CONDITIONS

What are Cataracts?

A cataract is a clouding of the lens of the eye that causes the lens to lose its ability to properly focus light, resulting in blurry vision. The CDC reports that an estimated 20.5 million (17.2%) Americans aged 40 years and older have a cataract in one or both eyes. Beyond that, 6.1 million (5.1%) have had their lenses removed surgically to eliminate cataracts. By 2020, the total number of Americans who have cataracts is estimated to jump to 30.1 million.

What Causes Cataracts

Cataracts occur when tissues in the lens break down and conglomerate on the surface of the lens. As a result, the lens becomes clouded and light cannot effectively travel through the lens and focus on the retina for clear vision. . Tissue breakdown can occur for a variety of reasons, including:

  • Aging.There is natural degradation of lens tissues with age.
  • Congenital or developmental reasons. Certain cataracts are hereditary and/or related to birth defect.
  • Diabetes. Diabetes is the leading cause of blindness in adults ages 24-74.
  • Trauma from an eye injury

Risk Factors For Cataracts

The following are risk factors for cataracts:

  • Age. The risk of cataracts increases with age.
  • Diabetes. Diabetes is the leading cause of blindness in adults ages 24-74.
  • Steroid medications. Steroid medications such as prednisone have been linked to higher rates of cataract development.
  • Trauma from an eye injury

Diagnosing Cataracts

The following diagnostic tests are available for cataracts:

Slit-lamp exam. Slit-lamps are special microscopes that allow doctors t0 check for abnormalities in the areas at the front of your eye like the cornea, iris, lens, and the space between your iris and cornea. Light is focused on very specific areas, allowing doctors to exam small portions of the eye at a time in greater detail.

Dilated eye exam. During dilated eye exams, special eye drops are given to patients to dilate, or widen, the pupil. The widening of the pupil allows for more light to enter the eye, giving doctors a better view of the workings of inner eye components. The drops take about twenty minutes to have their full effect. Once the pupil is fully dilated, the doctor can examine the eye with an ophthalmoscope, a specially designed optometric instrument to view the retina and other areas of the back of the eye. If he or she detects macular degeneration, an amsler grid (see below) can be conducted. The dilation caused by the drops can last for several hours following the exam, and typically results in temporarily blurred vision.

Refraction and visual acuity test. This is the standard test during which patients must read letters on an eye chart that progressively decrease in size to the best of their ability. Patients look at objects through a device called a phoroptor to assess sharpness and clarity of their vision. Each eye is tested separately.

Symptoms of Cataracts

You probably won’t notice any signs of cataracts early on, though later, you may find that your vision is becoming cloudy and that you have trouble seeing in low light. You may also see halos around lights and colors may appear faded or yellowish. Double vision can also be a symptom.

Prognosis

Some cataracts are small enough that they affect vision only minimally and don’t require surgery. For cataracts large enough to cause visual impairment, surgery to implant an intraocular lens corrects the problem is the vast majority of cases. After the surgery, you’ll need to wear glasses or contact lenses but you won’t lose your sight.

Living With Cataracts

In many cases, depending on the eye disease or condition you have and your response to treatment, your vision may not be not noticeably impaired and you won’t experience any pain or only mild discomfort.

However, you may need to compensate for partial loss of vision if you have a condition such as wet AMD that can’t be treated. Ask your eye care specialist about low-vision rehabilitation devices and services that will help you learn coping strategies so that you can to continue to live independently.

Many people with some vision loss have to stop driving. If that happens to you, visit SeniorDriving.AAA.com to get information about affordable and convenient ways to maintain your mobility.

Screening

Serious eye diseases and conditions often have no symptoms until irreversible damage to vision has been done. If you wear prescription glasses and/or contacts, you probably go to an optometrist for an annual check-up to make sure your prescription hasn’t changed and to order a new batch of contacts if you’re running out of them. Optometrists conduct vision tests to check for basic vision impairment, and can prescribe glasses and contact lenses. They can also spot early warning signs and give you a referral to an ophthalmologist, an eye doctor with a medical doctor degree, for a more thorough examination. If you do not wear contact lenses or glasses, chances are you miss out this periodic optometric screening. Many times, family doctors with conduct a visual acuity test, which is a series of letters decreasing in size on a chart that patients are asked to read to the best of their ability. This gives doctors the opportunity to do as the optometrists would.

The standard recommendation for all adults over the age of 40 is to have an eye exam at least every two years, and for adults over 65, to have an eye exam every year.  According to the National Federation of the Blind, prompt detection and treatment can preserve your vision for a lifetime even if you do contract a serious eye condition or disorder. Schedule an eye exam with an optometrist. If he or she spots any problems that may be of concern, you will most likely be referred to an ophthalmologist, a medical doctor specializing in eyes, for further testing. Be sure to make an appointment with the ophthalmologist and follow recommendations regarding the frequency of follow-ups should any diseases or conditions be detected.

People with diabetes or at risk of developing gestational diabetes are recommended to get additional ophthalmic screening.

The American Academy of Ophthalmology recommends the eye screening schedule:
     Type 1 Diabetes: Within five years of being diagnosed and yearly thereafter.
     Type 2 Diabetes: At the time of diagnosis and yearly thereafter.
     During pregnancy: During the first trimester and follow-ups if indicated.

Prevention

Our best defense is to have regular checkups because eye diseases do not always have symptoms. Early detection and treatment are the keys to preventing vision loss.

Beyond that, a healthy diet that has sufficient vitamin and other nutrients will help keep your eyes lubricated and free of infections.

Also, avoid second hand smoke and if you smoke, kick the habit.

Protect your eyes from injury by wearing plastic eye guards if you’re involved in any activity that poses a risk of flying objects or particles.

Finally, remember that overexposure to the sun is just as bad for your eyes as it is for your skin. Wear sunglasses and stay away from tanning beds.

Medication And Treatment

If your vision is only slightly blurry, you may only need a change in the prescription for your glasses and/or contacts. However, if that doesn’t cause enough improvement, you may want to consider surgery. Waiting for the cataracts to “ripen” is no longer necessary and recovery is faster than it used to be.

The National Federation of the Blind reports that a great deal of progress has been made recently in the development of improved forms of cataract surgery, including use of freezing probes and ultrasonic  devices that make removal of the lens possible through a small opening. An estimated 95% of patients regain useful sight.

  • Phacoemulsification is the most common type of cataract surgery and is also known as “small incision cataract surgery.” During this procedure, a small incision is made on the side of the cornea and a tiny probe is inserted into the eye. The probe emits ultrasound waves that break up the lens, allowing doctors to remove it from the eye. It is then replaced with an intraocular (artificial) lens.
  • Extracapsular surgery requires a longer incision in the cornea, as the lens is removed in one piece and not broken up by ultrasonic waves. After the clouded lens has been removed, an intraocular lens is put in its place.

Cataract surgery can slightly increase your risk for retinal detachment. Follow up appointments with your doctor may be necessary to monitor for complications.

Complementary and Alternative Treatment

The National College of Complimentary and Alternative Medicine (NCCAM) reports that supplements of antioxidants (vitamins C and E and beta-carotene) do not prevent cataracts or slow their progression. There is little evidence of other alternative treatment methods for cataracts.

When To Contact A Doctor

In addition to your regularly scheduled visits to your eye care professionals, get immediate medical attention if you notice any sudden change in your vision or experience unusual symptoms such as extreme eye pain, burning, itching, redness, or fluid coming out of your eye.

Questions For A Doctor

Before you visit your doctor, write down a list of questions and concerns. Consider bringing a friend or family member along who can help you make sure you get all the information you need. In addition, writing down the doctor’s answers and recommendation for later reference is a good idea. Also come prepared with your medical history, information about any allergies you have, your family medical history, and a complete list of all medications you take including over-the-counter herbs and supplements.

Here are some questions you might pose when you visit your optometrist:

  • I started having trouble reading up close not long after I turned 40, so I bought a pair of readers at the drugstore. Is that OK? And did I pick the right strength?
  • I’ve always been nearsighted. Do I now need bifocals or progressive lenses?
  • I’ve heard about progressive contact lenses and monovision lenses. Would one of those options be right for me?
  • My eyes feel dry even when I blink. Is that a sign of a condition I’ve heard about called dry eye?
  • My eyes tear in cold weather, especially when it’s windy out. Is that a bad sign?
  • I work at a computer all day. Is that a risk for eyestrain?
  • Has my prescription changed in the last year? If so, is that a bad sign?

Here are some questions you might pose if you are referred to an ophthalmologist:

  • Which eye diseases or conditions are you screening me for?
  • If you diagnose an eye disease or condition, how much will medication and/or surgery cost?
  • Will the treatments control my problems so that I retain my vision?
  • How often will I need to come back to you for check-ups?
  • Should my adult children be checked if my condition is hereditary?
  • Are there any lifestyle changes I can make that will help prevent other eye diseases or the progression of the ones I already have?