Cataracts & Their Treatment

November 15, 2014 - Cataracts are very common. More than half of Americans over 80 either have a cataract or have already had surgery for this condition. I have been asked to review the situation as there is so much interest, so many ads about various types of treatment and, as a result, a good deal of confusion. First of all, it is very important to form a good relationship with a competent ophthalmologist whom you trust, and discuss the treatment options with him/her for a definitive opinion.

Cataracts are the result of a clouding of the lens of the eye, which is normally transparent and helps focus an image on the back of the eye. There are a few different types of cataracts with the most common by far being caused by aging. Trauma, congenital (being born with the condition), and some medications can also cause the lens to opacify (become cloudy). Smoking and diabetes are believed to accelerate the development of cataracts.

The lens is composed mostly of water with some protein. They are arranged in a very specific manner to expand and contract depending on the distance to the object or scene we want to see. This complex mechanism breaks down with age (don’t we all know that feeling?) and the clear lens develops small areas of cloudiness. As these cloudy areas come together, a cataract may form.

Cataracts develop slowly with age. For some time, a person may not even know they are developing a vision problem as the changes are very gradual and incremental. Colors dim and everything may take on a brownish shading as images lose their sharpness. Night vision and night driving become increasingly difficult, halos develop around headlights and streetlamps, and eye glass prescriptions change frequently.

Treating cataracts has become more complicated as there are now so many good options. According to the National Eye Institute, which has excellent subject material on the internet, conservative and non-invasive therapy includes new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses.

When someone starts to have trouble with everyday activities such as driving, watching TV, reading, it becomes time to consider surgery. There is, however, no rush; surgery, or the results from surgery are not worsened by delaying. You have only given up some functional time.

Of the two most common types of surgery currently available, phacoemulsification – or phaco – is more common. The other is extracapsular surgery which removes the lens through an incision in the side of the eye.

Phaco is performed with a smaller incision through the side of the eye, after which a tiny probe is inserted next to the lens which breaks up the lens with the cataract inside using ultrasonic waves. The lens containing the cataract is then suctioned away. Finally, in both cases a new clear intraocular lens, made of plastic, is inserted permanently. The patient never feels or sees the new lens. There are three different types of lenses but the basic monofocal is used most frequently. Often glasses are still needed after the surgery in order to see objects nearby or correct astigmatism, a condition where the back of the eye is not completely symmetrical.

As always, there are risks associated with any surgery. Cataract surgery is the most common surgery in America today. About 90% of people who have this surgery enjoy good vision afterwards. After the surgery and once the swelling subsides, there may be some temporary sensitivity to light and mild discomfort.

Overall, it is rather amazing as to what is now available to help folks with a common illness. Even the surgery, now normally done on an outpatient basis and lasting about an hour, is much easier than ever before. So, if you have the problem, see your ophthalmologist and consider your options.


 
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Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.