic glaucoma)",
]:
    story.append(bullet(b))

story.append(sp(4))
story.append(h3("8.2 Surgical Methods"))

surgical_data = [
    ["Method", "Details"],
    ["Phacoemulsification\n(GOLD STANDARD)", "Ultrasonic emulsification via small incision (~2.4–2.8 mm); foldable IOL implanted; rapid recovery, low astigmatism"],
    ["ECCE (Manual Extracapsular)", "Larger incision; nucleus expressed intact; used where phaco unavailable or for hard brunescent nuclei"],
    ["ICCE (Intracapsular)", "Entire lens including capsule removed; largely obsolete"],
]
t4 = Table(surgical_data, colWidths=[TW*0.32, TW*0.68])
t4.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#2e6da4")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f0f5fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#bbbbbb")),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(t4)

story.append(sp(4))
story.append(h3("8.3 Key Preoperative Considerations"))
for b in [
    "<b>Alpha-blockers</b> (e.g. tamsulosin) → <b>Intraoperative Floppy Iris Syndrome (IFIS)</b> – must be disclosed",
    "Manage <b>anticoagulants</b> per local protocol (check INR within 24 h in stable patients)",
    "Screen for allergy: iodine, latex, antibiotics, sticking plaster",
    "Check for MRSA carriage",
    "<b>Pupillary RAPD</b> – cataract never causes RAPD; if present, suggests posterior pole pathology",
    "Corneal endothelial cell count (specular microscopy) if cornea guttata suspected",
]:
    story.append(bullet(b))

story.append(sp())

# ── HIGH YIELD ────────────────────────────────────────────────────────────────
story.append(h1("9. High-Yield Exam Points"))

hyl = [
    ("Most common cause", "Reversible blindness worldwide"),
    ("No medical treatment", "Prevents or reverses cataract"),
    ("PSC", "Worst impact per opacity size (nodal point); worse with miosis"),
    ("Nuclear sclerosis", "Myopia + 'second sight'; yellow/brown hue; urochrome pigment"),
    ("Cortical", "Spoke-like opacities; starts inferonasally"),
    ("Morgagnian", "Liquefied cortex; nucleus sinks — hypermature stage"),
    ("Glaukomflecken", "Pathognomonic of previous acute angle closure"),
    ("Second sight of aged", "Nuclear myopia → can read without glasses"),
    ("Gold standard surgery", "Phacoemulsification + IOL"),
    ("Tamsulosin", "Alpha-blocker → causes IFIS during phaco"),
]
hyl_table = Table(hyl, colWidths=[TW*0.35, TW*0.65])
hyl_table.setStyle(TableStyle([
    ("FONTNAME", (0,0), (-1,-1), "Helvetica"),
    ("FONTNAME", (0,0), (0,-1), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [colors.HexColor("#eaf2fb"), colors.HexColor("#f7fafd")]),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#bbbbbb")),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("TEXTCOLOR", (0,0), (0,-1), colors.HexColor("#1a3a5c")),
]))
story.append(hyl_table)
story.append(sp(20))

story.append(hr())
story.append(Paragraph(
    "Source: Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Edition – Chapter 10: The Lens  |  "
    "Generated by Orris Medical AI  |  For educational purposes only",
    SOURCE))

# ── Build ─────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")