Cataracts

If your vision has become cloudy or things you see are not as bright as they used to be, a cataract may have developed in one or both of your eyes. A cataract is a clouding of the eye’s naturally clear lens. The lens becomes like a window that is frosted or yellowed.

The only way to know if you have cataracts for certain is when your ophthalmologist (Eye M.D.) does a dilated eye exam. Get a baseline exam at 40 years old, when early signs of disease and changes in vision may start to occur. Your Eye M.D. will let you know how often you should return for follow-up exams. At any point, if you have symptoms or risks for eye disease, see your Eye M.D.  Because your risk for cataracts and other eye diseases increases as you get older, starting at age 65 you should see your Eye M.D. every year.  A complete eye examination will rule out any other condition that may be causing blurred vision or eye problems.

The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.

There are many misconceptions about cataract. A cataract is not:

• A growth or film over the eye;
• A cause of irreversible blindness;
• A result of overusing the eyes;

Cataracts are a common cause of vision loss, especially as we age, but they are treatable. Your Ophthalmologist (Eye M.D.) can tell you whether cataract or some other problem is the cause of your vision loss and can help you decide if cataract surgery is appropriate for you.

Most age-related cataracts develop gradually. As a result, you may not immediately notice changes in your vision when cataracts first develop.

In time, you may have symptoms such as:

• Painless clouded, blurry or dim vision;
• Increasing difficulty seeing at night or in low light;
• Sensitivity to light and glare, seeing halos around lights;
• Colors seem faded or yellowed;
• The need for brighter light for reading and other activities;
• Frequent changes in eyeglass or contact lens prescription; or
• Double vision within one eye.

Who is at risk for cataracts?

Cataracts occur as part of the aging process, so everyone is at risk eventually.  By age 75, about 70 percent of people will have cataracts. The eye’s lens slowly becomes less flexible, less transparent and thicker. Then areas of the lens become cloudy. Usually cataracts develop in both eyes at about the same time.

These factors increase the risk of developing cataracts:

• Advanced age;
• Diabetes;
• Family history;
• Smoking;
• Previous eye injury or inflammation;
• Prolonged steroid use (especially combined use of oral and inhaled steroids); and
• Extensive exposure to sunlight.

What causes cataracts?

The design of the human eye is much like that of a camera. Light rays are focused through the lens onto the retina, a layer of light-sensitive cells at the back of the eye that is similar to film. In a normal eye, light rays pass through a clear lens and are focused onto the retina. This produces a bright, clear image.

As the body ages, the lens continues to grow layers onto the existing surface. Over time the lens hardens and becomes cloudy, which often results in dull, cloudy or blurred vision. This condition, known as an age-related cataract, is normal and occurs eventually in most people.

If the clouding is mild or affects only a small area of the lens, your vision may be only slightly affected. If there is more clouding and it affects the entire lens, your vision will become severely limited.

How are cataracts treated?

If your vision is only slightly blurry, a change in your eyeglass prescription may help for a while. However, if you are still not able to see well enough to do the things you like or need to do after the change in eyeglass prescription, cataract surgery should be considered.

Cataract surgery is often performed as an outpatient procedure and does not require an overnight stay. There are usually few restrictions, and you will be able to resume your normal activities within a few days after surgery.

Before surgery, the length of your eye will be measured in what is called an A-scan, and the curve of your cornea will be measured in a technique called keratometry. These measurements help your Eye M.D. select the proper lens implant for your eye.

With phacoemulsification, an ultrasound instrument breaks up the center of the cloudy lens and suctions it out in small pieces.

The most common procedure used for removing cataracts is called phacoemulsification.  A small incision (about 2-3 mm) is made in the side of the cornea (the front part of your eye). Your Eye M.D. inserts a tiny instrument through the incision that uses high-frequency ultrasound to break up the center of the cloudy lens and suction it out. The lens is removed in one piece, using a technique called extracapsular extraction.

After the cloudy lens has been removed, the surgeon will replace it with an intraocular lens (IOL) implant made of plastic, silicone or acrylic. This new lens allows light to pass through and focus on the retina. The IOL becomes a permanent part of your eye. In most cases, the IOL is inserted behind the iris, the colored part of your eye, and is called a posterior chamber lens. When the IOL is in place, the surgeon closes the incision. Stitches may or may not be used.