At my recent optometry appointment, I was told I have early cataracts and that cataract surgery could be indicated in 10 years.
Many of my patients have had successful cataract surgery, but until that appointment, I had hardly given my own eventual cataract surgery a thought. I decided to consult medical journal articles, talk to an eye doctor and interview several people about their experiences with cataract surgery.
The lens of the eye is composed of cells arranged in a highly ordered manner which impart transparency. Due to cell degeneration, the lens gradually becomes less clear, and the cloudy area is called a cataract.
More than half of Americans older than 65 develop them; the average age for cataract surgery is 73. While age is the major risk factor for cataracts, other factors include smoking, excessive alcohol consumption, excessive sunlight exposure, poor health habits (physical inactivity and a diet low in fruits and vegetables), diabetes, HIV, steroid use and a family history of cataracts.
What are the symptoms of cataracts?
Many people I spoke to were unaware of changes in their vision because their cataracts progressed so slowly. Others mentioned their vision was becoming cloudy or blurry, colors became faded, they had more trouble seeing at night, headlights seemed too bright or there was a halo around lights, they had trouble reading signs or they had to change their glasses prescription often.
There is no medical treatment for cataracts. The indication for surgery is when the cataract interferes with one’s job or the needs of daily living.
According to Dr. Michael Reynard, associate professor of ophthalmology at UCLA, an airplane pilot with slightly reduced vision has a much earlier indication for cataract surgery than someone with an advanced cataract whose daily life has hardly been impacted. Reynard points out that a comprehensive eye exam should be performed preoperatively to rule out coexistent pathology such as macular degeneration or glaucoma. Even if the cataract accounts for only partial loss of vision, cataract surgery may still be indicated as long as the patient understands that there will not be full recovery of visual acuity.
Most people who have cataract surgery have their existing lens removed and replaced with a synthetic intraocular lens (IOL). Usually the new lens that’s implanted has one point of focus called a “monofocal lens.” One such lens is good for distance vision (like driving or watching TV), and another is good for near vision (like reading).
People who get these monofocal lenses need to wear either glasses for distance or more commonly, need glasses for reading.
To address this problem of only one point of focus, “multifocal” lenses have been developed. In my assessment, these lenses have not been perfected quite yet; many people report vision problems such as glare and seeing halos.
My sister chose to have a different monofocal lens in each eye — one for near vision, and one for distance vision. When she drives, she inserts a contact in the eye that has been corrected for near vision.
There are also IOLs called “toric lenses” that correct for astigmatism.
Beware, other than monofocal lenses, none of the “premium lenses” are covered by Medicare or insurance companies.
There are certain medications which some people take routinely that have been associated with a serious postoperative complication called floppy iris syndrome. These medicines are alpha-1 antagonists (usually given for prostate problems) and specific antipsychotic medicines. It is important you inform your ophthalmologist if you take them.
More than 95 percent of people who undergo cataract surgery are pleased with the outcome, as long as they don’t have other underlying eye conditions. The comments I heard from people included “It was like a miracle,” “Colors are brighter and more vibrant,” “I see better now than I ever had in my life” and “There is no longer a shade or dimmer over my eyes.”
Cataracts are part of normal aging. In order to delay surgery as long as I can, I will try to eat healthy, exercise and protect my eyes from sunlight. When it’s time for me to undergo cataract surgery, I will review the different options for lens replacement and choose the type that will most likely work best for my lifestyle.