Frequently Asked Questions About Cataracts

What is a cataract and what are the symptoms?
A cataract is a cloudy or opaque area in the normally transparent lens of the eye. As the opacity thickens, it prevents light rays from passing through the lens and focusing on the retina, the light sensitive tissue lining the back of the eye. Early lens changes or opacities may not disturb vision. But as the lens continues to change, several symptoms including blurred vision; sensitivity to light and glare; increased nearsightedness; or distorted images in either eye, may develop.

The lens is located behind the iris, the colored portion of the eye, and the pupil, the dark center of the eye. Tiny ligaments, called zonules, support the lens capsule within the eye.

The lens has three parts, the capsule, the nucleus, and the cortex. The outer membrane, or capsule, surrounds the cortex which in turn surrounds the center or nucleus of the lens. If you imagine the lens as a piece of fruit, the capsule is the skin, the cortex is the fleshy fruit, and the nucleus is the pit.

Types of Cataracts
There are three types of cataracts. Each is described by its location on the lens. The most common type of cataract and the one associated with aging is called a nuclear cataract.

A nuclear cataract occurs in the center of the lens. Common symptoms include blurring or dimming of your vision, glare and visual distortion. A nuclear cataract can induce myopia, or nearsightedness, a temporary improvement in your reading vision sometimes referred to as "second sight." Unfortunately "second sight" disappears as the cataract gets worse.

The cortical cataract begins as wedge-shaped spokes in the cortex of the lens. The spokes extend from the outside of the lens to the center. When the spokes reach the center, they interfere with the transmission of light and cause glare and loss of contrast. Many people with diabetes develop this type of cataract. Although a cortical cataract usually develops slowly, it may impair both distance and near vision so significantly that surgery may be suggested at a relatively early stage.

A subcapsular cataract develops slowly and starts as a small opacity under the capsule, usually at the back of the lens. Significant visual symptoms may not appear until the cataract is well developed. Typical symptoms are glare and blur. A subcapsular cataract is often found in people with diabetes or high myopia, adults with retinitis pigmentosa, and in people taking steroids.

Photos courtesy of The Lighthouse Inc., (Lighthouse National Center for Vision and Aging)
New York, NY, 800-334-5497.

How is a cataract diagnosed?
A cataract usually cannot be seen by the naked eye. An ophthalmologist ( MD), or an optometrist (OD) can dilate the pupil and examine the lens using a special microscope to determine whether a cataract is present.

What causes cataracts and how can they be prevented?
In developed countries like the U.S., cataracts are most often related to age. Other factors that can contribute to cataract formation include heredity, chronic use of steroid drops, or previous eye surgery, injury or inflammation. There is also some evidence that the cumulative lifetime exposure to ultraviolet (UV) light may play a role in the subsequent development of cataracts. However, there is no evidence that the wearing of UV-blocking sunglasses can prevent or slow the progression of cataracts. (On the other hand, there is not evidence that UV-blocking sunglasses are harmful, either.) No glasses, medications, exercises, or dietary supplements have ever been shown to prevent or slow cataract formation.

How can a cataract be treated?
The cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for a while.

There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. When you are not able to see well enough to do the things you like to do, cataract surgery should be considered. Surgery is the only way to remove a cataract.

Cataracts cannot be removed with a laser, only through a surgical incision. In cataract surgery, the cloudy lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.

What can I expect if I decide to have surgery?
Before surgery
Once you and your eye doctor (family eye physician and/or surgeon) have decided that you will have your cataract removed Ask your ophthalmologist if you should continue your usual medications. You will have two appointments before your surgery. One will be a consultation about the options in lens implant technology and the second detailed measurements will be taken to calculate the strength of your lens implant.

The day of surgery
Surgery is done on an outpatient basis. Upon arrival for surgery, you will be given eye drops, and perhaps medications to help you relax. Eyedrops will make the operation painless. Though you may see light and movement, you will not be able to see the surgery while it is happening, and will not have to worry about keeping your eye open or closed. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your head. After a short stay in the outpatient recovery area, you will be ready to go home. You should plan to have someone else drive you home.

Following surgery
You will need to:

• Use the eye drops as prescribed;
• Be careful not to rub or press on your eye;
• Use over-the-counter pain medicine if necessary;
• Avoid very strenuous activities until the eye has healed;
• Continue normal daily activities and moderate exercise;
• Ask your doctor when you can begin driving;

How is the surgery done?
Under an operating microscope, a small incision is made into the cornea. Ultrasound is used to fragment the lens and suction removes the particles from the eye. The back membrane of the lens (called the posterior capsule) is left in place. A plastic intraocular lens implant will be placed inside the eye to replace the natural lens that was removed. The incision is self-sealing. No stitches are used.

When is the laser used?
The posterior capsule sometimes turns cloudy several months or years after the original cataract operation. If this blurs your vision, a clear opening can be made painlessly in the center of the membrane with a laser. Laser surgery is never part of the original cataract operation.
Multifocal lens implants

Will cataract surgery improve my vision?
Over 95% of cataract surgeries improve vision, but a small number of patients may have problems. Symptoms including infection, bleeding and swelling or detachment of the retina are some of the more serious complications that may affect your vision. Call your ophthalmologist immediately if you have any of the following symptoms after surgery:

• Pain not relieved by non-prescription pain medication;
• Loss of vision;
• Nausea, vomiting or excessive coughing;
• Injury to the eye.

Pre-existing conditions
Even if the surgery itself is successful, the eye may still not see as well as you would like. Other problems with the eye, such as macular degeneration, glaucoma and diabetic damage may limit vision after surgery. Even with such problems, cataract surgery may still be worthwhile.

If the eye is healthy, the chances are excellent that you will have good vision following removal of your cataract.

What is the success rate of cataract surgery?
Assuming that there are no other problems that may limit vision, the chance of improved vision after cataract surgery is 99%.

What is the complication rate?
Dr. Bolings complication rate when performing cataract surgery is less than 0.1%.

Are there any restrictions on daily activities?
You may resume "light" activities immediately. You may read, watch television, sleep, walk and eat without restriction. After the first day you can resume "moderate" activity with the exception of strenuous/aerobic exercise. After six weeks you can return to your most active lifestyle.

When can I return to work?
Depending on the type or work, if it is primarily a desk job, you can resume work the next day after surgery. More strenuous types of work can be resumed within a few weeks.