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Clearing up Questions about Cataracts
By Devin Gattey, MD
What is a Cataract?
The crystalline lens is an organ behind the iris that’s the shape of an M&M candy or a Skittle. That little organ starts out crystal clear when we’re born, but eventually becomes cloudy and opaque. That clouding is referred to as a cataract. When you’re born, the lens looks like clear Jell-O, and for people lucky enough to reach the age of 100, the lens would look like parmesan cheese. And it’s not so easy to see through a chunk of parmesan cheese. Plus, as the lens becomes cloudy, it also changes color and becomes yellow, which affects your color perception.
Cataracts usually become more and more opaque over the years, gradually affecting the quality of vision. Sometimes cataracts seem to come on overnight, when vision changes rapidly. This is rare. If your parent or loved one complains of hazy or blurred vision, has trouble reading or seeing at night, or suddenly starts wearing odd color combinations, a cataract may be the cause.
Risk Factors
- Age – The more birthdays you have, the more likely you are to have cataracts.
- Use of corticosteroid medications, (such as prednisone) especially in eye drops or oral form
- Diabetes
- Radiation or chemotherapy
- Smoking
- Excessive sunlight exposure without sunglasses
Treatment
The only treatment for cataracts is cataract surgery. Fortunately, it’s a fairly quick and painless procedure. It’s the most common surgery performed in the world.
Surgery
Cataract surgery is a day surgery in most cases, done under topical eye drop anesthesia, often with a mild sedative. It usually takes less than 15 minutes, and the total time in the surgery center is less than three hours in most cases.
Patients need to use eye drops both before and after surgery – and that’s probably the most bothersome part of the whole process. Cataract surgery is rarely uncomfortable, and people often recover within a matter of days.
Lens Implant
During surgery, we usually implant an acrylic or silicone lens. This is called an intraocular lens (IOL) implant, and it’s meant to correct vision as much as possible. Without the IOL, a patient would have to wear extremely thick eyeglasses. In fact, that’s what people wore after cataract surgery in the 1950s and ‘60s.
Today, we have foldable lens implants that we roll up like a little taco and inject with an inserter through an incision that’s less than one-quarter inch long. It’s rather miraculous, when you think about it. This tiny incision allows for quick healing, and the lens will last the patient’s lifetime.
There are now even implants that allow people to see both far away and close up without eyeglasses. Unfortunately, these premium implants are not typically covered by insurance, so there is an out of pocket expense that can exceed $1,000 per eye. These lenses that can replace eyeglasses are only recommended for people who don’t have other conditions that affect vision, such as macular degeneration or glaucoma.
Good News
There are many reasons to be positive if your parent has a cataract. Vision loss from cataracts can usually be restored through a common and relatively painless surgery. With surgery, not only is the cloudy vision improved, but the patient’s dependence on glasses can be greatly reduced. Unfortunately, this is not the case with many other forms of vision loss.
Dr. Devin Gattey is the Director of Comprehensive Ophthalmology and the Co-Director of International Ophthalmology at the Oregon Health & Science University, Casey Eye Institute. Additionally he is the Associate Residency Program Director in charge of Surgical Education. He received his medical degree at UC Davis and completed his residency at the Casey Eye Institute, OHSU. Dr. Gattey is a former U.S. Peace Corps Volunteer who served in Nepal.
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