What is a Cataract?

If the human eye is compared to a camera, then a cataract can be considered as a cloudy lens in the camera, resulting in blurry images.

Normally, the crystalline lens is clear and transparent, allowing light to filter through to be perceived by the retina, which then sends the light signal through the optic nerve to the brain to be processed. A cataract, i.e. a cloudy lens, loses its transparency over time, and as a result, light rays are unable to pass through freely and the vision becomes foggy and blurry. Here is an excellent animation explaining cataract formation. 

What causes a Cataract?

Aging

I often tell my patients, "like wrinkles and aging spots, if we live long enough, we are all going to develop cataracts at some point of our lives." Over time, the proteins that make up the crystalline lens start to clump together and the lens eventually loses transparency. By the age of 80, more than half of the population will either have a cataract or already had cataract surgery. Although cataract is largely an age related issue. I am starting to see more and more young patients developing early cataracts in their 50's and even 40's. Below are a list of factors that contribute to early cataract formation.

Tobacco Smoking 

We all know smoking is bad for you. Examples include cancer, heart attack, stroke, and COPD, just to name a few. Adding one more to the list is BLINDNESS. It's a well known fact that smokers are 500% more likely to develop Age Related Macular Degeneration. Smoking also triples the rate of cataract formation. That's all the more reason to start quitting smoking. 

Diabetes

Many medical diseases increase the rate of development of cataracts. Among them, Diabetes Mellitus (DM) is probably the most common cause. DM is associated with 5-fold higher prevalence of cataracts. High blood sugar level causes the lens to swell up and loses its ability to focus light and image. However, as with most complications of diabetes, maintaining good control of your blood sugar levels will help reduce your risk. 

UV Rays (including welding flashes)

The damaging effects of UV rays are well known. You can't see these invisible rays, but they certainly can damage the lens causing cataracts. Proper sunglasses are the key to protect your eyes especially if you spend long hours under the sun. Look for UV 400 on the labels for complete coverage of the UV rays. I like the old transition lenses poster, "these are your eyes without UV protection, any questions?"

Medication

Although cataract is largely an age related issue. More and more young patients are developing early cataracts in their 40's even 50's especially if they are on long term use of oral steroids. Crohn's disease, lupus, arthritis are just a few examples of systemic conditions that may require long term steroid treatment. If you are someone who is on oral steroids, be sure to see your optometrist regularly for cataract assessment. 

Trauma 

Trauma to the head and the eyes disrupts the protein in crystalline lens and will result in opacification of the clear lens thus leading to early cataracts. Patients who had prior accidents that resulted a blow to the head and eye area such as a bad fall, a motor vehicle accidents, and accident at work, are all at risk for developing traumatic cataracts. Also, patients who participate in high impact sports like football, wrestling, boxing...etc, are strongly recommended check their eyes regularly as well.

Treatment 

When the cataract is mature enough, cataract surgery can be performed to remove the cloudy lens. A standard cataract surgery usually takes 10-15 minutes. No hospital stay is needed, which means cataract surgery is done in an out-patient basis! There has been amazing technological advancement when it comes to cataract surgery in the last decade. It's a lot safer, a lot more precise, and with the newest surgical methods, patients will no longer need to depend on glasses!

When the cataract is removed, an artificial lens implant inserted to replace the natural crystalline lens. OHIP covers for the standard cataract surgery with the standard basic lens implant. However, the being said, there are numerous premium lens implant choices available. There are lenses that block UV rays to protect the retina; there are aspheric lenses which is optically more superior and gives you sharper vision; there are lenses that correct for astigmatism. Finally, multifocal lens implants allow patients to see both far and close up distances, essential eliminating the need for glasses after cataract surgery!

The newest advancement in cataract surgery is a procedure called Laser Refractive Cataract Surgery. It's a whole new level of precision and reproducibility in cataract surgery. It creates a clean incision and breaks up the lens fragment with laser, allowing the surgeons to remove the cataracts with utmost accuracy! It does come with a hefty price tag, but it certainly is an option worth contemplating. 

After Cataract Surgery

You will need eye drop medication to help the healing of the wounds, antibiotics to prevent eye infection, and anti-inflammatory to reduce the inflammation. After you are finished with all your eye drops, your surgeons will let you know when it's time to return to your Optometrist for regular follow-up. The prescription after the cataract surgery will be very different from what you have before the surgery, and Optometrist can give you a new and updated prescription. Most likely it will just be a simple reading prescription as the cataract surgery aims to eliminate your distance prescription. 

It is important to continue your annual eye exam with your Optometrist. We will continue to monitor if there is any changes to your eye health such as development of glaucoma and ARMD. Furthermore, secondary cataract can arise years after cataract removal, and it will require laser treatment to clean the film off the lens implant. So come in and have your regular eye examination and help fight low vision.

By: Rachel Lin, Vision & Eye Care Expert at AgeComfort.org Health Care Resource Centre