Cataracts are a common age-related vision problem. About 22 million Americans age 40 and older have cataracts. The older a person gets, the greater the risk for developing cataracts. Women are more likely to develop cataracts than men, and African-Americans and Hispanic Americans are at particularly high risk.
In addition to age, other factors may increase the risk of cataract development. These include:
- Overexposure to sunlight
- Certain medications, such as steroids
During the early stages, cataracts may have little effect on vision. Symptoms vary due to the location of the cataract in the eye (nuclear, cortical, or posterior subcapsular). Depending on the type and extent of the cataract, patients may experience the following symptoms:
- Cloudy vision
- Double or blurry vision
- Glare and sensitivity to bright lights
- Colors appear faded
- Difficulty reading due to reduced black-white contrast
- Difficulty driving at night
Cataracts never go away on their own, but some stop progressing after a certain point. If cataracts continue to grow and progress, they can cause blindness if left untreated. Fortunately, cataracts can almost always be successfully treated with surgery. Millions of cataract operations are performed each year in the United States, and there is a very low risk for complications. However, before opting for surgery, patients need to consider on an individual basis how severely a cataract interferes with their quality of life. Cataract surgery is rarely an emergency, so patients have time to consult with their doctors and carefully consider the risks and benefits of surgery.
Cataract Removal Surgery
Surgery involves removing the cataract and replacing the abnormal lens with a permanent implant called an intraocular lens (IOL). The operation takes less than 1 hour and is performed on an outpatient basis. The procedure is generally painless and most patients remain awake, but sedated, during it. If you have cataracts in both eyes, doctors recommend waiting at least 1 month between surgeries.
A cataract is an opacity, or clouding, of the lens of the eye.
The lens of an eye is normally clear. If the lens becomes cloudy or is opacified, it is called a cataract.
How Cataracts Form
The likelihood of developing cataracts increases with age. Cataracts typically develop in the following way:
- The lens is an elliptical structure that sits behind the pupil and is normally transparent. The function of the lens is to focus light rays into images on the retina (the light-sensitive tissue at the back of the eye).
- In younger people, the lens is elastic and changes shape easily, allowing the eyes to focus clearly on both near and distant objects.
- As people reach their mid-40s, biochemical changes occur in the proteins within the lens, causing them to harden and lose elasticity. This causes a number of vision problems. For example, loss of elasticity causes presbyopia, or far-sightedness, requiring reading glasses in almost everyone as they age.
- Cataracts develop when proteins in the lens clump together, forming cloudy (opaque) areas. The lens also changes color from transparent to a yellowish or brownish tint, which further worsens visual sharpness.
- Depending on how dense they are and where they are located, cataracts can block the passage of light through the lens and interfere with the formation of images on the retina, causing vision to become cloudy.
- Age-related cataracts usually develop slowly over several years. With cataracts due to other causes, loss of vision may progress rapidly.
Some cataracts stop progressing after a certain point but they never go away on their own. If extensive and progressive cataracts are left untreated they can cause blindness. In fact, cataracts are the leading cause of blindness among adults age 55 and older. Fortunately, cataracts can nearly always be successfully removed with surgery, greatly improving vision.
Types of Cataracts
Cataracts can form in any of three parts of the lens and are named by their location.
- Nuclear sclerotic cataracts form in the nucleus (the center) of the lens. This is the most common type of cataract associated with the aging process. Nuclear cataracts increase nearsightedness and may initially improve close-up reading vision. As the cataract progresses, the lens color may darken, making it more difficult to distinguish colors and see clearly.
- Cortical cataracts first form in the cortex (the outer edges of the lens) and then progress inwards to the center of the eye. They have a striped or spoke-like appearance. This type of cataracts can cause glare and also affect night vision and the ability to see contrast.
- Posterior subcapsular cataracts form toward the back of the capsule that surrounds the lens. They can cause glare or halos and affect near-distance vision.
Most cataracts are due to age, but there are other causes as well. Doctors categorize cataracts based on their cause:
- Age-related (cataracts due to the aging process)
- Secondary (cataracts caused by other medical conditions or treatments)
- Radiation (cataracts caused by exposure to ultraviolet radiation)
- Traumatic (cataracts caused by injury to the eye)
- Congenital (cataracts that appear at birth or early childhood caused by inherited disorders or infections that occurred during pregnancy )
Aging is the most common cause of cataracts. Doctors are still not certain about the exact biologic mechanisms that tie cataracts to aging. Oxidative stress may play a role in damaging the proteins in the lenses of the eye, and causing them to clump together.
Oxidative stress is an imbalance between oxidants and anti-oxidants:
- Oxygen-free radicals (also called oxidants) are molecules produced by natural chemical processes in the body. Toxins, smoking, ultraviolet radiation, infections, and other factors can create reactions that produce excessive amounts of oxygen-free radicals.
- When oxidants are overproduced, these chemicals can be very harmful to cells throughout the body.
- Protective anti-oxidants, such as glutathione, help fight back against oxidants.
- Cataract formation is one of many damaging changes that can occur from overproduction of oxidants, possibly in combination with deficiencies of glutathione.
One theory is that in the aging eye, barriers develop that prevent glutathione and other protective antioxidants from reaching the nucleus in the lens, thus making it vulnerable to oxidation.
Secondary cataracts refer to cataracts that result from another medical condition or medical treatment. Causes of secondary cataracts include:
- Medications. Long-term use of oral corticosteroids is a well-known cause of cataracts. It is unclear whether inhaled and nasal-spray steroids increase the risk for cataracts. Some studies have linked statin drugs (used for cholesterol treatment) to an increased risk for cataracts; more research is needed. Other types of medications can also increase the risk for cataract development.
- Medical Conditions. Medical conditions that increase the risk for cataracts include diabetes, high blood pressure, obesity, and skin conditions such as atopic dermatitis (a type of eczema). Medical conditions that require long-term use of oral steroids are associated with secondary cataracts.
- Eye Conditions and Eye Surgery. The inflammatory eye condition uveitis is strongly associated with cataracts. Glaucoma does not increase the risk for cataracts but certain types of surgery (trabeculectomy) and medications (miotics) used to treat glaucoma do increase cataract risk. Other types of eye surgery associated with cataract development are vitrectomy and peripheral iridectomy.
Cataracts can develop from overexposure to radiation, including sunlight. A common cause of radiation cataracts is the ionizing radiation used in radiation for head and neck cancer. Cataracts are also a side effect of total body radiation treatments, which are administered for certain cancers.
Traumatic cataracts are caused by blunt or penetrating injury to the eye. This type of cataract can develop right after the injury or many years later.
In rare cases, a baby is born with cataracts or develops them during infancy. Causes of congential cataracts include:
- Genetic disorders (such as Down or Marfan syndrome)
- Prenatal infections (such as rubella or herpes simplex)
- Maternal abuse of alcohol or drugs during pregnancy
Aging is the primary risk factor for cataracts, but other factors are also involved.
Nearly everyone who lives long enough will develop cataracts to some extent. Some people develop cataracts during their middle-aged years (40s and 50s), but these cataracts tend to be very small. It is after age 60 that cataracts are most likely to affect vision. Nearly half of people age 75 and older have cataracts.
Women face a higher risk than men.
Cataracts tend to run in families.
Race and Ethnicity
African-Americans have nearly twice the risk of developing cataracts as Caucasians. This difference may be because African-Americans are also more likely to have diabetes, which is a risk factor for cataracts. African-Americans are much more likely to become blind from cataracts and glaucoma than Caucasians, mostly due to lack of access to medical care.
Hispanic Americans are also at increased risk for cataracts. In fact, cataracts are the leading cause of visual impairment among Hispanics.
Medical Conditions and Treatments
Certain medical conditions and treatments increase the risk for cataracts:
- Diabetes type 1 or 2 poses a very high risk for cataracts and the likelihood of developing them at a younger age. Cataract development is significantly related to high levels of blood sugar (hyperglycemia). (Cataract prevention is one of the many important benefits of controlling blood sugar.) Obesity, which is associated with diabetes type 2, and high blood pressure are also risk factors for cataracts.
- Long-term use of oral corticosteroids (commonly called steroids) increases the risk for cataracts. Medical conditions that use oral steroid medications for treatment include autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Other types of medications (such as statin drugs) may also possibly pose a risk.
- Radiation therapy for head and neck cancer is a risk factor for cataracts.
- Eye injuries and certain types of eye surgeries (such as trabeculectomy for glaucoma) increase the risk for cataracts. Uveitis is an inflammatory eye condition that is a significant risk factor for cataracts. It is not certain whether nearsightedness (myopia) is associated with increased risk for cataract formation; it does increase the risk for complications from cataract surgery.
Excessive exposure to ultraviolet B (UVB) radiation from sunlight increases the risk for cataracts. The risk may be highest among those who have significant sun exposure at a young age. People whose jobs expose them to sunlight for prolonged periods are also at increased risk.
Sunglasses or a wide-brimmed hat can help block the harmful effects of ultraviolet (UV) radiation. Protective sunglasses do not have to be expensive but it is important that they block 99 – 100% of UV light. Polarized, mirror-coated, or blue light-blocking lenses do not protect against UV radiation.
Smoking. Smoking a pack a day of cigarettes doubles the risk of developing cataracts. Smokers are at particular risk for cataracts located in the nuclear portion of the lens, which limit vision more severely than cataracts in other sites.
Alcohol. Chronic heavy drinkers are at high risk for a number of eye disorders, including cataracts.
Nutrition. Although it is not clear how much of a role nutrition plays in cataracts, there is some evidence that antioxidant-rich fruits and vegetables may offer some protection. The antioxidants most studied for cataract prevention are lutein and zeaxanthin, which are a type of antioxidant called carotenoids. Lutein and zeaxanthin are found in the lenses of the eyes.
Some research suggests that foods that contain these carotenoids, such as green leafy vegetables, may help slow the aging process in the eye and protect against cataracts. However, studies have not proven that taking supplements that contain lutein and zeaxanthin, or antioxidant vitamins such as vitamin C or E, reduce the risks for cataract formation.
During the early stages, cataracts have little effect on vision. People who have small cataracts can often see well enough around the clouded areas to function normally. But as a cataract grows larger and increasingly clouds the lens, it can interfere greatly with daily activities such as reading and driving.
As a cataract progresses, symptoms may include:
- Cloudy, blurry, or dim, vision. . You may feel as if you’re seeing objects through a fog or veil. It can become difficult to see clearly even in brightly lit environments, and extremely difficult to see at night.
- Glare, halos, and sensitivity to bright lights. You may notice halos of light around streetlights or the headlights of oncoming cars, which can make it difficult or impossible to drive at night.
- Muted or faded colors. Images may take on a yellowish tint as color vibrancy diminishes.
- Reduced contrast. Reading may become difficult because of a reduced contrast between letters and their background.
- Double vision or “ghost” images in a single eye. A cataract can cause you to see multiple images or to see faint shadow copies of an image.
- Frequent change in corrective lenses. As the cataract grows, it can affect both near and far vision (and even cause temporary improvement). You may find that you often need new prescriptions for eyeglasses or contact lenses.
- Symptoms may vary depending on the part of the lens that is affected. For example, nuclear cataracts – which cloud the center of the eye – can make it difficult to see in bright light when the pupil of the eye gets smaller. Cortical and posterior subcapsular cataracts can worsen problems with glare.
This photograph shows a cloudy white lens (cataract) over the pupil. Cataracts are a leading cause of decreased vision in older individuals, but children may have congenital cataracts. With new surgical techniques, the cataract can be removed, a new lens implanted, and the person can usually return home the same day.
Either an ophthalmologist or an optometrist can examine patients for cataracts, but only ophthalmologists are qualified to treat cataracts.
- An ophthalmologist is a medical doctor (M.D.) who specializes in the medical and surgical care of the eye.
- An optometrist is a doctor of optometry (O.D.) who practices eye care and prescribes corrective lenses but does not perform surgery.
The main tests used by an eye professional to diagnose cataracts are:
- Visual acuity
All of these tests are quick and painless.
Visual Acuity Tests
Visual acuity tests how clearly a person can actually see. The Snellen eye chart is often used, with rows of letters decreasing in size:
- From a specified distance, usually 20 feet, a person reads the letters using one eye at a time.
- If a person can read down to the small letters on the line marked 20 feet, then vision is 20/20 (normal vision).
- If a person can read only down through the line marked 40 feet, vision is 20/40; that is, from 20 feet the patient can read what someone with normal vision can read from 40 feet.
- If the large letters on the line marked 200 feet cannot be read with the better eye, even with glasses, the patient is considered legally blind.
The visual acuity test can be performed in many different ways. It is a quick way to detect vision problems and is frequently used in schools or for mass screening.
Ophthalmoscopy is performed to examine to back part of the eye (fundus), which includes the retina, optic nerve, and blood vessels. This test can help detect cataracts as well as other eye diseases such as glaucoma. The eye doctor may give you eye drops before the test to dilate (widen) the pupils of your eyes.
There are several ways that ophthalmoscopy can be performed:
- Direct ophthalmoscopy. The eye doctor uses a handheld device (ophthalmoscope) to shine a beam of light through the pupil.
- Indirect ophthalmoscopy. The eye doctor wears a headband with a light attached (like a miner’s light) and a handheld lens to view the eye.
- Slit-lamp ophthalmoscopy. The doctor has you rest your chin and forehead on a support to keep the head steady, and then uses a special magnifying instrument to examine the eye.
Tonometry measures the pressure inside your eye. It is used to find out if glaucoma is contributing to your symptoms. The clinician will first give you anesthetic drops to numb your eye. Next, a small device is gently pressed against your eye to measure intra-ocular (inside the eye) pressure. Eye pressure may also be evaluated in different ways such as with a hand-held electronic device or a gentle puff of air to indent the eye.
Other tests that may be used to diagnose cataracts or to determine if surgery is needed include:
- Contrast sensitivity. A chart similar to the Snellen chart, which has the same size letters, but in different contrasts with background, is used to test contrast sensitivity.
- Glare sensitivity. Glare sensitivity is tested by having the patient read a chart twice, with and without bright lights.
- Potential acuity. Potential acuity evaluates the eye’s acute vision center by testing macular function. It can help the ophthalmologist determine the expected improvement from cataract surgery.
- Corneal endothelium. The corneal endothelium, a layer of cells lining the cornea, is sensitive to surgical trauma and should be evaluated before any intraocular operation.
- Patients with other eye disorders may need other pre-operative tests.
Surgery is the only cure for cataracts, but it is almost never an emergency. Most cataracts cause no problem other than reducing a person's ability to see, so there is no harm in delaying surgery. Patients usually have plenty of time to carefully consider options and discuss them with an ophthalmologist.
There is no constant rate at which cataracts progress:
- Some cataracts develop to a certain point and then stop.
- Even if a cataract does progress, it may be years before it interferes with vision. Your doctor may recommend “watchful waiting” – delaying surgery while monitoring your condition on an on-going basis.
- It is very rare for people to need immediate cataract surgery.
The following measures may help manage early cataracts:
- Stronger eyeglasses or contact lenses
- Stronger indoor lighting
- Use of a magnifying glass during reading
Choosing Cataract Surgery
Cataract removal is the one of the most common type of eye surgeries performed in the United States, especially for people over age 65. In the past, cataract surgery was not performed until the cataract had become well developed. Newer techniques, however, have made it safer and even more efficient to operate in earlier stages. Cataract surgery improves vision in up to 95% of patients and prevents millions of people from going blind.
Nevertheless, cataract surgery may be performed more often than needed. In general, even if cataracts are diagnosed, the decision to remove them should be based on the patient's own perception of vision difficulties and the effect of vision loss on normal activity or independent living. The patient should also be aware of all the risks and costs of surgery.
Questions for the Ophthalmologist
You should ask the ophthalmologist the following questions before deciding to have cataract surgery:
- Is my cataract surgery an emergency?
- Are the cataracts the only cause of my poor vision?
- How much experience do you have with this procedure?
- Do I have other eye diseases that might complicate surgery or reduce my benefit?
- Do I have other health problems that might further complicate eye surgery?
- What type of lens will you implant?
- What type of procedure will you use?
- Afterward, what are my chances of having poorer vision or becoming totally blind in that eye?
- How well should I ultimately be able to see out of the operated eye?
- How long will it take to heal?
- What precautions should I take during the healing process?
- How long will it take to achieve my best eyesight?
- Will I have to wear glasses or contact lenses after surgery?
- When will I get my final eyeglass prescription?
- How soon after surgery will I be able to see well enough to go back to work? Drive a car? Return to full activity?
If you have further questions or doubts about the procedure, you may want to get a second opinion from another ophthalmologist.
Treatment for Patients with Accompanying Eye Conditions
Cataracts in the Second Eye. If a patient has a cataract in a second eye, the issues for decision making are the same as for the first eye. In general, surgery for a second cataract is usually performed 4 – 8 weeks after surgery for the first eye. Although not common, in some circumstances surgery may be performed on both eyes at the same time..
Cataracts and Glaucoma. There are various approaches to treating patients who have both cataracts and glaucoma. Your doctor recommend an approach on your individual condition. Some options include:
- For patients who have mild glaucoma, the doctor may recommend performing only cataract surgery and controlling the glaucoma with medication.
- For patients who have moderate-to-severe glaucoma, the traditional approach has been combination cataract-glaucoma surgery (phacotrabeculectomy). This combination surgery involves performing both trabeculectomy (glaucoma filtration surgery) and phacoemulsification (cataract extraction).
- New techniques are being developed. Approved in 2012, the iStent is a tiny tube that is implanted in the eye during cataract surgery. It is used in place of trabeculectomy. The stent helps improve the outflow of aqueous humor and lower intraocular pressure (IOP).
Treating Cataracts in Children
Infants. Treatment of infants first depends on whether one or both eyes are affected:
- For infants born with cataracts in one eye, the American Academy of Ophthalmology recommends surgery as soon as possible, by age 4 months or ideally even earlier. The procedure is followed by contact lens correction and patching of the unaffected eye. Although this approach is successful in many cases, some children still become blind in the affected eye. There is also a high risk for glaucoma after surgery.
- In infants with cataracts in both eyes, surgery is not always an option. Sometimes surgery may be performed sequentially, with the second eye operated on a few days after the first. Phacoemulsification appears to pose a much higher risk for secondary cataracts than standard lens removal.
Toddlers and Older Children. Intraocular lens replacement is now standard treatment for children age 2 years and older.
Preparing for Cataract Surgery
Cataract surgery is usually done as an outpatient procedure under local anesthesia and takes less than an hour. Preoperative preparations may include:
- Having a general physical examination is important for patients with medical problems such as diabetes. Diabetes can cause damage to the blood vessels of the eye’s retina, a condition called diabetic retinopathy. If you have diabetes, discuss with your doctor how your blood sugar level may affect the surgery.
- Reviewing all medications with the ophthalmologist. In particular, men who take tamsulosin (Flomax, generic), or similar drugs for prostate problems, require special surgical techniques to prevent complications.
- The ophthalmologist will use a painless ultrasound test to measure the length of the eye and determine the type of replacement lens that will be needed after the operation.
- Topical antibiotics (such as ofloxacin or ciprofloxacin) may be applied preoperatively to protect against postoperative infection.
- Most healthy patients receive either a local injection or topical anesthetic. They may also receive a sedative. Some patients may need general anesthesia.
All cataract procedures involve removal of the cataract-affected lens and replacing it with an artificial lens.
Phacoemulsification. Phacoemulsification (phaco means lens; emulsification means to liquefy) is the most common cataract procedure performed in the United States.
The procedure generally involves:
- The surgeon makes a small incision.
- A thin probe that transmits ultrasound is used to break up the clouded lens into small fragments.
- The tiny pieces are sucked out with a vacuum-like device.
- A replacement lens is then inserted into the capsular bag where the natural lens used to be.
Phacoemulsification requires only local anesthesia. Most phacoemulsification procedures take about 15 minutes, and the patient is usually out of the operating room in about an hour. There is little discomfort afterward, and visual rehabilitation takes about 1 - 3 weeks.
Phacoemulsification is sometimes combined with glaucoma surgical procedures, for patients who have both glaucoma and cataracts.
Extracapsular Cataract Extraction. Extracapsular cataract extraction, the original standard procedure, is now generally used only in patients who have an extremely hard lens. In this procedure, the surgeon leaves intact the posterior capsule, which adds structural strength to the eye. A replacement lens is then inserted. .
Replacement Lenses and Glasses
With the clouded lens removed, the eye cannot focus a sharp image on the retina. A replacement lens or eyeglasses are therefore needed:
Intraocular Lenses (IOLs).An artificial lens, known as an intraocular lens (IOLs), is usually inserted after the cataract is extracted. Most IOLs are made out of acrylic, although other materials, such as silicon, are also used.
IOLs are designed to improve specific aspects of vision. The choices include:
- Lenses that address a single fixed focal point. Such lenses are suitable either for reading or distance vision, but not both. If a distance lens is implanted, the surgeon prescribes glasses or contact lenses for reading. If a reading lens is implanted, lenses for seeing distances will be prescribed.
- Lenses that address multifocal points. Multifocal lenses can focus at different points for both reading and distance vision. However, contrast may be reduced, and some patients experience glare and halos, particularly at night.
- Lenses are available to correct astigmatism after cataract surgery.
The patients and the doctor must make these decisions based on specific visual needs. Many patients also need eyeglasses after cataract surgery for reading or to correct astigmatism.
Complications of Cataract Surgery
Cataract surgery is one of the safest of all surgical procedures. Most complications, even if they occur, are not serious. They can include:
- Swelling and inflammation can occur in the days or weeks following surgery. Risk is about 1%. This complication can be particularly harmful for patients with existing uveitis (chronic inflammation in the eye, which can be due to various medical conditions).
- Retinal detachment. In rare cases, the retina at the rear of the eye can become detached.
- Glaucoma. This is an eye condition in which the pressure of fluids inside the eye rises dangerously. Risk is very low, but patients should be sure to avoid activities after surgery that increase pressure.
Glaucoma is a disorder of the optic nerve that is usually marked by increased fluid pressure inside the eye. The increased pressure causes compression of the retina and the optic nerve which can eventually lead to nerve damage. Without treatment, glaucoma can cause partial vision loss, with blindness as a possible eventual outcome.
- Infection. This is very rare (0.2%) but may be significant if it does develop.
- Bleeding can develop inside the eye.
- Posterior capsular opacification is one the more common complications of cataract surgery.
Preventing Infection and Reducing Swelling. The ophthalmologist may prescribe the following medications after surgery:
- A topical antibiotic may protect against infection.
- Corticosteroid eyedrops or ointments are often used to reduce swelling, but they can pose a risk for increased pressure in the eye.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, ketorolac, naproxen, and voltaren, also reduce swelling and do not have the same risks as steroids. Newer NSAIDs approved to treat pain and swelling after cataract surgery include bromfenac (Xibrom) and nepafenac (Nevanac).
Factors that Increase Risk for Complications. The risks of complications are greater for the following people:
- Patients who have other eye diseases.
- People with diabetes. Intracapsular and extracapsular cataract extraction can pose a high risk for the development or worsening of retinopathy, a known eye complication of diabetes.
- People who have taken tamsulosin (Flomax, generic) or other alpha-1 blocker drugs. Tamsulosin is a muscle relaxant prescribed for treatment of several urinary conditions, including benign prostatic hyperplasia (BPH). Tamsulosin may cause intraoperative floppy iris syndrome (IFIS), a loss of muscle tone in the iris that can cause complications during eye surgery. Problems have been reported both for patients who were taking the drug during surgery as well as those who had stopped taking the drug weeks or months before surgery. Men who have taken tamsulosin or similar drugs should inform their eye surgeon. The surgeon may need to use different techniques to minimize the risk of IFIS and other complications.
Returning Home and Follow-up Visits.
- Patients usually leave the surgical site within an hour of surgery. Cataract surgery almost never requires an overnight hospital stay.
- Patients need someone to drive them home and stay with them for a few days until their vision improves.
- The patient is usually examined the day after surgery and then during the following month. Additional visits occur as necessary.
- Vision usually remains blurred for a while but gradually clears, usually over 2 - 6 weeks. (It can take longer.)
- When the doctor decides the condition has stabilized, the patient will receive a final prescription for glasses or contacts.
Protecting the Eye. Postoperative protection of the eye typically involves:
- The ophthalmologist usually tapes a bandage over the eye to protect it during the healing process.
- When changing the bandage, the eye can be cleaned gently using a washcloth dipped in warm water without soap. A new bandage can then be positioned and taped.
- It is very important not to press or rub the eye during this procedure.
- An eye shield may be placed over the bandage at night.
Avoiding Glaucoma. Cataract surgery can cause glaucoma, a condition in which the pressure of fluids inside the eye rises dangerously. It is very important to minimize any activity that increases internal eye pressure. Postoperative cataract patients should take the following precautions:
- Minimize vigorous exercise.
- Put on shoes while sitting and without bending over.
- Kneel instead of bending over to pick something up.
- Avoid lifting.
- Limit reading since it requires eye movement (watching television is all right).
- Sleep on the back or on the unoperated side.
Treatment of Posterior Capsular Opacification (Secondary “After Cataract”)
About 15% of patients who have cataract surgery develop a secondary "after-cataract" called posterior capsular opacification. Posterior capsular opacification is a clouding of the lens capsule that was left behind when the original cataract was removed. It generally occurs because after surgery there are still some natural lens cells left behind that proliferate on the back of the capsule.
The standard treatment for posterior capsular opacification is a type of laser surgery known as a YAG capsulotomy. (Capsulotomy means cutting into the capsule, and YAG is an abbreviation of yttrium aluminum garnet, the laser most often used for this procedure.) This procedure can help improve vision and reduce glare.
- This is an outpatient procedure and involves no incision.
- Using the laser beam, the ophthalmologist makes an opening in the clouded capsule to let light through.
- After the procedure, the patient remains in the doctor's office for an hour to make sure that pressure in the eye is not elevated.
- The doctor will usually prescribe anti-inflammatory eyedrops for the patient to take at home.
- Most patients will find that their vision improves within a day.
- An eye examination for any complications should follow within 2 weeks.
Complications. YAG laser capsulotomy is generally a safe procedure. Serious complications are rare, but can include retinal detachment.
Awasthi N, Guo S, Wagner BJ. Posterior capsular opacification: a problem reduced but not yet eradicated. Arch Ophthalmol. 2009 Apr;127(4):555-62.
Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20;301(19):1991-6.
Chang JR, Koo E, Agrón E, Hallak J, Clemons T, Azar D, et al. Risk factors associated with incident cataracts and cataract surgery in the Age-related Eye Disease Study (AREDS): AREDS report number 32. Ophthalmology. 2011 Nov;118(11):2113-9.
Christen WG, Glynn RJ, Sesso HD, Kurth T, MacFadyen J, Bubes V, et al. Age-related cataract in a randomized trial of vitamins E and C in men. Arch Ophthalmol. 2010 Nov;128(11):1397-405.
Fernandez MM, Afshari NA. Nutrition and the prevention of cataracts. Curr Opin Ophthalmol. 2008 Jan;19(1):66-70.
Findl O, Buehl W, Bauer P, Sycha T. Interventions for preventing posterior capsule opacification. Cochrane Database Syst Rev. 2010 Feb 17;2:CD003738.
Friedman AH. Tamsulosin and the intraoperative floppy iris syndrome. JAMA. 2009 May 20;301(19):2044-5.
Leuschen J, Mortensen EM, Frei CR, Mansi EA, Panday V, Mansi I. Association of statin use with cataracts: a propensity score-matched analysis. JAMA Ophthalmol. 2013 Sep 19. [Epub ahead of print]
Moeller SM, Voland R, Tinker L, Blodi BA, Klein ML, Gehrs KM, et al. Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the Carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Women's Health Initiative. Arch Ophthalmol. 2008 Mar;126(3):354-64.
Olitsky SE, Hug D, Plummer LS, and Stass-Isern M. Abnormalities of the lens. In: Kliegman RM, Stanton BF, St. Geme III JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. St. Louis, MO: WB Saunders; 2011; chap 620.
Pan CW, Cheng CY, Saw SM, Wang JJ, Wong TY. Myopia and age-related cataract: a systematic review and meta-analysis. Am JOphthalmol. 2013 Aug 9. [Epub ahead of print]
Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol. 2010 Jan;21(1):20-4.
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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