Cataract Symptoms and Treatment
A cataract is a clouding of the lens of the eye, resulting in a gradual loss of vision. The lens is the structure just right behind the iris (the colored part of the eye). Most cataract types are related to aging – by age 80 more than half of Americans either have a cataract or have had cataract surgery. Two other common non-age related types include traumatic cataracts and those related to long-term corticosteroid use (like prednisone and cortisone).
In the healthy state, the transparent lens allows the passage of light through to the retina. When a cataract forms, the cloudy lens does not allow as much light through and vision becomes dull or blurry, and colors lose their brightness. Lights at night may have halos around them.
The lens is made mostly of water and protein. As we age, the proteins clump together creating a loss of transparency. The doctor notices the color of the lens becoming a yellow-green. Generally, cataracts cannot be seen with the naked eye – external, surface ocular scars are not cataracts, though many people call them that. A slit-lamp microscope is used to determine the presence or absence of the problem.Risk factors for cataracts include:
- age (primarily)
- certain diseases like diabetes
- alcohol use
- steroid use
- prolonged exposure to the ultraviolet (UV) radiation in sunlight
It has become routine to recommend UV protection in all eyewear for patients, including wearing sunglasses outdoors, in an attempt to reduce the risk of this problem later in life. Incidentally, UV exposure has also been linked to the development of macular degeneration in later life.
In the early stages, the patient’s vision may be improved with simple prescription changes. However, the problem usually escalates to the point that surgery is required.
Cataract surgery is the most common surgical procedures performed in this country; 90% of patients that have a cataract removed have better vision afterward. The procedure is done on an out-patient basis and only requires perhaps a half-day at the surgeon’s office.
The cataract is removed and an artificial lens, or implant, is inserted to replace it. The implant is necessary to replace the refractive power of the eye lost by removing the lens. Without the implant, a post-op cataract patient would require very thick spectacle lenses.
Eye drops are generally used to promote healing and prevent infection for a few days. Heavy exercise is discouraged for several weeks – but overall, the adjustment in lifestyle is minimal and quite temporary.
The exciting thing about modern cataract surgery is that the surgeons have become quite adept at calculating an implant power that often leaves the patient requiring minimal to no distance correction post-operatively. Readers are still required, unless the patient opts for one of the new types of implant.
Generally the patient’s medical insurance – which is usually Medicare for this problem – covers a large part of the fees. Patients may now elect to pay more out-of-pocket for a multifocal implant, which could allow them good vision at all ranges, without any correction, after surgery (see the Lens Implant page).
Some patients develop what is commonly referred to as an “after-cataract” several months to years after the surgery; this is a clouding of the tissue surrounding the implant. It is easily and quickly fixed by a quick and painless laser procedure at the surgeon’s office.