Cataract

Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make vision blurred or misty. They can develop in one or both eyes, and one eye can often be more affected than the other.

Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make vision blurred or misty. They can develop in one or both eyes, and one eye can often be more affected than the other.
The Lens

The lens is normally clear and allows light to pass through to the back of the eye. However, if parts of the lens become cloudy (opaque), light is unable to pass through these cloudy patches. Over time, these can become bigger, and more of them develop. As less light is able to pass through the lens, the person’s vision is likely to become blurred or cloudy. The cloudier the lens becomes, the more the person’s sight will be affected.

How common are cataracts?

Cataracts are the main cause of impaired vision in the world, particularly in developing countries. They affect men and women equally. Cataracts most commonly affect older people and are known as age-related cataracts. In the UK, it is estimated that more than half of people who are over 65 years of age have some cataract development in one or both eyes. In rare cases, babies can be born with cataracts (congenital cataracts), or children can develop them at a young age.

Outlook

If cataracts are mild, a change in spectacle prescription and brighter reading lights may be all that is required to enable people to live with the condition. Once cataracts start interfering with daily activities such as driving or watching the TV, surgery is usually recommended. It is estimated that around 10 million cataract operations are performed world wide each year. Cataract operations are generally very successful with few complications. If you have cataracts, it may affect your ability to drive. It is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. The Directgov website has advice about how to tell the DVLA about a medical condition.

 

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Cataract symptoms usually develop over a period of many years, and most commonly affect older people.

Over time, the lens gradually becomes cloudy. If your cataracts are mild, you may not notice any symptoms to start with.

If you have cataracts in both eyes, one eye may be more affected than the other. Your vision may:
  • be blurred
  • be cloudy or misty
  • have small spots or dots on it (patches where your sight is not as clear)

Your sight may be affected by the light. For example, you may find it more difficult to see:
  • if the light is dim
  • when the light is bright, such as on a very sunny day, or in bright artificial light

Other ways that cataracts may affect your sight can include:
  • the glare from bright lights may be dazzling or uncomfortable to look at
  • colours may look faded or less clear
  • everything may have a yellowish tinge
  • reading, watching television and other daily activities may be more difficult than they used to be
  • you may have double vision (seeing two images of an object instead of one)
  • you may see a halo (a circle of light) around bright lights, such as car headlights or street lights
  • if you wear glasses, you may find that they have become less effective

The symptoms of cataracts can be similar to those of other eye conditions. It is, therefore, important to arrange a sight examination with us even if you are not yet due.
Although the causes of age-related cataracts are unknown, research suggests that some factors may increase the risk of cataracts developing.

Changes to the lens in the eye
As people grow older, protein changes can occur in the lens. Some experts think that this may be linked to how fluids and nutrients reach the eye and that the changes in the lens protein can cause cloudy areas to develop.

Risk factors
Research suggests that some factors may increase your risk of developing age-related cataracts. These include:
  • a history of cataracts in your family
  • smoking
  • lifestyle factors, such as poor diet
  • overexposing your eyes to sunlight
  • taking steroid medicines (medicines that contain powerful chemicals called hormones) for a long time

Other causes
In younger people, cataracts may have other less common causes. For example:
  • diabetes (a long-term condition caused by too much glucose in the blood)
  • injuries to the eye
  • other eye conditions, such as uveitis (inflammation of the uveal tract in the eye)
Cataracts are treated by having surgery to remove the cloudy lens in your eye. In most cases, the natural lens is replaced with an artificial, clear plastic lens. This is called an intraocular implant or intraocular lens (IOL).

Most cataract operations in the UK are carried out under local anaesthetic, as keyhole surgery, where a very small incision is made. You will probably be admitted as a day patient, which means that you will not need to stay in hospital overnight.

The most common cataract operation is called phacoemulsification, and is sometimes referred to as phaco extracapsular extraction. Cataracts cannot be treated with laser surgery.

Before the operation
Before having cataract surgery, you will be referred to an ophthalmologist or an ophthalmic surgeon. They will assess your eyes and your general health. This is called a pre-operative assessment.

During the assessment, your eyes will be measured. The artificial lens that will replace your natural lens can then be prepared. An appointment will probably be made for your operation to take place during a separate visit.

Just before the operation, drops to dilate your pupil will be put into your eye. You will also be given a local anaesthetic that will prevent you feeling any pain during the procedure. This may be applied to your eye as drops, although sometimes an injection in the tissue around the eye may be used.

Once the anaesthetic takes effect, you will not be able to feel anything. While the operation is taking place, all you will be able to see is a bright light. You will not be able to see what is happening.

The operation
During the operation, your ophthalmologist will make a very small incision in the cornea. A tiny probe will be inserted through this cut. The probe breaks up the cloudy lens into tiny pieces using ultrasound (high frequency sound waves). The tiny pieces will then be sucked out of your eye.

Once this is done an artificial, clear plastic lens will be inserted through the incision. The lens sits in a little ‘pocket’ called the lens capsule to keep it in place. The lens is folded when it is inserted, and once it is in position it is allowed to unfold.

The operation usually takes 15 to 30 minutes, although sometimes it can take slightly longer.

After your operation
The vision of most people who have cataract surgery improves almost immediately. However, it may take a little time to settle down completely. The incision in the eye’s surface is so small that it usually heals by itself, although sometimes a small stitch may be needed.

You will probably be advised to take it easy, for example, by:
  • avoiding sports and any vigorous activities
  • not rubbing your eye
  • not getting soapy water in your eye, for example, while taking a shower
  • wearing a pad over your eye to protect it
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