Getting a clearer view of cataracts

Although few things in life are certain, cataracts seem to be as inevitable as death and taxes. Half of those between ages 52 and 64, and most people over age 75, have them. Symptoms include blurred vision, sensitivity to light and glare, increased nearsightedness, and double vision. As a result, it may be difficult to read, write, drive, recognize faces and perform a host of other important visual tasks.

These symptoms may be caused by many different eye conditions, so it’s important to see an ophthalmologist for a comprehensive eye examination. Should cataracts be diagnosed, the next step is to determine whether surgery will improve visual function. Cataract surgery is safe and nearly always improves vision in otherwise healthy eyes. In addition, technological advances such as flexible, multifocal lens implants are improving outcomes and reducing recuperation time. However, sometimes, surgery can be avoided by using a stronger eyeglass prescription and better illumination for reading.

Cataract surgery is one of the most frequently performed operations in the Philippines. When to opt for surgery is largely up to the patient. But because vision generally declines gradually, it can be difficult to know when to move forward. Understanding more about cataracts – especially how they progress and what to expect from treatment – can help you make an informed, properly-timed decision.

What Is A Cataract?

A cataract is a cloudy area in the lens (see illustration). Located in the front of the eye behind the pupil, the lens is ordinarily clear. Under normal circumstances, light passes through it and converges on the retina, which senses the light and passes electrical information down the optic nerve in the back of the eye to the brain.

Once a cataract forms and begins to progress, the lens becomes increasingly opaque. The more opaque it becomes, the more the cataract interferes with the transmission and convergence of light. A a result, the ability to perceive fine detail gradually declines. Eventually, symptoms (most commonly, blurred vision and glare) may become highly disabling. A cataract can develop in one or both eyes, and it may not affect an entire lens. The severity and exact nature of symptoms depend on the type and density of the cataract.

Seeing The Problem

Although the underlying causes of cataracts are largely unknown, several risk factors have been identified. Age is by far the strongest. Others include prolonged use of corticosteroids, diabetes, excessive exposure to sunlight, smoking and excessive alcohol consumption. It may be possible to decrease the likelihood of cataracts by addressing these risks whenever feasible. For instance, aggressive treatment of diabetes is likely to have a positive impact on vision.

Using sunglasses with ultraviolet (UV) ray protection is highly recommended. Not smoking, moderation when consuming alcoholic beverages and maintaining a low-fat diet rich in fruits and vegetables may be beneficial with regard to cataracts. Recent research suggests that vitamins C and E may have anti-cataract properties, but there are not enough data to support specific recommendations for supplementation.

When To Consider Surgery

Surgery should be considered when cataract problems become bothersome or when they interfere with everyday activities. Thus, cataracts that cause no symptoms do not require surgery. Some symptoms can be managed temporarily with simple lifestyle measures, such as improved lighting for reading.

Here are some ways to improve your vision:

• Light sources. Use incandescent light fixtures rather than fluorescent; keep fixtures below eye level (table lamps are better than ceiling fixtures) or over your shoulder; install dimmer switches so you can adjust the light levels depending on the activity you’re doing and the time of the day.

• Outside. Protect your eyes and reduce glare by wearing sunglasses with UV protection and a wide-brimmed hat; spend most of your time in the shade rather than in the sun.

• Reading. Read large-print publications. Use a magnifying glass to enlarge regular print if it is crisp and clear. Keep in mind that magnification won’t help if the print is blurry.

• Safety. Make sure stairs, entrances and hallways are well-lit.

• Reflections. Reposition mirrors to minimize confusing or multiple images.

However, if your cataracts progress to the point that they force you to give up something that’s important to you – such as driving, reading, working or watching television – you will want to consider surgery.

Restoring Your Vision

Cataract surgery is highly successful – more than 90 percent of the people who have their cataracts removed end up with better vision. The surgery may now be done on an outpatient basis and could take less than an hour. Local anesthesia is typically used for cataract surgery. If both eyes are affected, surgery is performed on one eye at a time, allowing the first to heal before surgery is done on the second.

Cataracts are removed through microsurgery that takes out the cataract but leaves much of the natural lens capsule in place. The capsule helps support an artificial replacement lens that’s inserted during the procedure. Generally, one of two surgical methods is used, depending on the type of cataract involved.

• Extracapsular. Through an incision, about 3/8 inch long, the surgeon opens the lens capsule and removes the harder, central portion of the lens in one piece. The softer parts of the lens are then vacuumed out.

• Phacoemulsification. This is a relatively new form of extracapsular surgery in which a specially-designed instrument is used to break up the cataract with ultrasound waves. The pieces are then vacuumed out. Only a small incision – about 1/8 inch – is required in this procedure. Commonly referred to as "phaco," it is the most modern means to remove cataracts. The procedure is routinely done today by many outstanding Filipino ophthalmologists.

Artificial Lens

Once the cataract is out, your surgeon inserts an artificial lens implant that has been corrected to meet your eye’s specific needs. Finally, a stitch or two may be needed to close the incision. Recovery time is generally minimal. Initially, your eye may be mildly inflamed. It may also feel a little scratchy and irritated for a couple of days.

Sometimes, it is necessary to wear an eye shield for a few weeks, and protection from injury is essential. You’ll also need to apply drops to assist with the healing process. Normal activities can generally be resumed within a day or two, although strenuous exercise and heavy lifting should be avoided for several weeks. If you have a sedentary job, you can probably return to work in about a week or less.

New Outlook

Although cataract surgery can’t promise 20/20 vision, it often means people are able to enjoy activities again that otherwise may have been limited by poor vision. The improvement in one’s overall quality of life may be immeasurable.