Cataracts

Overview

A cataract is a clouding change to the naturally clear lens inside the eye. Normally, light enters the eye and passes through the lens without difficulty. When a cataract develops, the light may scatter or be blocked by the cloudy lens leading to blurry vision. Cataracts can develop from normal aging changes, from an eye injury, from metabolic changes (like diabetes), or from some medications (like steroids).

Symptoms

Cataracts cause blurred vision, dulled vision, decreased night vision, poor contrast, light sensitivity, glare, and ghost images. When the vision changes from the cataract interfere with your daily activities, then it is time to have the cataract removed. Common activities that can be impacted by cataracts include driving (especially at night), reading, and watching TV.

Treatment

Eye surgery is the only way to treat a cataract. The good news is that cataract surgery today has evolved tremendously. For example, there are many excellent options to improve your vision and reduce dependence on glasses at the time of the procedure. Also, for most patients the procedure only takes a few minutes.  Of course, you can decide not to have the cataract removed. However, if you choose to wait then your vision loss from the cataract will continue to get worse over time.

Types of Cataracts

There are many different types of cataracts. The three most common types are nuclear, cortical, and posterior subcapsular cataract. Each of these types of cataracts can cause different problems with the vision and you may have more than one type of cataract at the same time. The good news is that all types of cataracts can be effectively treated with cataract surgery.

Nuclear

A nuclear cataract is a gradual hardening and yellow/brown color change to the lens in the eye. This type of cataract tends to progress slowly over the course of years. In addition to blurry vision, nuclear cataracts can cause a gradual dulling and yellowing of colors. A nuclear cataract is a common age related cataract. In addition, it is common to form after retina surgery.

Cortical

A cortical cataract is a white change to the lens. These cataracts can be associated with glare, light sensitivity, and decreased vision too. While a cortical cataract is age related, it can also be seen after trauma and in patients with a history of inflammation in the eye and in diabetic patients.

Posterior Subcapsular

A posterior subcapsular cataract is a hazy/frosting change to the back surface of the lens. This type tends to progress the most rapidly. A subcapsular cataract can become significant in just a few months and can be associated with a rapid decline in vision. This type of cataract causes significant glare which can make driving at night difficult.

Evaluating Your Cataract

The first step in evaluating your cataract is a visit with your ophthalmologist (eye surgeon) to see if there is any other reason for decreased vision other than the cataract. If a cataract is determined to be the reason for vision decline, the next step is to assess vision limitations and the level of impairment the cataract is causing on your daily activities. Determining how much the cataract inhibits your activities helps guide the treatment discussion. Together, you and your eye surgeon will decide if it is time to proceed with cataract surgery.

Optimize the Eye First

Prior to surgery, your eye surgeon will evaluate the overall health of the eye and take precise measurements of your eye to help determine the power needed for your lens implant (IOL). Sometimes the surface of the eye (the cornea) is too dry or in need of repair prior to undergoing cataract surgery measurements. Optimizing the cornea surface improves the accuracy of your eye measurements and the quality of your vision after surgery. For example, your eye surgeon may recommend a corneal polishing procedure or dry eye treatments to smooth a rough/irregular eye surface prior to surgery. Once the corneal surface is optimized you will then proceed with the eye measurements.

Impact of Dry Eye After Cataract Surgery

Many patients have dry eye disease which can worsen after any eye surgery and can last for several months. It is common to need to improve control of dry eye disease prior to surgery. There are many options for treating dry eye and some preoperative treatments may include lubricating eye drops, oral supplements, warm compresses, and procedures such as Lipiflow.

It is important to review all your medications with your doctor prior to surgery and you may be asked to adjust some medications before surgery. You may also be asked to start eye drops prior to your surgery to help reduce swelling and inflammation and risk of infection after surgery.

The only way to treat a cataract is with surgery. Cataract surgery is a procedure to remove the lens inside your eye when it is cloudy and affecting your vision. During cataract surgery, the cloudy lens is removed and replaced with a clear lens implant called an IOL (Intraocular Lens Implant). The purpose of the natural lens in your eye is to bend light rays into focus so you can see clearly and the implant will serve the same function. There are many different kinds of lens implants, each with advantages and disadvantages. An exam and discussion with your ophthalmologist will help you select the right intraocular lens implant for your vision needs.

Here is a video by Dr. Kane describing what a cataract is and how it is treated with cataract surgery. He explains the basic steps of cataract surgery and provides an overview of what the patient may experience.

To watch the video click HERE