Cataracts

What Are Cataracts?

Cataracts are the formation of cloudy areas on the eye’s lens. The lens, primarily composed of crystallin proteins, becomes less clear as these proteins break down with age. This leads to the development of opaque patches that affect one’s vision. Over time, this may result in a perception of viewing the world through a hazy or dirty window and a gradual decline in vision. Healthcare providers commonly regard cataracts as an inevitable consequence of aging, with age-related cataracts being the most prevalent form. However, it’s important to note that cataract surgery can effectively address this issue.

Categorizing Cataracts

Cataracts come in various forms, but we will focus on age-related cataracts. Other types include:

1. Pediatric Cataracts: These affect infants and children and can be congenital or develop after birth. They often have a genetic component but can also be caused by eye injuries or other conditions. Timely treatment is essential to prevent complications like amblyopia (lazy eye).
2. Traumatic Cataracts: These result from eye injuries, and their treatment is more complex due to potential damage to surrounding eye structures.
3. Secondary Cataracts: These are cloudy patches that form on the lens capsule, the membrane covering the lens. Another term for this condition is posterior capsular opacification, which is a common but easily treatable complication of cataract surgery.

Types of Age-Related Cataracts

Age-related cataracts can be classified based on their location in the lens. People often have more than one type simultaneously, as cloudy patches can develop in various parts of the lens. The three most common types are:

1. Nuclear Sclerotic Cataract: These form in the nucleus, the central part of the lens, similar to the core of an apple.
2. Cortical Cataract: These develop in the cortex, which surrounds the nucleus, analogous to the edible part of an apple surrounding its core.
3. Posterior Subcapsular Cataract: These form in the posterior cortex, which is the part closest to the retina behind the lens. “Posterior” implies the “back” of the lens, and “subcapsular” means the cataract forms at the outer edge of the cortex, just beneath the lens capsule.

Onset and Prevalence

Cataracts typically begin when the proteins in the eye’s lens start breaking down at around age 40. However, noticeable symptoms typically emerge around age 60 or later. Certain medical conditions, such as diabetes, may lead to earlier symptoms.

Cataracts are highly prevalent in both the United States and globally. According to the World Health Organization, approximately 17% of people worldwide experience cataracts that interfere with their vision. However, the prevalence varies significantly by country and region, with higher rates in middle-income and low-income nations due to increased risk factors and limited access to cataract treatment. In the United States, nearly one in five people aged 65 to 74 has cataracts that affect their vision, and over 50% of those over 80 either have cataracts or have undergone cataract surgery.

Symptoms and Causes

Recognizing Cataracts and Seeking Help

Cataract symptoms encompass:

• Cloudy, blurry, foggy, or filmy vision.
• Alterations in color perception, with colors appearing faded or less vivid.
• Sensitivity to bright sunlight, headlights, or lamps.
• Glare, including the presence of halos or streaks around lights.
• Difficulty seeing at night.
• Changes in vision prescription, including worsening near-sightedness.
• A need for brighter lighting to read.
• Occasional double vision.

Cataracts usually do not cause pain, but they can make the eyes more sensitive to light.

The primary cause of cataracts is the gradual degradation of proteins within the lens. Nevertheless, several genetic and environmental factors can elevate the risk of developing cataracts or experiencing them at a younger age than others.

Risk Factors for Cataracts

Risk factors for cataract formation fall into three main categories: environmental, medical, and genetic.

1. Environmental Risk Factors: These factors are encountered in one’s surroundings and may include exposure to toxic substances, leading to increased free radicals in the body, which can damage healthy cells and contribute to cataract development. Environmental risk factors consist of:

• Air pollution.
• Tobacco smoke.
• Alcohol consumption.
• Exposure to industrial chemicals.
• Pesticide exposure.
• Prolonged exposure to UV light from the sun.
• History of radiation therapy to the upper body.

Reducing exposure to these environmental risk factors may slow down cataract formation, although researchers continue to investigate the exact role of preventive measures.

2. Medical Risk Factors: Certain medical conditions or interventions can raise the risk of cataracts, including:

• Having diabetes or high blood sugar.
• Undergoing specific eye surgeries, such as those for glaucoma.
• Using corticosteroids to treat certain medical conditions, such as rheumatoid arthritis.
• Having eye diseases like retinitis pigmentosa or uveitis.

2. Genetic Risk Factors: A family history of cataracts increases the likelihood of developing them. Some genetic mutations can lead to congenital cataracts, present at birth. When it comes to age-related cataracts, genetic mutations may render the lens more vulnerable to damage from environmental risk factors. Researchers are continually exploring these connections. While you cannot alter your genetic risk, being aware of your family history and sharing it with your healthcare provider can be valuable.

Diagnosis and Tests

Cataracts are typically diagnosed through a comprehensive eye exam performed by ophthalmologists and optometrists. During this exam, your eyes are closely examined for signs of cataracts, and their severity is assessed. Additionally, your provider will inquire about your vision, medical history, and any challenges you face in everyday activities due to deteriorating vision. Specific tests for cataract diagnosis may include a slit lamp exam and a visual acuity test.

Management and Treatment

Cataract surgery is the most effective method for removing cataracts and restoring clear vision. During this surgery, an ophthalmologist removes the clouded natural lens and replaces it with an intraocular lens (IOL). IOLs are artificial lenses that permanently reside in the eye, and there are various options that your provider can discuss with you. The key advantage of IOLs is their clarity, resembling the natural lens. Furthermore, they can correct refractive errors, potentially reducing the dependence on glasses or contact lenses following the surgery.

Cataract surgery is considered one of the safest and most commonly performed surgeries in the United States, with most individuals experiencing no serious complications. Nevertheless, it’s essential to be informed about potential risks, including retinal detachment and infection, which can be influenced by certain eye diseases or underlying medical conditions. Therefore, discussing your individual risk with your healthcare provider before surgery is crucial. Your provider can also advise on addressing any possible complications.

Recovery from cataract surgery involves mild pain and discomfort, which can be managed with pain relievers for the first day or two. Full recovery typically takes four to eight weeks, although improvements in vision may be noticed much earlier. Your

provider will guide you on when it’s safe to resume your regular activities.

Prevention

While cataracts are often an integral part of the aging process, there are steps you can take to protect your eye health and potentially slow their progression:

1. Avoid Smoking: Smoking is associated with an increased risk of cataracts. If you are a smoker, consider seeking resources to quit.
2. Protect Your Eyes from the Sun: Wearing sunglasses or eyeglasses with anti-UV coatings, along with a brimmed hat, can help shield your eyes from harmful UV radiation.
3. Regular Eye Care: Consult your provider regarding the recommended frequency of eye check-ups. Ensure you adhere to your appointments and promptly report any new or changing symptoms.

Outlook and Prognosis

The outlook for individuals with cataracts can vary based on the severity of their condition. Early on, surgery may not be necessary, as symptoms may be mild. However, cataracts tend to progress over time, potentially leading to more noticeable symptoms. If these symptoms start to interfere with daily life, your healthcare provider may recommend surgery to enable you to carry out your routine tasks safely.

Living With Cataracts

If you have cataracts, there are steps you can take to manage and improve your quality of life:

• Wear polarized sunglasses to reduce glare when exposed to strong sunlight.
• Utilize a magnifying glass to aid in reading.
• Enhance the lighting in your living space by using brighter lightbulbs to read more comfortably.
• If glare from headlights bothers you at night, consider avoiding nighttime driving.
• Adhere to the schedule provided by your eye care provider for check-ups and keep your eyeglasses prescription up to date.
• If you have underlying medical conditions like diabetes, managing them effectively can contribute to overall eye health.

When to Seek Medical Attention

Contact your healthcare provider if you experience symptoms of cataracts or notice changes in your vision. Issues like blurred vision can be indicative of various eye problems, not limited to cataracts. Therefore, it’s important to consult a provider to identify the specific cause of your symptoms and receive appropriate treatment.

Emergency Care

In rare instances, a retinal detachment can occur after cataract surgery. This is a serious condition affecting approximately 1 in 100 people. Seek emergency care immediately if you experience the following warning signs:

• Sudden onset of floaters and flashes in your field of vision.
• Perception of flashes of light, whether your eyes are open or closed.
• The appearance of a shadow or curtain spreading across your line of sight.

Questions to Ask Your Eye Care Provider

When discussing your cataract diagnosis and treatment with your provider, consider asking the following questions:

• Do I exhibit signs of cataracts?
• How severe are my cataracts?
• What is the type and location of my cataracts within the lens?
• Are both of my eyes affected?
• When might I need cataract surgery?
• What are the specific risks associated with cataract surgery in my case?
• Which type of intraocular lens (IOL) is most suitable for me?
• What measures can I take to improve my vision until I undergo surgery?
• What lifestyle adjustments should I consider?