What are Cataracts?
Cataracts are the painless clouding of the eye’s normally clear lens. This is a common eye condition that can happen normally with aging. They usually take years to develop but overtime reduce the quality of vision in the affected eye. The cataract or clouded lens scatters light and makes it harder for the eye to focus light into a clear image. Think of it like looking through a froggy window. Cataracts can form in both eyes. But one lens may become cloudy faster or more severely than the other. Cataracts are a significant cause of vision loss, especially in older adults, if not treated properly.
Common Symptoms of Cataracts:
- Cloudy or blurry vision
- Trouble seeing at night
- Seeing glare or halos around lights
- A change in how you see colors or color fading
- Double vision can occur usually in one eye
- Increased nearsightedness resulting in changes in eyeglass prescriptions
These symptoms usually occur gradually over a long period of time. It is common to not notice any of these symptoms in the early stages of cataract development. Therefore, it is important to not take any of these symptoms lightly. If experienced, it is important to see an eye care provider immediately.
What Causes Cataracts?
For most, cataracts are a natural part of aging. Age-related cataracts may start to develop by the age of 40. Whereas the average age of cataract removal surgery is 73 years old. Other causes of cataracts include:
- Genetics: Family history can increase risk of developing cataracts and genetic mutations can cause cataracts at birth
- Congenital: Cataracts that occur at birth can be caused due to exposure to infections, metabolic syndromes, or genetic mutations
- Medical Conditions: Diabetes and other health issues can increase the risk of cataract development
- Long-term Sunlight Exposure: Prolonged exposure to UV rays can contribute to cataract formation
- Eye Injury: Traumatic cataracts can form after blunt or penetrating eye injury
- Long-term use of Steroid Medications: Studies show that long-term use of high-dose steroids can promote cataract formation
Diagnosing Cataracts
An eye care provider will perform a full evaluation to assess eye health and determine the development of cataracts. This will include discussion of full medical history, vision tests, and an eye exam. This evaluation will most likely occur with an optometrist. Based on the results, the optometrist can refer you to an ophthalmologist to discuss advanced cataract treatment options.
Your Medical History
An eye care provider will assess full medical history by asking questions about possible vision and other eye problems. They will also ask about other health problems such as diabetes, hypertension, and so on. It is important to disclose all pertinent information including any medications, supplements, or herbal remedies being consumed.
Testing Your Vision
An eye care provider will perform several tests to check your vision. This includes using a Snellen eye chart and testing your vision under different lighting. Bring any eyeglasses or contacts you may wear to this exam so that the eye care provider can check your prescription. It may be possible that simply updating to a new prescription for eyeglasses will improve your vision.
Examining Your Eye
An eye care provider will use a slit lamp and an ophthalmoscope, during an eye exam, to look inside your eye. The use of eyedrops to dilate the pupils may occur before the exam. This will allow the provider to get a better look at the components of the eye.
Discussing Your Treatment Options
An eye care provider will discuss your treatment options after the full evaluation and exam is completed. A new prescription for eyeglasses or contacts may provide temporary improvement of your vision. However, surgery is the only way to remove a cataract and provide long term improvement of vision. Usually, if the slow development of a cataract is not interfering in your daily life, it may be feasible to wait to have it removed through surgery. Together you and your eye care team will decide what’s best for you.
Removing Cataracts
The only effective treatment for cataracts is surgery. Cataract surgery involves the removal of the clouded natural lens and replacement with a clear artificial lens by a trained ophthalmologist who most often specializes in cataract surgery.
Measuring Your Eye
Before surgery, several measurements of the affected eye need to be taken. A special tool called an A-scan will measure the length of the eyeball. Having accurate measurements helps an eye care provider choose the appropriate new lens to replace the cloudy lens.
Types Of Incisions
To remove the cloudy lens an incision will be made in the affected eye. The size of the incision depends on the procedure used to remove the lens. A microscope and tiny tools or a laser can be used to make the incision.
- Small incisions heal quickly and often do not need stitches. These are normally used with the phacoemulsification method of removing the lens.
- Large incisions are used why the entire cloudy lens is removed at once typically with the extracapsular extraction method. Stitches may be needed to close the incision.
- Limbal relaxing incisions are used in cases of severe astigmatism. These are small incisions made at the edge of the cornea to change its shape and may help improve vision. These incisions are made in addition to lens removal incisions.
Phacoemulsification
Out of the two standard procedures to remove a cloudy lens, phacoemulsification utilizes ultrasound to break the lens into small pieces for removal. In this method, after a small incision is made, an ultrasound probe in inserted into the lens. Sound vibrations from the probe breaks the cloudy lens into tiny pieces, which are then suctioned out. A new lens will then be put in its place. Stitches are usually not needed in this procedure
Extracapsular Extraction
The other standard procedure to remove a cataract is extracapsular extraction. This method involves removing an entire lens and requires a larger incision to be made. After the incision is made, a tool called the lens loop will be uses to remove the clouded lens. A new lens will then be put in its place. Stitches are usually necessary to close the incision in this method.
Intraocular Lens (IOL)
The artificial lens that will replace the cataract are called intraocular lens (IOL). The eye care team will choose the type of IOL that is best suited to fit the eye and vision needs. An IOL does not change the appearance of your eye but can possibly improve vision. Glasses may still be necessary for certain tasks even with the placement of an IOL. The IOL is meant to last a lifetime.
Cataract Surgery in a Nutshell
Preoperative preparation is usually minimal for cataract surgery. Typically, you will be asked to refrain from consuming any food or beverages for a few hours before the surgery. Eye drops to the dilate the pupil will be administered. Local anesthesia in the form of numbing drops is usually administered as well. It may possible that an oral sedative is given to help you relax. Cataract surgery typically takes about 15 to 30 minutes per eye to complete in an outpatient setting. Meaning that you will most likely go home the same day. It’s important to have someone available to drive you home, as your vision will be blurry, and you may feel the effects of the sedative. You will also need to follow specific aftercare instructions to ensure proper healing.
References
Isaacs R, Ram J, Apple D. Cataract blindness in the developing world. Journal of Agromedicine. 1996;3(4):7-21. doi:10.1300/j096v03n04_02
Kauh CY, Blachley TS, Lichter PR, Lee PP, Stein JD. Geographic variation in the rate and timing of cataract surgery among US communities. JAMA Ophthalmology. 2016;134(3):267. doi:10.1001/jamaophthalmol.2015.5322
Kiziltoprak H, Tekin K, Inanc M, Goker YS. Cataract in diabetes mellitus. World Journal of Diabetes. 2019;10(3):140-153. doi:10.4239/wjd.v10.i3.140
Shiels A, Hejtmancik JF. Biology of inherited cataracts and opportunities for treatment. Annual Review of Vision Science. 2019;5(1):123-149. doi:10.1146/annurev-vision-091517-034346
Thompson J, Lakhani N. Cataracts. Primary Care: Clinics in Office Practice. 2015;42(3):409-423. doi:10.1016/j.pop.2015.05.012
