Cataracts are a common result of aging and occur frequently in older people. About one in five adults over the age of 65 has a cataract. Cataracts are a clouding and darkening of the eye lens, which blocks vision. Stronger lighting and eyeglass adjustments can help when cataracts are small. As cataracts grow, many people need surgery.

Causes

The proteins in the lens of your eye gradually change shape and clump together as you age. With time, your lens tissue becomes thicker, less flexible, and less transparent. The color of the lens changes too, becoming yellowish as the lens is stained by the protein clumps. Eventually, the discolored lens begins to block the light coming through your pupil.   

Risk Factors

Many conditions and lifestyle habits make cataracts more likely to develop. These risk factors include: 

• Aging (the most important risk factor)

• Diabetes

• Alcohol use

• Excessive exposure to sunlight

• High blood pressure

• Smoking

• Inadequate vitamin intake

• Excessive exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy

• Family history of cataracts

• Previous eye injury or inflammation

• Previous eye surgery

• Prolonged use of corticosteroid medications (such as prednisone)

Symptoms

Cataracts start small and affect only a minor part of the lens at first. Therefore, most people have no idea that a cataract is present. Often, only one eye is involved in the beginning. Your ability to see things close up or far away will be affected depending on where the cataract is located. The change may be most obvious at night, or you may notice it more in bright daylight. After months or years, your cataract will grow to cover more of the lens, affecting a greater part of your range of vision.

Common signs and symptoms of cataracts are listed below. However, these symptoms can also be signs of other eye problems. If you have any of these symptoms, you should schedule a check-up with your eye doctor.

• Cloudy, blurry, or dim vision

• Poor night vision or increased difficulty seeing in the dark

• Sensitivity to light and glare (including car headlights, lamps, or sunlight)

• "Halos" appear around lights

• A need to change eyeglass or contact lens prescriptions more often

• Faded or yellowing colors

• Double vision or multiple images in a single eye (this symptom may disappear as the cataract grows).

If you notice any changes in your vision, have an eye check-up right away. Sudden vision changes, such as double vision or blurring, require an immediate appointment with your healthcare provider.

Diagnosis & Tests

Eye Examination

Your eye doctor (ophthalmologist or optometrist) will ask you some questions about your symptoms, such as:

• How long have you noticed symptoms? Do the symptoms come and go or are they always there?

• Do you experience vision problems in bright light?

• How severe are your symptoms? Do your symptoms make it harder to drive, read, or do your job?

• Have you ever had an eye injury or eye surgery?

• Have you ever been diagnosed with an eye problem, such as iritis (inflammation of the iris)?

• Have you ever received radiation therapy to your head or neck?

• What medications are you taking now?

The eye doctor will then examine your eye, using specific tests. The more common ones include:  

• Visual acuity test. This uses a standard eye chart with rows of different-sized letters to check how well you see at various distances.

• Slit-lamp exam. This test uses a special microscope with an intense line of light to light up the front parts of your eye—the cornea, iris, lens, and the spaces in between.

• Dilated eye exam. In this test, your eye doctor puts drops in your eyes to make the pupils dilate (get larger). Your retina and optic nerve can then be examined with the slit-lamp or a special instrument called an ophthalmoscope. Your vision may be blurry for a few hours after the test.

• Tonometry. In this test, numbing drops are placed in the eye, then the pressure inside the eye is checked.

Care & Treatment

Prevention 

Research suggests that you may be able to lower your risk of cataracts, or slow down their formation, by following the below recommendations. 

• See your eye doctor regularly. Ask your healthcare provider how often you should have an eye exam.

• Quit smoking. Your healthcare provider can help you find the best way to quit.

• Wear sunglasses. Sunglasses can block ultraviolet B (UVB) rays when you are outdoors. You can also wear a broad-brimmed hat to block the sun.

• Take care of other health problems. This is especially important if you have diabetes or other medical conditions that can increase your risk for cataracts.

• Eat plenty of fruits and vegetables. Try to eat colorful fruits and vegetables, which have the most vitamins, minerals, antioxidants, and other nutrients.

Treatment 

If your cataracts are small and not bothersome, simply using eyeglasses or contact lenses, anti-glare glasses, or magnifying lenses may be all that you need. 

Follow all the steps listed above in the Prevention section to slow down cataract growth. Have regular check-ups with your eye doctor. You may not need cataract surgery for several years. In fact, you may never need surgery.  

Make sure that your eyeglasses or contact lenses have an up-to-date and accurate prescription.  This will help you deal with cataract symptoms until surgery is necessary.

When to consider cataract surgery

Most eye doctors recommend cataract surgery if your quality of life or ability to perform normal daily activities are affected (such as reading, watching TV, or driving at night).

In some cases, you may need to have a cataract removed even if it is not affecting your vision. For example, if the cataract blocks the examination or treatment of a different eye disease such as age-related macular degeneration, or diabetic retinopathy. 

Surgery 

Cataracts can only be cured by surgical removal. Cataract surgery has been carried out safely and effectively for many decades. It is one of the most common operations performed in the US. For 9 out of 10 patients, vision improves after surgery, and visual acuity is usually 20/40 or better. Cataract surgery has also been found to enhance mental outlook, ability to carry out daily functions, and quality of life in general. 

If you decide to have surgery, your doctor will perform some tests and eye measurements a few days before. You may have to stop taking certain medications temporarily. In addition, you must not eat or drink for twelve hours beforehand.  

The operation usually takes less than 30 minutes and is performed under local anesthetic, or a topical preparation applied directly to the eye. You will probably be awake during the surgery. It is an outpatient procedure, so you will come home the same day. If you have cataracts in both eyes, you will normally have one eye done at a time with a period of a few weeks between surgeries.

The two types of cataract surgery are:

• Phacoemulsification (phaco) or “small incision cataract surgery.” This is the most common method. In phacoemulsification, your surgeon makes a small incision on one side of your cornea, the covering on the front of your eye. The surgeon inserts a tiny probe through the incision that emits extremely high sound waves. This breaks up the discolored lens so that it can then be easily removed by suction. The surgeon will replace your old lens with an artificial plastic lens, called an intraocular lens (IOL).

• Extracapsular surgery. If the surgeon decides to use extracapsular surgery, a larger incision will be made on your cornea and the core of the lens will be taken out in one piece. Suction is used to remove the rest of the lens. The surgeon will replace your old discarded lens with an IOL.

• The IOL becomes a part of your eye, fulfilling the same function as your old lens when it was healthy. You won’t feel any difference. If you are not able to have an IOL because of another eye condition or problems during surgery, you may use a special soft contact lens, or high-magnification glasses, after your own discolored lens is removed, to make up for the missing lens. 

• After the operation, your eye will be covered with a patch and you will rest while the medical team monitors you for any problems, such as bleeding. You will not be able to drive home after the operation and will need someone to help take you home. There may be some mild pain which should be gone within a day or two. You will probably be told to use eye drops for a few days, and must avoid rubbing or touching your eyes, bending from the waist, or lifting anything heavy. 

• Although cataract surgery is usually very safe, as with any surgery, there is always a risk of infection and bleeding. Cataract surgery also increases the risk of a detached retina, which must be treated immediately to avoid serious vision loss. If you have a sudden increase in flashes or floaters, inform your provider immediately. This may be a sign of retinal detachment and must be treated as a medical emergency. 

• In about 15% of people, a part of the eye called the posterior capsule becomes cloudy within three years of cataract surgery. This is called an “after-cataract” and can easily be corrected using a special laser. No surgery is needed. 

• Contact your healthcare provider immediately after your cataract surgery if you have any inflammation (pain, redness, swelling), bleeding, signs of infection, loss of vision, or double vision.

Lifestyle & Management

Your vision may be blurry after your cataract surgery, and it may take some days before both eyes adjust to the change. You will probably notice greatly improved color vision. You can return to most of your daily activities quickly but you should check with your healthcare provider before you start lifting heavy objects, bending, or driving. You will also need a new prescription for eyeglasses and contact lenses after recovering from surgery.

If you have a permanent decrease in your vision from a cataract, a complication of surgery, or any other reason, your eye doctor can refer you to a low vision specialist, who will prescribe useful devices and connect you with special services that offer training and counseling to people with low vision.

Your vision is important and prevention and quick detection of eye problems is key to sustain your eye health. If you have questions about cataracts, you should contact your doctor and or eye doctor immediately. If you have questions about at home care, we hare here too!