Cataracts

1 What are Cataracts?

A cataract is an ocular disorder characterized by clouding of the lens which otherwise are clear. Clouding of the lens can impair vision and cataract is the leading cause of blindness in people over 40.

Cataract myths

Cataracts can impair your vision significantly and often you may find it difficult to perform activities like reading a newspaper or driving a car. Cataracts progress gradually and don't impair your vision at early stages.

But as the disease progresses, cataracts will cause reduced vision. At an early state when the symptoms are benign, cataract associated vision impairment can be overcome by using brighter lights and eyeglasses. But when the cataracts become severe and start affecting your usual activities, a surgery may be needed to correct the problem.

Cataract surgery is generally a simple, short, safe and effective procedure.

2 Symptoms

Signs and symptoms of cataracts include:

  • Clouded or blurred vision
  • Vision gets worse at night or when the light is very bright (glare)
  • Seeing "halos" around bright objects
  • Fading or yellowing of colors
  • Rarely, double vision in one eye

At the early stage, you may not notice any sign of visual impairment as only a small portion of the lens is clouded. With gradual progression of the cataract, a larger portion of the lens is affected and signs of visual disturbances become apparent.

When to see a doctor

Schedule an eye exam if you have any issues with vision. Consult your doctor immediately if notice sudden vision changes, such as double vision or blurriness.

3 Causes

Age is the main causing factor of cataracts.

You may be at a greater risk if you have a family history of cataract. Various factors like eye injury, eye inflammation, long term use of steroids and diabetes could also boost your chances of cataracts.

How a cataract forms?

Cataract develop when your eye lens becomes clouded due to various reasons, age being the most prominent one. Normally, the lens is clear, transparent and allows light to pass through it. But when cataract causes clumping of tissues on the lens, the lens becomes opaque and consequently, vision is blurred. Age related changes are responsible for development of tissue clumps on the lens. Initially, only a smaller portion of the lens is affected but as the disease progresses, a larger portion may be involved.

Types of cataracts

  • Nuclear cataracts: These cataracts affect center of your lens, hence called nuclear cataracts. Initially, you may experience nearsightedness or even a temporary vision improvement. Then you may notice your lens is gradually turning densely yellow and eventually brown.
  • Cortical cataracts: These cataracts affect the edges of your lens. It starts with the development of whitish streaks on the outer edge of the lens cortex which expand to the center as the disease progresses. Eventually, you may experience vision problems as the streaks interfere with light passing through the center of the lens. You might notice problems with glare if you develop cortical cataracts.
  • Posterior subcapsular cataracts: These cataracts affect posterior part of your lens. A small, opaque area may form near the back of the lens thereby interfering with the passage of light into the retina. You may have problems with reading and bright light vision. It might also cause glare or halos around lights at night.
  • Congenital cataracts: These are the cataracts you're born with or you might develop during your childhood. Some factor that might cause congenital cataracts are infection during pregnancy, myotonic dystrophy, galactosemia, Lowe's syndrome or rubella.

4 Making a Diagnosis

Making a diagnosis of cataracts is done by performing several tests.

Visit your doctor if you notice any problem with your vision or other visual changes. If suspected of having a cataract, your doctor may be refer you to an eye specialist who can perform cataract surgery (ophthalmologist).

What you can do

  • Make a list of all the symptoms and medications, vitamins or supplements you are taking.
  • Write down key personal information, other medical condition, if any.

Make a list of questions to ask your doctor. Some relevant questions can be:

  • Do I have cataracts?
  • What could be other possible causes for my vision problems?
  • Do I need cataract surgery?
  • When will my vision get back to normalcy after the cataract surgery?
  • Are the any risks of cataract surgery? If yes, how severe can they be?
  • What will be the cost of surgery, and is it covered by my insurance?

Your doctor may ask:

  • When was the first time you started experiencing symptoms? How severe are the symptoms?
  • Do you experience vision problems in bright light or at night?
  • Is the vision problem affecting any of your normal activities like reading or driving?
  • Do you have a history of cataract in your family?
  • Have you ever suffered an eye trauma or been through eye surgery?

Testing for Cataracts

  • Visual acuity test: Your doctor will ask you to read a chart to detect if your eyes have any problem reading.
  • Slit-lamp examination: In a slit lamp examination, your doctor views parts of your eye like cornea, iris, lens, and the space between your iris and cornea as they are illuminated by an intense line of light, a slit. Viewing these structures in small sections allows your doctor to detect any tiny abnormalities.
  • Retinal examination: In a retinal examination, your eyes are first dilated by administration of dilating agent like atropine eye drops. Then, the dilated pupils are examined by your doctor using a device called ophthalmoscope.

5 Treatment

Surgery is the definite treatment for cataracts. Talk to your doctor to determine if surgery is the right option. For most people, cataracts do not pose a real threat to vision and time of surgery does not affect the extent of recovery.

A cataract surgery is safe, simple and effective treatment for cataracts. During a cataract surgery, your surgeon removes the affected lens and replaces it with a clear artificial lens. In certain patients when replacement with artificial lens is not possible, the doctor can remove the cataract and recommend the use of eyeglasses or contact lenses to correct the vision.

Generally safe, cataract surgery may increase risk of retinal detachment and cause some discomfort for a few days. Your eyes heal within eight weeks of a cataract surgery.

In case when both the eyes need cataract surgery, your doctor recommends a gap of one or two months between the surgeries of the two eyes.

6 Prevention

Simply, there are no ways proven to prevent or slow down cataract.

However, following suggestions might help you minimize the risk or prevent complications:

  • Regular eye examinations: Early detection through periodic examination can help reduce complications.
  • Quit smoking: Talk to your doctor to find out which smoking cessation strategy works for you.
  • Drink in moderation: Excessive alcohol use is a contributing factor for cataracts.
  • Wear sunglasses: Wearing proper eyeglasses can protect your eyes from the UV rays. Chose sunglasses that block ultraviolet B (UVB) rays.
  • Manage other health problems: Keep other diseases like diabetes in check.
  • Maintain a healthy weight: Stay healthy and maintain a healthy weight through exercise and proper diet.
  • Choose a healthy diet: A diet that contains plenty of fruits and vegetables provides adequate amounts of vitamins and other nutrients necessary to maintain health including that of your eyes.

Till now, no studies have documented the benefits of using antioxidant pills to prevent cataracts. However, a recent large population study has linked consumption of vitamin and mineral-rich diet to lowered risk of developing cataracts.

7 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with cataracts.

Follow these tips to manage the signs of cataracts until you decide to have surgery:

  • Wear eyeglasses or contact lenses according to your need
  • Use brighter lamps in your home
  • Wear sunglasses or a broad-brimmed hat if you are outdoors during the day
  • Do not drive during night, as far as possible
  • Opt for cataract surgery if the signs affect your everyday activities.

8 Risks and Complications

There are several risk factors associated with cataracts, which include:

  • Age
  • Diabetes
  • Hypertension
  • Obesity
  • Smoking habit
  • Heavy drinking
  • Excessive exposure to sunlight
  • Exposure to ionizing radiation like X-rays or those during cancer radiation therapy
  • Family history
  • History of eye injury, inflammation or eye surgery
  • Chronic corticosteroid use
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