If you live long enough, you’ll probably get cataracts, which are an inevitable consequence of getting older. The eye lens can begin to cloud in middle age and by 80, more than half of all Americans will either have cataracts or have had cataract surgery. “I liken cataracts to wrinkles and gray hair,” says Anupama Horne, an ophthalmologist and eye surgeon at Duke University in Durham, N.C. In the end, nearly everyone will develop them.
But the good news is that today’s high-tech procedures restore clear vision in 90 percent of the 3 million Americans who undergo cataract surgery every year.
What they are
Cataracts usually occur when normal proteins in the lens of the eye break down, causing the lenses to become cloudy. The lens of the eye works much like a camera's: It focuses light onto the retina at the back of the eye, which then relays nerve signals to the brain, and it adjusts the eye’s focus, enabling us to see things clearly up close and far away. But the normal wear and tear of aging causes the proteins to clump together, which clouds the lens, gradually making it harder to see as the cataract grows larger. Cataracts usually take a long time to develop, and can occur in one or both eyes but won't spread like an infection from one eye to the other.
Aging is the most common cause of cataracts, but other culprits can contribute, including certain medications, chronic illnesses, poor health habits or too much sun without protection. “Being extremely near-sighted is also associated with a higher frequency of cataracts,” says John D. Dugan Jr., an ophthalmologist and cataract surgeon at the Wills Eye Hospital in Philadelphia. “But we’re not sure why.” Family history plays a role, too.
Because age-related cataracts generally develop over time, gradually worsening vision may not be noticeable. But as the clear lens of the eye slowly turns a yellowish/brownish color, the increased tinting may make it more difficult to read and colors seem faded. Other symptoms include blurry or double vision, glare — when headlights, lamps or sunlight appear blindingly bright — and poor night vision that can make driving hazardous.
“It’s like a piece of clear plastic becomes yellowed and discolored,” says John Bartlett, an ophthalmologist and eye surgeon at UCLA Stein Eye Institute in Los Angeles. “As new layers are added, it becomes denser and harder.”
If you have a constellation of these symptoms, see a doctor for an eye exam. Experts recommend that people over age 65 get checkups every year or two; those younger should have their eyes checked at least once every two years — more if they have certain health issues. “If you’re on corticosteroids, you should have regular eye exams,” says Dugan. “You might not even be aware that it is starting to affect their vision.”
Cataracts are usually identified by a thorough exam that includes a visual acuity test, where you read letters of varying sizes off an eye chart. This measures the sharpness and clarity of your vision, and how well you can see at various distances.
You’ll also be given a dilated eye exam, in which drops are used to dilate and widen the pupils, offering the physician a clearer view of the back of your eye. Your doctor will then use a slit-lamp microscope to look for signs of cataracts, as well as examine the retina and optic nerve for signs of eye damage and other problems such as glaucoma.
When cataracts are in their early stages, patients can find some relief with new eyeglass prescriptions, brighter lighting, antiglare sunglasses or magnifying lenses. But once the cataract progresses and symptoms are interfering with the activities of daily living — reading, driving, watching TV — then surgery to remove the cataract is the only alternative.
“Don’t get fooled by scams,” says UCLA’s Bartlett. “I’m constantly seeing ads for eye drops that purport to get rid of cataracts. The only treatment to remove cataracts is surgical.”
Before surgery, your surgeon may have you see your family doctor to have a thorough medical exam to make sure you’re stable enough for surgery, says Ravi Goel, a New Jersey eye surgeon and clinical spokesperson for the American Academy of Ophthalmology. Certain heart and lung conditions, as well as dementia, may make patients poor candidates for surgery.
Surgery — what to expect
Preparations: A week before surgery, your doctor will test your eyes to measure the curve of the cornea and the size and shape of your eye. The information will help the surgeon choose which type of artificial lens — known as an intraocular lens (IOL) — is right for you. You may also need to temporarily stop taking certain medications. If you have cataracts in both eyes, each eye will be treated at a separate time to allow for healing.
Procedure: The surgery itself, which usually takes less than 30 minutes, is generally done on an out-patient basis under local anesthesia that numbs the nerves in and around the eye. The procedure involves removing the cloudy lens and replacing it with a clear, plastic one. The eye surgeon makes a tiny cut in the cornea, the clear dome-shaped surface that covers the front of the eye. A tiny probe is inserted through the cut. Using ultrasound, the probe breaks up the cloudy lens into very small pieces, which are suctioned out.
The artificial lens is inserted through the cut and positioned inside the lens capsule, which holds the new lens in place. Sometimes, the cut in the eye will need a stitch, but it is normally small enough to heal on its own. The operation can be done using traditional surgical tools, or it may be laser-assisted.
Complications: After surgery, most people’s vision improves quickly and colors will be more vivid. They can resume their normal activities when they get home, although they may need to wear a patch over the eye. Itching and mild discomfort are normal and eyes may be sensitive to light and touch. But within a day or two, unpleasant aftereffects should diminish. For a week or so after surgery, patients will need to use eye drops to help with healing and decrease the risk of infection, and may wear an eye shield or eyeglasses to protect their eyes.
As with any surgery, there is a possibility of complications, such as infection, bleeding, inflammation, double vision and high or low eye pressure. In rare instances, retinas can become detached. However, these problems can usually be treated with prompt medical attention. Occasionally, the eye tissue that encapsulates the IOL can cloud the new lens — a condition that is called after-cataract, which can develop months or even years after the surgery. This normally can be corrected with a laser.
If you smoke, stop; limit alcohol consumption and keep diabetes under control. When you’re outside, wearing a hat and sunglasses with UV400 or 100 percent UV protection to block harmful ultraviolet sunlight may help delay their onset. “Long-term exposure to UV light does increase risks,” says Shahzad Mian, an eye surgeon at the Kellogg Eye Center at the University of Michigan in Ann Arbor. “People who live in equatorial climates get more advanced cataracts and at a younger age because of the more intense sunlight.”
Doctors recommend cutting out sugary carbohydrates and consuming green, leafy vegetables, fruit and other nourishing edibles that contain natural antioxidants because many believe oxidative damage from sunlight and environmental exposures damages the lens of the eye.