Most cataracts occur in the over 60’s and are considered to be as normal as grey hair and wrinkles! Apart from age, other causes include diabetes, trauma and long term use of some drugs and there are even babies who are born with cataracts.

What is a cataract?

It is not a skin growing over the eye, but it is a clouding of the lens inside your eye. The lens sits behind the iris so you cannot see it, or the cataract, unless it is very mature. The lens is used by the eye to do the fine focusing of images and consists of proteins and water encased in an outer shell. Cataracts are formed when the arrangement of proteins is disrupted, so that light is not transmitted normally causing reduced cloudy vision.

Types of Cataract or where are they?

There are 3 main types of cataracts:

Subcapsular.

This begins at the back of the lens just in front of the outer shell. It is mainly found in Diabetics, people who are longsighted (farsighted) and those taking high doses of steroids.

Nuclear.

This forms at the centre of the lens due to normal ageing processes. As you look through this area at all times, whatever the lighting levels, this type of cataract affects you the quickest and your vision is worse in good light.

Cortical.

This forms at the periphery of the lens,which is covered by the iris most of the time. This means that until it has advanced into central vision, you have very few problems and so they can be left alone.

Signs and symptoms or what will I notice?

Slight blurring which gets worse with time may be the initial sign

The sun or household lights may appear bright or glaring.

Vision may be better in poorer light than bright light

Increased glare from headlights

Colours appear less bright (muted)

With nuclear cataracts, your spectacles may become too strong if you are longsighted. This may occur before you notice any blurring and you will need regular changes in your spectacles. Eventually your vision will go cloudy.

Causes or how can I help myself?

Research has shown that apart from age (which you can do nothing about) there are other causes of cataracts.

These include

Trauma – protect your eyes when doing DIY and gardening. Also when playing ball sports especially squash.

Sunlight – living in countries with good levels of daylight mean increased UV and blue light getting into the eye which can speed up the aging process. Always wear good sunglasses or prescription sunglasses when outside. Snow and water increases reflected light and therefore the risk

Disease – Diabetes is a risk factor for cataracts. Keep your diabetes under control and have regular eye examinations

Diet – diets low in Vitamins A, C, and E, low in selenium and high in salt may increase the risk of early cataracts

Drugs – long term use of certain prescribed drugs e.g. steroids can cause early cataracts. DO Not stop taking your tablets but talk things over with your GP if you are concerned.

Treatment or what happens when I get one?

Often, new spectacles are all that is needed in the early stages of a cataract to correct your vision. A slight tint may help dilate the pupils so that you can see better in bright light. You may require a change in spectacles every 6 months. A regular eye examination is always recommended to assess the cataract and to make sure no other problems are developing.

When the cataract has developed enough to impair your vision and affect your life then surgery is required. You no longer have to wait till the cataract is “ripe”. Gone are the days of a 3 week stay in hospital and coming out wearing milk bottom spectacles! Surgery is mainly done on a day case basis, often under local anaesthetic. Studies from the USA have shown that 90% of patients who have cataract surgery achieve good vision after surgery.

Surgery or what do they do?

The surgeon removes the cloudy part of the lens and replaces it with a clear, plastic artificial lens. The operation only lasts 15 to 20 minutes and the eye is not removed from the socket. Vision is usually very good within 2-3 days. Colours look brighter (and the house looks dustier!) New lenses are being developed so that you could be completely spectacle free after the operation.

Another set of statistics show that cataract surgery is 98% successful – by this they mean that there are no medical complications to the operation. The main complications of the operation are macular changes, raised eye pressure and retinal detachments, but these are very rare. Long term the most common complication is a posterior capsule opacity. This can occur a few years after surgery and is treated by using a laser and takes only a few minutes to sort out.

Poor vision after surgery is usually due to other underlying eye problems including macular degeneration and diabetic eye disease. Unfortunately, these changes cannot be seen until after the cataract surgery has been performed.

Cataract surgery is not something to be afraid of and can improve both your vision and quality of life so please consider having the operation if you consultant advises it, I know I will.