Cataract: What You Need to Know

July 10, 2022


Contributing Author: Dr. Thanh Nguyen

According to the American Academy of Ophthalmology (AAO), cataracts are one of the primary causes of blindness in the United States, affecting millions of people each year. More than 24.4 million Americans are affected by cataracts, and it’s estimated that by age 75, half of all Americans will have cataracts.

Cataracts can be treated with a quick, simple, and relatively safe surgery. Approximately 3 million cataract surgeries are performed annually in the United States. 

What Are Cataracts?

Imagine the human eye as a camera, where the natural human lens is the camera lens and the retina is the film. Light is refracted onto the retina by transparent lenses in a healthy eye. When cataracts develop, the lenses become cloudy. This cloudiness prevents light from passing through the lens properly, resulting in blurry vision, double vision, halos/glares and decreased color discrimination. Cataracts can impair one or both eyes, but they do not spread from one to the other.

What Causes Cataracts?

Age-related changes in the eyes are the cause of most cataracts. The eye lens is primarily made of water and protein. However, as you age, some of the protein clumps together and begin to cloud a small area of the lens, resulting in cataracts. The cataract will gradually grow and cloud more of the lens over time, making it difficult to see.

Am I at Risk for Cataracts?

In addition to the natural aging process, the following risk factors can also increase your likelihood of having the disease:

  • Environment factors (prolonged exposure to ultraviolet light)
  • Previous eye injury or inflammation
  • Excessive smoking
  • Diabetes
  • Obesity
  • High blood pressure
  • Previous eye surgery (glaucoma surgery or retina surgery)
  • Prolonged use of certain medications (steroids)
  • Radiation treatment on your upper body
  • Excessive alcohol consumption

Cataract Symptoms

While cataracts develop slowly and will not impair your vision at first, they will eventually interfere with your vision and may even cause vision loss. The following are the most common symptoms of cataracts. However, each person may experience cataract symptoms differently:

  • Cloudy or blurry vision
  • Poor night vision
  • Decreased contrast sensitivity
  • Decreased color discrimination
  • Light sensitivity or glare
  • Halos around lights
  • Double vision
  • Frequent prescription changes in your regular eyeglasses or contact lenses

These symptoms may also indicate other eye diseases. Consult your eye doctor if you experience any of these symptoms.

Types of Cataract

Although the natural aging process causes most cataracts, there are other types of cataracts. They are categorized according to how and where they occur in the eye:

Age-Related Lens Changes:

  • Nuclear cataracts – form in the middle of the lens, turning the center of the lens yellow or brown. It’s the most prevalent type of cataract and is linked to advanced age. A nuclear cataract affects long-distance vision more than near-distance vision. Nuclear cataracts often progress slowly. Common symptoms include poor color discrimination and poor vision in low light.
  • Cortical cataracts – form around the edges of the lens. Cortical senile cataracts can develop slowly and remain stable for an extended period or progress rapidly. A common symptom of cortical cataracts is glare around light sources, such as car headlights.
  • Posterior subcapsular cataracts (PSC) – begins as a small, opaque area near the back of the lens, directly in the path of light. PSCs affect near vision more than distance vision. The patient often reports symptoms of glare and poor vision under bright-light conditions.

Other causes of cataract include drug-induced lens changes, traumatic cataracts, congenital cataracts, radiation cataracts, metabolic cataracts, and inflammation-associated cataracts.

According to the Centers for Disease Control and Prevention (CDC), an estimated 20.5 million Americans aged 40 and above have a cataract in one or both eyes, with 6.1 million having had their lens surgically removed. It is estimated that the number of people with cataracts will rise to 30.1 million by 2020.

Cataracts vs. Glaucoma

Both cataracts and glaucoma are severe conditions that can lead to visual loss. However, cataract-related visual loss can be restored with surgery. Glaucoma-related visual loss is currently irreversible.

  • A cataract is an eye disease in which cloudiness or opacity in the lens obstructs or alters light transmission, impairing vision.
  • Glaucoma causes progressive, irreversible vision loss, and often without warning or symptoms. Damage to the optic nerve results in impaired vision with glaucoma.

Cataract Treatment

According to the National Eye Institute (NEI), cataract surgery is the only way to get rid of a cataract. However, cataract surgery is an elective procedure, and if your cataract symptoms do not interfere with your daily activities, an updated eyeglass prescription may be all you need to see better. Cataract surgery is only recommended when alternative measures do not help or when cataracts interfere with your quality of life.

You can make an informed decision about whether cataract surgery is right for you once you understand the benefits and risks of the procedure. In most cases, delaying surgery will not result in long-term eye damage. However, when the cataract is very mature, there is an increased risk of complications during cataract surgeries, including but not limited to longer surgery, need for second surgery, worsening vision, and rarely the loss of sight.

Cataract Surgery

Cataract surgery is a simple procedure that typically lasts between 30 and 45 minutes. It is frequently performed as an outpatient procedure under local anesthesia, and you should be able to return home the same day.

You will be given eye drops to dilate your pupil, a sedative to help you relax. Local anaesthetic agents are given around and inside the eye. During cataract surgery, the clouded natural lens of your eye will be removed and replaced with an artificial lens (intraocular lens or IOL). In certain instances, a cataract can be extracted without the implantation of an artificial lens.

The following surgical methods are used to eliminate cataracts:

  • Small-incision surgery (phacoemulsification) – a small incision is created in the front of your eye (cornea) and a needle-thin ultrasound probe is used to break up (emulsify) the cataract and suction out the fragments. Then an IOL is inserted, and the wound is often closed without any suture.
  • Large-incision surgery (extracapsular cataract extraction) – is a less common surgical method, requiring a bigger incision than phacoemulsification. This is often reserved for very dense cataracts. Through this wider incision, the entirety of the lens is removed without ultrasonic energy.  The wound may require sutures to close properly
  • Femtosecond laser surgery – involves using a specialized laser to accurately create incisions and break up the cataract. Phacoemulsification is still required to remove the cataract from the eye, followed by the insertion of an IOL. If the patient also has astigmatism, the femtosecond laser can help reshape the front of the eye to correct this condition.

Your vision is essential to your daily life, and the thought of losing it can be frightening. To avoid vision loss, you must understand some of the best ways to care for your eyes. A simple eye examination every one or two years can mean the difference between having healthy eyes and having vision problems.

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