Vision Health Part 3: Cataracts

November 23, 2019

"Cataract surgery is done millions of times per year in the United States alone."

So far in his four-part series on the health of our eyes, Dr. Keller Wortham, MD, has given us an overview of how the eye works, and a close look at a serious condition called Diabetic Retinopathy.

Today he's back for part three, talking about the number one cause of reversible blindness in the world: cataracts. We'll learn what causes cataracts, what the symptoms are, and (as always) how to treat them, and what we can do to prevent them.

Video Highlights

  • 01:34: What Cataracts Are
  • 03:18: Three Common Categories of Cataracts
  • 04:39: Risk Factors for Developing Cataracts
  • 06:14: Diagnosing Cataracts
  • 08:53: Treating Cataracts
  • 10:12: Cataract Surgery
  • 14:24: Preventing Cataracts
  • 16:16: Wrap-Up

What Cataracts Are

If you're starting to get up there in years, you might already be familiar with cataracts, or you might have a family member who's had them. This condition affects millions of people worldwide. The word “cataract” comes from the term waterfall. The term may have been coined because cataracts create a white, hazy filter that you have to see through. It can feel a bit like like looking through a waterfall. Additionally, if you look closely at the eye of someone who has bad cataracts, it can also look like a white cloudy waterfall within their eye. 

A cataract is basically a clouding of the lens in the eye. In part one, we discussed how the lens, much like the lens in a camera, is the device that takes the light coming into the eye, and bends it so that we can focus that light on the retina at the back of the eye. Over time, little proteins can build up within the lens, and these little proteins become white and cloudy, causing the lens to lose its clarity. Again, we can use the camera analogy to understand this — if you're trying to get light through a dirty camera lens to project an image onto film, the picture will not be clear. And that is exactly what happens in your eye. 

Three Common Categories of Cataracts

  • Age-related cataracts. This is the most common category. Cataracts are frequent among people who are getting into their 60s, 70s, and 80s. 
  • Congenital or childhood cataracts. These can occur for a variety of reasons. And we're not going to go into those too much today because they're not as common, but these reasons can include metabolic disorders, or issues with the pregnancy in utero. 
  • Acquired or secondary cataracts. These are cataracts that occur not just because of age but because of other issues. Issues that could lead to cataracts include health conditions like diabetes, trauma or damage to the lens, or medications like steroids or chemotherapy medications, which might have secondary effects that damage the lens.

Again, the primary category for cataracts is the first — naturally occurring cataracts that happen as we age. 

Risk Factors for Developing Cataracts

In addition to aging, there are a few other risk factors that could contribute to the development of cataracts: 

  • UV light. This is a major risk factor. We know we need UV light for our skin, and it's unavoidable in the environment, but UV light can damage the lens over time. We see this especially with people who either work outside all the time, or who live near the equator where UV intensity is stronger, or who live at high elevations where UV light is not filtered out as much by the atmosphere. 
  • Smoking 
  • Alcohol use
  • Being overweight
  • High blood pressure

If you've got a combination of these factors — for example if you're aging, you've worked outside for a lot of your life, or you're at high elevation or near the equator, and maybe you've got some of these other lifestyle things that aren't helping: smoking, excess weight, or blood pressure issues, then you are at risk of cataracts. 

How Do You Know If You're Getting A Cataract? 

Cataracts can start very mildly and you might not notice any symptoms at all in the beginning. But over time, as these proteins build up in your lens, you're going to start to notice the effects of insufficient light coming through your lens to the back of your eye, where it is translated into sight. That can include cloudy vision, perhaps double vision in a particular eye, or glare, especially if the light is very bright. You may also experience glare at night, and it might become a lot harder to see at night, especially if there are traffic lights or headlights from other cars, which can hit those proteins within the lens. 

You might also start to have difficulty seeing colors, because of the smaller amount of light getting through to the back of the lens. We need a more intense level of light in the back of our eye to really register vibrant colors. Finally, you could also become quite nearsighted. 

Diagnosing Cataracts

If you think you might be developing these changes in vision, and that they might be related to a cataract, go see your doctor, and get evaluated. A doctor can often tell when someone's developing a cataract by looking into the eye with a device called a funduscope, which helps them look through the lens at the retina. If they see reduced clarity through the eye, or reduced reflection of the light on the back of the retina, then it’s likely that the lens is clouded and causing impaired vision. If that's the case, your doctor can then refer you to an ophthalmologist, where you will get a dilated eye exam. An ophthalmologist can get a good picture of your lens, and they'll see if cataracts are causing your vision changes. 

Treating Cataracts

This is where there’s some good news. Cataracts aren't really damaging to the eye, so you don't have to do anything about them. It's not like some of the other conditions that we discussed, like diabetic retinopathy which is a serious condition that's going to lead to irreversible blindness. A cataract will affect your vision, and that can be a problem in and of itself, but it's not going to damage your eye. 

So, putting off management of your cataracts might be annoying and reduce your vision, but it won’t result in irreversible vision loss. That being said, cataracts can be dangerous for you in other ways. If you can't see very well, you might be at a higher risk of a traffic accident, or falling, or running into things at night. 

Have a discussion with your doctor about how cataracts are affecting your lifestyle, and looking at the overall picture of your health to find out if you're in good shape to undergo cataract-removal surgery, which is the definitive treatment for reversing cataracts. 

Cataract Surgery

Surgery on the eye sounds scary, but cataract surgery is done millions of times per year in the United States alone and 95% of the people who get the surgery say they see much better afterwards, and experience few if any complications. It's also an outpatient surgery, which means you go in that morning, have the surgery done, and go home that same day. 

Cataract surgery involves removing the affected lens, and that's done by making a very small incision in the anterior portion of the eye (where the cornea, the iris, and the pupil are located). Once they've made that little incision, they use a specialized little ultrasound to send shockwaves to the old lens that has that cloudy protein in it, which the ophthalmologist then removes. It sounds kind of intense but basically, it's just a tiny shockwave and a tiny little vacuum to extract the old lens from the eye. 

These days they can often use a laser to help make those small incisions, or even to help break up the lens and these techniques have allowed us to make much smaller incisions. That can reduce the risk of some of the possible issues with cataract surgery, including infection and retinal detachment. Those are serious consequences, so you should take them into account, but again they're extremely infrequent and cataract surgery is usually very safe. 

After they've removed the old lens, the doctor is going to insert a new synthetic lens to replace it. This is a small crystal lens that is inserted right behind the iris where your old lens was, and it's going to serve the same function the original lens served. This basically fixes the problem. 

The doctor may put a patch on your eye afterwards to help protect the eye and allow it to heal. After surgery, your vision will improve dramatically over the next several weeks. Usually within eight weeks' time, your vision will be completely healed and you'll be ready to drive and able to see vivid colors again.

Now, cataracts tend to develop on both sides because what's affecting one eye is typically affecting the other eye — whether that's in your environment or within your body. It might not happen exactly at the same pace, but it means you probably need to have surgery on both eyes. If this is the case, your doctor will usually operate on one eye first, allow it to heal, and then perform surgery on the other eye later. 

Preventing Cataracts

Cataract surgery is really the only way to help you get rid of a cataract once you have it. But as always, the best treatment is prevention. So, what are the best steps you can take to prevent this leading worldwide cause of reversible blindness? 

Wear UV Eye Protection 

It's so important to wear sunglasses, especially if you're working outside, if you're near the equator, or if you live at a high elevation. You need to block the UV light coming into your eyes. Make sure you get lenses that are UV protective, and thus reduce the primary risk factor for most cataracts. 

Make Lifestyle Changes

Improving your lifestyle can also help prevent cataracts:

Wrap-Up

Hopefully you now have a better understanding of this extremely common condition — how to recognize it, and how to prevent it. If you're starting to notice vision changes as you age, and think you might have a cataract, don't stress — go talk to your doctor. Again, cataract surgery sounds scary but among all the surgeries that exist, it’s a very safe and well-tolerated surgery. So get screened, take steps to prevent it from happening, and hopefully cataracts will not be an issue for you. 

Stay tuned for the final installment in our vision health series, coming soon.

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