All About Cataracts

What is a cataract?

The healthy lens of the eye is transparent, and its role is to concentrate light on the retina in order to get a clear and focused view of the object in front of it.  A cataract appears as cloudiness on the lens of the eye.  The cloudiness obscures the light as it travels to the retina, and as a result the eye receives a blurred picture.  It is similar to looking through a dirty window, and as the cataract develops it becomes like a curtain that blocks the sight completely. This opacity in the lens develops generally as part of the process of aging, but it could be also result of injury in the eye, certain diseases or as a side effect of certain medicines.  Likewise, genetic factors can influence the development of cataracts.

There are common misconceptions about cataracts, but the cataract:

• Is not an enlarged membrane of the eye
• Is not the result of overuse of the eyes
• Is not contagious
• Does not cause irreversible blindness.

Common symptoms that indicate the presence of a cataract:

• Blurring of vision that is not accompanied by pain
• High frequency of change in the eyeglass prescription
• Hypersensitivity to light
• Sudden dazzling light (such as during driving)
• Double vision
• Need for stronger the illumination for reading
• Weak night vision
• Discoloration or yellowing of visible colors.

The major risk factor for cataracts is the aging process.

Other factors are:

• Family background
• Medical problems, such as diabetes
• Injuries to the eye
• Certain drugs, such as steroids
• Exposure to the sun, over many years, without protection (such as sunglasses)
• Previous eye surgery.

How does the cataract develop?

The majority of cataracts develop by chance.  The cataract that results as a process of aging of the eye can develop by degrees over a period of years.  Cataracts in diabetics and young people can develop over a period of months.

How are cataracts diagnosed?

An ophthalmologist can diagnose the existence of cataracts and determine their seriousness, and the existence of other problems that can endanger the vision, as well as issues with the retina.  If there are additional problems, they can be treated, and after the removal of the cataract there can be a significant improvement in the vision.

How are cataracts treated?

It is possible to remove the cataract completely only with surgery.  It is not possible to treat cataracts with medicines or laser therapy (there is some confusion on the subject of laser treatment, and many sufferers believe it is effective, but the laser has no effect on the cataract.)  If the symptom is blurred vision it is easy to make adjustments to the lens to restore proper vision. If the cataract becomes irritated later, it can be treated with surgery.

Currently there are no medicines, nutritional replacements, physical activity or optical devices that can deter or treat cataracts. Protecting the eyes from sun damage with sunglasses that filter U.V. rays can help prevent development of cataracts or can slow down the development process.

It is important to stress that there is no treatment for cataracts other than surgery.  Your ophthalmologist can tell you how far your cataract has developed.

When should you have cataract surgery?

You should consider surgery when the weakness of vision interferes with normal living.  There is no need to wait until the cataract develops further before removing it.  It is up to you to determine the time and place of the surgery according to needs of your vision.  Is your vision sufficient for your work?  For driving?  Can you read or watch television comfortably?  Can you see well enough to execute daily activities such as cooking, shopping and taking medicines?  Based on the answers to these questions you and your ophthalmologist will fix the appropriate time and place for the surgery.

What can you expect from cataract surgery?

Before the surgery

Your ophthalmologist will fix for you the date of the surgery.  Close to the day of surgery your eye will be measured in order to determine what lens will be transplanted.

On the day of the surgery

The surgery usually is done using local anesthesia, on an outpatient basis.  Before the procedure drops are administered to dilate the pupil in the affected eye.  Because the surgery is done under local anesthesia, you will be awake during the surgery.  The second eye will be covered during the surgery.  During the surgery you may be able to see some movement but during the surgery you will not be able to see anything. 

The surgeon will use a microscope during the surgery and make a small incision in the eye.  The damaged lens will be removed, and a special plastic lens transplanted.  Afterwards the surgeon will close the cut, using stitches if necessary. When the surgery is complete, the eye will be cleaned and disinfected, then covered with a sterile bandage.  After a short observation time you will be released, and asked to return the next morning for examination

After the surgery

After the surgery you will be asked:

·       to use the eye drops ordered by the surgeon.

·       to be careful to avoid abrasion or pressure on the eye.

·       to use a pain medicines (such as aspirin or ibuprofen) if needed.

·       to avoid using the eye until it has recover (the doctor will specify a number of weeks).

·       to continue your usual daily routines and easy exercise.

·       ask the doctor when you will be able to return to driving.

·       to use glasses, sunglasses or eye patch as directed by the doctor.

Is a laser ever used with cataract surgery?

Laser surgery does not constitute a part of the cataract surgery.  However, there are times when the rear membrane of the lens can lose transparency a number of months or years after the original surgery.  If this leads to blurred vision, it is possible to restore transparency using laser treatment.  This treatment sometimes is referred to as ancillary cataract removal, but this is only the secondary treatment of the lens and has nothing to do with the cataract.

Will cataract surgery really improve my vision?

The percentage of success in the surgical removal of the cataract is excellent, and in the majority of cases the vision improves as a result of the surgery.  In United States, over one million people have cataract surgery every year, and of these about 95% complete the surgery without significant complications.  When patients have the disease Glaucoma, the cataract surgery is more complicated, but even these patients achieve significant improvement with cataract surgery.  With Glaucoma there is a chance of complications during and after cataract surgery, but you should not hesitate to visit your ophthalmologist as soon as possible!

Possible complications:

Complications occur, only rarely, in a very small number of patients, which can damage the vision:

¾     bacterial infection

¾     hemorrhage

¾     detached retina

¾     Need for additional surgery

You should call your ophthalmologist as soon as possible, especially in the first two weeks after the surgery if you experience any of the following:

·     pain not relieved by analgesic (such as aspirin or ibuprofen). 

·     loss of vision or significant blurriness

·     injury of the eye after the surgery

·     white or yellow discharge

·     other diseases in the treated eye

In conclusion:

·      Cataracts cause decreased quality of vision, mainly among the adult population

·      Cataracts are treatable!

·      Your ophthalmologist can tell you why your vision is affected, diagnose cataracts, and recommend the appropriate treatment for you

·      If your cataracts are serious enough, you can have surgery to correct them.

·       There are additional diseases that can affect your vision, and even if you have the cataract surgery it is possible that your vision will not be greatly improved.  These diseases include macular degeneration, severe Glaucoma, and diabetes can limit your vision after the surgery.  Your doctor will be able to diagnose these diseases and explain to you the expected outcome of the surgery.