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Senior Citizen Health & Medicine
By Age 80 Half of All Americans Have Developed a
Cataract
Lens replacement surgery proven safe, effective and
very common
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Normal Vision |
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Cataract Vision |
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July 2, 2007 - Heres an eye-opening statistic from
the July issue of Mayo Clinic Womens HealthSource: By age 80, more than
half of all Americans either have a cataract or have had cataract
surgery. Age is the primary risk factor. A cataract occurs when the
normally clear lens in the eye becomes cloudy, blurring vision and
preventing the lens from focusing an image on the retina, the
light-sensitive tissue at the back of the eye. (Read more about
cataracts from National Eye Institute below news story.)
While cataracts dont spread from one eye to
another, both eyes are commonly affected.
The only effective treatment for a cataract is
surgery to remove the clouded lens. Typically, its replaced with an
artificial lens known as an intraocular lens. Made from clear plastic,
acrylic or silicone, intraocular lenses become a permanent part of the
eye.
Cataract surgery is one of the safest and most
effective surgical procedures performed in the United States. In years
past, it was often recommended that patients wait for a cataract to turn
white before having it removed. Today, there are no set recommendations
on the best time to remove a cataract. The standard is to have one
cataract removed at a time, allowing the eye to heal prior to the second
surgery.
Most cataracts dont disturb vision in the early
stages, but as the clouding progresses, a cataract can interfere with
everyday life. After successful surgery, patients notice a vision
improvement within days. Complete healing generally takes four to six
weeks.
Regular eye exams remain the best way to detect
cataracts early and monitor their progression. Adults of any age can
develop a cataract, but age is the single greatest risk factor.
For senior citizens, people over 65, an eye exam at
least every other year is recommended.
Cataract Information
from the National Eye Institute
 What
is a cataract?
A
cataract is a clouding of the lens in the eye that affects vision. Most
cataracts are related to aging. Cataracts are very common in older
people. By age 80, more than half of all Americans either have a
cataract or have had cataract surgery.
A
cataract can occur in either or both eyes. It cannot spread from one eye
to the other.
What is the lens?
The
lens is a clear part of the eye that helps to focus light, or an image,
on the retina. The retina is the light-sensitive tissue at the back of
the eye.
In a
normal eye, light passes through the transparent lens to the retina.
Once it reaches the retina, light is changed into nerve signals that are
sent to the brain.
The
lens must be clear for the retina to receive a sharp image. If the lens
is cloudy from a cataract, the image you see will be blurred.
Are there other types of cataract?
Yes.
Although most cataracts are related to aging, there are other types of
cataract:
1.
Secondary cataract.
Cataracts can form after surgery for other eye problems, such as
glaucoma. Cataracts also can develop in people who have other health
problems, such as diabetes. Cataracts are sometimes linked to steroid
use.
2.
Traumatic cataract.
Cataracts can develop after an eye injury, sometimes years later.
3.
Congenital cataract.
Some babies are born with cataracts or develop them in childhood, often
in both eyes. These cataracts may be so small that they do not affect
vision. If they do, the lenses may need to be removed.
4.
Radiation cataract.
Cataracts can develop after exposure to some types of radiation.
Causes and
Risk Factors
What causes cataracts?
The
lens lies behind the iris and the pupil (see diagram). It works much
like a camera lens. It focuses light onto the retina at the back of the
eye, where an image is recorded. The lens also adjusts the eye's focus,
letting us see things clearly both up close and far away. The lens is
made of mostly water and protein. The protein is arranged in a precise
way that keeps the lens clear and lets light pass through it.
But as
we age, some of the protein may clump together and start to cloud a
small area of the lens. This is a cataract. Over time, the cataract may
grow larger and cloud more of the lens, making it harder to see.
Researchers suspect that there are several causes of cataract, such as
smoking and diabetes. Or, it may be that the protein in the lens just
changes from the wear and tear it takes over the years.
How can cataracts affect my vision?
Age-related cataracts can affect your vision in two ways:
1.
Clumps of protein reduce the sharpness of the
image reaching the retina.
The
lens consists mostly of water and protein. When the protein clumps up,
it clouds the lens and reduces the light that reaches the retina. The
clouding may become severe enough to cause blurred vision. Most
age-related cataracts develop from protein clumpings.
When a
cataract is small, the cloudiness affects only a small part of the lens.
You may not notice any changes in your vision. Cataracts tend to "grow"
slowly, so vision gets worse gradually. Over time, the cloudy area in
the lens may get larger, and the cataract may increase in size. Seeing
may become more difficult. Your vision may get duller or blurrier.
2.
The clear lens slowly changes to a
yellowish/brownish color, adding a brownish tint to vision.
As the
clear lens slowly colors with age, your vision gradually may acquire a
brownish shade. At first, the amount of tinting may be small and may not
cause a vision problem. Over time, increased tinting may make it more
difficult to read and perform other routine activities. This gradual
change in the amount of tinting does not affect the sharpness of the
image transmitted to the retina.
If you
have advanced lens discoloration, you may not be able to identify blues
and purples. You may be wearing what you believe to be a pair of black
socks, only to find out from friends that you are wearing purple socks.
When are you most likely to have a
cataract?
The
term "age-related" is a little misleading. You don't have to be a senior
citizen to get this type of cataract. In fact, people can have an
age-related cataract in their 40s and 50s. But during middle age, most
cataracts are small and do not affect vision. It is after age 60 that
most cataracts steal vision.
Who is at risk for cataract?
The
risk of cataract increases as you get older. Other risk factors for
cataract include:
● Certain diseases
such as diabetes.
● Personal behavior such as smoking and alcohol use.
● The environment such as prolonged exposure to sunlight.
What can I do to protect my vision?
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight
may help to delay cataract. If you smoke, stop. Researchers also believe
good nutrition can help reduce the risk of age-related cataract. They
recommend eating green leafy vegetables, fruit, and other foods with
antioxidants.
If you
are age 60 or older, you should have a comprehensive dilated eye exam at
least once every two years. In addition to cataract, your eye care
professional can check for signs of age-related macular degeneration,
glaucoma, and other vision disorders. Early treatment for many eye
diseases may save your sight.
Symptoms
and Detection
What are the symptoms of a cataract?
The
most common symptoms of a cataract are:
●
Cloudy or blurry vision.
● Colors seem faded.
● Glare. Headlights, lamps, or sunlight may appear too bright. A halo
may appear around lights.
● Poor night vision.
● Double vision or multiple images in one eye. (This symptom may clear
as the cataract gets larger.)
● Frequent prescription changes in your eyeglasses or contact lenses.
● These symptoms also can be a sign of other eye problems. If you have
any of these symptoms, check with your eye care professional.
How is a cataract detected?
Cataract is detected through a comprehensive eye exam that includes:
1.
Visual acuity test.
This eye chart test measures how well you see at various distances.
2.
Dilated eye exam.
Drops are placed in your eyes to widen, or dilate, the pupils. Your eye
care professional uses a special magnifying lens to examine your retina
and optic nerve for signs of damage and other eye problems. After the
exam, your close-up vision may remain blurred for several hours.
3.
Tonometry.
An instrument measures the pressure inside the eye. Numbing drops may be
applied to your eye for this test.
Your
eye care professional also may do other tests to learn more about the
structure and health of your eye.
Treatment
How is a cataract treated?
The
symptoms of early cataract may be improved with new eyeglasses, brighter
lighting, anti-glare sunglasses, or magnifying lenses. If these measures
do not help, surgery is the only effective treatment. Surgery involves
removing the cloudy lens and replacing it with an artificial lens.
A
cataract needs to be removed only when vision loss interferes with your
everyday activities, such as driving, reading, or watching TV. You and
your eye care professional can make this decision together. Once you
understand the benefits and risks of surgery, you can make an informed
decision about whether cataract surgery is right for you. In most cases,
delaying cataract surgery will not cause long-term damage to your eye or
make the surgery more difficult. You do not have to rush into surgery.
Sometimes a cataract should be removed even if it does not cause
problems with your vision. For example, a cataract should be removed if
it prevents examination or treatment of another eye problem, such as
age-related macular degeneration or diabetic retinopathy. If your eye
care professional finds a cataract, you may not need cataract surgery
for several years. In fact, you might never need cataract surgery. By
having your vision tested regularly, you and your eye care professional
can discuss if and when you might need treatment.
If you
choose surgery, your eye care professional may refer you to a specialist
to remove the cataract.
If you
have cataracts in both eyes that require surgery, the surgery will be
performed on each eye at separate times, usually four to eight weeks
apart.
Many
people who need cataract surgery also have other eye conditions, such as
age-related macular degeneration or glaucoma. If you have other eye
conditions in addition to cataract, talk with your doctor. Learn about
the risks, benefits, alternatives, and expected results of cataract
surgery.
What are the different types of
cataract surgery?
There
are two types of cataract surgery. Your doctor can explain the
differences and help determine which is better for you:
1.
Phacoemulsification,
or phaco. A small incision is made on the side of the cornea, the
clear, dome-shaped surface that covers the front of the eye. Your doctor
inserts a tiny probe into the eye. This device emits ultrasound waves
that soften and break up the lens so that it can be removed by suction.
Most cataract surgery today is done by phacoemulsification, also called
"small incision cataract surgery."
2.
Extracapsular surgery.
Your doctor makes a longer incision on the side of the cornea and
removes the cloudy core of the lens in one piece. The rest of the lens
is removed by suction.
After
the natural lens has been removed, it often is replaced by an artificial
lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens
that requires no care and becomes a permanent part of your eye. Light is
focused clearly by the IOL onto the retina, improving your vision. You
will not feel or see the new lens.
Some
people cannot have an IOL. They may have another eye disease or have
problems during surgery. For these patients, a soft contact lens, or
glasses that provide high magnification, may be suggested.
What are the risks of cataract surgery?
As
with any surgery, cataract surgery poses risks, such as infection and
bleeding. Before cataract surgery, your doctor may ask you to
temporarily stop taking certain medications that increase the risk of
bleeding during surgery. After surgery, you must keep your eye clean,
wash your hands before touching your eye, and use the prescribed
medications to help minimize the risk of infection. Serious infection
can result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment.
Other eye disorders, such as high myopia (nearsightedness), can further
increase your risk of retinal detachment after cataract surgery. One
sign of a retinal detachment is a sudden increase in flashes or
floaters. Floaters are little "cobwebs" or specks that seem to float
about in your field of vision. If you notice a sudden increase in
floaters or flashes, see an eye care professional immediately. A retinal
detachment is a medical emergency. If necessary, go to an emergency
service or hospital. Your eye must be examined by an eye surgeon as soon
as possible. A retinal detachment causes no pain. Early treatment for
retinal detachment often can prevent permanent loss of vision. The
sooner you get treatment, the more likely you will regain good vision.
Even if you are treated promptly, some vision may be lost.
Talk
to your eye care professional about these risks. Make sure cataract
surgery is right for you.
Is cataract surgery effective?
Cataract removal is one of the most common operations performed in the
United States. It also is one of the safest and most effective types of
surgery. In about 90 percent of cases, people who have cataract surgery
have better vision afterward.
What happens before surgery?
A week
or two before surgery, your doctor will do some tests. These tests may
include measuring the curve of the cornea and the size and shape of your
eye. This information helps your doctor choose the right type of IOL.
You
may be asked not to eat or drink anything 12 hours before your surgery.
What happens during surgery?
At the
hospital or eye clinic, drops will be put into your eye to dilate the
pupil. The area around your eye will be washed and cleansed.
The
operation usually lasts less than one hour and is almost painless. Many
people choose to stay awake during surgery. Others may need to be put to
sleep for a short time.
If you
are awake, you will have an anesthetic to numb the nerves in and around
your eye.
After
the operation, a patch may be placed over your eye. You will rest for a
while. Your medical team will watch for any problems, such as bleeding.
Most people who have cataract surgery can go home the same day. You will
need someone to drive you home.
What happens after surgery?
Itching and mild discomfort are normal after cataract surgery. Some
fluid discharge is also common. Your eye may be sensitive to light and
touch. If you have discomfort, your doctor can suggest treatment. After
one or two days, moderate discomfort should disappear.
For a
few days after surgery, your doctor may ask you to use eyedrops to help
healing and decrease the risk of infection. Ask your doctor about how to
use your eyedrops, how often to use them, and what effects they can
have. You will need to wear an eye shield or eyeglasses to help protect
your eye. Avoid rubbing or pressing on your eye.
When
you are home, try not to bend from the waist to pick up objects on the
floor. Do not lift any heavy objects. You can walk, climb stairs, and do
light household chores.
In
most cases, healing will be complete within eight weeks. Your doctor
will schedule exams to check on your progress.
Can problems develop after surgery?
Problems after surgery are rare, but they can occur. These problems can
include infection, bleeding, inflammation (pain, redness, swelling),
loss of vision, double vision, and high or low eye pressure. With prompt
medical attention, these problems can usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy and may
blur your vision. This condition is called an after-cataract. An
after-cataract can develop months or years after cataract surgery.
An
after-cataract is treated with a laser. Your doctor uses a laser to make
a tiny hole in the eye tissue behind the lens to let light pass through.
This outpatient procedure is called a YAG laser capsulotomy. It is
painless and rarely results in increased eye pressure or other eye
problems. As a precaution, your doctor may give you eyedrops to lower
your eye pressure before or after the procedure.
When will my vision be normal again?
You
can return quickly to many everyday activities, but your vision may be
blurry. The healing eye needs time to adjust so that it can focus
properly with the other eye, especially if the other eye has a cataract.
Ask your doctor when you can resume driving.
If you
received an IOL, you may notice that colors are very bright. The IOL is
clear, unlike your natural lens that may have had a yellowish/brownish
tint. Within a few months after receiving an IOL, you will become used
to improved color vision. Also, when your eye heals, you may need new
glasses or contact lenses.
What can I do if I already have lost
some vision from cataract?
If you
have lost some sight from cataract or cataract surgery, ask your eye
care professional about low vision services and devices that may help
you make the most of your remaining vision. Ask for a referral to a
specialist in low vision. Many community organizations and agencies
offer information about low vision counseling, training, and other
special services for people with visual impairments. A nearby school of
medicine or optometry may provide low vision services.
Content last reviewed April 2006
>>
For the latest information on cataract from the National Eye Institute,
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