What is cataracts?

Our eye lens has the ability to accommodate (adjust) to what we are seeing, allowing you to see near and distant objects. It also serves as a natural protection against UV rays. With cataracts, the lens of the eye becomes cloudy. 

"In cataracts, vision is impaired due to the clouding of the lens, where the patient has blurred vision, as if looking through fogged glass. There are changes in the proteins that make up the lens, where the tissue of the normally transparent lens become opaque (cloudy). Over time, the problem becomes more intense and in the worst cases can lead to complete blindness," explains doctor Vadim Fridman, MD, MBA, FEBO, head of Ophthalmology at Canadian Medical.

However, the surgical treatment nowadays is so advanced, that it can stop the progress of the disease far in advance of the risk of blindness. A large cataract is visible on the eye as a whitening or graying of the pupil space. Some patients then suffer from secondary cataracts (or sometimes referred to as after-cataracts), which can occur after cataracts surgery and cause a clouding of the lens case. In general, cataracts can be divided into the following sub-types: 

• Subcapsular cataract - usually occurs on the posterior surface of the lens. Patients with diabetes and those taking higher doses of corticosteroids are most at risk.
• Nuclear cataract - occurs in the central zone of the lens. It is associated with aging and can significantly affect the need for prescription glasses.
• Cortical cataract - occurs in the cortex of the lens (around the central nucleus). Here, white, wedge-shaped vitreous opacities are typical, starting at the periphery of the lens and progressing to the centre of the lens

Causes of cataracts

Cataracts is mainly an age-related disease - it is a natural process of ageing of the human eye and lens (senile cataract). It most often starts to appear around the age of 65 and over, but it can also appear later. Surveys indicate that cataracts affect over 75% of the population over the age of 70.

However, the actual cause of cataracts is not yet fully understood. Although senile cataracts are the most commonly diagnosed, the following factors, in addition to age, may also contribute to the development of the disease:

• hereditary predispositions,
• gender - cataracts is more common in women,
• race - higher incidence in African Americans,
• systemic and metabolic diseases (e.g. diabetes),
• other eye diseases (inflammation of the eye or iris, eye tumor, glaucoma...),
• trauma or major injuries to the eye (traumatic cataracts),
• use of certain medications (corticosteroids, cytostatics, etc.),
• long-term use of certain eye drops,
• severe dioptric defects or intraocular surgery - can accelerate the development of the disease,
• poor dietary habits
• smoking and drug use,
• overexposure to infrared and ultraviolet radiation,
• levels of air pollution,
• radiation exposure.

Some patients are born with cataracts - called congenital cataracts, also referred to as childhood cataracts. In such cases, genes play a particularly important role. If cataracts develops in a newborn, it could be due to an infection the mother contracted while she was pregnant.

Symptoms of cataracts

How do cataracts manifest? Initially, it may not affect vision in any way, but the cloudiness gradually increases and vision deteriorates. As already mentioned, there is a clouding of the normally clear lens of the eye, which prevents the passage of light rays to the retina and reduces its transparency.

The patient does not suffer from eye irritation, pain or other problems. However, they often start to notice unpleasant changes, including:

• blurred vision,
• higher sensitivity to light,
• different color perception,
• double vision,
• increasing myopia,
• increasing astigmatism,
• increasingly limited field of vision,
• complete blindness if left untreated.

Cataracts is more likely to affect both eyes. The clouding of the lens gradually intensifies, and only when the cataract is extensive is it visible on the outside of the eye. The speed of development of the disease is highly individual - it takes months or years and can lead to complete blindness. However, cataracts is usually surgically removed in time. The appropriate timing of the operation is determined by the patient's specific difficulties, the extent of impaired vision or the findings on examination.

Treatment of cataracts

If a patient starts to notice any of the symptoms mentioned, it is necessary to see an ophthalmologist as soon as possible. He or she will examine the family history and the patient's specific visual complications. This is followed by an eye examination to confirm or refute the diagnosis.

"The doctor will measure the visual acuity and refraction of the eye. The examination will then focus on the vitreous and the front of the eye, but the focus will be on the lens, the background of the eye and the peripheral retina. Instruments such as a slit lamp or ophthalmoscope are used in the examination. At Canadian Medical, we also examine clients with an OCT (optical coherence tomography) machine. The pupillary reflex, eye movements, intraocular pressure and usually the patient's field of vision are also examined," describes Dr. Friedman.

Cataract surgery

Cataracts cannot be treated “non-invasively” using medication or glasses. However, in some patients, the deterioration of vision can be slowed down, at least temporarily, with glasses or contact lenses. Therefore, the only treatment option is surgery, in which the clouded lens is removed and replaced with an artificial one.

The artificial intraocular lens stays in the eye permanently. It perfectly compensates for the dioptric power of the original lens, so that by choosing the right type of artificial lens, myopia and hyperopia can be eliminated. The patient can also choose a multifocal lens, which improves vision at all distances. The operation is always indicated by an ophthalmologist, is performed on an outpatient basis, and is gentle and painless.

Types of surgical procedures include phacoemulsification by ultrasound or cataract removal by femtosecond laser. And the price? Cataract surgery, including the basic intraocular lens, is fully covered by all health insurance companies.

The primary reason for the surgery is a decrease in visual acuity. However, the indication is very individual and the needs and wishes of the patient must always be taken into account. Early surgery is suitable for patients who also suffer from glaucoma.

Cataract surgery and recovery

Since the procedure is performed in an outpatient setting under local anaesthesia, the patient should be able to go home immediately after the cataract surgery, of course with a chaperone. Subsequent recovery of vision is quite rapid - complete stabilisation of vision occurs within 2 to 4 weeks.

In the first few days after surgery, the patient may experience a slight burning sensation or watery eyes. However, if the pain is severe and the eyes are red, if there is light blindness or sudden deterioration of vision, an immediate visit to the doctor is required. Cataract drops or artificial tears are then used to prevent any inflammatory responses.

As part of the post-operative regimen, it is advisable to limit activities that can be strenuous to the eyes. Wear sunglasses, avoid going to the sauna or swimming pool, avoid dusty environments and protect the eyes from damage. Also, intraocular pressure should be monitored, e.g. deep bending, sleeping on the stomach, lifting heavy objects, and rubbing the eye or applying make-up are not recommended.

Post-operative complications

The risk of postoperative complications is relatively low. Inflammation or bleeding may occur in the early postoperative period, and there is also a risk of a change in intraocular pressure. Later on, retinal detachment, clouding of the posterior lens capsule or a change in the position of the new lens may occur.

What can I do to prevent cataracts

The real possibility of prevention is questionable, and the early onset of cataracts cannot be completely prevented. However, studies show that it can be at least partially delayed by protecting the eyes from UV radiation and following a balanced diet rich in antioxidants. Your diet should include vitamins A, C and E, carotenoids and foods containing omega-3 fatty acids.

MUDr. Vadim Fridman MBA, FEBO, Chief physician of Ophthalmology