A cataract is cloudiness of the lens of the eye, which limits light passage into the eye and inhibits the ability of the lens to focus images on the retina. It is the leading cause of blindness worldwide. Fortunately, this eye condition is reversible and vision can often be restored with cataract surgery. Prevent Blindness America has declared June as Cataract Awareness Month.
Most cataracts form due to age-related process in the crystalline lens. Changes in the lens protein structure as a result of wear and tear from the aging process, cloud the lens and makes it harder to see. Other factors, such as diabetes, long-term steroid medication use, smoking, excessive sunlight exposure, and prior ocular surgery or trauma also increase the risk of cataract formation. Some patients are born with congenital cataracts or form them in early childhood, but these cases are much less common. Smoking cessation, wearing UV blocking sunglasses outdoors, and eating a well-balanced diet rich in antioxidants are important factors to modify cataract formation and progression.
Patients typically present with painless, progressive vision loss. Often this progress occurs slowly over several years, but some types of cataract, such as posterior sub-capsular cataract or traumatic cataract, can form more rapidly. Blurred vision, halos and glare with nighttime driving, and a constant film over the eyes are common symptoms. Both eyes are often affected similarly, although asymmetric cataract progression can also occur. In earlier stages, changing the glasses prescription can often help improve a patient’s functional quality of vision. Once symptoms are visually significant and persist despite updating glasses, cataract surgery is recommended.
Modern cataract surgery is one of the most common and most successful surgical procedures performed in the U.S. Over 3.5 million procedures are performed in the U.S. each year. Conventional surgery utilizes ultrasound energy (phacoemulsification) to remove the cataract but in recent years, femtosecond laser-assisted cataract surgery has also been incorporated in certain cases. Surgery typically takes less than 30 minutes under conscious sedation, with patients usually spending less than 2 hours at the surgery center.
The average age of a patient undergoing cataract surgery continues to get younger. Currently, studies indicate the average age is 65, while this was approximately age 75 in 2004. Several factors have contributed to this trend; surgery has become safer, clinical and surgical technologies have improved significantly, and patients are maintaining more active lifestyles later in life.
Another factor motivating younger and more active patients to pursue cataract surgery is the advancements in lens implant technology. Image quality and overall optics with the standard monofocal lenses are exceptional. Toric lenses have become standard of care for correcting visually significant corneal astigmatism (non-spherical corneal shape that causes blurry vision even after cataract is removed). Multifocal lenses or extended depth of focus lenses can also be considered for patients looking to reduce their dependence on glasses or contact lenses.
Recent data has suggested cataract surgery has a big impact on improving a number of factors for quality of life and patient safety. A significant reduction in rate of falls and hip fractures has been reported. Other studies suggest a decline in car accidents, improvement in depression and anxiety, increased activity, and reduced sense of social isolation for patients who have undergone cataract surgery.
Cataracts are almost inevitable as we age. Development of cataracts may start as early as 40, but symptoms tend to go unnoticed until later in life. Many patients seek an eye exam after realizing their quality of vision has diminished but there are additional steps to take. At your next routine physical exam, mention any vision impairment and even ask for a vision screening. Your family doctor will likely recommend an eye exam with an eye doctor if they have any concerns regarding your vision.