Cataracts

What you might see if you have cataracts

Some Background Information

Cataracts are a leading cause of blindness among adults in the United States, accounting for one out of every seven cases of blindness in people 45 years of age or older. Although most prevalent in older adults, a cataract can occur in young people, and can sometimes be found in a baby’s eyes at birth.

As medical advances have succeeded in lengthening the human life span, more and more Americans are-and will be-entering the age group associated with the development of the cataract condition. It has been said that if we live long enough, most of us will develop a cataract.

The treatment for a cataract is surgery, which offers a safe and successful means to restore vision in more than 95 out of 100 cases!

This means that the cataract patient no longer has to accept blindness from cataract as a price of aging. A highly effective and proven method exists to return the patient to a world of vision.

What is a cataract?

A cataract is an opacity or clouding of the eye’s lens, which blocks or changes the passage of light needed for vision. The lens of the eye is located behind the pupil and the colored iris, and normally is transparent. Its role is to help focus images onto the retina at the back of the eye, which transmits the images to the brain.

The underlying cause of cataract formation has not yet been determined, although it is known that a cataract is associated with chemical changes in the lens. Most often a cataract is related to the normal aging of the person and the eye. Other factors that may play a role include:

• exposure to intense heat or long-term exposure to ultraviolet radiation (called UV rays) emitted by the sun;
• inflammation within the eye;
• hereditary influences and congenital events, such as German measles in the mother;
• some medications, such as long-term steroid therapy;
• physical and chemical injury to the eye; and
• eye diseases and certain systemic diseases, including diabetes.

What are the symptoms?

Cataract formation is generally not associated with symptoms such as pain, redness or tearing. The symptoms of a cataract all revolve around diminished vision:

• blurred vision, double vision, ghost images, the impression of a “film” over the eyes;
• problems with light, such as finding lights not bright enough for reading or near work, or being “dazzled” by intense light; and
• the need for frequent changes of eyeglass prescriptions, which may not improve vision.

As one eye physician has described it, “You need more light on your work, but less light near your eyes.”

Furthermore, as a cataract develops it may be noticeable to others as a milky or yellowish spot in the normally black pupil.

When the area of clouding is small and away from the center of the lens, there may be little interference with vision, except for the annoyance of corresponding loss of detail in the visual image. If a cataract progresses a great deal, however, or if the cataract began in the center of the lens, visual difficulty may be noticeable and may interfere with everyday activities. The eye surgeon usually advises surgery when this point of “life interference” is reached.

A cataract is not contagious, is not a kind of infection and is not tissue growing over the eye. It will not be made worse by using the eyes, nor can it be made better by medicines. Other than surgical removal of the cataract, there are no proven treatments, eye drops or other medications that will dissolve a cataract or slow down its progression.

A cataract may develop rapidly over a period of a few months, or it may progress very slowly over a period of years. In other instances it may progress so far and then stay the same-many people never experience visual difficulty to the point that the eye doctor will advise surgery.

What can be done?

The only proven effective treatment of a cataract is surgery. Although it is a delicate operation, it is one of the safest operations done today. Cataract surgery has been perfected to the point where success is attained in more than 95 out of 100 cases. In fewer than five percent of cases, the surgery can be complicated by inflammation, bleeding, infection and retinal detachment. Generally, cataract surgery is needed when the cataract causes enough vision loss to interfere with a patient’s livelihood, recreation or daily activities. The patient and eye surgeon should work together to decide when surgery is needed, in accordance with the patient’s degree of vision loss, interference with normal life activities and other important factors.

In cataract surgery, the clouded lens is removed. There are varying techniques for the surgical procedure itself. The eye surgeon will select the method best suited for the patient, considering such factors as the degree of the cataract, the age of the patient, the patient’s general health, other ocular conditions and any other important influences.

Cataract removal can be done by cutting the front lens capsule with a tiny surgical scalpel and by breaking up the lens with an ultrasonic needle and extracting it with suction.

The patient who is hesitant about surgery may feel better when he or she considers the number of advances in this field. Most patients go home the same day and, depending on their condition, some go home in a few days.

Cataract surgery is like taking the lens out of a camera. Substitute lens power is needed so that the eye can focus images onto the retina, as a camera lens focuses images on film.

Today a patient has three choices for a substitute lens:

• cataract eyeglasses (which at one time were the only answer);
• contact lenses; or
• an intra ocular lens implant.

Currently, a lens implant is used in most cataract operations. This is a plastic lens inserted into the eye to replace the cataract-damaged lens that is removed. But not everyone is a candidate for implants. For people who are extremely nearsighted or who have certain eye diseases, lens implants may not be advisable. Sometimes complications arising from an implanted lens can necessitate removal of the lens, but such problems are rare.

Contact lenses can be prescribed instead. They are thin plastic disks placed by a finger on the outside surface of the eye. They now include soft, extended-wear types that are removed periodically-rather than daily-for required cleaning.

Will vision be normal?

Depending on the method used to correct vision, the patient’s vision may be near normal. The intra ocular lens implants provide vision that is closest to an unclouded human lens. However, the patient may not be able to see distant objects clearly for as long as two months after the operation. Even then, thin eyeglasses may be needed to refine vision for near or distant work.

Contact lenses for a cataract patient magnify things only about eight percent, and there is no loss of side vision-the lenses move with the eyes.

Cataract eyeglasses provide satisfactory but not normal vision. They magnify everything about 30 percent, and there is a loss of side vision-the patient must turn his or her head and look straight at objects. Although cataract glasses may be given to a patient immediately after the operation, the curvature of the cornea may change during the first six weeks due to the healing process. This means that the type of glasses used to correct the patient’s vision may also need to be changed during healing.