Cataract

What is a cataract?
A cataract is a clouding of the lens, the clear part of the eye that helps to focus light on the retina. A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

What causes cataract to develop?
Most cataracts develop as an aging process with wear and tear changes in the lens. The other factors that can lead to cataract are:

  • Diabetes (especially if the blood sugar is poorly controlled)
  • Prolonged use of steroids
  • Eye injury (sometimes even years later)
  • Congenital cataract (cataract present in babies at birth due to nutritional deficiency during pregnancy)
  • Glaucoma or retinal detachment surgery
  • Smoking and long term excessive use of alcohol
  • Radiation exposure or prolonged exposure to sunlight

When are you most likely to have a cataract?
Although cataract is considered a disease of the aging eyes, it may be found in any age group. Even new born babies can have cataract.

What are the symptoms of a cataract?
The most common symptoms of a cataract are:

  • Cloudy or blurry vision
  • Colors seem faded
  • Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights
  • Poor night vision
  • Double vision or multiple images in one eye
  • Frequent prescription changes in your eyeglasses or contact lenses

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

How is a cataract detected?
Cataract is detected through a comprehensive eye exam that includes:

  • An eye chart test that measures how well you see at various distances.
  • Dilated eye exam: Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
  • Tonometry: An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

What can I do to protect my vision?
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.

If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.

How is a cataract treated?
The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.

Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.

What are the different types of cataract surgery?
There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:

Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called “small incision cataract surgery.”

Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.

After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.

Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, a soft contact lens, or glasses that provide high magnification, may be suggested.

Is cataract surgery effective?
Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward.

What happens before surgery?
A week or two before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of IOL.

What happens during surgery?
At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed.

The operation usually lasts less than one hour and is almost painless. Many people choose to stay awake during surgery. Others may need to be put to sleep for a short time.

If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After the operation, a patch may be placed over your eye. You will rest for a while. Your medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. You will need someone to drive you home.

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