What Are Cataracts?
A cataract is a clouding of the normally clear lens of the eye. The lens, which lies just behind the pupil, helps the eye to focus. When the lens becomes clouded, the passage of light to the back of the eye is partially blocked, and a person’s ability to see is reduced. This clouding of the lens of the eye is called a cataract. Thus, a cataract is not a growth or a tumor, but a change in the clarity of the lens.Cataracts may form in the eyes of people of any age, but they are most common in older adults. In fact, after age 65, many people have a cataract. It is important to remember that if you have a cataract, you may not necessarily require an operation because many people have some minor clouding of the lens that does not affect vision. An operation to remove the cataract becomes necessary only if the patient’s vision and ability to function become impaired. If you do need an operation to remove a cataract, you should know that advances that have been made in cataract operations in recent years have made cataracts one of the most treatable of eye disorders.
Remember, as common as cataract surgery is, no two people undergoing the procedure are alike. The reasons for and the outcome of any operation depend on your overall health, age, the severity of lens opacity (cloudiness), and any other abnormalities of the eye or existing health conditions.
What Causes Cataracts?
Most people who develop cataracts are older adults. Almost everyone over the age of 65 has a cataract in one or both eyes that interfere with vision. Diseases, such as diabetes, and the long-term use of some medications, such as corticosteroids, can contribute to the formation of cataracts. Physical injuries, such as a puncture wound to the eye, and injuries caused by chemicals hitting the eye or by exposure to excessive X-rays, intense heat or, possibly, too much sunlight also can cause cataracts. In addition, smokers tend to have a higher occurrence of cataracts than non-smokers.
Cataracts may take years to form, or they may worsen rapidly in a few months. Furthermore, cataracts can affect both eyes at the same time, but they may develop at different rates. People with cataracts often experience one or more of the following symptoms:
- Blurred or hazy vision.
- Poor vision at night or in very bright light
- Difficulty driving, especially at night because of glare from headlights of oncoming cars.
- Seeing “ghost” images.
- Change in color vision.
- Loss of contrast.
- Poor distance vision.
Many people do not need to have an operation for a mild cataract. But when a cataract begins to interfere with your ability to carry out desired tasks — for instance, if you have difficulty reading a newspaper or you experience difficulty driving — it is time to discuss the option of a cataract operation with your ophthalmologist
Can Cataracts Be Treated Non-Surgically?
Cataracts do not go away on their own or with the use of medication. The only way to treat cataracts is to have them removed surgically. However, there are a few things that can be done to provide temporary relief from the symptoms of cataracts until an operation can be performed. Eye drops that widen the pupil of the eye may help you to see better if the cataract is small and near the back of the lens; your surgeon will be able to determine the exact location of the cataract and whether eye drops may be a temporary option for you. Wearing sunglasses or other special types of glasses will protect your eyes from sunlight.
Wearing a visor to prevent light from shining directly into the eyes is often helpful. Also, using standard 60 or 100 watt light bulbs or brighter instead of fluorescent lighting may help you to see better indoors.
Screening And Diagnosis
An eye specialist can detect and track the development of cataracts during routine eye exams. Have your eyes examined:
- Every 2 to 4 years if you’re between ages 40 and 65
- Every 1 to 2 years if you’re 65 or older
- Any time you develop new, unexplained eye symptoms
If you find yourself “fighting” with your eyes – blinking more often to clear your vision of what may feel like a thin film over your eyes – or you experience other symptoms of cataracts, see your eye doctor. An eye doctor can diagnose cataracts with the help of a careful eye exam.
If it’s determined that you have cataracts, an assessment of how cataracts affect your day-to-day life can help determine whether the next step should be surgery.
Surgical Removal of Cataracts
Cataract Surgery Techniques
Extracapsular cataract extraction technique
The surgeon makes an incision where the cornea and sclera meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the capsule and removes the hard center, or nucleus, of the lens. Using a microscopic instrument, the surgeon then suctions out the soft lens cortex, leaving the capsule in place.
Is a modification of the extracapsular cataract extraction. In Phacoemulsification, the nucleus is fragmented by an ultrasonic oscillating probe. The nuclear fragments are simultaneously suctioned from the eye. The size of the incision is smaller than the incision needed to remove the capsule in the extracapsular technique.
An intraocular lens (IOL) is a clear plastic lens that is implanted in the eye during the cataract operation. Lens implants have certain advantages. They usually eliminate or minimize the problems with image size, side vision and depth perception noted by people who wear cataract eyeglasses. They are also more convenient than contact lenses because they remain in the eye and do not have to be removed, cleaned, and reinserted.
You may experience some swelling of the eye area immediately after the operation. If you do, it can be treated with eye drops that contain anti-inflammatory medication. Fortunately, infection is rare after a cataract operation. Nonetheless, an antibiotic ointment or eye drops may be applied directly to the eye for several weeks to ensure that no infection develops.
You should be up and walking soon after the operation. However, you may find that exposure to bright light is uncomfortable. Sunglasses and eye drops can relieve most discomfort you may experience. Your level of activity will depend on your surgeon’s instructions. Usually, you can resume normal, non-strenuous activity on the first day after the operation. You also may be asked to wear eyeglasses, both indoors and outdoors, for seven-to-10 days following the operation. In addition, to prevent scratching or irritating the healing wound, you may be asked to sleep with a protective eye shield until the healing process is well under way.
Are There Any Complications?
As with any surgical procedure there may be complications that occur during or following cataract removal. Although complications are rare, those that occur most commonly are:
Inflammatory reaction. Your eye and the area around it may swell and be tender or painful. You will be treated with an antibiotic and/or anti-inflammatory drugs in drops, by local injection, or through the bloodstream. Very rarely, if the infection progresses, small amounts of an antibiotic may be injected into the eye.
Fluid in the retina (or macular edema). This complication occurs more commonly in people who have certain conditions, such as diabetes. Although the problem usually clears up by itself, eye drops or pills are sometimes used to help remove the fluid.
Other serious, but less common complications, that may occur following cataract surgery include: dislocation of the lens implant, infection, retinal detachment and excessive bleeding. You should discuss these unlikely difficulties with your ophthalmologist if you are concerned about them.
Life After Surgery
Once a cataract has been removed, light can once again pass undistorted through the cornea and the IOL to the retina (back of the eye). However, your vision will not be clear unless the light is focused directly on the retina; eyeglasses provide that focus, so you may be required to wear glasses to see more clearly. In addition, the artificial implanted lenses or IOLs cannot change shape the way the eye’s natural lens did when you were younger, and you will most likely need to wear bifocal lenses or reading glasses in order to see clearly at close range. It is important to note that you may need to have your eyeglass prescription changed following a cataract operation.