The facts about cataracts


By Mark S. Siegel, MD, FAAO

What is a cataract?
We are born with a crystalline lens inside the eye located behind the pupil that helps the eye focus light onto the back of the eye.  A cataract is the clouding of the natural lens in the eye. When the natural lens is clouded, this can lead to decreased vision.

What causes a cataract?
Most commonly, this clouding occurs due to the normal aging process, usually after the age of 60. Other causes of cataracts include ocular diseases, medical problems (such as Diabetes Mellitus), trauma to the eye, the use of certain medications such as steroids and excessive UV radiation exposure.

How do I know if I have a cataract?
People with cataracts usually complain of blurred vision and sometimes experience difficulty reading or driving. Sometimes it may seem that you are looking through a cloudy window. Another common symptom of cataracts is increased glare. People with cataracts may notice significant glare around lights or oncoming headlights when they are driving which can make it harder to drive at night. Some people also notice that colors do not appear as vibrant or bright as they used to. If you have any of the above risk factors and are experiencing difficulty with your vision, you may have a cataract. Your eye physician can diagnose cataracts by performing a complete eye exam. Light passes through the normal lens properly to a focused point on the back of the eye. However, in the cloudy lens affected by cataract, light is bent in all different ways and prevents the light from focusing on the back of the eye. This causes blurred vision.

How are cataracts treated?
There are no medications or drops that can help treat a cataract. Once cataracts affect your vision to the point where your activities of daily life are affected, they can be removed in order to improve vision. Many people believe that cataracts can be removed with laser surgery. This is not true, as they can only be removed by microscopic eye surgery in the operating room by your eye physician and surgeon. Lasers are beginning to be used to perform portions of cataract surgery such as the incisions to enter the eye, the opening of the lens (capsulotomy) and dividing the lens into fragments. The laser is not covered by any insurance and is still performed in an OR. However, a phacoemulsification (ultrasound) probe is still required to remove the cataract fragments, which is covered by insurance.

What can I do to prevent the formation of cataracts?
Cataracts occur due to the natural aging process, but there are some steps you can take that may be helpful in delaying a cataract. First, if you are a smoker, quitting smoking may help delay the progression of a cataract. Also, protecting yourself from excessive exposure to UV light, by wearing sunglasses and a hat, may also help delay cataracts.

How is cataract surgery performed?
If the cataract is found to be affecting your activities of daily living, the cataract can be removed by your eye physician and surgeon in the operating room. First, the eye that is undergoing surgery will be numbed, typically with topical anesthesia. You will usually be made to feel sleepy during the surgery, but will still be able to hear the surgeon and staff interacting with you. You will not need to worry about keeping your eye open during the procedure because the surgeon will do that for you. Then, a small incision is made into the front window of the eye (cornea) and the cloudy lens is removed through this incision using ultrasound power and suction. After the cloudy lens is removed, a clear acrylic or silicone lens is inserted in its place in order to properly focus light onto the back of the eye again. Cataract surgery is one of the most successful surgeries performed in the United States. It is uncomplicated and successful in 95% of patients who undergo the surgery.

Are there different types of lens implants?
Yes, there are many different types and powers of lens implants. Your eye physician will determine the proper lens power to be implanted by taking measurements in the office before surgery. The standard lens implants are typically “monofocal” lenses, or lenses that focus the vision to a certain distance. In order to have clear near vision, reading glasses are still needed. There are other types of lens implants, such as “multifocal” or “accommodative” lenses, or lenses with more than one focus point. These lenses allow you to focus both near and far. Ask your eye physician for more information about multifocal lens implants.

What happens after surgery?
Immediately after surgery you will typically be monitored for about 30 minutes to an hour. You should have someone with you to drive you home. It is best that you rest for the remainder of the day after surgery. Your eye surgeon will have more specific instructions of what you should do after surgery. For more information, consult with your eye surgeon.

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