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What Is a Cataract?

Posted Aug 24 2008 1:49pm
ANNOUNCER: Getting older isn't for sissies. Pop idols start to look like your kids; your old clothes are now considered "vintage," and then there's your eyesight.

PENNY ASBELL, MD: The most common cause of cataracts is really just aging. We know that some diseases are more commonly associated with cataracts, such as diabetes. We know that some drugs can cause cataracts, such as steroids or prednisone. But in general, we see an increased incidence of cataracts as we age. So it's one of those aging phenomena that happens to almost everybody if we live long enough.

ANNOUNCER: Cataracts disrupt the functioning of one of the most important parts of our eyes.

PENNY ASBELL, MD: The whole function of the eye is to get the light that's coming into the eye into focus in the back of the eye, the retina. And part of that focusing mechanism is the lens inside the eye. So it's a little lens, just like your glasses. Now, if that lens gets cloudy, we change its name from lens to cataract. So a cataract is a cloudy lens inside the eye.

ANNOUNCER: More than half of our population over 65 develops them. While the condition is painless, vision does change.

PENNY ASBELL, MD: Maybe you can't read anymore. Maybe you're having trouble driving. Another symptom can be glare or, particularly like driving at night with headlights coming toward you. Some people also complain about a change in color, that the color doesn't seem as rich as it used to be.

ANNOUNCER: People might think all they need is a new prescription.

PENNY ASBELL, MD: But even if you change your glasses and you still can't see well, typically that cause, or the most common cause, is cataracts.

ANNOUNCER: The only way to truly identify any vision problem is to seek advice from an expert.

PENNY ASBELL, MD: One of the reasons to have an eye exam is not just to diagnose cataracts or no cataracts, but to make sure there isn't any other problem that's causing loss of vision. It could be glaucoma, diabetes in the eye, other serious problems that might be changing the vision, and that's important to determine. Is it cataract alone, or is there any other issue going on?

ANNOUNCER: Like grey hairs that slowly creep in, cataracts do their damage over time.

Cataracts typically, in adults, progress slowly. Your vision may still be very good and very functional. Generally, gradually, there's a change or loss of visual acuity.

ANNOUNCER: But at some point, cataracts make changes that become significant.

PENNY ASBELL, MD: The timing for cataract surgery really depends almost always on the patient. When does your vision become a problem? When can you no longer drive, maybe no longer do the activities you like to do, see TV, read, do your crossword puzzle? When you can't get by, that's the time to do cataract surgery.

If it's not treated, the vision really can get so poor that you become legally blind, meaning you see the light, but no images, no detail. Fortunately, in the United States, most people seek care before they get that bad, but that's the potential if they don't care for it.

ANNOUNCER: Over a million cataract operations are performed every year.

PENNY ASBELL, MD: Cataract surgery is one of the most successful surgeries that are done today. The patient comes in goes home the same day, and it's a relatively brief surgery. Certainly, about an hour or maybe even less. Given all of that, really, it can be done in almost any patient at any age when it's appropriate for vision needs. The eye doctor will put drops in the eyes to numb up the surface of the eye. Sometimes we do give an injection near the eye to numb the eye. If that's done, typically you work with an anesthesiologist who will give some sedation medicine so it doesn't bother you. And then the surgery begins.

The eye doctor may ask you to look at a light to keep your eye from moving around too much during the surgery, and we make a tiny little incision in the eye and then start removing the cataract.

ANNOUNCER: The goal of this operation is to replace the defective lens with an artificial substitute.

PENNY ASBELL, MD: What we do is take out all the lens, except we leave part of the capsule behind, because if we're going to take out that lens, we want to replace it with something. And the replacement is an IOL or intraocular lens. It's made out of plastic. It's measured to give the right power, and it's put back in after you take the cataract out.

ANNOUNCER: The procedure may be fairly routine, but naturally there is still a small amount of risk.

PENNY ASBELL, MD: Some of the complications can be serious, such as bleeding, infection, damage to the inside of the eye, the retina, all of which can cause loss of vision. So that's why we don't just do the surgery on everybody who walks in. They have to have a visual complaint in order to consider taking on the risk, albeit a small one but there's still some risk with every surgery, cataract surgery, too.

ANNOUNCER: After the surgery, recovery is brief with relatively few restrictions on an active life.

PENNY ASBELL, MD: The next day, you're going to see your eye doctor to make sure it's beginning to heal, typically then about a week later, and then maybe about a month or so later after that. During that time you're going to be using eye drops, maybe for a week to about a month.

The key thing after surgery is not to get hit in the eye. So some patients wear a plastic shield to protect their eye, their glasses or sunglasses. And for the first, certainly, couple of weeks, you want to be careful with water, with swimming, things like that, because that water probably isn't clean or sterile. And then usually about a month is when you'll find out if you need new glasses or a change in your glasses. Or if you're lucky, maybe you won't use glasses at all.

ANNOUNCER: Some people can still develop a kind of residual cataract.

PENNY ASBELL, MD: We leave a little bit behind, the envelope or capsule around the cataract, and sometimes over time that gets cloudy. It's sometimes called an aftercataract, and if it really gets cloudy it can interfere with vision.

The good news is, if you do have that opacification, in the office you can use a laser to make a little hole in that leftover envelope or capsule, and then your vision comes back again. So it's not back to the operating room. It actually can be done in the office.

ANNOUNCER: Since cataracts usually affect both eyes, it might seem practical to take care of both eyes at once, but it's not advised.

PENNY ASBELL, MD: Most surgeons will do one eye, make sure that eye is healed and doing well, and then consider the other eye if you're visually symptomatic. In some patients the other eye is still good vision. You don't have to do anything about it. But if you do have loss of vision, it's still bothering you, actually, the studies suggest if you do both eyes you improve your visual function. In most cases in the United States we do one eye and make sure it's healed, and wait about a month before we proceed with the other eye.

ANNOUNCER: Many patients are now reaping extra benefits from cataract surgery.

PENNY ASBELL, MD: We have implants now that can block ultraviolet light, UV light. We have implants that can correct astigmatism, residual refractive errors. And just recently there was approved an implant that can actually correct for distance and reading vision. So a little bit like you were young again, to see well at distance, at near. So there's a lot of modifications, and there continues to be plenty of research and interest in making it better and better.

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