A cataract is a clouding of the normally clear lens of your eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window.
Clouded vision caused by cataracts can make it more difficult to read, drive a car (especially at night) or see the expression on a friend’s face.
Most cataracts develop slowly and don’t disturb your eyesight early on. But with time, cataracts will eventually interfere with your vision.
At first, stronger lighting and eyeglasses can help you deal with cataracts. But if impaired vision interferes with your usual activities, you might need cataract surgery. Fortunately, cataract surgery is generally a safe, effective procedure
Signs and symptoms
Signs and symptoms of cataracts include:
- Clouded, blurred or dim vision
- Increasing difficulty with vision at night
- Sensitivity to light and glare
- Seeing “halos” around lights
- Frequent changes in eyeglass or contact lens prescription
- Fading or yellowing of colors
- Double vision in a single eye
At first, the cloudiness in your vision caused by a cataract may affect only a small part of the eye’s lens and you may be unaware of any vision loss. As the cataract grows larger, it clouds more of your lens and distorts the light passing through the lens. This may lead to signs and symptoms you’re more likely to notice.
Types of cataracts
Cataract types include:
- Cataracts that affect the center of the lens (nuclear cataracts)
- Cataracts that affect the edges of the lens (cortical cataracts)
- Cataracts that affect the back of the lens (posterior subcapsular cataracts)
- Cataracts you’re born with (congenital cataracts)
A nuclear cataract may at first cause you to become more nearsighted or even experience a temporary improvement in your reading vision. But with time, the lens gradually turns more densely yellow and further clouds your vision. As the cataract slowly progresses, the lens may even turn brown. Advanced yellowing or browning of the lens can lead to difficulty distinguishing between shades of color.
A cortical cataract begins as whitish, wedge-shaped opacities or streaks on the outer edge of the lens cortex.
As it slowly progresses, the streaks extend to the center and interfere with light passing through the center of the lens. People with cortical cataracts often experience problems with glare.
A posterior subcapsular cataract starts as a small, opaque area that usually forms near the back of the lens, right in the path of light on its way to the retina.
A posterior subcapsular cataract often interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night.
Some people are born with cataracts or develop them during childhood. Such cataracts may be the result of the mother having contracted an infection during pregnancy.
These cataracts also may be due to certain conditions, such as myotonic dystrophy, galactosemia, Lowe’s syndrome or rubella. Congenital cataracts don’t always affect vision, but if they do they’re usually removed soon after detection.
Factors that increase your risk of cataracts include:
- Increasing age
- Drinking excessive amounts of alcohol
- Excessive exposure to sunlight
- Exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy
- Family history of cataracts
- High blood pressure
- Previous eye injury or inflammation
- Previous eye surgery
- Prolonged use of corticosteroid medications
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- Do you experience vision problems in bright light?
- How severe are your symptoms?
- Do your vision problems make it difficult for you to drive?
- Do your vision problems make it difficult to read?
- Do your vision problems make it difficult to do your job?
- Have you ever had eye surgery?
- Have you ever had an eye injury?
- Have you ever been diagnosed with an eye problem, such as inflammation of your iris (iritis)?
- Have you ever received radiation therapy to your head or neck?
- What medications are you currently taking?
When to see a doctor
Make an appointment for an eye exam if you notice any changes in your vision. If you develop sudden vision changes, such as double vision or blurriness, see your doctor right away.
Most cataracts develop when aging or injury changes the tissue that makes up your eye’s lens.
Some cataracts are related to inherited genetic disorders that cause other health problems and increase your risk of cataracts. Cataracts can also be caused by other eye conditions, medical conditions such as diabetes, trauma or past eye surgery. Long-term use of steroid medications, too, can cause cataracts to develop.
How a cataract forms
The lens, where cataracts form, is positioned behind the coloured part of your eye (iris). The lens focuses light that passes into your eye, producing clear, sharp images on the retina — the light-sensitive membrane on the back inside wall of your eyeball that functions like the film of a camera.
A cataract scatters the light as it passes through the lens, preventing a sharply defined image from reaching your retina. As a result, your vision becomes blurred.
As you age, the lenses in your eyes become less flexible, less transparent and thicker. Age-related changes cause tissues within the lens to break down and clump together, clouding small areas within the lens. As the cataract continues to develop, the clouding becomes denser and involves a greater part of the lens.
Cataracts may develop in only one eye, but they usually develop in both of your eyes. However, the cataracts usually aren’t totally symmetrical, and the cataract in one eye may be more advanced than the other.
Tests, Diagnosis and Surgery
Tests and DIagnosis:
To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:
- Asking you to read an eye chart (visual acuity test)
- Using a light and magnification to examine your eye (slit-lamp examination)
- Dilating your eyes (retinal examination)
A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment.
A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification.
The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any tiny abnormalities.
To prepare for a retinal examination, your eye doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine the back of your eyes (retina).
Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a cataract
When to consider cataract surgery
Talk with your eye doctor about whether surgery is right for you. Most eye doctors suggest considering cataract surgery when your cataracts begin to affect your quality of life or interfere with your ability to perform normal daily activities, such as reading or driving at night.
It’s up to you and your doctor to decide when cataract surgery is right for you. For most people, there is no rush to remove cataracts because they usually don’t harm the eye.
Delaying the procedure won’t make it more likely that you won’t recover your vision if you later decide to have cataract surgery. Take time to consider the benefits and risks of cataract surgery with your doctor.
If you choose not to undergo cataract surgery now, your eye doctor may recommend periodic follow-up exams to see if your cataracts are progressing. How often you’ll see your eye doctor depends on your situation.
What happens during cataract surgery
Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as your natural lens, and it remains a permanent part of your eye.
For some people, other eye problems prohibit the use of an artificial lens. In these situations, once the cataract is removed, vision may be corrected with eyeglasses or contact lenses.
Cataract surgery is generally done on an outpatient basis, which means you won’t need to stay in a hospital after the surgery.
During cataract surgery, your eye doctor uses local anesthesia to numb the area around your eye, but you usually stay awake during the procedure.
Cataract surgery is generally safe, but it carries a risk of infection and bleeding. Cataract surgery increases the risk of retinal detachment.
After the procedure, you’ll have some discomfort for a few days. You generally will be healed within eight weeks.
If you need cataract surgery in both eyes, your doctor will schedule surgery to remove the cataract in the second eye a month or two after the first surgery.
Lifestyle and home remedies
To deal with symptoms of cataracts until you decide to have surgery, try to:
- Make sure your eyeglasses or contact lenses are the most accurate prescription possible
- Use a magnifying glass to read
- Improve the lighting in your home with more or brighter lamps
- When you go outside during the day, wear sunglasses or a broad-brimmed hat to reduce glare
- Limit your night driving
Self-care measures may help for a while, but as the cataract progresses, your vision may deteriorate further. When vision loss starts to interfere with your everyday activities, consider cataract surgery.
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