| What
is a Cataract?  A
cataract is a clouding or
discoloration of the normally clear lens of the eye.
It can be compared to a window that is frosted, steamed
or yellowed. There are many misconceptions about cataracts.
It is not a film over the eye nor is it caused by overusing
the eyes. It is not a cancer and does not spread from one
eye to the other. It does not cause irreversible blindness.
Symptoms related to cataract can include a painless blurring
of vision associated with glare,
halos, starbursts, light sensitivity
and worsening of night vision. Patients frequently
have to change their eyeglass prescription to
avoid cataract surgery and on occasion can even notice
double vision, or ghosted images in the involved eye. They
frequently need brighter (more) light to read and have poor
night vision. They may even complain of fading or yellowing
of colors,
and often times confuse black, brown, and navy blue colors
in their wardrobe selection. The amount and pattern
of this cloudiness varies within the lens itself. If the
cloudiness is not to the center of the lens, you may not
be aware that a cataract is present. The
mere presence of a cataract does not mean it requires surgical
intervention automatically. Surgery should only be done
when patient lifestyles are altered because of the decline
in vision related to the cataract. For example, one cannot
see well enough to cook, read, drive, work or watch television
(daily activities) despite the best prescription eyeglass
or contact lenses possible. Typically this starts for most
patients at the visual decline point of 20/40 or worse,
best corrected. This is the typical visual and lifestyle
standard recognized by Medicare and most insurance companies.
What Causes Cataracts?
The most common type of cataract
is caused by lifetime
exposure to ultraviolet radiation to the eye, which as we
age, increases naturally. Persons who have lived or
worked out in the sunlight most or all of their lives, tend
to show cataracts more intensely, and at earlier ages. There
are also other causes that include a positive family history
of cataract, other medical problems including diabetes (this
can more rapidly speed up cataract formation) and inflammatory
eye diseases (iritis, uveitis), past injury to the eye,
and perhaps medications such as steroids
(oral prednisone). Long
term unprotected exposure to sunlight and previous intraocular
eye surgery have all been implicated in the origin
and progression of cataracts. The only way a cataract can
be detected is by a thorough dilated
eye examination by your ophthalmologist (medical
eye doctor). He or she can detect the presence and extent
of the cataract as well as any other condition that may
be causing blurred vision or visual
disturbances.
Cataracts develop differently in individuals and may even develop differently between the two eyes. Most cataracts are associated with
ultraviolet exposure and the natural aging process and gradually get worse over a period of many years. Other cataracts, especially in younger people and those with diabetes, may progress rapidly over a few months causing a worsening of vision. It is not possible to
accurately predict how fast cataracts will develop in any given patient, however there are certain types and diseases that we know accelerate cataract formation. Surgery is the only way your ophthalmologist can
permanently remove a cataract, however, if symptoms from the cataract are mild, a change in glasses may be all that is needed for you to function more comfortably.
What Can be Done?
There are no medications, exercise,
or optical devices that have been shown to prevent or cure
cataracts.  Recent
studies have shown that daily protection from sunlight may
help prevent or slow the progression of cataracts. Sunglasses
that screen out ultraviolet light and regular glasses with
a clear anti-UV coating offer this protection. Cataract
surgery should be considered when cataracts cause enough
loss of vision to interfere with daily activities. It is
no longer true that cataracts need to be ripe before they
can be removed. Cataract surgery can be performed when your
visual needs (lifestyle)
and declining visual acuity both require it. Many
patients relate that it is like driving a car with a dirty
windshield. You must decide if you can see to do your job
and drive safely, or if you can read and watch TV in comfort
comfort
and without difficulty.
Also, if you can perform daily tasks such as cooking, shopping,
yard work, and taking medications without visual difficulty.
Based on your symptoms, you and your
ophthalmologist should decide together when surgery is appropriate.
Over 1.4 million people have cataract surgery each year
in the United States. 95% of these are without complication.
 During
cataract surgery, which is usually performed outpatient
under local and
sometimes topical anesthesia as an outpatient
procedure, the cloudy lens is removed from the eye. In most
cases, the focusing power of the natural lens is restored
by replacing it with a permanent intraocular lens implant.Your
ophthalmologist performs this delicate intraocular
surgery using a surgical microscope, microsurgical techniques
such
using an ultrasonic device that delicately breaks up the
cataract into tiny pieces and then safely removes them from
inside the eye, as well as other modern technology.
A
number of our cataract surgeons perform topical, clear corneal,
no stitch cataract surgery techniques. While this approach
is not possible or in the best interests
of all patients, it is utilized at times as being a more
advanced technique that  allows
for a more rapid visual recovery. Although
it is a common misconception, lasers are not typically
used to remove cataracts.
Surgeons
at Sabates Eye Centers certified in the laser method of
cataract removal many years ago, when it first became available
here in the United States. This method of cataract surgery
was not felt to be an improvement over current methods used
by our cataract surgeons, and thus this method was never
used any further. We put our patient’s best interests
at heart, remaining cutting edge in our advancements in
cataract surgery.
In approximately one-fifth of people
having previously
undergone successful cataract surgery, the natural
capsule that supports the intraocular lens will eventually
later become cloudy. Laser surgery is then used to open
this cloudy capsule to restore clear vision. Following cataract
surgery, you may return almost immediately to all but the
most strenuous activities. You will have to take medicated
eye drops as your ophthalmologist directs for several weeks,
and wear a safety shield over your operative eye while sleeping
for a brief period of time. Several post-operative
visits are needed to check the progress of the eye as it
heals.
Modern cataract surgery is a
highly successful procedure. Improved vision results in
over 95% of cases, exceptions
being when there are other disease processes
going on in the eye (glaucoma,
macular degeneration). It is important to
understand that complications can occur during and after
surgery, some of which may be severe enough to limit vision.
As with any surgery, 20/20
vision cannot be guaranteed, but the odds are greatly
on your side of having a very good end result at
the end of the process. In conclusion, cataracts
are a common cause of poor vision, particularly in the elderly,
but they are quite treatable. We can tell you whether cataract
or some other additional problem is the cause of your loss
of vision or
visual disturbance, and can help you decide if cataract
surgery is appropriate for you.
Video
Presentations
Cataracts
Related Links:
American Society of Cataract and Refractive Surgery
www.ascrs.org
National Eye Institute
www.nei.nih.gov/health/cataract/cataract_facts.asp
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