Cataracts are a condition that affects the lens in the eye where the lens becomes cloudy and vision is impaired. Cataracts are common in older people.  In the U.S., over half of people who reach 80 years have a cataract, or have had cataract surgery.   You can get cataracts in one eye or both.  

Cataracts and age

Many people develop small cataracts in their 40’s and 50’s, but it does not affect their vision.  However, by the time they are older, the cataracts can cause great loss of vision if left untreated.  Although most cataracts are “age-related”, there are several other types of causes for cataracts. 

A few other non-age-related cataracts are: 

• Traumatic  - Traumatic cataracts are sometimes formed following an injury to the eye.  Even many years after the trauma, these cataracts may show up.
• Secondary – These cataracts can develop as a result of other eye surgeries, for example if you had surgery for glaucoma. Diabetes and certain use of steroids have also been known to cause secondary cataracts.  
• Congenital  - Occasionally people are born with very small cataracts, which generally do not affect vision.  IN cases where vision is impaired, surgery may be performed and the lens replaced.
• Developmental -   These small cataracts can develop in children and young people as a result of exposure to a toxic substance, inflammation of the eye, malnutrition, or even heredity. They do not usually affect vision.
• Radiation  - Some types of radiation in the eye can cause these cataracts. Examples of radiation are xrays, non-inonizing radiation ( infrared heat rays), ultraviolet, or microwaves.
  

There are many other types of cataract that describe specific conditions not mentioned here.

Cataracts affect the lens of the eye

The lens is a convex-shaped clear structure located beneath the cornea and pupil of your eye.  It is composed primarily of water and protein.  It functions to focus images you see on the retina, which is a light-sensitive area in the back of your eye.  The image is then transmitted into nerve signals and travels through the optic nerve to your brain, where it is processed.  The lens is normally clear, but a cataract on it will cause your vision to be blurred or discolored.  

Two main types of age-related cataracts

Among the more common age-related cataracts, two types of impairment can occur:

1. Blurring of vision - this is caused by clumps of protein that form on the lens over time, which will obscure the sharpness of the image on retina.  When these protein clumps are small, you may not notice them and the image reaching the retina still appears sharp.  Over time, the clumps can grow larger, and become more numerous.  When this occurs, they can produce blurred or duller vision. This is the most common type of age-related cataract.  

2. Yellowing of the lens – With these cataracts your clear lens develops a yellowish or brownish color, which also takes many years.  The result is seeing the world with a brownish tint.  This coloring may make it more difficult to read or distinguish dark colors from one another, such as black and purple.  However, people with this type of cataract generally do not experience any blurring.

Will I get cataracts?

The older you get, the higher the likelihood of getting cataracts.  Many factors can determine if you get them and how severer they become.  There are several things you can do to prevent them.  Doctors recommend a good diet with plenty of fresh fruits and vegetables, including green leafy vegetables high in antioxidants, as well as wearing sun protection for your eyes, such as sunglasses and hats.  In addition, smoking can contribute to cataract formation, so quitting – if you smoke – will help prevent them as well.  If you have diabetes, diet will be especially important. 

How do I know if I have a cataract?

There are several symptoms you may get when you have a cataract. 

- Cloudy vision
- Blurry vision
- You see halos around bright lights
- Bright lights and sunlight bother you and appear to glare and are too bright
- You get double vision or even multiple vision in one eye
- Some colors seem faded, or you have difficulty in distinguishing dark colors
- Reduced night vision
- If you wear glasses or contact lenses, you change the prescription more often

Some of these symptoms can also be symptoms of other problems.  It is best to schedule an appointment with your ophthalmologist to identify your condition.  If you are older than 60, you should have an eye exam every year.  In addition to cataracts, your doctor can find out if you have any other eye problems, such as glaucoma or macular degeneration.

The Exam

If you have a cataract, your doctor will discover it during the exam.  He/she will administer some tests that will determine if you have a cataract.  

You doctor will first ask you some questions about your medical history that could have affected your eyes.  Any incidences of eye trauma, or health problems such as heart disease, asthma, diabetes, or hypertension should be discussed. 

Once this information is recorded, your eyes will be examined and tested with three procedures:

• The Visual acuity test – this is a simple eye chart and you will be asked how well you can read it.  It will measure how you are able to see at various distances.
• Eye Exam with Dilation- Your eye care professional will place some drops in your eyes to dilate the pupils.  This will allow him/her to use specialized lens to look into your inner eye and examine your retina and optic nerve.  The lens magnifies the image so the ophthalmologist can look for cataracts or other eye problems.  Because your pupils remain dilated for a few hours, your vision will be blurred and you will be light-sensitive for a few hours afterward.  It is best to wear sunglasses when you leave the office.
• Tonometry – This is a test that measures how much pressure you have inside the vitreous gel filled part of your eye. You may receive numbing drops before this test. 

There may be other tests your eye care professional will perform as well.

Treatment for vision-impairing cataracts

In many cases the symptoms of smaller cataracts do not require surgery, and can be treated with anti-glare sunglasses, a new prescription, or other external corrections.   If you do have a large cataract that is reducing your vision, and interfering with your everyday activities, it can be treated with surgery.  If left untreated, your vision could become worse and worse.  Surgery is a highly effective treatment and most people regain their normal sight.  The procedure involves removal of the damaged lens replacing it with an artificial one made of a special plastic.  Cataract surgery is one of the safest in the U.S., and about 90% effective.  Your eye care professional should be able to refer you to a specialist.

Risks of Surgery

Any surgical procedure involves some risks, such as bleeding during the operation or infection afterward.   Because of these factors, certain medications should be stopped a few weeks or days before the surgery.  Following the surgery, you will be prescribed medication to prevent infection, as well as instructed to be very careful with your eye.  Keeping your eye free of debris and bacteria is extremely important because permanent vision loss can result from infection.   Minimal touching of the eye and washing your hands before touching your eye are recommended. 

Another risk of cataract surgery is retinal detachment.  If you have a disorder such high myopia (nearsightedness), your risk of retinal detachment may be increased after cataract surgery.  A symptom of retinal detachment is a sudden increase in seeing eye floaters or flashers.  Eye floaters look like "cobwebs" or specks that appear to float around in your eye, but you can’t really see them or focus on them.  If after your cataract surgery you notice an increase in floaters or flashes, you should immediately see your doctor.  There is no pain associated with retinal detachment, but it is a medical emergency.  If left untreated you could lose vision in that eye.   

Some uncommon problems can occur after cataract surgery which includes loss of vision, double vision, or eye pressure changes.  These issues can usually be successfully treated as long as you see your doctor right away.  In less instances, patients can develop what is called an “after-cataract”.  This is when the surrounding eye tissue grows around the new lend (IOL), and causes blurriness.  This condition occurs months or years following cataract surgery.  An After cataract can be successfully treated with a laser with a procedure called a YAG laser capsulotomy.  

Two types of Cataract Surgery – which one is for me?

Cataract surgery involves removing the lens and replacing it with an artificial one.  The new lens is made from a special plastic and will become part of your eye.  This artificial lens is called an intraocular lens (IOL).  You won’t feel it or have to do anything to maintain it, and you will see clearly.  There are two different procedures that doctors employ to remove the lens.  Your doctor will consult with you to determine which one is best for you.  In either case, the cornea – the dome-shaped covering of the eye – is cut to allow access to the lens.   

• Smaller incision - Phacoemulsification, or phaco is also called “small incision cataract surgery” In this procedure the surgeon makes a very small incision in the cornea and uses as tiny probe into the eye to reach the lens.   The probe then emits ultra sound waves that can soften and even break apart pieces of the lens.  It is then suctioned out.  
• Larger Incision - Extracapsular surgery - Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.
  

The surgical procedure

This operation is mostly performed while the patient is awake, and people usually go home the same day.  Dilation drops will be placed in your eye and numbing drops if you are awake.  Some people may need a general anesthesia.  The entire operation usually lasts an hour or less, and afterwards, the doctor will have you rest and watch for anything unusual such as bleeding.  A patch will be placed over your eye, and due to the dilation drops and/or anesthesia, someone else must drive you home.

Following your surgery

For the first two or three days, you may experience some discomfort.  Common issues are itching and mild discomfort, as well as discharge of fluid, and sensitivity to touch or light.  You may be asked to use eyedrops to speed healing.  You will wear some type of protection for your eye, such as a shield or patch, and you should avoid rubbing your eye.  

After about 8 weeks, most healing should be complete.  You should have a follow up visit or two with your doctor to ensure your eye is healing properly.

What to expect after cataract surgery

Your eye will take some time heal and adjust to its new status.  You may experience blurry vision in the first month or two, and it will take time for your operated eye to focus itself with your other eye.  You may also need a new prescription for eye glasses or contact lenses, because your new lens’ focus may not match your old one.