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 Topics on this page include: |
| What is a cataract? |Causes | Symptoms | Treatment | Surgical procedure | Post surgery |
What is a cataract?
Just inside the pupil of the eye is a clear lens that focuses light entering the eye onto the retina at the back of the eye. The lens is made of protein and water. During the aging process, the protein may begin to clump together and start to cloud some parts of the lens. When this occurs, it is called a cataract, and light is blocked from reaching the retina.
Cataracts begin slowly and may take years to develop. They don't cause pain, redness, or tearing in the eye. Cataracts cannot be prevented, and everyone will develop them if they live long enough. Cataracts usually develop in both eyes, although one may be further advanced than another. At first they are small and don't affect the vision much. However, with time cataracts may become large or thick, and they will need to be removed surgically. Cataract surgery is the primary therapeutic surgical procedure performed on Americans aged sixty-five and older. Approximately 1.5 million cataract surgeries are done each year in the United States.
The main cause of cataracts is aging. By age fifty-two to sixty-four, there is a fifty percent chance that a person is developing a cataract although he or she won't notice a vision problem until about age sixty-five. By age seventy-five, nearly everyone has a cataract, and fifty percent of people have lost some vision.
Cataracts seem to develop earlier in people who live at high altitudes or who spend a lot of time in the sun. Therefore, most doctors recommend wearing sunglasses and hats to provide protection from ultraviolet rays.
Recent studies show that diabetics and users of steroids, diuretics, or major tranquilizers seem to have a higher risk of developing cataracts earlier in their life. Smokers may also be at a greater risk of developing cataracts.
Occasionally babies are born with cataracts. These are known as congenital cataracts. A traumatic cataract can form as a result of injury to the eye or inflammation of the eye.
The main symptom of a cataract is a painless decrease in vision. People with a developing cataract may have difficulty reading. Their sensitivity to light and glare may increase, causing difficulty driving at night and vision problems in bright sunlight. Colors may not be as vivid, and the cataract patient may have difficulty distinguishing colors. Lights may have a spoke-like appearance. Cataract patients may experience distortion or ghost images in either eye. They may experience double or multiple vision. However, this symptom will usually go away as the cataract grows. Finally, cataract patients may find they need to have their glasses changed more frequently in order to see.
If you are experiencing some of the symptoms described here, it does not necessarily mean you have cataracts. However, if you experience one or more of these symptoms, you should contact your eye doctor for a complete exam. Click here for information on emergency or immediate care.
During the early stages of the development of the cataract, treatment is unnecessary. The patient's vision can be improved by changing his or her eyeglasses, using stronger lighting, or using magnifying lenses. Delaying surgery will not generally cause damage to the eyes. However, the doctor may decide to remove the cataract earlier than expected because it interferes with the treatment of another eye disease such as macular degeneration or diabetic retinopathy.
When the cataract begins to interfere with everyday activities, surgery will be necessary to remove it. If the patient has cataracts in both eyes, the surgeon will only operate on one cataract at a time. The second cataract will be removed at another time.
There are two main types of cataract surgery. The first is extracapsular cataract extraction. In this surgery, an incision is made where the cornea and sclera meet. After opening the lens capsule, the center of lens is removed, and the soft lens cortex is suctioned out. The capsule is left in place.
In most cases, a plastic intraocular lens (IOL) is placed inside the capsule to replace the cloudy lens . It requires no care and becomes a permanent part of the eye. The plastic intraocular lens implant replaces the thick cataract glasses patients used to have to wear. It also eliminates the need for contact lenses that must be removed and cleaned. After cataract surgery, improvement in vision is seen in ninety-five percent of cases.
The other type of cataract surgery is phacoemulsification. It is also called phaco or small incision cataract surgery. A very tiny incision is required in this type of surgery. A small probe is placed in the eye. It emits ultrasonic waves that soften and fragment the cloudy center of the lens, which is then removed by suction. The back membrane of the lens, or posterior capsule, is left in place. After the plastic intraocular lens implant is placed inside the eye, the incision is closed.
A week or two before surgery, the eye professional will conduct tests to measure the patient's cornea and the size and shape of the eye. This helps the doctor determine the size of the intraocular lens needed.
Most cataract surgery is done on an outpatient basis. The patient will be asked to skip breakfast. On the day of the surgery, medication will be given to relax the patient, and eye drops will be administered to dilate the eye.
During surgery, which will take approximately fifteen to thirty minutes, a local anesthetic will probably be used instead of general anesthesia. The patient, who will be able to see light and movement, but not the surgery itself, will not have to worry about keeping their eye open or closed. The surgical staff will cleanse the skin around the eye, and place sterile coverings around the patient's head before surgery.
After surgery, a protective shield will be placed over the patient's eye. Following a brief stay in the recovery area, the patient can go home. They will need someone to drive them home.
After surgery, the patient may feel itching and mild discomfort for a day or two. They may also have some discharge and experience sensitivity to light. Vision may be blurry for a time, and for patients who receive an intra-ocular lens, things may appear reddish in bright sunlight. Colors should return to normal in a few weeks. After the eye has healed, the patient will probably need new glasses.
During the recovery period, the patient should:
- Use eye drops as prescribed.
- Avoid rubbing or pressing on the eye.
- Use over-the-counter pain medication as needed.
- Avoid strenuous activities until the eye has healed.
- Continue normal activities and moderate exercise.
- Wear eyeglasses or a shield to protect the eye.
- Attend follow-up visits with the doctor.