Cataracts

Vision_Care_Associated_Cataracts_1

What Are Cataracts?

A cataract is the clouding of the internal lens of the eye. Cataracts occur in about 50% of people ages 65 to 74. Once you get into the age bracket of over 75, about 70% of the population will develop cataracts. Cataracts can be worse in one eye, but they are usually found in both eyes.


What are the common symptoms?

There are several symptoms of cataracts. The main symptom is cloudy, fuzzy, foggy or filmy vision. Another common symptom is the glare from headlights when driving at night, or glare from lights or the sun. Colors can also become dull. Frequent changes in your prescription are common. Some patients with cataracts see double images, ghost images, or halos around lights.


Who is at risk?

Although most patients develop cataracts in their 60s and 70s, some may start to notice early symptoms as early as their 40s or 50s. There are many people who have early cataracts, which are not severe enough to require surgery. Other factors that can increase the risk of cataracts at a younger age include diabetes, family history of cataracts, previous eye injury, some medications (corticosteroids such as cortisone, predisone), excessive sun exposure, and previous radiation therapy to the eye area.

Studies have been shown that by shading your eyes, you can decrease the risk of cataracts. "Shading your eyes," means using UV protected glasses. If you do not need prescription sunglasses, make sure the UV protection says "UV absorption up 400 nm (nanometers)" or "100% UV-A and UV-B filter". The darkness of the lenses has no bearing on the effectiveness of the UV filter. If you wear prescription sunglasses, make sure you get the UV protection. That is the reason you are getting the sunglasses anyway. A close fitting wrap style of sunglass does offer the best protection. You can get the UV protection on your clear prescription glasses at any time. This coating is clear and does not affect your vision. The other way to help protect your eyes, besides sunglasses, is to wear a wide brim hat.


How are they diagnosed?

Eye exams are the way to detect cataracts. Between the ages of 40 and 65, you should have your eyes examined every 1-2 years. After the age of 65, you should have your eyes examined at least once a year. Components of the eye exam should include a visual acuity test, pupil dilation and tonometry, or a pressure check. These aspects of the eye exam will help the doctor determine whether the cataract is ready for surgery. Once the cataract affects your daily activities, such as reading, driving, using a computer, sewing, or other hobbies, then it is time to consider surgery.


Treatment of cataracts

Before having cataract surgery, you may want to try other options first. Often, a change in eyeglass prescription will improve your vision for a while. A magnifier or a stronger reading light will help with reading small print. Cataract surgery will improve the vision in over 95% of patients.


The surgical procedure of removing a cataract

Before the surgery is scheduled, important eye measurements are taken during an examination. These measurements precisely determine the length of the eye and the curvature of the cornea, and help to determine the lens power of the intraocular lens implant (IOL) that will be inserted during the surgery. The cataract surgery is usually done on an outpatient basis.

After numbing the eye, a very small incision (3mm or 1/8th in.) is made in edge of the cornea. The next step is phacoemulsification, which uses ultrasound power to remove the hard, central portion of the cloudy lens. Lasers are never used during the actual cataract surgery. This is a common misconception. Once the cloudy cataract lens is removed, it is replaced by a crystal clear lens implant. The whole procedure usually takes 10-15 minutes. Usually patients are awake, but very relaxed and comfortable with a mild sedative.

When you leave the outpatient surgical center, you will be wearing an eye patch. This is to be left on throughout the day and will be removed the following day. Most activities can be resumed shortly after the surgery, but you should avoid heavy lifting, and vigorous sports activities. You will need a driver on the day of surgery, because the surgery centers do not allow patients to drive after receiving a sedative.


What happens after surgery?

Your vision may be blurry for a few days from mild swelling of the cornea. Your old eyeglass prescription will no longer be correct for your eye. Your vision will gradually improve, and you will be given a new prescription about one month after surgery. Once again, you should avoid heavy lifting (nothing over 20 pounds), swimming and aerobics for once week. It is ok to cook, walk, bend at the knees, ride a bicycle, and even play a round of golf the next day. You may return to work within one to two days if you avoid heavy lifting and exertion. You will be given three different eye drops to use. These drops reduce inflammation, and help prevent infections. You should also wear a protective eye shield at bedtime for the one week.

You will usually receive your new glasses about 4-6 weeks after the surgery. Your vision and your eyeglass prescription will fluctuate during the first few weeks after surgery. If you need surgery on the other eye, it is best to wait until the second eye surgery is done before getting your new glasses.


What are the benefits and risks of cataract surgery?

Benefits of the surgery are improved vision for everyday activities, and reduced glare symptoms. Once you have cataract surgery, you may also experience an increase in self-confidence, independence and your own safe well being because you will be able to see better again.

There are risks involved in any surgery. The risks of cataract surgery are very rare, but still present. They may include high intraocular pressure, serious internal eye infection, mild drooping of the upper eyelid, retinal detachments, swelling and clouding of cornea, and very rarely, loss of vision. Complications occur in less than 2% of surgeries. The doctor will go over the risks and answer any question you may have about the surgery.


Can cataracts grow back again?

No, cataracts never grow back once they have been removed. Although the lens implant will remain clear forever, the natural lens capsule may slowly become cloudy in some patients. The lens capsule is the outer layer of the human lens, and it holds the lens implant within the eye after surgery. This lens capsule may become cloudy months or years after the actual cataract surgery. If this happens, a YAG laser capsulotomy is performed. This is done on an outpatient basis in the doctor's office. A laser beam is used to create a small opening in the cloudy lens capsule.