Cataracts

Cataract Surgery

The formation of a cataract is an unfortunate fact of life for the majority of the population. As the natural lens in the eye begins to age, it loses its transparency, becoming both yellowish and cloudy. The cloudiness is referred to as a cataract.

The progression of cataract formation is different from one person to another – some people may never develop a cataract while others may find themselves needing cataract surgery at a much younger age than the general population. While the blurred vision and increased glare caused by cataracts is bothersome, we are all lucky to be living in an era where surgical cataract extraction has become a well-established and successful surgery. More than 95% of patients walk away from cataract surgery with improved vision! In fact, with recent advances in the technology of intraocular lens implants, you may just find yourself completely free from glasses after cataract extraction!

Types of Cataracts

There are three basic types of cataracts: nuclear cataract, cortical cataract, and subcapsular cataract. Types of cataract are categorized according to the part of the crystalline lens in which the cataract begins to develop.

Nuclear Cataract: also known as nuclear sclerosis or nuclear sclerotic cataract, this type of lens opacity begins to form in the nucleus (center) of the lens. It is the most common type of cataract and occurs as a natural aging process.

Cortical Cataract: form in the outside edges of the lens (cortex). The spoke-like opacities of a cortical cataract somewhat resemble the spokes of a bicycle wheel and begin in the periphery, moving towards the center of the lens. Many diabetics develop cortical cataracts.

Subcapsular Cataract: begin to form at the back of the lens, which is in direct line with the visual axis, so these cataracts are detected early. People with diabetes, high myopia, retinitis pigmentosa are all more highly susceptible to subcapsular cataract, along with people who are taking high doses of steroids.

Despite the type of cataract, all treatment is the same: cataract extraction surgery. What differs is the point along progression of cataract that cataract surgery becomes necessary. Posterior subcapsular cataracts develop directly in the line of vision, so these are often removed earlier on. Nuclear cataracts are highly variable among individuals: the more bothersome the cataract is to vision, the sooner the cataract is removed. Cortical cataracts tend not to bother people as much, simply because the opacity occurs in the periphery of the lens, which is not used for central vision.

Living With Cataracts

Cataract surgery, although a simple procedure, is generally delayed until the point where a cataract begins to cause severe vision loss (for example, loss of best corrected vision acuity to the point where a person can no longer legally own a driver's license). During the time between which a cataract is first noticed and when cataract surgery is held, patients are finding themselves dealing with a most frustrating new flaw to their vision that is not easily ignored. Here are a few simple tips for making life a little simpler while you are waiting for your cataract surgery:

make sure to wear sunglasses, especially in when in bright light
buy new glasses or stronger bifocals
use a magnifying lens
alter lighting to a level that optimizes your vision

Cataract Surgery: What to Expect

Cataract surgery has become an extremely quick and efficient outpatient procedure in most areas. Although it is a stressful time for patients, it is a straightforward and relatively simple procedure for experienced surgeons – take comfort in this!

The first step towards cataract surgery begins when symptoms occur. Increased glare and distortions in vision are common symptoms of cataracts. Such frustrating symptoms will prompt most people to visit their optometrist, who will assess the cataract and make arrangements for cataract surgery.

Before cataract surgery, you will have a consultation with the eye specialist who will be performing the cataract surgery. Take this opportunity to discuss any concerns you may have about the procedure itself as well as any medications that you are currently taking which may interfere with the results of the cataract surgery. During this consultation, your eyes will be examined to determine the power of the intraocular lens that will be put in your eye to replace the natural crystalline lens.

On the day of your cataract surgery, you will be given eye drops (one of which is an anesthetic so that you will feel no pain during the cataract surgery). If necessary, you may also opt to be given a sedative to calm your nerves. One of the most perplexing aspects of cataract surgery is that you will be awake for the entire procedure, but there is absolutely no pain - besides perhaps the slight difficulty you might experience in an attempt to remain sitting still during the procedure.

Once the area around your eyes has been cleaned and sterilized to ward off infection, the first incision is made (usually near the limbus). The lens, which is encased in a membrane called the lens capsule, may be removed as is, or else broken up while inside the membrane – a process called phacoemulsification. If phacoemulsification is used, the remnants of the lens will be “vacuumed” out. Once the natural lens is removed, the plastic intraocular lens (IOL) will be put in. This IOL will fit inside the lens capsule. Following placement of the IOL, the incision is then wiped clean and in some cases, stitches will be used to close it, though stitches are rarely necessary.

Once the operation is over, the eye surgeon may put a shield over your eye as a precautionary measure to ensure the eye is protected as it heals. After a short stay in the patient recovery area, you will be ready to go home. Make sure you have made arrangements to have someone drive you home.

Cataract Surgery Complications

Although cataract surgery is an extremely safe and efficient procedure, it is a surgery all the same, and is not without risks. Complications can arise at any point following surgery – possibly even years later. Here is a list of potential cataract surgery complications:

bleeding in the eye
chronic inflammation
infection
increased pressure inside the eye (high IOP)
clouding of the posterior capsule (necessitating laser posterior capsulotomy)
irritation or discomfort
eye lid drooping (ptosis)
clouding of the cornea
retinal detachment

Keep in mind that the risk of having worse vision following cataract surgery is just 1%. Most of the above complications are of extremely low incidence.

Posterior capsule opacification is a very common complication of cataract surgery. Treatment for posterior capsule opacification involves the use of a YAG laser to vaporize the opacified membrane tissue behind the IOL implant – a procedure known as posterior capsulotomy, or a YAG laser capsulotomy. The YAG laser burns a small hole in the lens capsule, eliminating the opacity and restoring vision. Posterior capsulotomy is a common procedure with a fantastic success rate.

How to Prevent Cataracts

Cataracts are a natural aging process and really can't be prevented, although some researchers and eyecare professionals believe that the progression of cataract formation can be significantly slowed.

One of the best ways to prevent cataracts is to wear sunglasses with adequate UV protection whenever you are outside. It is a well-established fact that UV exposure speeds up the progression of cataracts. For diabetics, control of insulin and glucose levels is important for preventing the formation of cortical and subcapsular cataracts.

It is believed that a diet high in antioxidants such as vitamin C, vitamin A, and carotenoids (found in vegetables such as spinach and kale) have a protective role against cataracts. On the other hand, a diet high in salt is believed to be a risk factor for cataracts.

Estrogen as taken by women after menopause is also believed to have a protective role, but should not be used for this purpose alone.

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