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Aging often brings with it some health issues that must be addressed. Cataracts are the leading cause of blindness in the world. There are congenital cataracts that can be present at birth, and there are age-related cataracts. Age-related cataracts will be the focus of this article. In the US, over 20% of adults aged 65-74 will have cataracts that interfere with vision. By age 75, over half of US adults will have cataracts severe enough to warrant treatment or have already had cataracts removed.
Normally the eye's lens is clear and acts like a camera lens, focusing the light as it enters the eye. Until age 45, the lens can change shape on demand to focus on objects near or far away. As we age, the proteins in the lens start to break down. This makes the lens less flexible and makes it more difficult for the lens to focus on close-up objects. Over time, the lens becomes cloudy, and the vision gradually and painlessly becomes blurry at all distances.
Factors that may speed cataract formation or increase the risk of cataracts include:
*Diabetes
* Family history of cataracts
*Eye inflammation
*Smoking (Smokers are two to three times more likely to develop cataracts)
*Eye injury
*Long-term use of steroid medications taken by mouth
*Radiation exposure
*Excessive alcohol consumption
*Surgery for another eye problem
*Too much exposure to ultraviolet light (sunlight)
*Obesity (several studies have shown a link between obesity and cataract development, however, obesity is an indirect cause, as obesity is a risk for diabetes, and diabetes is a known risk factor for cataract development).
As the years progress, so do the signs and symptoms of cataracts. Often one eye will have more decrease in vision than the other, or both eyes may be equally affected.
Cataract signs and symptoms may include:
*Glare (halos or starbursts around lights)
*Needing more light to see well
*Problems distinguishing colors like dark blue from black
*Cloudy, fuzzy, or filmy vision
*Difficulty seeing at night
*Loss of color intensity
*Frequent changes in eyeglass prescription.
Diagnosing cataracts may start with your primary care physician. Knowledge of cataract symptoms, how to evaluate them, and a basic understanding of the surgery to correct cataracts make primary care doctors an important part of treating this leading cause of preventable blindness. If you complain to your provider about vision changes, your provider will likely recommend a visit to an ophthalmologist. Your eye doctor will likely dilate your eyes so a thorough exam can occur, including using a slit lamp for accurate diagnosis of the extent and characteristics of the cataract. A well-developed cataract will appear as white, grey, or yellow-brown opacities in the lens.
Treatment
In the early stages of cataract development, your eye doctor may recommend some of the following:
*Change in your eyeglass prescription
*Better lighting at home
*Magnifying lenses
*Sunglasses
As a cataract progresses, making changes in your home may be necessary to avoid being injured in a fall. If a cataract is not causing major issues, surgery can often be postponed. Having a cataract usually does not damage the eye, so you and your eye doctor can determine when it is best to have a cataract surgically removed. When your normal activities such as driving, reading, working on hobbies, watching TV, or using the computer are impacted, your doctor will likely recommend surgery.
Some research has pointed to cataract surgery lowering the risk of dementia, but more research is needed to solidify these early findings. Diabetic retinopathy, a result of diabetes, often cannot be treated until any cataract present is surgically removed. Other than the instance of diabetic retinopathy, no benefit has been established for early cataract removal.
Cataract surgery
The only actual treatment for a cataract is surgical removal. In surgery, the lens with the cataract is removed, and a plastic or silicone lens is inserted in its place. The cataract extraction is usually done with topical or local anesthesia and IV sedation.
There are two types of cataract-removal surgery, namely, traditional or laser-assisted.
* Traditional - the ophthalmologist makes the incision by hand and uses ultrasound to break up the cloudy lens and remove the pieces. This is a safe and reliable approach and is the most common type of cataract surgery.
* Laser-assisted - often used if the patient has astigmatism or if a premium Intraocular lens (the premium lens will correct for more than just distance vision) will be used. The surface of the eye is mapped by the laser system, then the laser makes precise incisions exactly where needed. The laser can also be used to soften the old lens so it can be more easily removed.
You will need to discuss with your ophthalmologist which type of surgery will best fit your needs. Laser surgery will be more expensive and may not be covered by insurance.
Possible side effects: Cataract surgery usually is noneventful, however, rarely there can be side effects such as:
*Redness
*Swelling
*Bleeding
*Infection
*Blurry vision caused by scar tissue.
These side effects can result after laser-assisted surgery. After traditional surgery, the same side effects can happen with some additional risks added which include:
*Retinal swelling
*Retinal detachment
*Glare, dark shadows, and circles around lights at night
*Vision loss
*Lens shifting in the eye.
If you find that you are dealing with any of these side effects, it is crucial to notify your ophthalmologist right away so he/she can help mitigate any issues.
Post-Surgical Care:
After surgery, you will usually have an eye patch until you visit your doctor which is often the next day There will typically be a regimen of three types of eye drops to be used at home over four weeks. These will taper and become less frequent until they are stopped. These drops are:
*Antibiotic drops to prevent infection
*Steroid drops to prevent swelling
*Non-steroidal anti-inflammatory drops (NSAIDs) to prevent inflammation.
In conclusion, aging brings with it health challenges we would all like to avoid. Developing cataracts is one of those senior issues. Maintaining a healthy lifestyle (not smoking, limiting alcohol use, keeping blood sugar within normal range, and avoiding excessive sunlight among other factors) can help lower the risk of cataracts. Faithful eye exams are crucial to monitoring any cataract development. Cataract surgery is a very common and effective procedure, restoring vision to 20/40 or better in 95% of patients. Finally, a senior malady that has a reliable fix!
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Written by June Pomeroy RN BSN. Assessed and Endorsed by the MedReport Medical Review Board