Palmetto Cataract and Eye Specialists

Cataracts: Quick Facts

Cataracts

Introduction

A cataract is the clouding of the natural crystalline lens inside the eye. The natural lens help to focus light onto the back of the eye (known as the retina). Worldwide, cataracts are the most common cause of blindness. Cataracts typically form in your 50-60s. However, you may not have symptoms for many years. Nearly everyone will develop cataracts as the eyes age.

Causes

There are numerous causes of cataracts, including,

Age

Age is the most common cause of cataracts. Certain cells in the lens help to maintain the lens clarity. Over time, there is a natural degradation of these cells, leading to a cloudy lens.

Diabetes

Patients with diabetes tend to form cataracts earlier in life. This is thought to be due to a wider fluctuation in sugar (glucose) levels and deposits of glucose byproducts in diabetics.

Sunlight/radiation

Ultraviolet light has been demonstrated to lead to cataract formation. There is some evidence suggesting that UV protection with sunglasses can slow the development of cataracts.

Cigarette Use

Smokers have a two to three fold risk of developing cataracts compared to non-smokers.

Medications

Medications, especially steroids, can increase the risk of cataract formation. Other medications associated with cataracts are antipsychotic drugs and anticholinesterases.

Trauma

Severe head or eye trauma can cause swelling of the lens cells that leads to a cataract.

Ocular diseases

Cataracts have a greater chance of forming in patients with uveitis or iritis (inflammation in the eye).

Systemic diseases

Cataracts are associated with systemic diseases such as Wilson disease, myotonic dystrophy, Down syndrome, and atopic dermatitis.

Genetics

Genetics has been shown to play a role in cataract formation. If your parent needed cataract surgery earlier in life (40s), you may need surgery earlier in life as well.

Symptoms

If you have mild or early cataracts, you may not experience any symptoms. However, as the cataract becomes more dense and cloudy, you may notice blurry vision for the distance and near. Your doctor may not be able to correct your vision with glasses or contact lens.

Glare, particularly from oncoming headlights, can also be a sign of worsening cataracts. You may notice a halo effect (ring around the lights) or sunburst effect (light rays coming from the light), worse at night or in the rain. Some people stop driving at night because they become incapacitated by the glare.

You may also experience decrease contrast sensitivities and have trouble distinguishing similar colors. Colors may appear more muted and less vibrant.

Types

There are three main types of cataracts.
  • 1. Nuclear: the central part of the lens becomes yellow and cloudy.
  • 2. Posterior subcapsular: the back part of the lens becomes cloudy.
  • 3. Cortical: spoke-like opacities extending from the periphery to the central part of the lens.
You may have one type of cataract, such as a nuclear cataract, or you may have multiple types of cataracts, such as a combined nuclear and posterior subcapsular cataracts.

Nuclear cataracts typically blur your distance vision. Posterior subcapsular cataracts lead to blurred vision as well as significant glare symptoms. Cortical cataracts usually cause problems with glare.

Below is an example of an early cataract. Note the slight yellowing on the back layer of the lens.
Early Cataract
Below is an example of a dense cataract. Note the extensive yellow/brown color of the lens.
Early Cataract

Diagnosis

If you believe you are experiencing symptoms from cataracts, you should see an ophthalmologist for a comprehensive eye examination.

A comprehensive examination includes a refraction, or a test of your best corrected vision.

If you have normal vision, your vision will be recorded as 20/20. If you have abnormal vision, the second number (or the denominator) will increase. For instance, if your vision is 20/60, you can only see at 20 feet what a normal eye should be able to see from 60 feet away.

If you complain of glare symptoms, your examination may involve the use of bright lights to determine if your vision deteriorates.

A dilated eye examination is required to evaluate the nature of your cataract. It also allows the surgeon to develop a surgical plan. For instance, if your eyes do not dilate well, additional steps may be added to the cataract surgery.

A dilated exam also allows the surgeon to assess the overall health of the age and to ensure that you do not have other eye conditions which may affect your vision. Your doctor can best determine whether your symptoms are related to cataracts by excluding other causes of blurry vision and glare.

Measurements

If you elect to have cataract surgery, the surgeon will obtain measurements of the eye. These measurements are important for determining the best intraocular lens for your eye.

An intraocular lens or IOL is placed into the eye after the cataract is removed. The IOL is important for focusing the light rays onto the retina (or back surface of the eye).

Before intraocular lens were implanted into the eye, post-cataract patients needed thick ("coke bottle") glasses to help focus the light.

Intraocular lens (IOL)

There are many types of intraocular lens, including
  • Monofocal/standard lens: focuses your vision at only one focal distance. Most surgeons and patients will elect to have the lens set for the distance, providing better distance than near vision. However, for bookworms, a lens focused for near may be a better option. If you choose to have the lens set for the distance, you will need reading glasses. You may also need glasses for distance vision if you have significant astigmatism.
  • Toric lens: corrects astigmatism. A Toric lens may benefit you if you have corneal astigmatism. If the front clear covering of your eye, the cornea, is not perfectly round, you have corneal astigmatism. Residual astigmatism after surgery may cause blurry vision or glare, unless corrected with glasses. If you elect to have a Toric lens placed into your eye, you will be less dependent on glasses for distance vision. However, you will still need glasses for near vision. Read more about astigmatism.
  • Multifocal lens: allows for near, intermediate, and distance vision. These lens are made from concentric rings with each ring focused at one distance. With time, most people can usually train themselves to look through the correct part of the lens. Patients with multifocal lens may experience more glare and halos around lights at night compared to patients with monofocal or Toric IOLs. Patients with multifocal lens also have decreased contrast sensitivity. You also sacrifice a little distance vision clarity for the convenience of being less dependent on glasses. Up to 80% of patients with multifocal lens are glasses independent. An example of a multifocal lens is the Restor lens.
  • Accommodative lens: allows for near, intermediate, and distance vision. This lens changes shape as your eye muscles contract and relax. This mimics the natural lens in the eye. However, the amount of accommodation or near focusing differs among the population. An example of a accommodative lens is the Crystal lens.
  • Below is an example of a monofocal intraocular lens or IOL.
    Intraocular lens
Below is an example of a multifocal intraocular lens, the Restor. Please hover over the image to see the concentric rings.
Restor Intraocular lens

You should have a thorough discussion with your surgeon to determine the best lens option for your eyes. The decision will be based upon your vision needs as well as the structure and health of your eyes.

Standard or monofocal lens cost is covered by your medical insurance. However, your medical insurance considers the use of Toric, multifocal, and accommodative lens as cosmetic. Therefore, you will be responsible for the additional costs for these lens.

Prevention

Although you cannot reverse aging, there are several lifestyle changes you can make to slow down cataract formation. If you are outside, you should wear sunglasses. Sunglasses wear is especially important when you are younger. If you are diabetic, you should keep good control over your sugar levels (generally an average blood sugar of 120-140s is considered good control). Smokers should quit cigarette use, not only because of the increase risk of cataract, but also because of the increase risk of macular degeneration. It is also important to eat a healthy diet.

Treatment / Cataract Surgery

Surgery is the only treatment for cataracts. Cataract surgery has evolved over the decades to an outpatient surgery with minimal recovery time. Although one does not receive general anesthesia, one will receive intravenous (IV) relaxing medication during the surgery. The surgery should be painless.

Cataract surgery is the most commonly performed surgery in the United States. An estimated 2-2.5 million cataract surgeries are performed per year.

Most modern cataract surgeries use a small incision in the cornea. Your ophthalmologist will then create a circular opening in the capsule (which surrounds the lens or cataract). Using a phacoemulsification or sound-wave machine, the surgeon will break up the cataract into many small pieces and vacuum these pieces out of your eye. An intraocular lens or IOL is then placed into the eye.

If you think of a cataract like a candied M&M, the surgeon will create a circular opening in the front candy shell (the capsule). The surgeon will then break up the chocolate center (cataract), leaving the rest of the candy shell (capsule) intact.

Although most people (over 99%+) do well after cataract surgery, there are some known risks as with any surgery. About one in three thousand patients may develop an infection of the eye, known as endophthalmitis. You will use antibiotic drops before and after the surgery to prevent infection. Another risk of cataract surgery is a slightly increase risk of a retinal detachment. Should you note increase floaters or flashing lights after the surgery, you should contact your surgeon immediately. There is also a small chance that the fragile capsule that surrounds the cataract can rupture during the surgery. However, we must stress that the great majority of patients do very well and will never encounter these problems.
The risks from cataract surgery are higher in eyes with dense cataracts. Certain eye conditions such as pseudoexfoliation syndrome, prior eye trauma, extreme near-sightedness, and extreme far-sightedness can also make cataract surgery more difficult.

Ideally, the best time to undergo cataract surgery is when the cataract is affecting your vision and before it becomes very dense.

Special Considerations

If you have ever taken Flomax, a medication used for urinary flow, you should inform your surgeon. Flomax use, even past use, can affect the stability of your iris, the colored part of your eye. Your surgeon can take additional measures to treat this so-called "floppy iris syndrome."

If you have had prior refractive surgery, such as LASIK or PRK, you should also notify your surgeon. Prior refractive surgery can affect the calculations used to determine the strength of your intraocular lens.

Post-operative care

Most people will see very well the day after cataract surgery. However, depending on your body's healing process, it may take up to 7-14 days for the vision to clear. After surgery, you will continue using eye drops for infection and inflammation for about a month.

You can continue to read and use your eyes after surgery. You will wear an eye patch nightly for one week. Additional restrictions after cataract surgery include not lifting over 30 lbs for a week after the surgery and not swimming underwater for a month after the surgery. Besides these restrictions, you can continue to live a normal life with better vision!

Our services

Dr. Itharat performs small incision cataract surgery, utilizing the most modern intraocular lens selection. We also use the most modern lens measurement system, called the Lenstar, to ensure accurate lens selection. This technology allows for precise vision correction and decreased dependence on glasses.

Rest assured, Dr. Itharat will continue to assume your care in the post-operative period. He prides himself in being a comprehensive eye doctor (and not just a surgeon).

If you think you are having symptoms from cataracts, please call 843-259-2002 to schedule a consultation.

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