Cataracts Symptoms, Diagnosis and Treatment

Anyone privileged to live long enough will eventually experience blurry vision to some degree, many times from cataracts.

In fact, by the time we reach the age of 80, more than half of us will have either developed cataracts or had cataract surgery to restore clearer vision.

In the United States alone, eye doctors perform approximately 3 million cataract removal procedures each year-more than any other surgery anywhere in the body. Those numbers will continue to rise as the population ages.

Cataracts are the leading cause of blindness worldwide, with an estimated 50 million cases expected to be diagnosed in the U.S. by the year 2050.

While many individuals start noticing the blurred vision of cataracts as young as 40, most people are 60 or older before a cataract becomes problematic. The good news is that the condition is easily treatable and life-changing.

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What is a cataract?

The natural lens of the eye where cataracts form is located behind the iris (the colored part of your eye that is visible to others).

When the lens is clear and shaped properly, we see-the lens focuses the light onto the retina so you can see clearly.

As people age, the natural lens gradually becomes cloudy, leading to increasingly blurry, dim or hazy vision. This lens clouding is called a cataract, a condition that is practically a given in older adults. Cataracts are the leading cause of vision loss and blindness in people over the age of 40 the world over.

It is important not to confuse cataracts with age-related macular degeneration (AMD), which clouds the retina at the back of the eye. While cataracts prevent light from reaching the retina, AMD clouds the retina itself.

There is no evidence that macular degeneration will predispose patients to developing cataracts-nor will it prevent them-and is not considered a disqualification for cataract surgery. However, the two conditions require separate treatments.

What are the causes of cataracts?

Composed mostly of natural protein and water, the eye lens relies on the proper arrangement of those proteins to maintain its clarity and allow adequate light to pass through.

With cataracts, protein clusters together, causing cloudiness within the lens. This cataract will spread out and thicken, gradually blocking more light and definition from reaching the retina.

Usually, cataract development occurs in both eyes, though not always. The eye disease may progress at different rates in each eye.

Age, eye injury, and certain medical conditions will often hasten the breakdown of the lens. However, it’s not always entirely clear why some patients find themselves developing cataracts at 40, while others have relatively few cataract symptoms at 90.

We do know that certain lifestyle and health factors that may influence your own risk of developing cataracts.

What are risk factors for cataracts?

As with any health condition, genetics may play a role in cataract development. A family history of cataract is a strong indicator that you could also be susceptible to this vision problem as you grow older.

In addition, conditions related to overall health-and a few key lifestyle choices, may influence your cataract risk:

  • Smoking

  • Statins used to treat high cholesterol

  • Long-term corticosteroid use

  • Exposure to ultraviolet radiation

  • High alcohol consumption

  • High myopia (nearsightedness, or poor distance vision)

  • Certain other eye conditions, inflammation, or injuries

Of course, the biggest risk factor for cataracts is simply living long enough to develop them!

While those years roll by, you can reduce your risk for cataract and other eye disease by avoiding the known risks above and adopting some of these healthy habits.

  • Get some color on your plate. Colorful fruits and vegetables are good sources of eye-healthy vitamins A, C and E, as well as omega-3 fatty acids and antioxidants.

  • Kick butt. That is, kick those cigarette butts to the curb.

  • Go for the glass half-full. Cut back on alcohol.

  • The future’s so bright … if you wear shades. Choose sunglasses with UV protection any time you expect some sunlight. If you wear corrective lenses, consider purchasing photochromic lenses like Transitions. They will darken for you automatically, or buy a separate prescription set of sunglasses.

  • Do not rub your eyes. Ever. Rubbing can damage the delicate tissues of the eye, even if cataracts aren’t an issue yet. Just don’t do it.

These changes alone will go a long way toward keeping those peepers in good shape, or helping you bounce back more quickly from surgery should cataract removal become necessary.

Finally, take the invitation from your eye doctor to set up an annual eye exam. Catching the condition as early as possible gives your eye doctor adequate time to plan surgery so you can get back to all the things you enjoyed before vision got cloudy.

What are the symptoms of cataracts?

  • Blurred vision is the most common sign of cataracts, although the onset and manifestation of that symptom will depend on the type of cataract that is developing in your eye.

  • You may notice glares or halos around lights, especially at night. You may also notice an overall haziness, as though looking through a smoky environment.

  • Colors may look dull and you may even have trouble telling some colors apart.

  • For other people, or those with other types of cataracts, near vision or distance vision-or both-may suffer.

  • Depth perception can become difficult as the lens clouds and distorts.

  • Some kinds of cataracts develop very quickly, while others take years to become noticeable. This is due largely to the type of cataract and your overall health, but certain symptoms are common to different cataract types.

What are the different types of cataracts?

Nuclear sclerotic cataract. The nuclear cataract forms in the center, or nucleus, of the lens. It is the most common type and is inevitable for anyone who lives long enough. In the early going, this type of cataract may cause a paradoxical improvement in vision called “second sight.” This phenomenon is short-lived. As the condition worsens, blurred vision sets in, along with halos and dulled color perception. You may find it difficult to pick up all the little details you used to see.



Posterior subcapsular cataract develops at the back of the lens. This type of cataract causes vision to decrease quickly. Diabetes, injuries or eye swelling can increase the risk of a subcapsular cataract. Symptoms such as double vision, light sensitivity, glare and blurriness may not appear until cataracts are well advanced.


Cortical cataract forms around the perimeter of the lens, called the cortex, and works its way toward the center like tiny “spokes.” The effect is a scattering of the light entering the eye. This causes blurriness, glare, haziness and difficulty with depth perception. Many cataract patients first notice problems driving at night, due to the glare around streetlights.


Congenital cataract. Between 1 and 6 of every 10,000 infants are born with congenital cataracts, which account for nearly 10 percent of childhood vision-loss. Fortunately, the condition is very treatable and sometimes does not require surgery.


Traumatic cataract. As the name implies, this type of cataract is brought on by traumatic injury to the eye.

How are cataracts diagnosed?

Diagnosing cataracts is straightforward and can be easily done by an optometrist during a routine eye examination.

Before the exam starts, patients are asked for medical history information that could be relevant to eye health. The doctor will also want to check your eye movement, pupillary response and eye pressure.

Your eye doctor will dilate your pupils and use a slit lamp microscope or ophthalmoscope to examine the lens for visual signs of a cataract, the retina and optic nerve at the back of the eye. (S)he may employ other sophisticated ocular imaging technology to get detailed images and “maps” of the entire eye structure. And, of course, no eye exam is complete without a thorough reading of the lettered vision chart.

If cataracts are diagnosed, your doctor will discuss your symptoms and eye health history with you to determine what, if any, cataract treatment is necessary.

What is the treatment for cataracts?

In many cases where there are no significant symptoms, treatment for cataracts may not be necessary right away.

  • A patient in the early stages of cataract development may already be using a stronger eyeglass prescription, anti-glare glasses or multifocal lenses to help see more comfortably.

  • Extra lighting and even a magnifying glass may even come in handy until the time comes to treat cataracts more aggressively with surgery.

  • Visual aids, however, treat only the symptoms of cataracts, not the condition. At some point, cataracts may interfere with the ability to live a full, independent and active life. Patients may find they can no longer drive safely or enjoy the travel and hobbies that bring them joy. Ultimately, the only way to treat a cataract that has advanced to this point is to remove the clouded lens surgically.

  • Cataract removal surgery involves extracting the clouded lens. In many cases, an eye doctor will replace the natural lens he/she removed with an intraocular lens (IOL), such as the Toric IOL, multifocal IOL or another type of implantable contact lens. If a lens is implanted after cataract removal depends on whether there are other refractive errors affecting vision, such as, myopia (nearsightedness), hyperopia (farsightedness, )presbyopia (“over 40” vision), or astigmatism.

What is cataract surgery like?

Start to finish, cataract surgery usually takes only a few minutes per eye. The surgeon uses a laser to make a small incision to the front of the eye through which the cataract is extracted.

If an artificial lens is being implanted, the surgeon will do this once the cataract is removed. If there are cataracts in both eyes, the surgeon will treat one eye at a time, either on the same day or on different days.

The surgery is quick and essentially painless. You will need someone to drive you home afterward and a bit of time to heal. Most people can return to work or regular activities after a few days.

Risk of treatment?

Cataract surgery to remove the cloudy natural eye lens is a common procedure that is generally considered safe and is done on an outpatient basis.

Even if an artificial lens such as a Toric lens is implanted to correct a refractive error, cataract/intraocular lens surgery does not require a hospital stay.

That said, every surgery, no matter how minor, comes with some risks. The most common risks of cataract surgery are:

  • Eye inflammation and/or retinal swelling

  • Temporary sensitivity to light

  • Photopsia, or flashes of light in the visual field

  • Elevated eye pressure

Your surgeon will inform you of the risks of cataract surgery, steps to take to reduce the side effects and when to contact him/her for additional treatment. Complications, however, are rare and most people see better after healing.

What are complications of cataracts?

Once cataracts appear, they will continue to worsen over time. This clouding of the lens gradually robs you of your ability to see clearly and can have a negative affect on your quality of life. The light sensitivity, glares and halos brought on by cataracts can make night driving-and eventually day driving-frightening and dangerous.

Reading, even with prescription glasses, can become extremely difficult and uncomfortable. As can other hobbies like sewing, birdwatching, sports and more. Worst of all, without treatment, cataracts can lead to total blindness.

What is the prognosis of cataracts?

The prognosis for patients who receive treatment for cataracts is exceptional. An estimated 98 percent of cataract surgeries are successful, with few complications and most patients reporting satisfaction with the results. Early treatment offers the greatest chance for success.

Cataracts that are left untreated for a long time will negatively affect vision or may become “hyper-mature.” Hyper-mature cataracts are more difficult to remove than those in the earlier stages and pose a greater risk of surgical complications.

Because cataract removal does not in itself correct refractive errors, reading glasses or contact lenses may still be needed after surgery.
Implantable contact lenses (ICLs) installed at the time of cataract removal can correct refractive errors.

However, since insurance doesn’t cover vision correction surgery such as astigmatism and the need for reading glasses, you may have to explore financing options to pay for lens implants to ditch glasses and contacts for good.

How does laser cataract surgery benefit the environment? A note about contact lens disposal

It’s estimated that up to 20 percent of the more than 45 million disposable contact wearers in the United States flush their lenses down the toilet or drain. These could be daily, weekly, bi-weekly or monthly contacts, which adds up to billions of bits of plastic and silicone introduced into the environment.

In fact, researchers presenting at the 2018 National Meeting & Exposition of the American Chemical Society (ACS) estimated that up to 10 metric tons of plastic lenses are finding their way into wastewater each year in the U.S.
These discarded lenses pose a tremendous threat to aquatic animals that can accidentally ingest intact lenses and die.

Although the plastic eventually breaks down into tiny particles called microplastics, they still pose an environmental danger. Since plastics are not digestible, they can be hazardous to the digestive system of marine animals-many of which end up in the human food supply chain. That means human ingestion of microplastics and all the contaminants and pollutants come with them.

For these reasons, eye doctors strongly recommend protecting wildlife, the environment and human health by properly disposing of contact lenses in a trash bin. Even better, consider laser cataract surgery, which can correct your vision so you no longer require contact lenses or glasses to see.

Conclusion

Cataracts are the leading cause of blindness worldwide, robbing individuals of eyesight and the freedom and quality of life that come with it. It doesn’t have to be that way.

Not only are cataracts easily treatable through surgery, but you may be able to correct nearsightedness, farsightedness or astigmatism at the same time to achieve sharper vision than you ever thought possible. Discuss your cataract risk with your eye doctor. If you have cataracts, review treatment options for cataracts and other vision problems.

Sources

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts

https://www.hopkinsmedicine.org/wilmer/conditions/cataracts_faq.html

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts/cataract-surgery

https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/cataract-data-and-statistics

https://medlineplus.gov/cataract.html

https://www.cdc.gov/visionhealth/basics/ced/index.html

Owsley C, Stalvey B, Wells J, Sloane ME. Older drivers and cataract: driving habits and crash risk. J Gerontol A Biol Sci Med Sci. 1999;54(4):M203-M211. doi:10.1093/gerona/54.4.m203

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