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Cataracts: caring for your eyes

March 2008 – Vol. 12, No. 3

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

A cataract is the clouding of the natural lens of the eye. “When the lens of the eye becomes cloudy, light rays cannot pass through easily, and vision becomes blurry.”¹ Some describe the sensation as if you were looking through a window that is frosted, fogged, or yellowed.²

Approximately 20.5 million Americans age 40 and older have cataracts, and more than 1.6 million cataract surgeries are performed in the U.S. each year.¹ Cataracts are very common among older people. In fact, by age 80, more than half of all Americans either have a cataract or have had cataract surgery.³ These are known as “age-related” cataracts.

Cataracts, however, can also occur in infants (i.e., congenital cataracts) or children and among people with illness, on certain types of medication, or who have had an injury to the eye^4,5 (i.e., secondary or traumatic cataracts). There are three types of cataracts (PDF); each is described by its location on the lens (center, cortex, or under the capsule at the back of the lens) and what group of people is most commonly at risk.⁶

“Cataracts are the leading cause of blindness worldwide.”¹ Early identification of cataracts and appropriate treatment, however, can improve and even restore vision.

Do I Have a Cataract: Signs & Symptoms

The first thing to do if you suspect a cataract or any eye problem is to see your eye doctor (ophthalmologist or optometrist) and have a complete eye exam. Some common signs and symptoms of a cataract are:

painless clouding or blurring of vision; may also be described as dim vision;
needing brighter light to read;
colors seem faded or yellowed;
sensitivity to light; glare; headlights, lamps, or sunlight may appear too bright; a halo may appear around lights;
poor night vision;
double vision or multiple images in one eye (this symptom may clear as the cataract gets larger);
frequent prescription changes in your eyeglasses or contact lenses; and
sudden temporary improvement in close-up vision (sudden nearsightedness).^1,3,5,7

Note: These symptoms can also be a sign of other eye problems.³ If you have any of these symptoms, check with your eye doctor. Regular eye exams can catch an eye condition in the very early stages.⁸

Detecting a Cataract: The comprehensive exam

“By performing a thorough eye examination, your ophthalmologist (eye M.D.) can detect the presence of a cataract.”² A careful and comprehensive eye examination will also rule out any other conditions that may be causing blurred vision or other eye problems.²

The comprehensive eye exam to detect a cataract will likely include:

Visual acuity test – An eye chart test is used to measure how well you see at various distances.³
Dilated eye exam – Drops are placed in the eyes to widen (dilate) the pupils. A special magnifying lens is then used to examine the retina and optic nerve (at the back of your eye) for signs of damage or other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry – An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.³

These are just some of the tests that may commonly be done. Your eye doctor may do other tests to learn more about the structure and health of your eye.³ Talk with your eye doctor about what other tests are needed.

It is important to understand that problems with other parts of the eye (e.g., cornea, retina, optic nerve) can be responsible for vision loss and may prevent vision improvement after cataract surgery. For this reason, if improvement in your vision is unlikely due to other complications, your doctor may not recommend cataract removal. Your ophthalmologist will tell you how much visual improvement is likely based on your individual case.²

Optician, Optometrist, Ophthalmologist – Who Do I See?

Finding the right eye care specialist can be confusing. Here is some help:

Optician – An optician fills prescriptions issued by an optometrist or ophthalmologist. These prescriptions may include eyeglasses, contact lenses, low vision aids, and ocular prostheses. An optician is not responsible, nor trained, for eye examinations or treatment solutions. An optician, however, may take eye measurements to ensure the eyeglass prescriptions are correct and fit properly. Opticians will help you select frames and adjust them to fit comfortably. An optician typically has a two-year college degree and may be certified by the American Board of Opticianry or The National Contact Lens Examiner, but these certifications are optional.
Optometrist – An optometrist must have 2–4 years of undergraduate education plus a 4 year optometry degree. The optometrist does not have a medical degree and does not perform surgery. An optometrist is, however, called a doctor of optometry. An optometrist is a doctor who performs annual eye exams to treat any vision problems and detects signs of disease and abnormal conditions. An optometrist can diagnose eye disease and prescribe eyeglasses, contact lenses, vision therapy, and medications to treat eye diseases. In general, optometrists work more with patients who have “healthy” (i.e., without disease) eyes.
Ophthalmologist (MD or DO) – An ophthalmologist is a medical doctor. An ophthalmologist must complete 4 years of undergraduate education, 4 years of medical school, and 4 years of residency and internship relating to the diagnoses and treatment of diseases of the eye, including eye surgery. Ophthalmologists diagnose and treat eye diseases, prescribe medications, and perform surgeries to improve or prevent the worsening of vision-related conditions. If you require cataract removal, you will see an ophthalmologist.^9,10,11,12

In short, opticians provide eye-wear. Optometrists provide eyewear and eye exams, and in some states low level eye treatment for diseases. Ophthalmologists provide eye exams, prescriptions, and surgeries.¹³ If you suspect a cataract, see an ophthalmologist. An optometrist may also detect the cataract but will ultimately need to refer you to an ophthalmologist for care.

Treatment for Cataracts: Cataract surgery

If your eye doctor detects a cataract, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification or magnifying lenses, brighter lighting, anti-glare sunglasses, or other visual aids.^3,14 When a cataract seriously impairs your vision and interferes with everyday activities (e.g., driving, cooking, and reading), the cataract will likely need to be removed.

It is up to you to decide if you can see well enough to perform essential daily tasks. Discuss your vision and quality of life with your doctor. If you need to have a cataract(s) removed, surgery is the only option currently available. Cataracts cannot be treated with medicine or laser procedures.^15,16

The good news is that more than 95 percent of cataract surgeries are performed without complications, and they result in significant improvement in vision.¹⁷ “It has proven to be a highly safe and effective procedure, with significant improvement in visual function and quality of life.”¹⁸

Before, During, After Surgery: What t0 expect?

Before surgery (pre-operative).

Before cataract surgery, discuss any medication and/or supplements (prescribed or over-the-counter) you are taking with your doctor. Decide if you should remain on these medications and/ or supplements. Also, ask your doctor whether or not you should eat prior to the surgery.

During surgery.

During cataract surgery, your ophthalmologist will make a small incision, remove the cloudy lens from your eye, and in most cases, replace the lens with a permanent, clear, artificial lens called an intraocular lens (PDF). “Through the use of careful measurements of the eye taken before surgery, your doctor will be able to select a lens power to correct for nearsightedness or farsightedness, helping to reduce dependence upon corrective eye wear after surgery.”¹⁶

Cataract surgery is usually done on an outpatient basis, either in a hospital, outpatient surgical center, or ambulatory surgery center. A local or topical anesthetic is used to numb the eye, which may be done by using drops or an injection to keep the eye stable during surgery. Sedating medications may also be given, but they may not be required in all cases.⁷

“Cataract surgery is performed using a microscope. In most cases, a very small incision is made, and an ultrasound device is used to break up and remove the cloudy lens.”¹⁶ If your cataract has advanced to the point where the ultrasound device can’t break up the clouded lens, your surgery may require a larger incision so your surgeon can remove the lens in one piece.¹⁹ “When both eyes have cataracts, the worse eye is usually operated on first.”¹⁶ The second eye is typically operated on 4–8 weeks after the first, giving the first eye time to stabilize.³

After surgery (post-operative).

Once the surgery is completed, your doctor may place a shield over your eye to protect it from rubbing, being poked, or getting debris inside. After a short stay in the outpatient recovery area, you will be ready to go home.

Following surgery you will need to:

Use eyedrops as prescribed.
Be careful not to rub or press on your eye.
Avoid strenuous activities until your ophthalmologist tells you to resume the activities.
Ask your doctor when you can resume driving.
Wear eyeglasses or an eye shield, as advised by your doctor.

You can continue most normal daily activities after surgery. Over-the- counter pain medicine may be used, if necessary.⁴

“Though they rarely occur, serious complications of cataract surgery are:

infection,
bleeding,
swelling, and
detachment of the retina.⁴

Call your ophthalmologist immediately if you have any of the following symptoms after surgery:

pain not relieved by nonprescription pain medication;
loss of vision;
nausea, vomiting, or excessive coughing; or
injury to the eye.”

“Even if cataract surgery is successful, some patients may not see as well as they would like to.”⁴ Other eye problems such as macular degeneration (aging of the retina), glaucoma (elevated eye pressure), or diabetic retinopathy may limit vision after surgery. “Even with these problems, cataract surgery may still be worthwhile.”⁴ The benefits of modern cataract surgery can be many, including improved color vision, improved vision clarity, increased independence, improved quality of life, and reduced dependence on corrective eyeware.²⁰

Can Cataracts Be Prevented? What you can do

Although the exact cause of cataract formation is unknown, there are things that seem to influence cataract formation, and some of them are controllable. Some things that may increase the risk for cataracts include:

age;
family history;
medical problems, such as diabetes;
injury to the eye;
medications – especially steroids, but also possibly diuretics and major tranquilizers;
radiation;
long-term, unprotected exposure to sunlight;
previous eye surgery;
smoking;
heavy alcohol consumption;
air pollution;
premature birth; and
high salt intake.^1,2,4,5,7,14

Though many of these factors are uncontrollable, here are some things you can do to help prevent cataracts.

Comprehensive eye exam.

Because the risk of cataracts increases with age, you should have a comprehensive eye exam every 2–4 years from ages 40–64 years and every 1–2 years for people 65 years and older. If you have a history of eye problems or a medical condition, such as diabetes, that puts you at higher risk, you should have your eyes examined more often – once a year or as recommended by your doctor.⁵

Block ultra-violet (UV) light.

One of the most important things you can do is to protect your eyes from the ultra-violet light of the sun. When outside in daylight, wear wraparound sunglasses that block 100 percent of UVA and UVB (see label on glasses), and wear a hat with a wide brim.^3,17

Stop smoking.

If you smoke, quitting can help reduce your risk for cataracts.

Reduce alcohol consumption.

Drink alcohol only in moderation or not at all.

Consider nutrition.

Some evidence suggests that eating a diet high in antioxidants, which neutralize the action of free radicals and thereby prevent damage to cells, may forestall the development of cataracts.^3,14,17,21 Meanwhile, eating a lot of salt may increase your risk.^14,17 Antioxidants are found naturally in food (particularly plant sources) and include vitamin C, vitamin E, carotenoids, and anthocyanidins. The minerals selenium and zinc are also factors for naturally occurring antioxidant enzymes.^6,21 Researchers recommend eating a variety of fruits and vegetables of various colors for antioxidant intake, and limiting your salt intake to reduce the risk for cataract development.

Hormone replacement therapy (HRT).

For women taking estrogen as part of HRT, there may also be some good news. “There is evidence that estrogen greatly decreases the risk of developing cataracts.”¹⁷

It is so important to take care of your eyes. Do all you can to reduce your risk for cataract development through regular eye exams, sun protection, unhealthy behavior reduction, and increased consumption of antioxidants found in fruits and vegetables. If you have a concern about your vision, always see your optometrist or ophthalmologist as soon as possible. Early detection of cataracts or other eye complications can help you get the information you need to best protect your vision.

Often, there is a sense of fear brought on by misconceptions about cataracts. Many medical improvements have been made over the years in caring for your eyes. Take time to read this important information on misconceptions about cataracts (PDF), and learn the truth to help dispel some of the natural fears that come with cataract detection.

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

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