Signs, symptoms and options for treating cataract
Published on: Tuesday, August 01, 2023
By: Dr Sim Pek Eng
Dr Sim Pek Eng
CATARACT is the leading cause of blindness and visual impairment.
According to the World Health Organisation (WHO), an estimated 20 million people worldwide are blind secondary to cataract.
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This condition is readily treatable with a simple and affordable operation and nobody should be blinded by cataract in this modern era.
Cataract occurs because of clouding of the naturally clear lens in the eye.
A clear lens is essential to focus light or an image onto the retina. In a normal eye, light passes through a transparent lens to the retina.
Once it reaches the retina, light is changed into electrical signals that are sent to the brain to be interpreted as an image.
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The lens must be clear for the retina to receive a sharp image. If the lens is cloudy (due to cataract), the image you see will also be blurred.
Causes of cataract
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Most cataracts are age-related.
The majority of elderly people who are older than 60 years old will have some amount of cataract affecting their vision.
This may be the result of a lifetime exposure to ultraviolet radiation contained in the sunlight or may be related to other lifestyle factors such as cigarette smoking, diet and alcohol consumption.
Cataract can also occur because of eye trauma, exposure to toxic substances/ radiation or following certain diseases such as Diabetes Mellitus.
It can also be secondary to taking medication such as steroids (which is present in certain traditional medications) for a prolonged period.
A small minority of cataracts may even be present at birth due to genetic defects, developmental abnormality or exposure to diseases such as rubella during pregnancy.
These are known as congenital cataracts.
How it impacts vision
Cataract can affect your vision in two ways:
- The light entering the eye fails to be focused onto the retina because of the cloudy lens and causes one to have blurred vision.
- It gradually reduces the amount of light entering your eye leading to low contrast sensitivity.
Symptoms
When the cataract is mild, the patient may not notice any symptoms initially. However, as cataract worsens and becomes denser, the patient starts to experience the following
- Cloudy or blurry vision.
- Reduced contrast sensitivity and, hence, colours seem faded.
- Glare with headlights, lamps or sunlight.
- A halo may appear around lights.
- Poor night vision.
- Double vision or multiple images in one eye.
- Frequent changes in the refractive power of the glasses may be a sign of cataract.
Typically, these symptoms occur slowly without any eye pain and progressively worsen with time.
Cataract complication
Left untreated, cataract will worsen with time and eventually leads to blindness.
If the cataract becomes too dense it can cause acute glaucoma and can potentially leads to permanent blindness.
Should this occur, the patient may not be able to regain their vision even after a successful cataract surgery.
Therefore, cataract surgery should be performed before the cataract becomes too dense or ‘mature’.
A lot of our patients still have the wrong perception that cataract surgery can only be performed when the cataract is dense and ‘mature’ enough.
This is no longer true with the advancement of modern cataract surgery (phacomulfication)
Detecting cataract
If you have problems with your vision, you should consult your ophthalmologist.
They will be able to detect the presence and the severity of your cataract. Sometimes cataracts are diagnosed during a routine eye test, even if you have had no visual symptoms.
Approach your ophthalmologist to arrange for a comprehensive eye exam which includes:
1. Visual acuity test to measure how well you see at a certain distance
2. Dilated eye exam. Drops are placed in your eyes to widen the pupils and facilitate examination of your retina and optic nerve for signs of other related eye problems.
3. Tonometry. An instrument that measure’s they eye’s pressure.
Treating cataract
The symptoms of early cataract may be improved with glasses, brighter lighting, anti-glare sunglasses or magnifying lenses.
As the visual symptoms worsen and it starts to affect your daily activities, surgery is the only effective treatment.
Cataract surgery involves removing the diseased lens and replacing it with a suitable artificial lens.
Types of surgery
There are two types of cataract surgery: Phacoemulsification and Extracapsular surgery.
1. Phacoemulsification is the surgery of choice currently.
This is a keyhole surgery performed under local anaesthetic.
It involves inserting a tiny probe through a small incision/ wound made on the side of the cornea (the clear surface that covers the front of the eye).
The tip of this probe emits ultrasonic waves that break the diseased lens into smaller pieces which can then be sucked out from the eye.
After the diseased lens has been removed, an artificial bio-compatible clear acrylic lens, called intra-ocular lens (OCL), is implanted into the eye.
The lens sits in a little ‘pocket’ (the lens capsule) in the eye.
The intra-ocular lens is folded during implantation and once it is in position, it will unfold and become a permanent part of your eyes, taking over the optical function of the diseased lens to focus light onto the retina.
As the incision is so small, it is self-sealing, and no stitches are required during the procedure. Recovery from the surgery is fast and associated with a very good visual outcome.
2. With the Extracapsular surgery procedure, a longer incision on the side of the cornea is made to remove the cloudy core of the lens in one piece and then a non-foldable intra-ocular lens is implanted into the eye.
As the incision is generally bigger, multiple stitches are required to close the wound and the recovery is much slower.
Intra-ocular lens
Different types of intra-ocular lens, or replacement lens, are available in the market and they can be divided into the following:
- monofocal – provide clear vision at one focal point only, usually the distance vision and, therefore, the patient will need to wear glasses (usually reading glasses) after the procedure.
- multifocal lenses – provide clear vision for both near and distance vision, hence, the patient doesn’t need to wear glasses anymore after the procedure.
- toric lenses – for the patient who has astigmatism Your ophthalmologist will discuss with you to decide on the most suitable intra-ocular lens to be implanted.
Cataract surgery
Cataract surgery is usually performed as a day-care operation, which means the patient can go home on the same day of the surgery.
Local anaesthesia is administered and the patient is fully awake throughout the procedure.
For uncomplicated cases, the operation usually takes less than 30 minutes. It is usually painless and well tolerated.
After the surgery, patients might complain of a slight discomfort and tearing over the operated eye for the first one or two days.
The visual recovery is fast and the patient should be able to achieve about 95 per cent of their vision on the day following surgery.
A complete recovery is expected in four weeks’ time.
However, one will have to be in compliance to the eye drops prescribed during this period.
Cataract surgery is a relatively safe surgery with minimal risks of complication, such as infection and bleeding.
Protecting your vision
It is not possible to prevent cataract development as it is part and parcel of our aging process.
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. Adopting a healthy lifestyle with no smoking and excess alcohol consumption is also helpful.
Researchers also believe that good nutrition can help reduce the risk of age-related cataract.
They recommend eating green leafy vegetables, fruit and other foods with antioxidants.
In summary, if you are 50-years or older, you should have a comprehensive dilated eye exam at least once a year for early detection of any vision disorders.
These include cataract, age-related macular degeneration, glaucoma and other vision disorders.
Timely and appropriate treatment of cataract will improve your vision and allow you to enjoy a better quality of life.
This article was contributed by
Dr Sim Pek Eng who is a Consultant Ophthalmologist at Gleneagles
Hospital Kota Kinabalu.
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