An Introduction to Cataracts

Abstract Cataracts will affect almost everyone’s vision at some point in their life. Some people may be able to deal with the cataracts with glasses while others must have cataract surgery in order to improve their vision. The paper explains what a cataract is, who it affects, the development of cataract surgery leading to modern day surgical techniques, as well as the possible complications and benefits after cataract surgery. There was once a time that cataracts caused people to become what they considered blind, but now with modern technology and modern medicine people have the ability to proceed with their life with just minor adjustments to their daily activities. An Introduction to Cataracts and Cataract Surgery Everyone has different vision, and everyone has different points in their life where they may notice their vision changing. One major medical condition that can affect a person’s vision is a cataract. It is important to understand what a cataract is and who it commonly impacts, the development of cataract surgery leading to the modern surgical technique, and the possible complications and benefits of having cataract surgery. What is a Cataract and Who is Commonly Impacted? A cataract, simply put, is the cloudiness of the clear natural lens in the eye (Buettner, p. 101). People who have cataracts have trouble seeing sharp figures, often times the objects they see are fuzzy or dim. The cataracts do not form suddenly but progress and get more advanced with time. The natural proteins of the lens begin to deteriorate between the age of 40 and 45 (Newmark, 38). People with cataracts often have trouble driving, difficulty reading, and even trouble seeing expressions on other’s faces. Cataracts can also cause extreme trouble with sensitivity to sunlight and headlights or streetlights (p. 101). Cataracts occur with the normal aging sclerosis, as the lens becomes less resilient, less transparent, and thicker (Gordon, p. 50). In The Eye Book cataracts are compared to wrinkles and gray hair, eventually it is something everyone will get. It just isn’t acknowledged until someone has a lot of the above mentioned gray hair and wrinkles (Cassel, p. 128). Most Americans by the age of 65 have some type of cataracts or clouding of the lens. According to the National Eye Institute, cataracts occur in roughly half of Americans aged 65 and over (Gordon, p. 49). Certain factors can also increase the risk for developing cataracts. The factors include: advanced age, diabetes, a family history of cataracts, extensive exposure to sunlight, smoking, obesity, high blood pressure, previous eye injury or inflammation or swelling to the eye (American Academy of Ophthalmology, p. 1). Cataracts are also found to be more present in women than in men, more common in African Americans than in Caucasians, and more common in developing countries along the tropical belt than in the United States and Europe (Cassel, p. 132). A recent study also showed that poor nutrition also increased the percentage of cataract formation (Guttman, p. 1). The formation of cataracts can also be advanced by the use of corticosteroid use and excessive alcohol consumption (Buettner, p. 106). It is also worth mentioning that occasionally children can be born with cataracts or develop them at a very young age, this is called a Congenital cataract. This can be caused by the mother having German measles during pregnancy, due to a chemical imbalance, or a developmental imbalance. These cataracts are removed quickly if they are determined to be affecting the child’s vision (p. 106). If a person truly feels that they do not see to their full potential then it is in their best interest to consult with their ophthalmologist and have their vision evaluated to see if surgery would be beneficial. What is the Process of Cataract Surgery? Once the patient decides they are ready to pursue cataract surgery a few steps need to be taken. The patient will need to be seen by an ophthalmologist. The patient will have a dilated eye exam with the doctor along with testing prior to surgery. The testing performed is done to determine what power of Intraocular lens, or IOL, should be placed in the eye to give the patient to best vision possible. The testing is often called an A-scan or an IOL Master. The patient may also have a Corneal Topography done if they have an astigmatism. An astigmatism is an irregular shaping of the cornea and the corneal topography is just a picture or mapping of the cornea. The doctor also uses this test when determining which power of lens will be implanted at the time of surgery. Of course before any surgery can take place the patient must also complete the necessary paperwork. Cataract surgery used to be a major surgery, an inpatient procedure with general anesthesia and about a week stay in the local hospital (Gordon, p. 59). The procedure itself was much harder on patient. The physician made an incision about a half-inch long, through which they removed the cataract and replaced it with a thick glass lens and then later an artificial lens (p. 9). Today the procedure is done on an outpatient basis under local anesthesia in about thirty minutes. In fact, each year over 1. 5 million cataract surgeries are performed in the United States (p. 49). There two different ways a cataract can be removed, either by extracapsular surgery or phacoemulsification (Kanski, p. 346). Extracapsular surgery became common in the 1980s when IOLs became more widely used (p . 346). The capsular bag is opened approximately 10 mm and the lens material is removed in one piece. This technique is beneficial for dense and firm cataracts that would be difficult to break up by phacoemulsification, which will be discussed later (Cassel, p. 150). Once the artificial lens is implanted the incision is stitched. The stitches rarely have to be removed, and usually disintegrate over time (Gordon, p. 60). Because the size of the incision on the eye is rather large, healing does take a few weeks (p. 60). This type of cataract surgery can also induce significant post-operative astigmatism resulting from the large incision and the need for stitches (Kanski, p. 346). Phacoemulsification is the newest and most common method of cataract extraction (Gordon, p. 60). The doctor makes a tiny incision, about 3mm long and uses a tool, called a phaco handpiece, that breaks up the solid cataract into tiny pieces using ultrasound. Then a vacuum is used to essentially suck out the tiny fragments of the cataract from the capsule. (Buettner, p. 111). No stitches are needed to close the incision because the incision is so small that the natural pressure within the eye holds the incision tightly closed, and allows the wound to heal quickly (Gordon, pp. 60-61). Another major difference is how the artificial lens is implanted. The lens is actually folded before it is inserted into the capsule and once placed into the capsule it is unfolded. This is done because the incision is so small the unfolded lens wouldn’t be able to fit through the opening (p. 61). The smaller incision makes the procedure safer and provides an earlier refraction postoperatively (Kanski, pp. 346-347). There is also less risk for iris prolapse (p. 347). Phacoemulsification offers good long-term results and in 97-98 percent of all cases there are no complications, when done by a well experienced surgeon (Gordon, p. 1). Following surgery a protective shield is placed over the eye and the patient is sent home with instructions to use postoperative drops to prevent infection and inflammation (p. 67). The patient will follow up with their doctor the day after surgery and then during the following 6 weeks to check the eyes healing (Buettner, p. 112). Former restriction s were placed on patients that kept them from bending and lifting are becoming things of the past. Patients can resume normal activities almost immediately following surgery, of course any activites should be cleared by the patients physician (Cassel, p. 52). Patients will need to wear dark sunglasses following surgery when they are outdoors in order to reduce the effects of glare (Gordon, p. 67). What are the Complications and Benefits of Surgery? As with any type of surgery there is always risk involved when you have an operative procedure done. Although cataract surgery is one of the lower risk surgeries performed in the United States, there are some complications that should be discussed. Some complications can happen during the surgery and some can happen after the surgery during the healing process. While the physician is extracting the cataract the posterior capsule can rupture (Kanski, p. 349). If this happens the patient can be left with long term complications including vitreous loss, an up-drawn pupil, uveitis, vitreous touch, vitreous wick syndrome, endophthalmitis, glaucoma, posterior dislocation of the IOL, retinal detachment, and chronic cystoid macular edema (p. 349). Another serious risk is dislocation of the IOL after surgery, the IOL can become dislodged into the vitreous cavity and is a result of improper implantation (p. 53). If left untreated it can lead to vitreous hemorrhage, retinal detachment, uveitis, and chronic cystoid macular edema (p. 353). A suprachoroidal hemorrhage is a bleed into the suprachorooidal space which could result in the extrusion of intraocular contents, it is an unlikely complication with the phacoemulsification technique (p. 353). Unfortunately, dislocated IOLs are becoming more frequent with the changing IOL designs and it is necessary that those dislocated lens be addressed immediately for the patient’s benefit (Rajecki, p. 1). Endophthalmitis is a rare but serious infection, symptoms include vision loss, pain not relieved by OTC pain medications, a significant increase in eye redness, flashes of light or floaters, nausea or vomiting (Buettner, p. 113). Of course the benefits of surgery are very clear. The patients can walk away with improved vision and also the possibility of not having to wear glasses. Technology continues to improve and there are multiple lenses for patients to choose from. These lenses offer deluxe options such as correction for astigmatism and multiple focal points. This allows people who have never been able to function without their glasses on to have cataract surgery to live their lives without glasses, and in a true sense live a whole new life! The patients that have successful cataract surgery do not regret the choice they made; in fact they likely wonder why they waited so long to make the choice to proceed with surgery. They often times say they didn’t realize the house was so dirty or they had so many wrinkles until they got home from the cataract surgery. It is clear that cataracts and cataract surgery is a very complicated and detailed subject. It should be very important to the patient that they make a wise decision when it comes to their eyes and the care they receive. Patients will continue to see ophthalmology care grow and change all the time and it will continue to get better. It is encouraging to see that through time things have only gotten better and more advanced for patient care. References American Academy of Ophthalmology. (2011). Who Is at Risk for Cataracts? Billig, O. D. , Michael, Cassel, M. D. , Gary, Randall, M. D. , Harry. (1998). The Eye Book: A Complete Guide to Eye Disorders and Health. Baltimore, MD: Johns Hopkins Press. Buettner, M. D. Helmut. (2002). Mayo Clinic on Vision and Eye Health. Rochester, MN:Kensington Publishing. Gordon, Sandra. (2001). The Aging Eye. New York, NY: Simon & Schuster. Guttman, Cheryl. (2009, October 1). Analyses Examine Association Between Risk Factors,Cataracts. Ophthalmology Times. Kanski, Jack J. (2007). Clinical Ophthalmology: A Systemic Approach. Philadelphia, PA:Butt erworth, Heinemann, Elsevier. Newmark, M. D. , Emanuel. (2006). Ophthalmic Medical Assisting. San Francisco, CA: Essilor Rajecki, Ron. (2008, October 15). Advances in Cataract Surgery Bring New ComplicationsAlong with Benefits. Ophthalmology Times.