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Cataract Surgery — A Common Procedure as We Age

Cataracts are a very common problem in healthy aging. After age 40, proteins in the lens of the eye begin to break down, and this causes the normally clear lens to gradually cloud. Although cataracts are classified as an eye disease, they are part of the normal aging process. The lens of the eye is similar to the lens on a camera. If a camera's lens is not clear, the picture will appear fuzzy or distorted, and the same thing happens with eyes that have cataracts. Vision becomes blurred or sometimes doubled. Cataracts can cause light sensitivity, frequent changes in eyewear prescriptions, and faded colors. Symptoms include difficulty with reading, driving at night, watching television, and making out recognizable features of other people.

While the main cause of cataracts is age, other factors can contribute, including hereditary enzymatic diseases, trauma to the eye, eye infections, excessive exposure to ultraviolet light, diabetes, and smoking. Also, some medicines, steroids, and long-term-use statins can cause a predisposition to cataracts. The only proven prevention of cataracts is wearing anti-UV light coated sunglasses when outside in the sun.

The risk of cataracts increases with each decade of life starting around age 40. According to statistics from the National Institutes of Health, by age 75, half of white Americans have cataracts. By age 80, 70 percent of whites have cataract compared with 53 percent of African Americans and 61 percent of Hispanic Americans. Cataracts are more likely to occur among women. In 2010, 61 percent of Americans with cataracts were women. The number of Americans in 2010 with cataracts was 24 million and expected to be 30 million by 2020 as the population ages.

Treatment — Surgery

The only treatment for cataracts is surgery. However, surgery is not indicated in every person who has a cataract. Cataracts are generally detected at routine annual visits to your physician and are often reported as a finding without any recommendation for treatment.

The indications for surgery are best described as visual interference with daily living. For example, if reading becomes too difficult or night driving seems impossible, then it is time for correction of the cataracts with surgery.

Cataract surgery involves the removal of the diseased (opacified) lens and the insertion of a new, artificial lens that works like the natural lens by bending light to focus on the retina. The artificial or manufactured lens is called an “intraocular lens" or IOL. The most commonly implanted lens is a monofocal lens, which improves distance vision. You will still need glasses if you used them before surgery. Accommodative lenses can change shape and allow focus at different distances, like the natural lens, but these are more expensive and often not covered by insurance.

There are three types of approaches that the ophthalmologist can use in the operation: phacoemulsificationextracapsular, and intracapsular. The most common is phacoemulsification. This involves a tiny incision by laser or small scalpel and the use of an ultrasound instrument that breaks up (emulsifies) the diseased lens and removes the remnants. The extracapsular approach, performed for large, advanced cataracts, uses a larger incision that allows the removal of the entire lens in one piece. The intracapsular technique is rarely used and is a more extensive surgery requiring removing the entire lens capsule in one piece. All three approaches require the artificial lens to be inserted where the old lens was.

What to Expect

When you and your ophthalmologist agree that surgery is indicated, a number of things must be done. First, the lens must be decided upon. This may mean measurements, and you may need to stop wearing contact lenses for a couple of weeks until the measurements can be confidently made. A physical exam and meeting with an anesthesiologist are generally done prior to the day of surgery.

On the day of surgery, patients are often asked not to drink or eat anything for six hours before the procedure. The surgery is usually performed in an outpatient eye clinic, ambulatory surgery facility, or hospital. An anesthesiologist or anesthesia team member will interview you before preparing you for monitoring and sedation if needed. The ophthalmologist will either use topical (eye drops) or nerve blocks for local anesthesia.

The procedure usually is performed within 30 minutes and while you are awake. There should be no pain, but you are aware of pressure and that something is being done to your eye. After the surgery is completed, you go to the recovery area and are observed for 30 to 60 minutes until the medication wears off. You should be accompanied home by an adult who can drive and see that you arrive safely. The next several days should be spent taking it easy and not driving or exercising. An eyepatch may be prescribed for several days and certainly will be for sleep to protect the eye.

You will be prescribed some eye drops to take post-operatively for several days. Do not rub your eyes or get soap in them. Within a few days, vision should be improved and a post-operative visit after a week is often recommended. If vision is impaired in the days immediately following surgery, call your ophthalmologist for a consultation.

Complications

There are risks to all surgery and cataract surgery is no exception. However, the complication rate is very low (less than 5 percent) and usually not serious. Some early complications are eye infection, bleeding, swelling around the eye, detached retina, damage to other parts of the eye, pain, drooping eyelid, IOL dislocation, and vision loss. A late complication, capsular opacification, may occur weeks, months, or years after the surgery and produces cloudy or blurry vision similar to the original cataract problem. This can be treated with a laser procedure that generally restores clear vision. Risks of complication are greater for people with general medical diseases or eye diseases. Only rarely does the surgery not improve vision. 

The Bottom Line

Cataracts are a normal result of getting older. They generally do not require any treatment until they interfere with vision so that your normal living activities become limited. The only treatment is surgery that involves replacing the diseased lens with an artificial one. Surgery is usually short, uncomplicated, and most importantly restorative for your vision.