Robert Dickey, 56, of North Hollywood, California, recently caught a movie with his wife. “You just cannot believe how vivid the imagery was,” he says. He’s not talking about the cinematography, but the fact that one month after cataract removal on his right eye — and two days after surgery on his left eye — the image on the big screen is crisp and clear instead of foggy and blurry.
Blurriness, Glare and Fading Colors
A cataract is a cloudy area in the lens of the eye. The lens’ job is to focus light back onto the retina and to adjust focus to help you see both up close and at a distance. The lens is composed of protein and water. A healthy lens should be clear. When protein clumps together in an area of the lens, making it opaque, that’s a cataract.
With cataracts, symptoms always start “with some level of blurred vision that is not corrected by your eyeglasses,” says David Chang, a clinical professor of ophthalmology at the University of California–San Francisco. Symptoms are all visual, he says, and have nothing to do with your eye being red or uncomfortable.
“Sometimes it’s subtle,” Chang says. “Sometimes people think their vision isn’t that bad. But what it really amounts to is that they’re just working a lot harder. You’re compensating because it’s a very gradual process.”
Besides reducing clarity, cataracts can affect color perception over time. Colors may fade, and as the lens gradually turns yellow/brown, your vision can take on a brownish tint, according to the National Eye Institute. With advanced discoloration, you may not be able to distinguish purple or blue from black. Double vision or seeing multiple images with one eye can also be a problem. Night vision can deteriorate, glare increases and you may see a halo around lights.
Some people with cataracts never need surgery, and waiting a few years until you’re ready is fine, the NEI says. But when adaptations and adjustments — such as new eyeglasses, anti-glare sunglasses, brighter lighting and using a magnifying glass — don’t work anymore, it may be time.
According to the American Academy of Ophthalmology, about 24.5 million Americans are affected by cataracts, and cataract surgery is the most common major eye procedure.
Aging and Other Risk Factors
Cataracts often come with aging, but can also be due to an eye trauma, congenital conditions or radiation contact. They can be related to diabetes or to medical treatment with systemic steroids. Secondary cataracts can develop after eye surgery, like surgery for glaucoma.
“There’s no question that advancing age is the number-one risk factor,” says Chang, who is past president of the American Society of Cataract and Refractive Surgery. “However, it’s not unusual for people to develop cataracts in their 40s and 50s.” Highly nearsighted people tend to develop cataracts at a much younger age, he says.
Family history is another risk factor. Dickey’s family tree is filled with cataracts: his great-grandfather, father, a sister and a brother all had them. When Dickey did an informal “eye genealogy,” he found an old-fashioned photo of his great-great-grandfather with the word “blind” printed beneath.
One step people can take to prevent early cataracts, particularly those who spend a lot of time outdoors, is reducing their exposure to ultraviolet light, Chang says — like fishermen wearing sunglasses to protect their eyes.
Postponing the Inevitable
Dickey’s first cataract developed at 52, starting as “a little speck” in the center of his eye and gradually progressing in the next couple years from a “light mist” to a “London fog” that got thicker and more opaque.
He’d delayed cataract surgery as long as he could. With both myopia (nearsightedness) and astigmatism (an irregularly shaped cornea or lens) since his teens, he’s tried remedies such as supplements, acupuncture and Ayurvedic medicine, an ancient holistic approach, to improve his vision. Both an actor and a rancher, Dickey continued to work outdoors without too much difficulty but still relied more and more on his wife, who eventually took over driving.
Driving often triggers people toward having the surgery done, Chang says — when they have glare symptoms during night driving and trouble with far-distance details like road signs.
Artificial Lens Replacement
Cataract surgery involves removing the original lens of the eye and replacing it with a plastic lens, called an intraocular lens implant.
Surgeons use a tiny eye incision and a technique called phacoemulsification. With phaco, the surgeon uses an ultrasonic instrument to break the lens into particles and remove the pieces by vacuum. Patients are usually awake for this outpatient procedure. They have their eyes dilated and receive sedation medicine and numbing eye drops for the procedure, which usually takes less than half an hour.
When you’re choosing the ophthalmologist to perform your cataract surgery, consider his or her level of experience, Chang says. And if patients are looking for extras like special lens implants, they should ask if the surgeon offers these options. Different types of lens can address other vision problems at the same time as cataract removal and may reduce the need for eyeglasses.
Cataract treatment with standard monofocal (single-focus) lenses is usually covered as a medical necessity by Medicare and most insurers. Special lenses such as multifocal and toric lenses are not, and patients have to pay the difference out of pocket. Extra costs for multifocal or toric lenses range between $1,000 and $3,000, Chang says.
Recovery Time
“Most people undergoing this process find it surprisingly easy,” Chang says. Patients take a series of eye drops before surgery and during recovery. Blurry vision can last anywhere from two days to more than two weeks after surgery.
While people often develop cataracts in both eyes, it’s standard to wait a month or two between individual procedures for each eye. That way, while one eye is recovering, the other eye can take on all the work of seeing.
Patients are usually asked to avoid heavy lifting (over 10 pounds) and bending or exercising that may stress the eye for a week or more after surgery. Avoiding swimming and hot tubs during the first few weeks helps prevent infection of the healing incision.
Dickey says the only downside he noticed, mostly after his first eye surgery, was a feeling that there was something in his eye. “It felt like an eyelash or a piece of dust, and you just want it out. It’s irritating,” he says. But that faded with time. Artificial tears can ease discomfort or dry eyes after surgery.
Surgery Risks
Complications from cataract surgery, while uncommon, can include bleeding, infections, pain, redness and swelling. Vision loss, double vision and changes in eye pressure are also possible. These problems can usually be treated. Retinal detachment is a rare complication, but when it happens it’s an emergency and immediate treatment is needed to prevent vision loss.
Success rate is very high for cataract surgery, Chang says. “The chances of the vision turning out worse than it was to start with are probably 1 percent or less,” he says. The chances of someone totally losing their vision after the surgery “are very remote,” he adds. In about 90 percent of cataract surgery cases, people have better vision afterward, according to the NEI.
In his global humanitarian work, Chang has witnessed what happens when people don’t have access to cataract surgery. “It’s probably pretty startling for most people to think that half of all the blindness in the world is caused by cataracts, when it’s simply cured by sight-restoring surgery,” he says.
A New View
Dickey is thrilled with the results of his surgeries, both from the cataract removal and vision-correcting lenses. He can drive again, without glasses, and says the difference in how the world looks now is a “miracle.”
“I was just looking at a flock of birds flying quite a distance away. And I’m looking at stars at night that are little spots of bright light instead of aberrated,” he says. “I used to look at a crescent moon and see three or four moons.” Now, he says, “the moon is just one crisp crescent.”
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Getting Clear on Cataracts originally appeared on usnews.com
