What Are Cataracts?
Cataracts are when the naturally clear lens (responsible for bending light before it gets to the retina) of the eye becomes cloudy. This results in foggy and dusty vision. Cataracts are usually the result of aging when lens proteins start to break down.
Cataracts are common and are the leading cause of blindness worldwide. Over 20 million Americans have cataracts in one or both eyes.2
After age 40, many people experience a change in vision, leading to several eye conditions, including cataracts.
Fortunately, cataracts can be treated with cataract surgery, which limits vision loss and prevents blindness.
Symptoms of Cataracts
Cataracts are a progressive disease that worsens over time.
At first, symptoms might be mild or nonexistent. As the cloud spreads over the lens, symptoms worsen and include:
- Blurred vision
- Cloudy vision
- Trouble seeing at night
- Halos around light
- Double vision
- Eyeglass prescription changes frequently
- Sensitivity to light
If left untreated, cataracts will lead to vision loss and eventual blindness.
What Causes Cataracts?
Aging most commonly causes cataracts. As we age, eye proteins start to weaken and break down, causing clumping and a cloudy lens.
Other causes of cataracts include:
- Exposure to ultraviolet radiation (not wearing sunglasses)
- Prolonged use of medication containing steroids
- Eye injury or trauma
- Radiation therapy on the upper body
Who is at Risk for Cataracts?
While the natural aging process puts everyone at risk for developing cataracts, there are factors that put people at a higher risk, including:
- Older adults
- Family history of cataracts
- Heavy alcohol consumption
- High blood pressure
- Exposure to X-rays and radiation treatment
- Previous eye surgery and eye injury
How Cataracts Are Diagnosed
A licensed ophthalmologist diagnoses cataracts during a comprehensive eye exam with pupil dilation (eye drops dilate the eyes).
Using a slit lamp, they examine the front of the eye, including the iris, cornea, and lens, to look for abnormalities and signs of clouding.
The eye doctor will also look at the back of the eye to examine the retina and optic nerve for signs of disease.
Additional vision tests during a comprehensive eye exam include:
- Glaucoma test (checks eye pressure)
- Visual acuity test (screens for clarity and distance vision)
- Visual field test (checks side vision, also known as peripheral vision)
Types of Cataract Surgery
Surgery is the only way to remove cataracts.
Many people who have cataracts use eyeglasses to manage vision changes without surgery. However, eye doctors recommend cataract surgery when symptoms interfere with the quality of life and the ability to do daily activities.
What is an IOL?
The eye doctor will replace the cloudy lens with an artificial intraocular lens (IOL) during cataract surgery. This corrects vision loss and prevents blindness.
Types of IOLs
Eye surgeons can use several types of IOLs in cataract surgery, each with different benefits. Insurance does not cover all types of IOLs.
Monofocal lenses correct one type of vision. Typically, people with monofocal lenses have them set for distance vision and use eyeglasses for reading.
Monofocal lenses are the most common type of lens used in cataract surgery. Medicare usually covers them.
Multifocal lenses have different zones built in for both near and distance vision. This allows you to see everything. These lenses can also correct mid-range vision.
While multifocal lenses take away the need for eyeglasses and contact lenses, they are expensive and often not covered under insurance.
Similar to monofocal lenses, accommodative lenses only correct a single focus strength.
However, they are designed to respond to eye muscle movement, allowing a shift in focus between near and distance vision.
Researchers believe advances in eye care will lead to accommodative lenses that provide the level of clear vision experienced during childhood.
Toric lenses correct astigmatism (abnormal eye curvature leading to blurry vision). A toric lens is a good option for people who have both cataracts and astigmatism.
Phacoemulsification Procedure and Recovery
Phacoemulsification, also called phaco, is the most common procedure used during cataract surgery.
This technique emulsifies (liquifies) the cataract lens using ultrasound waves. This allows the eye doctor to suction the natural lens and replace it with an artificial intraocular lens.
About a week before cataract surgery, the eye doctor uses ultrasound to measure the eye’s shape and size. This helps determine what type of IOL to use during surgery.
The eye surgeon will discuss the risks and benefits of cataract surgery before setting an appointment date and time.
Understanding the cost and insurance coverage helps avoid unanticipated expenses.
Day of Procedure
Cataract surgery is an outpatient procedure that occurs in a surgery center or clinic. It usually takes about an hour. Because your vision might be blurry after surgery, ask someone to drive you home.
Before surgery, the doctor will dilate your pupils with special eye drops. This allows them to see inside your eye. You will also receive anesthetic numbing eye drops and a sedative for relaxing.
Next, the eye doctor will make a small incision in the cornea (transparent front layer of the eye), where they will insert an ultrasonic probe to break up the cataract and remove the natural lens.
Then, they will insert an artificial IOL and stitch the incision to close it and keep the lens in place. They will place a patch or shield over your eye to promote healing.
Blurred and distorted vision that lasts a few days after cataract surgery is normal. Other common side effects after surgery include:
- Colors seem brighter
- Itchy eye
- Mild discomfort
Avoid rubbing or pushing on your eye after cataract surgery. Contact your doctor right away if you experience any of the following symptoms:
- Pain that is not relieved by over-the-counter (OTC) medication
- Vision loss
- Persistent red or bloodshot eyes
- Swelling of the eyelid
- Flashes or floaters in your field of vision
You will need to wear a patch or eye shield for a couple of days while you recover. Your doctor will prescribe daily eye drops to prevent infection and swelling.
Your eye doctor will schedule an appointment the day after surgery to check on healing. They will typically schedule additional visits both a week and a month after surgery to confirm the surgery was successful.
Laser Cataract Surgery Procedure and Recovery
Laser cataract surgery uses a laser to make the tiny, precise incision in the cornea needed to remove the natural lens. The laser also softens the lens before suctioning it out in fragments.
This technique is more precise and uses significantly less energy than the phacoemulsification method.
Before laser cataract surgery, the eye doctor will take a 3D picture of your eye to help guide the laser during the procedure. They will also choose which type of IOL to use during surgery.
Make sure to follow all preoperative instructions from the eye doctor to ensure you are prepared and the surgery runs smoothly.
Day of Procedure
Laser cataract surgery is an outpatient procedure that occurs in a surgery center or clinic. It usually takes about 30 minutes. Expect to be at the surgery center for about 3 hours and ask someone to drive you home.
Before surgery, your doctor will dilate your pupils with special eye drops that allow them to see inside your eye. You will also receive anesthetic numbing eye drops and a sedative for relaxing.
During laser cataract surgery, a laser creates tiny incisions in the cornea (transparent front layer of the eye). It breaks the natural lens into pieces before removing it. You might feel slight pressure and see a kaleidoscope of bright lights.
The eye surgeon will then insert an artificial IOL. They will place a patch or eye shield over your eye to promote healing.
There are some restrictions after laser cataract surgery, and it is normal to have blurry vision for a few days. Do not do any strenuous physical activity or heavy lifting for a week after surgery.
You will need to wear a patch or protective eye shield for a couple of days while you recover. Your doctor will prescribe daily eye drops to prevent infection and control inflammation.
Your eye doctor will schedule an appointment the day after surgery to check on healing. They will typically schedule another appointment both a week and a month after surgery to confirm the surgery was successful.
Complications and Risks of Cataract Surgery
While cataract surgery is one of the safest and most effective surgeries performed in the United States, it comes with risks.
Posterior capsular opacification (PCO) is a common long-term complication of cataract surgery where a “secondary cataract” forms on the artificial lens.
PCO is not an actual cataract, but a growth of cells on the capsule of your eye in which the IOL sits. PCO is easily treated with a 5-minute outpatient procedure called yttrium-aluminum-garnet (YAG) laser capsulotomy, which uses a laser beam to make a small opening for light to pass through.
Other complications of cataract surgery include:
- Bruising and swelling of the eyelid
- Increased eye pressure
- Allergic reaction to the medicated eye drops (steroids)
- Bacterial infection
- Retinal detachment
- IOL detachment
- Diabetic retinopathy
Surgery is currently the only way to remove cataracts.
However, researchers are actively working on alternative treatments, including eye drops, to remove cataracts.
In the meantime, people can take active steps in slowing the progression of cataracts and vision loss, including:
- Get a routine comprehensive eye exam
- Wear anti-glare sunglasses and eye protection
- Install brighter lights around the house
- Use a magnifying glass to read small print
Cataracts are a common age-related eye condition that progresses over time. Cataracts are caused by a breakdown and clumping of eye proteins that leave a cloud over the eye lens. This results in blurry vision and a dulling in colors.
If left untreated, cataracts can lead to blindness. Fortunately, they can be removed with cataract surgery and replaced with an artificial intraocular lens.
Cataract surgery is one of the safest and most effective surgeries in the United States, and a majority of people maintain clear vision years after surgery.
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