Cataracts

A cataract is the clouding of the normal lens in your eye. Sometimes a cataract occurs in children as a result of a congenital malformation. But, mostly, the nuclear sclerotic form of cataract occurs as we age (and maybe worsened by ultraviolet (UV) exposure and cigarette smoking). The lens in our eye gets more and more cloudy until prescription glasses are unable to compensate. Then cataract surgery is needed to remove the cloudy lens and replace it with an artificial special plastic intraocular lens (IOL). Diabetics tend to get posterior subcapsular cataracts which can also be caused by prolonged systemic or ocular steroid use.

Common signs and symptoms of cataracts include:

What Are The Treatments Available?

There is no medication that is known to slow down the worsening of or clear the clouded lens. However, controlling your diabetes, stopping smoking, and wearing UV protection or limiting sunlight exposure can slow down cataract development to some extent. Some supplements like anti-oxidants may slow progression, but a balanced diet is probably more important. .

In the early stages of the cataracts, new glasses, contact lenses, anti-glare sunglasses may help. However as the cataracts gets worse over time, surgery is the only effective treatment. Typically, the cataract has to cause a vision with the best pair of glasses to drop to 20/40* or worse before surgery is recommended. That is because the benefits of surgery have to outweigh the risks, which include a very small risk of infection inside the eye (endophthalmitis) and a very small life time risk of retinal detachment after surgery. However, glare and work requirements may sometimes justify cataract surgery even when the current vision is better than 20/40. After cataract surgery, the visual acuity can usually be restored 20/20 with a combination of distance glasses and bifocals unless the vision is limited by retina or other problems (such as macular degeneration). 

Timing and age differences of cataract surgery. While an adult or child older than 9 years of age can probably delay cataract surgery for a newly developed cataract until convenient, younger children or infants risk losing vision permanently because the cataract blocks imaged from stimulating the brain to make the neural pathways needed to see. So, even if the cataract is removed later, it may be too late. The vision may be limited by what the brain pathways allow the patient to see, even if the cataract obstruction has been cleared. 

Older patients can delay cataract surgery for sometime without without concer about brain pathways being affected. However, if the cataract lens thickens, the anterior chamber may narrow and increase the risk for certain kinds of glaucoma. Older patients with one eye severely hampered by cataract while the other eye is more normal may be at slightly increased risk for falls. Thus 

Choice of regular versus advanced intraocular lenses.  Over the past 20 years, there have been remarkable improvements in the surgical techniques of cataract surgery. It is safer and quicker now than ever. Surgery is performed the same day and usually performed under local or topical anesthesia. The intraocular lens (IOL) that is inserted into the eye as a part of cataract surgery has also been improved significantly. The basic or standard IOL that is covered by most commercial insurances and medicare/medicaid is still an excellent choice. However, astigmatism may not be corrected and glasses and bifocals may still need to be worn after surgery to fully correct the vision at distance and at near. Advanced IOLs, however, cost more and are not covered by medicare or most insurances. They can correct astigmatism and may allow a range of distance to near vision without use of glasses or bifocals. These allow a higher chance of freedom from glasses at both distance. Sometimes, however, light bounces off the lens in an unusual manner, resulting in glare or halos, which can be bothersome but usually go away with time. These options should be discussed with the cataract surgeon.