Cataract: an overview and more

Cataracts are the leading cause of vision loss in people over 55 years of age. They can make your vision look blurry or blurry, as if you are looking through a foggy window. Cataracts can develop due to normal aging. Additionally , risk factors such as diabetes and smoking can also predispose you to cataracts. Treatment can range from wearing sturdier glasses to cataract surgery, which may involve replacing a lens in the eye .

Types of cataracts

The lens consists of three layers: the outer layer (capsule), the middle layer (cortex), and the inner layer (nucleus). There are three different types of cataracts, which differ in the part of the lens affected .

Nuclear sclerotic cataract

This is the most common type of age-related cataract, causing a gradual yellow clouding and hardening of the lens nucleus. Vision changes are usually gradual.

As nuclear sclerotic cataracts develop, you may feel better with near vision before your vision deteriorates. This stage, called the second look , is usually temporary.

Illustration by Emily Roberts, Get Drug Information

Cortical cataracts

Diabetes is one of the main risk factors for the development of cortical cataracts. Cataracts usually appear as a whitish opacity in the lens cortex.

These cataracts often resemble the spokes of the wheels that point toward the front and center of the lens. Light tends to scatter when it hits opaque spokes.

Posterior subcapsular cataract (PSC)

These cataracts form at the back of the lens and tend to affect one eye more than the other. PSC is the cloudiness that develops on the back of the lens.

This type of cataract causes photosensitivity, blurred near vision and glare and halos around light sources. It is more common in people who have diabetes or who have been taking steroids for a long time.

Cataract symptoms

Cataracts can develop in one or both eyes. They are painless and will not change the appearance of your eyes. When cataracts are small, vision usually does not deteriorate early, but it usually deteriorates over time and can cause gradual vision deterioration.

The most common cataract symptoms include :

  • Blurry vision
  • Photosensitivity
  • Seeing halos around the lights
  • Impaired night vision
  • Yellowish or faded vision
  • Double vision
  • Change in depth perception

Vision changes due to cataracts are often gradual. You may need to change your eyeglass prescription frequently, which could be a sign of cataract development.

Most older people experience clouding of the lens, which is normal as we age. However, if left untreated, cataracts can ultimately lead to complete blindness.

Causes

Cataracts affect the lens of the eye, a transparent structure composed mainly of water and protein fibers. The lens is responsible for focusing light and creating sharp, clear images.

The entire lens is inside the lens capsule. As the eye ages, proteins and dead cells accumulate in it, forming cataracts and causing clouding of the lens. At first, a cataract may be a small, opaque spot. Over time, it can enlarge and cloud the lens more, making it difficult to see .

In cataracts, the light that is usually focused on the lens is scattered by cloudiness, making vision blurry and harsh.

Risk factor's

The biggest risk factor for developing cataracts is aging. Other risk factors include :

  • Diabetes
  • Eye surgery
  • Family history of cataracts
  • Of smoking
  • Certain medications, such as steroids and statins (a type of medicine that lowers cholesterol).
  • Ultraviolet irradiation
  • Radiation
  • Eye wound
  • Congenital (present at birth or in early childhood)

Diagnostics

Your healthcare provider can perform a series of detailed eye exams and eye tests to help diagnose cataracts. Generally, an ophthalmologist or optometrist should perform these tests because they have experience with visual evaluation, and some tests require special equipment.

If you have a possible cataract, you may need the following tests:

  • Visual acuity test : Your ophthalmologist will measure your visual acuity by asking you to read letters on a chart from a distance.
  • Contrast sensitivity test: This is an assessment of your ability to detect visual contrast, which may change due to the glare caused by your cataract. Ophthalmologists consider contrast sensitivity tests to be a valuable indicator of the quality of your vision.
  • Slit lamp exam: The slit lamp exam uses light and a microscope to examine the structures of the eye in detail. Your healthcare provider will ask you to rest your chin on a chin rest. Then the light will be directed to your eye. By looking through a slit lamp, especially when your pupil is dilated with eye drops, your doctor may see cataracts and other vision problems.
  • Retinal exam: With an ophthalmoscope, your healthcare professional can take a closer look at the inside of your eyes. This test is usually used to examine the optic nerve and the retina, but the lens can also be visualized. Your doctor may use eye drops to dilate your pupils.
  • Tonometric test : This test measures the pressure inside your eye, often using a small probe placed directly into the eye or a breath test . While this test is not specifically designed to evaluate cataracts, it can identify other eye problems that cause visual impairment, such as glaucoma .
  • Potential Visual Acuity Test (MAP) : This test measures how well you would see if you did not have cataracts. This will help you and your healthcare provider know if cataract surgery will improve your vision. The PAM test projects a visual acuity diagram into the eye with a laser, bypassing the cataracts. You can read the chart like the peephole on the wall. If your vision indicates 20/40 with a PAM test, cataract surgery is expected to give you 20/40 vision of that eye.

If you have vision loss and cataracts, it is important to know that you may have other conditions that contribute to vision loss in addition to cataracts.

Watch out

Small cataracts that have little effect on vision generally do not require treatment. Wearing stronger prescription glasses, wearing artificial tears, tinting your lenses to reduce glare, and wearing sunglasses can help with many of your symptoms.

Surgery is the only cure for cataracts, but getting a diagnosis doesn't mean you need the procedure right away. Many people live with mild cataracts for years. However, if a cataract causes significant vision loss, it is useless to wait until surgery. Advanced cataracts are also associated with an increased risk of complications during surgery .

Tears

There are many artificial tear drops on the market. While they are not a treatment for cataracts, they can help relieve symptoms. Talk to your doctor about which one is best for you. Wait 15 minutes after using prescription eye drops before using artificial tears.

You may have friends or family members who recommend Lanomax (lanosterol) eye drops for cataract treatment. This treatment is familiar to many people because it is used to treat cataracts in some animals, but it is not approved to treat cataracts in humans.

Cataract surgery

Cataract surgery involves removing the cloudy lens and possibly replacing it with an artificial lens implant.

Cataract surgery is usually done on one eye at a time. This is done to minimize potential complications. This is usually an outpatient procedure and you must go home the same day.

There are several types of cataract surgery, and the best procedure for you depends on the size and location of your cataract.

  • Phacoemulsification : This is the most common type of cataract removal procedure, sometimes called phacoemulsification surgery or small incision cataract surgery. The device, which vibrates at high speed, is inserted into the eye through a small incision. This device emits ultrasonic waves that gently soften and destroy the lens so that it can be removed by suction. Then an artificial lens can be inserted into the eye. Only one suture may be needed to close the wound (or none at all) .
  • Extracapsular cataract surgery: This procedure is similar to phacoemulsification, but a larger incision is made so that the lens can be removed in one piece. Multiple stitches or sutures may be needed to close the wound. Healing is usually slower than with small incision cataract surgery, and complications such as astigmatism can occur .
  • Intracapsular cataract surgery: The entire lens and its capsule can be removed through a large incision. This technique is generally used for large cataracts or eye trauma and can lead to more complications and slower healing than smaller incision surgery .
  • Laser Cataract Surgery – Uses a femtosecond laser that creates a high resolution magnified image using an integrated Optical Coherence Tomography (OCT) device . The laser makes an incision, the lens is broken into small pieces, and a phacoelement is inserted to remove the lens fragments. A new intraocular lens can then be implanted .

How to do it

While there are differences based on the type of cataract surgery performed, in general you can expect the following:
Before surgery, you may be given a mild sedative and eyedrops may be put into your eye to dilate the pupil. The skin around the eyes and eyelids will be cleaned and sterilized. A sterile napkin will be placed over the head and around the eye. Then numbing eye drops are applied.

Small incisions will be made in the peripheral cornea , the clear domed structure at the front of the eye. The capsule will then open. A small ultrasonic probe will be inserted into the eye. This tube will dissolve the cataract and the remaining material will be suctioned out.

If planned, a new clear lens implant can be inserted into the eye through the same small incision and replaced .

After cataract surgery, your doctor may apply an antibiotic ointment directly to your eye to prevent infection.

Recovery

It is possible to read, write, or watch television immediately after surgery, but you should wear sunglasses for the first few weeks when exposed to light, even indoors.

Most people develop inflammation after cataract surgery, which can cause a bit of grit or scratching at the eye for the first few days. Your vision may be blurry due to inflammation, pupil dilation, and antibiotic ointment.

You will be given a prescription and instructions for using the eye drops for the next two weeks after surgery. These eye drops are used to prevent infection and relieve inflammation.

Don't touch or lose your eyes. You will be asked to wear an eye patch the first night after surgery to protect your eye. You should avoid bending over or lifting heavy objects for the first two weeks after surgery.

Your healthcare provider will most likely ask you to return for several follow-up visits to monitor your recovery. After your first postoperative visit, you may be advised to wear a night watch bandage for the next few nights.

Possible complications

Cataract surgery is a safe procedure with very few complications. However, as with any surgery, postoperative problems can arise.

Complications to watch out for include:

  • Infection – An infection immediately after cataract surgery can be very serious and is considered an urgent eye problem. If you experience pain or redness, call your doctor immediately.
  • Swelling – Some swelling is expected after cataract surgery. The inflammation can cause sensitivity to light, pain, or weakness in the eyes.
  • Edema: swelling of the back of the retina can occur . While this requires attention, it usually clears up in about a month.
  • Retinal detachment : If you see spots, floating spots, or flashes of light, call your doctor.
  • Posterior capsule turbidity: The capsule behind a new lens implant can thicken and become cloudy in 20-40% of cases after cataract surgery. This can blur your vision. This cloudy capsule can be removed using a laser procedure known as a Yag capsulotomy .

Prophylaxis

No specific medications or treatments are used to prevent cataracts, but several strategies can reduce your risk.

Managing diabetes, quitting smoking, and wearing sunglasses can help prevent cataracts from developing or worsening, if you already have one.

Consuming antioxidants and omega-3 fatty acids reduces the risk of cataracts . This may be due to the action of these dietary components, which neutralize harmful substances in the body .

Get the word of drug information

If you have blurred vision, it is important to schedule a complete eye exam to determine the cause. Cataracts can cause vision problems, but other eye conditions can also cause blurred vision. Your ophthalmologist will perform various diagnostic tests to check the general condition of your eyes. Many eye problems can be prevented or corrected if they are caught early.

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