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Cataracts

If you’re over 60 and your vision has gotten blurry or cloudy, you may have cataracts. It’s a common condition in older adults, and it can be treated by your eye doctor.

What are the symptoms?

Don’t chalk up changes in your vision to just getting older. If the world is starting to look a little hazy, you could be getting cataracts.

Simply put, it means your eye’s lens is clouding over. This condition usually affects people 60 or older, but anyone can get it. And you can have it in both eyes.

Some cataracts may not need to be treated. But for others, you’ll need surgery to get your eyesight back to normal.

What does a cataract look like?

The lens of your eye is normally clear. This allows light to pass to the back of your eye so you can see normally. But with a cataract, your lens becomes cloudy. Your vision gets hazy, and it feels like you’re looking at the work through a dirty or smudged window.

If your cataract is advanced, you may even be able to see a whitish or gray film over your eye when you look in the mirror.

What are the symptoms?

Cataracts aren’t painful. You’ll know you need to get your eyes checked if, along with clouded vision, the world around you just doesn’t look the way it should.

  • It’s hard to see at night
  • You’re sensitive to light
  • Light sources have “halos”
  • You see things in twos, and they may overlap
  • Colors don’t look as bright as they used to

Do these symptoms come on all at once?

No. It may seem, early on, that cloudy vision affects only a small part of your lens. You may not even know there’s a problem. But in most cases, cataracts continue to grow. When they become larger, your vision gets more and more blurry.

What’s more, the lens of your eye – which is normally clear – may turn a yellowish or brownish color. The world may start to look like a very old photograph. That can make it hard to perform everyday tasks.

When do I need to see a doctor?

Anytime you notice a change in vision. To diagnose a cataract, your doctor will give you a very thorough eye exam. He’ll also give you eye drops so he can dilate your pupils.

Your doctor will then examine your entire eye and perform several different tests. Based on these results, he’ll tell you what he believes will be the best course of action.

Can my symptoms be treated?

Sometimes, a prescription for new eyeglasses may improve a cataract in the early stages. But over time, they may not be enough to restore good vision.

Your eye doctor may advise you to use brighter lighting for daily tasks, anti-glare sunglasses, or even magnifying lenses – all of which may help with your symptoms.

Types of cataracts

You usually get cataracts when you’re older, but not always. They can show up at birth, after an injury, or because you have another health problem. There are many different types, but they all have one thing in common: a cloudy lens – the part of your eye that helps you focus light.

As a cataract starts growing, it gets harder and harder to see clearly. Your doctor will talk with you about the type you have, and help you figure out your treatment options.

Nuclear cataracts

Also called a nuclear sclerotic cataract, this is the kind doctors see most. Anyone who lives long enough usually ends up with one.

They form in the center of the lens, known as the nucleus. As they get worse, your reading vision may actually get better at first. Its called second sight, but its short lived.

In times, the lens hardens and turns yellow or even brown. You have a hard time seeing small details, colors get less rich, and you see hallows around bright objects at night.

Cortical cataracts

These take shape on the outside edge of your lens, called the cortex. The start as white edges, like triangles that point toward the center of your eye. As they grow, they scatter light.

If you have these cataracts, the main symptom is glare. You may find it hard to drive at night. They can also make your vision hazy, like you’re looking through a fog. You may find it hard to tell similar colors apart or to judge how far away an object is.

Since they can spell trouble for both near and distance vision, you typically get them removed early on.

Posterior Subcapsular Cataracts

These cataracts form just inside the back of your lens capsule – the part of your eye that surrounds the lens and holds it in place. They’re directly in the path of light as it passes through the lens.

They’re quicker to come on than other cataracts, and you may get symptoms within months. They affect your close-up vision and make it harder to see in bright lighting.

Anterior Subcapsular cataracts

This type forms just inside the front of your lens capsule. An injury or swelling in your eye can lead to one. So can a type of eczema called atopic dermatitis.

Congenital cataracts

These are cataracts you’re born with or that form when you’re a child. Some are linked to your genes, and others are due to an illness, like rubella, that your mother had during pregnancy.

When they’re small or outside the center of the lens, they may not need treatment. But when a baby’s born with one that blocks vision, a doctor needs to remove it because it can stop the eye from learning to see.

Traumatic cataracts

Many kinds of injuries can lead to a cataract. You can get one if you’re hit in the eye by a ball or get hurt from a burn, chemical or splinter.

The cataract could come on soon after the injury or not show up until years later.

Secondary cataracts

When another condition or medical treatment leads to a cataract, doctors call it secondary. Diabetes, taking steroids like prednisone, and even cataract surgery are possible causes.

When you get one after cataract surgery, it’s called a posterior capsule opacification (PCO). Your doctor can treat with a quick procedure called YAG laser capsulotomy.

Radiation cataracts

You may know it’s important to protect your skin from the sun’s ultraviolet (UV) radiation, but it can take a toll on your eyes, too. You can sometimes get cataracts if you spend too much time in the sun without eye protection.

People who work outdoors, like fishermen and farmers, are more likely to get this kind of cataract. To prevent it, wear sunglasses with 100% UVA and UVB protection.

Cataracts are also a possible side effect from radiation therapy for cancer.

Lamellar or Zonular cataracts

This type typically shows up in younger children and in both eyes. The genes that cause them are passed from parent to child.

These cataracts form fine white dots in the middle of the lens and may take on a Y shape. Over time, the whole center of the lens may turn white.

Posterior polar cataracts

You get these on the back center of your lens, and they’re often due to genes that are passed down through your family.

Posterior polar cataracts often don’t cause symptoms, which is a big plus since they’re hard to remove.

Anterior polar cataracts

They form on the front and center of your lens, and look like small white dots. 

The good news is that these cataracts typically don’t bother your vision.

Post-Vitrectomy Cataracts

Vitrectomy is surgery to remove your vitreous, the clear gel at the center of your eye. The operation can help with certain eye problems but may lead to a cataract. Cataract surgery can treat it and improve your vision.

Christmas tree cataracts

Also called polychromatic cataracts, they form shiny, colored crystals in your lens. They’re most common in people who have a condition called myotonic dystrophy.

Brunescent Cataracts

If you don’t treat a nuclear cataract, it turns very hard and brown. When that happens, it’s called brunescent. This kind of cataract makes it hard for you to tell colors apart, especially blues and purples. Surgery to remove it is harder, longer, and riskier than when treated earlier on.

Diabetic Snowflake Cataracts

This is rare type of cataract that can happen if you have diabetes. It gets worse quickly and forms a gray-white pattern that looks like a snowflake.

If your vision is a bit cloudy lately and driving at night is getting tricky, it’s time to check if you have cataracts. Your doctor will help you figure out what’s going on and may suggest surgery or other ways to clear up your foggy view.

Diagnosis

To find out if you have cataracts, your doctor will want to know all about your symptoms. She’ll ask if things look blurry or hazy or if the glare from lights bothers you, especially at night.

Your doctor will look closely at your eyes and may do some tests:

 

 

 

 

 

 

Visual acuity test. This is a fancy way of saying “eye chart exam.” Your doctor will ask you to read letters from a distance to find out how sharp your vision is. First you’ll try it with one eye, then the other.

Slit-lamp exam. This uses a special microscope with a bright light that lets your doctor check different parts of your eye. She’ll look at your cornea – the clear outer layer. She’ll also examine the iris – the colored part of your eye – and the lens that sits behind it. The lens bends light as it enters your eye so you can see things clearly.

Retinal exam. Your doctor puts drops in your eyes to widen your pupils – the dark spots in the middle that control how much light gets in. This lets her get a good look at the retina – the tissue around the back of your eyes – and also a better view of the cataract

Manage symptoms without surgery

Surgery is the only way to treat cataracts, but you may not need it right away. If you catch the problem in an early stage, you might be able to get by with a new prescription for your glasses. A stronger lens can make your vision better for a while.

If you have trouble reading, you might try a brighter lamp or a magnifying glass. If glare is a problem for you, check out special glasses that have an anti-glare coating. They can help when you drive at night.

Keep close tabs on how your cataracts affect the way you see. When your vision troubles tart to get in the way of your daily routine – especially if it makes driving dangerous – it’s time to talk to your doctor about surgery.

Types of surgery

There are several kinds of operations for cataracts, but they all have one thing in common: Your surgeon takes out the cloudy lens that keeps you from seeing clearly and replaces it with an artificial one.

You might feel a little squeamish about the idea of an operation on a sensitive spot like your eye. But it’s a very common procedure, and it doesn’t hurt. During the surgery, you’ll have medicine called local anesthesia to numb your eye. You’ll be awake, but you won’t feel anything.

It usually takes about 15 to 20 minutes, and you don’t need to stay overnight in a hospital. If you have cataracts in both eyes, your doctor will wait until your first eye heals before she does surgery on the second.

Small-incision surgery. You may also hear your doctor call this phacoemulsification. Your surgeon makes a tiny cut on your cornea. She’ll put a small device in your eye that gives off ultrasound waves that break up your cloudy lens. Then she takes out the pieces and puts in your new, artificial lens.

Large-incision surgery. This isn’t done as often, but doctors sometimes suggest it for larger cataracts that cause more vision trouble than usual. It’s sometimes also called extracapsular cataract extraction. Your surgeon takes out your clouded lens in one piece, then swaps it out for an artificial one. You’ll probably need a little more time to heal from this surgery than from the small-incision type.

Femtosecond laser surgery. In this operation, your surgeon uses a laser to break up the lens. As with the other types, once this is done, she’ll put in the new lens. Your doctor may suggest this if you also have an astigmatism, a curve of your cornea that makes your vision blurry. Your surgeon can treat that problem during the cataract surgery by using the laser to reshape your cornea.

After your surgery

For most people, recovery goes smoothly. How long it takes depends on which type of surgery you get. But in general, you’ll notice your vision gets much better a few days afterward. After about a week or two, you can go back to doing all the things you enjoy.

As with any surgery, though, there are risks. It’s rare, but you could have an infection or bleeding. There’s also a chance your retina could pull away from the tissues at the back of your eye. This called a “detached retina.”

Some people have an issue after cataract surgery called posterior capsule opacification (PCO). Your vision may get cloudy again because the capsule in your eye that holds the artificial lens in place gets ticker. A type of laser surgery called YAG can fix the problem.

Who should have surgery?

If you have a cataract, that doesn’t always mean you need surgery. You may not even notice any change in your vision. Some people who have this condition see just fine if they wear prescription glasses, use a magnifying lens, or rely on brighter lighting.

But as cataracts grow, they can cause more symptoms. You could have dim, blurred, or yellow vision. You may also have double vision when you look at things through the eye with the cataract. These problems can make it hard to read, work on a computer, or do anything else that calls for clear eyesight.

You may have poor night vision and find it harder to drive when it’s dark. People with advanced cataracts can even fail the vision part of a driver’s test.

Cataracts can make you more sensitive to glare from the sun. You might see a halo around bright lights. This can keep you from being outdoors as much as you’d like. It also makes it harder to play some sports, such as skiing or golf.

If you have any of these symptoms surgery could help.

Sometimes you might need to get surgery even if your cataract doesn’t bother you. Your doctor may suggest it if the cataract makes it hard for her to get a clear view of the back of your eye during an eye exam.

How do I prepare for cataract surgery?

A week or two before your procedure, your doctor will do some tests to measure the size and shape of your eye. This way, she can choose the best artificial lens for you.

She’ll probably tell you not to eat or drink anything for 12 hours before the surgery.

What happens?

You’ll be awake for the procedure, but your doctor will numb your eye with medicine, so you won’t feel pain. She may also give you medication to help you relax.

The surgery usually takes under an hour. Your surgeon will make a tiny cut in the front of your eye, sometimes with the help of a laser. Through this she’ll put in a small tool to break up the cataract and gently suction it out.

Next, she’ll put in the new lens, which is made of plastic, silicone, or acrylic, and close the cut.

You won’t need to stay overnight at the hospital, but you’ll need someone to drive you home.

If you have cataracts in both eyes, you’ll probably get two separate surgeries, typically a few weeks apart. This gives the first eye a chance to heal.

What are the side effects?

Side effects are rare for cataract surgery, but some things that could happen are:

  • Eye infection or swelling
  • Bleeding
  • Retinal detachment – the breaking away of a layer of tissue at the back of your eye that senses light
  • Feeling of pressure inside your eye
  • Loosening of new implant
  • Fluid buildup in your eye
  • Drooping eyelid

After surgery

For a few days after surgery, your eye may itch or feel sore. During this time, you may also have some tearing and find it hard to see well in bright light.

Your doctor will give you eye drops to prevent infection. You’ll need to take it easy for a few days. Driving will be off-limits, and you shouldn’t bend over, pick up heavy things, or put any pressure on your eye.

For the first week, your doctor will likely suggest you wear an eye shield while you sleep. This protects the site of your surgery so your eye can heal. If you’re in pain or you feel your eye isn’t healing like it should, tell your doctor right away.

After 8 weeks, your eye should be fully healed. About 90% of people see better after cataract surgery. But don’t expect your vision to be perfect. You may still need to wear glasses or contacts.

What if my vision gets cloudy after surgery?

Sometimes after cataract surgery, you may find that things start to look cloudy again. It happens because a lens capsule – the part of your eye that holds your new artificial lens in place- begins to thicken up.

You may hear your doctor call this by its medical name: posterior capsule opacification. The problem may not show up right away. You may notice it months or ears later.

Your doctor may suggest a procedure called YAG to fix it. A surgeon uses a laser to open up the thickening around the lens capsule and let more light get through your artificial lens. That will clear up your cloudy vision.

How can I prevent cataracts?

Cataracts are a leading cause of blindness in the United States. There’s no sure-fire way to prevent them, but making some lifestyle changes might lower your odds of getting them.

Eat Right

You can’t do anything about your age or family history, but you can change your diet. Some research shows that eating foods high in antioxidants like vitamins C and E may help prevent cataracts. If you already have cataracts, it may slow their growth.

Good sources of vitamin C include:

  • Citrus (oranges, grapefruit, limes, etc.)
  • Tomato’s and tomato juice
  • Red and green peppers
  • Kiwifruit
  • Broccoli
  • Strawberries
  • Brussel sprouts
  • Cantaloupe
  • Potatoes

For vitamin E, look to vegetable oils like sunflower, safflower, or wheat germ. Nuts, especially almonds, are also good sources of vitamin E. So are peanuts. So are green veggies like spinach and broccoli. Some foods – maybe even your favorite breakfast cereal – contain extra vitamin E. Check the info on the package to be sure.

You may not have heard of lutein and zeaxanthin. These are two more vitamins that could help protect your eyes from cataracts. Eggs have them, as do green, leafy vegetables.

Make sure you eat fruits and veggies every day. Five servings can provide more than 100 milligrams of vitamin C and 5 to 6 milligrams of lutein and zeaxanthin. Just two servings of nuts can provide 8 to 14 milligrams of vitamin E. If you find it tough to fit all of this into your daily diet, consider multivitamins or supplements. But always talk to your doctor first.

Quit Smoking

You know that smoking is bad for your lungs and your heart, but it’s also really bad for your eyes. When it comes to cataracts, smoking is a risk factor you can control.

Smoking creates more free radicals in your eyes. These are chemicals that harm cells. Antioxidants – all those good chemicals that you get from fruits and vegetables – fight the bad chemicals. But smoking kills off the good chemicals. And it produces a lot of toxins that can cause cataracts.

If you kick the habit, it may help prevent cataracts, even if you’ve smoked a lot of cigarettes over a long period of time. Talk to your doctor about programs and medications that can help you quit.

If you don’t smoke, don’t start.

Wear shades

Sunglasses can make you look cool. They can also help cut your risk of getting cataracts.

Science shows that ultraviolet (UV) light can cause changes in your eyes. And researchers now know that UV light actually damages the proteins in your lens.

There are a lot of options for sunglasses that look good and protect your eyes at the same time. When shopping for shades, look for the kind that:

  • Block out 99% to 100% of UVA and UVB rays
  • Screen out 75% to 90% of visible light
  • Fit your face shape, with a frame that is close to your eyes
  • Have a gray tint, which is helpful when driving

Limit alcohol

You don’t have to give up that glass of wine with dinner. But there is some evidence that drinking too much alcohol can increase your risk for cataracts.

Research has shown that if you drink fewer than two standard-size drinks, your odds of getting cataracts may be lower than if you never drank at all. But research also shows that drinking more than two drinks a day (about 20 grams of alcohol), raises those odds.

Keep blood sugar in check

If you have diabetes, you know how important it is to keep your blood sugar under control. But did you know that it can also help prevent cataracts? That’s because people who have diabetes are more likely to develop the eye condition than people who don’t.

Your lens swells if your blood sugar stays too high for too long. Your lens also changes blood sugar into sorbitol. When this substance collects in the lens of your eye, you see less clearly, and a cataract may form.

Get regular eye exams

Your doctor can spot problems early on. If you’re between 40 and 64, you should get a complete eye exam every 2 to 4 years. (A “complete” exam means your eye doctor will dilate your pupils).

If you’re over age 65, you should get an exam every 1 to 2 years.

If your odds are high for certain eye diseases, your eye doctor may want to see you more often.