Cataract

What is a cataract and how is it treated?

Binary Data What is a cataract and how is it treated?
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What Is a Cataract?
A cataract is a clouding of the lens of your eye. As you age, proteins in your lens
begin to break down and the lens becomes cloudy. You may not even realize you have
a cataract because it usually grows very slowly and may not impede vision early on.
While cataracts are rarely dangerous, after a number of years they will likely
affect vision. By age 65, over 90 percent of people have a cataract and half of
the people between the ages of 75 and 85 have lost some vision due to a cataract. A
cataract is not caused by overuse of your eyes and it does not travel from one eye
to the other.

Symptoms
A decrease in the clarity of vision that is not correctable with glasses
Colors that appear faded or washed out
Sensitivity to light, glare, and halos around lights
Frequent changes to eyeglass prescriptions
An ophthalmologist or optometrist will be able to diagnose a cataract during a
dilated eye examination.

Causes
The human lens is transparent so that light can travel through it easily. It has no
blood supply and is 65 percent water. Although new cells are being made for the
lens continuously throughout our lifetime, many factors combine as we age to cause
areas in the lens to become cloudy, hard, and dense. The lens can then no longer
transmit a clear picture to the retina where it can be processed and sent through
the optic nerve to the brain. Cataracts can have many causes, as described below.

Age-related
This is the most common kind of cataract. There are three subclassifications, based
on location: nuclear, cortical, and posterior subcapsular.
Congenital
Although it is not common, some babies are born with cataracts or develop them
within the first year of life.
Traumatic
This type of cataract results from an injury to the eye.
Secondary This is a cataract that is caused either by medications (most commonly
prednisone or other corticosteroids) or disease, like diabetes. Cataracts are 10
times more common in diabetic patients than in the general population.
Risk Factors
Risk factors associated with cataracts include:

Aging
Heavy drinking
Smoking
Obesity
High blood pressure
Previous eye injuries
Family history
Too much UV light (sun) exposure
Diabetes
Exposure to radiation from x-rays and cancer treatments
Tests and Diagnosis
Cataracts can be diagnosed by your eye care professional during a dilated eye exam.
You may also have your vision checked in different lighting conditions and with an
updated glasses prescription. Imaging or invasive testing is not required to
diagnose a cataract. A complete eye exam is necessary to determine if anything else
is contributing to your visual symptoms.

Treatment and Drugs

Although there is no way to prevent cataracts from forming, there is some evidence
that protecting your eyes from ultraviolet light may prevent or slow the
progression of cataracts. Smoking also increases the rate of cataract formation, so
stopping smoking will decrease the risk. Once cataracts have formed, the only
treatment is surgical removal of the cataract and replacement with an artificial
lens. There are different types and powers of lenses that your surgeon can implant
during surgery, including lenses that help correct astigmatism. After surgery, your
need for glasses will often be reduced, but not eliminated. You and your surgeon
will discuss which implant lens type and power is the right choice for you.
Medications cannot be used to treat a cataract. Surgery is typically performed on
an outpatient basis under local anesthesia. When the cataract has become severe
enough that it compromises your quality of life, you and your ophthalmologist will
discuss the appropriate time to remove it.

Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient

basis, which means you don't have to stay in the hospital after the surgery.
Cataract surgery is very common and is generally a safe procedure.

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Why it's done
How a cataract affects your vision
How a cataract affects your visionOpen pop-up dialog box
Cataract surgery is performed to treat cataracts. Cataracts can cause blurry vision
and increase the glare from lights. If a cataract makes it difficult for you to
carry out your normal activities, your doctor may suggest cataract surgery.

When a cataract interferes with the treatment of another eye problem, cataract
surgery may be recommended. For example, doctors may recommend cataract surgery if
a cataract makes it difficult for your eye doctor to examine the back of your eye
to monitor or treat other eye problems, such as age-related macular degeneration or
diabetic retinopathy.

In most cases, waiting to have cataract surgery won't harm your eye, so you have
time to consider your options. If your vision is still quite good, you may not need
cataract surgery for many years, if ever.

When considering cataract surgery, keep these questions in mind:

Can you see to safely do your job and to drive?

Do you have problems reading or watching television?
Is it difficult to cook, shop, do yardwork, climb stairs or take medications?
Do vision problems affect your level of independence?
Do bright lights make it more difficult to see?
Request an Appointment at Mayo Clinic
Risks
Complications after cataract surgery are uncommon, and most can be treated
successfully.

Cataract surgery risks include:

Inflammation
Infection
Bleeding
Swelling
Drooping eyelid
Dislocation of artificial lens
Retinal detachment
Glaucoma
Secondary cataract
Loss of vision
Your risk of complications is greater if you have another eye disease or a serious
medical condition. Occasionally, cataract surgery fails to improve vision because
of underlying eye damage from other conditions, such as glaucoma or macular
degeneration. If possible, it may be beneficial to evaluate and treat other eye
problems before making the decision to have cataract surgery.

How you prepare

Food and medications
You may be instructed not to eat or drink anything 12 hours before cataract
surgery. Your doctor may also advise you to temporarily stop taking any medication
that could increase your risk of bleeding during the procedure. Let your doctor
know if you take any medications for prostate problems, as some of these drugs can
interfere with cataract surgery.

Antibiotic eyedrops may be prescribed for use one or two days before the surgery.

Other precautions
Normally you can go home on the same day as your surgery, but you won't be able to
drive, so arrange for a ride home. Also arrange for help around home, if necessary,
because your doctor may limit activities, such as bending and lifting, for about a
week after your surgery.

What you can expect

Before the procedure
A week or so before your surgery, your doctor performs a painless ultrasound test
to measure the size and shape of your eye. This helps determine the right type of
lens implant (intraocular lens, or IOL).

Nearly everyone who has cataract surgery will be given IOLs. These lenses improve
your vision by focusing light on the back of your eye. You won't be able to see or
feel the lens. It requires no care and becomes a permanent part of your eye.

A variety of IOLs with different features are available. Before surgery, you and
your eye doctor will discuss which type of IOL might work best for you and your
lifestyle. Cost may also be a factor, as insurance companies may not pay for all
types of lenses.

IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light.
Some IOLs are rigid plastic and implanted through an incision that requires several
stitches (sutures) to close.

However, many IOLs are flexible, allowing a smaller incision that requires few or
no stitches. The surgeon folds this type of lens and inserts it into the empty
capsule where the natural lens used to be. Once inside the eye, the folded IOL
unfolds, filling the empty capsule.

Some of the types of lenses available include:

Fixed-focus monofocal. This type of lens has a single focus strength for distance
vision. Reading will generally require the use of reading glasses.
Accommodating-focus monofocal. Although these lenses only have a single focusing
strength, they can respond to eye muscle movements and shift focus to near or
distant objects.
Multifocal. These lenses are similar to glasses with bifocal or progressive lenses.
Different areas of the lens have different focusing strengths, allowing for near,
medium and far vision.
Astigmatism correction (toric). If you have a significant astigmatism, a toric lens
can help correct your vision.
Discuss the benefits and risks of the different types of IOLs with your eye surgeon
to determine what's best for you.

During the procedure

Illustration showing two of the steps in cataract surgery
Cataract surgeryOpen pop-up dialog box
Cataract surgery, usually an outpatient procedure, takes an hour or less to
perform.

First, your doctor will place eyedrops in your eye to dilate your pupil. You'll
receive local anesthetics to numb the area, and you may be given a sedative to help
you relax. If you're given a sedative, you may remain awake, but groggy, during
surgery.

During cataract surgery, the clouded lens is removed, and a clear artificial lens
is usually implanted. In some cases, however, a cataract may be removed without
implanting an artificial lens.

Surgical methods used to remove cataracts include:

Using an ultrasound probe to break up the lens for removal. During a procedure
called phacoemulsification (fak-o-e-mul-sih-fih-KAY-shun), your surgeon makes a
tiny incision in the front of your eye (cornea) and inserts a needle-thin probe
into the lens substance where the cataract has formed.

Your surgeon then uses the probe, which transmits ultrasound waves, to break up
(emulsify) the cataract and suction out the fragments. The very back of your lens
(the lens capsule) is left intact to serve as a place for the artificial lens to
rest. Stitches may be used to close the tiny incision in your cornea at the
completion of the procedure.

Making an incision in the eye and removing the lens in one piece. A less frequently
used procedure called extracapsular cataract extraction requires a larger incision
than that used for phacoemulsification. Through this larger incision your surgeon
uses surgical tools to remove the front capsule of the lens and the cloudy lens
comprising the cataract. The very back capsule of your lens is left in place to
serve as a place for the artificial lens to rest.

This procedure may be performed if you have certain eye complications. With the
larger incision, stitches are required.

Once the cataract has been removed by either phacoemulsification or extracapsular

extraction, the artificial lens is implanted into the empty lens capsule.
After the procedure
After cataract surgery, expect your vision to begin improving within a few days.
Your vision may be blurry at first as your eye heals and adjusts.

Colors may seem brighter after your surgery because you are looking through a new,
clear lens. A cataract is usually yellow- or brown-tinted before surgery, muting
the look of colors.

You'll usually see your eye doctor a day or two after your surgery, the following
week, and then again after about a month to monitor healing.

It's normal to feel itching and mild discomfort for a couple of days after surgery.
Avoid rubbing or pushing on your eye.

Your doctor may ask you to wear an eye patch or protective shield the day of
surgery. Your doctor may also recommend wearing the eye patch for a few days after
your surgery and the protective shield when you sleep during the recovery period.

Your doctor may prescribe eyedrops or other medication to prevent infection, reduce
inflammation and control eye pressure. Sometimes, these medications can be injected
into the eye at the time of surgery.

After a couple of days, most of the discomfort should disappear. Often, complete
healing occurs within eight weeks.

Contact your doctor immediately if you experience any of the following:

Vision loss
Pain that persists despite the use of over-the-counter pain medications
Increased eye redness
Eyelid swelling
Light flashes or multiple new spots (floaters) in front of your eye
Most people need glasses, at least some of the time, after cataract surgery. Your
doctor will let you know when your eyes have healed enough for you to get a final
prescription for eyeglasses. This is usually between one and three months after
surgery.

If you have cataracts in both eyes, your doctor usually schedules the second
surgery after the first eye has healed.

Results
Cataract surgery successfully restores vision in the majority of people who have
the procedure.

People who've had cataract surgery may develop a secondary cataract. The medical
term for this common complication is known as posterior capsule opacification
(PCO). This happens when the back of the lens capsule — the part of the lens that
wasn't removed during surgery and that now supports the lens implant — becomes
cloudy and impairs your vision.

PCO is treated with a painless, five-minute outpatient procedure called yttrium-

aluminum-garnet (YAG) laser capsulotomy. In YAG laser capsulotomy, a laser beam is
used to make a small opening in the clouded capsule to provide a clear path through
which the light can pass.

After the procedure, you usually stay in the doctor's office for about an hour to
make sure your eye pressure doesn't rise. Other complications are rare but can
include increased eye pressure and retinal detachment.
Just behind the iris (the coloured part of the eye) is the lens. The lens helps
focus light onto the retina (the light-sensitive layer at the back of the eye).

Lenses need to be clear (transparent) to let the light pass through. A cataract is
the name for a lens that has become cloudy.

Cataract is a major cause of sight loss, as it affects approximately 380,000 people

in the UK. Approximately 390,000 cataract surgeries are carried out each year in
England and 16,000 in Wales.

Causes
Cataract is a common condition most often seen in older age as part of the normal
ageing process, but can happen at any age. Some rare inherited conditions mean that
babies will be born with cataract.

Cataracts develops due to the proteins of the lens changing their arrangement and
clumping together which causes the clear lens to become cloudy, which means light
is unable to pass through it directly.

Other causes of cataract include diabetes, eye injury and use of steroid eye drops
or tablets. Cataract is also often seen together with other eye conditions.

Symptoms
Cataract causes blurred or hazy vision, which may appear ‘washed out’, with less
contrast between black and white. Bright lights such as car headlamps might cause
glare or dazzle, especially at night. Colours can also seem altered or more yellow.

As cataract can affect each eye differently, some people will notice different
vision in one eye compared to the other.

Cataracts gradually get worse over time. Sometimes progression happens so slowly
that the person with cataract doesn’t notice the sight loss.

Cataract is not painful but can cause blindness if left untreated.

Treatments
Cataract surgery is very successful and serious complications are rare.

At the moment, cataract can only be treated with surgery. It is the most common
operation in the developed world.

This very delicate operation involves removing the cloudy human lens and replacing
it with a new artificial plastic lens.

In the UK, most people who have the operation are in their mid-70s. It takes about
30 minutes and is usually done under local anaesthetic as a day case.
Cataract surgery is very successful and serious complications are rare.

Prevention
Cataract cannot be treated, slowed down or prevented with medicine or eye drops.

Watching TV or computers does not cause cataracts. Some population studies suggest
that stopping smoking and wearing sunglasses with UV protection may help prevent
cataract or slow down its progress. But there is no evidence that these, vitamins,
diets or changes in life style are of benefit to individual people.

Research
Key topics in cataract research include developing a non-surgical treatment for
preventing or delaying cataract and preventing a common complication of cataract
surgery called ‘posterior capsule opacification’ in which the natural membrane
situated directly behind the artificial lens clouds over and needs treatment to
clear it again.

Read our research projects

Personal stories

Mother and daughter, Joy and Hazel, were both born with congenital cataracts a
condition that has affected three generations of their family.
Joy’s mother lived with the condition, which was passed onto Joy, who then passed
the gene onto her two daughters, Hazel and Melissa.

Joy, received ten operations when she was younger and was also diagnosed with
nystagmus. When aged 31 she was diagnosed with glaucoma and at the age of 48
received her first corneal graft and this procedure was repeated six years later.
This has had a huge impact on Joy’s vision – she has about three per cent of her
vision remaining and is now registered blind.

Her oldest daughter, Hazel, was born in 1978 and shortly afterwards was diagnosed
with the condition. She had corrective surgery when she was just a few months old.

Joy said: “I can remember me and my husband coming out of the doctors in floods of
tears after we received Hazel’s diagnosis. No one likes to see their children in
pain.”

Hazel also developed a slight nystagmus and has about ten per cent of her sight
remaining. Hazel went on to have two children, William, aged 10 and Andrew, 7.

Hazel started to notice that something was wrong with Andrew’s sight when he was
six weeks old. She said: “A mum just knows when something isn’t quite right. I
flagged this during Andrew’s eight week check-up and following tests, the GP
confirmed that the cataracts were there.”

Following this Andrew also went through a corrective procedure and thankfully
because of advances in science and research – the operation proved successful.

Hazel said: “Taking your baby to hospital and sitting there with an anaesthetist
putting them to sleep - is heartbreaking. I’m just so pleased that Andrew’s outcome
has been so much better than mine.

“Eye research is really important to me, so I support Fight for Sight because it’s
enabling more medical research to take place. My hope is that medical research will
continue to improve from generation to generation.”
Elfraihi Mohammed Younes
Groupe 04

Fight for sight

Cataract surgery is a procedure to cut off the lens of your eye and, in most cases,
replace it with an artificial lens. Normally, the lens of your eye is clear. A
cataract causes the lens to become cloudy, which eventually affects your vision.
By the age of 65 , over 90 percent of people have cataract and half of the people
between the ages of 75 and 85 have lost some vision due to a cataract.