A cataract is a cloudiness or opacity in the normally transparent crystalline lens of the eye. This cloudiness can cause a decrease in vision and may lead to eventual blindness.
The human eye has several parts. The outer layer of the eyeball consists of a transparent dome-shaped cornea and an opaque, white sclera. The cornea and sclera help protect the eye. The next layer includes the iris, pupil, and ciliary body. The iris is the colored part of the eye and the pupil is the small dark round hole in the middle of the iris. The pupil and iris allow light into the eye. The ciliary body contains muscles that help in the eye's focusing ability. The lens lies behind the pupil and iris. It is covered by a cellophane-like capsule. The lens is normally transparent, elliptical in shape, and somewhat elastic. This elasticity allows the lens to focus on both near and far objects. The lens is attached to the ciliary body by fibers (zonules of Zinn). Muscles in the ciliary body act on the zonules, which then change the shape of the lens. This process is called accommodation—the lens focuses images to help make vision clear. As people age, the lens hardens and changes shape less easily. As a result, the accommodation process becomes more difficult, making it harder to see things up close. This generally occurs around the age of 40 and continues until about age 65. The condition is called presbyopia
. It is a normal condition of aging
, generally resulting in the need for reading glasses.
The lens is made up of approximately 35% protein and 65% water. As people age, degenerative changes in the lens's proteins occur. Changes in the proteins, water content, enzymes, and other chemicals are some of the reasons for the formation of a cataract.
The major areas of the lens are the nucleus, the cortex, and the capsule. The nucleus is in the center of the lens, the cortex surrounds the nucleus, and the capsule is the outer layer. Opacities can occur in any area of the lens. Cataracts, then, can be classified according to location (nuclear, cortical, or posterior subcapular cataracts). The density and location of the cataract determine the amount of vision affected. If the cataract forms in the area of the lens directly behind the pupil, vision may be significantly impaired. A cataract that occurs on the outer edges or side of the lens will create less of a visual problem.
Cataracts in the elderly are so common that they are thought to be a normal part of the aging process. Between the ages of 52 and 64, there is a 50% chance of having a cataract, while at least 70% of those 70 and older are affected. In 2004, it was revealed that blacks are twice as likely to develop cataracts as whites. Cataracts associated with aging (senile or age-related cataracts) most often occur in both eyes, with each cataract progressing at a different rate. Initially, cataracts may not affect vision. If the cataract remains small or at the periphery of the lens, the visual changes may be minor.
Cataracts that occur in people other than the elderly are much less common. Congenital cataracts occur very rarely in newborns. Genetic defects or an infection or disease in the mother during pregnancy
are among the causes of congenital cataracts. Traumatic cataracts may develop after a foreign body or trauma injures the lens or eye. Systemic illnesses, such as diabetes, may result in cataracts. Cataracts can also occur secondary to other eye diseases—for example, an inflammation of the inner layer of the eye (uveitis
) or glaucoma
. Such cataracts are called complicated cataracts. Toxic cataracts result from chemical toxicity, such as steroid use. Cataracts can also result from exposure to the sun's ultraviolet (UV) rays.
Causes and symptoms
Recent studies have been conducted to try to determine whether diet or the use of vitamins
might have an effect on the formation of cataracts in older people. The results have been mixed, with some studies finding a connection and other studies finding none. Much interest has been focused on the use of antioxidant supplements as a protection against cataracts. Antioxidant vitamins such as vitamins A, C, E and beta-carotene help the body clean-up oxygen-free radicals. Some vitamins are marketed specifically for the eyes. Patients should speak to their doctors about the use of such vitamins.
and alcohol intake have been implicated in cataract formation. Some studies have determined that a diet high in fat will increase the likelihood of cataract formation, while an increase in foods rich in antioxidants will reduce the incidence. More research is needed to determine if diet, smoking, alcohol consumption, or vitamins have any connection to the formation of cataracts.
There are several common symptoms of cataracts:
- gradual, painless onset of blurry, filmy, or fuzzy vision
- poor central vision
- frequent changes in eyeglass prescription
- changes in color vision
- increased glare from lights, especially oncoming headlights when driving at night
- "second sight" improvement in near vision (no longer needing reading glasses), but a decrease in distance vision
- poor vision in sunlight
- presence of a milky whiteness in the pupil as the cataract progresses.
Both ophthalmologists and optometrists may detect and monitor cataract growth and prescribe prescription lenses for visual deficits. However, only an ophthalmologist can perform cataract extraction.
Cataracts are easily diagnosed from the reporting of symptoms, a visual acuity exam using an eye chart, and by examination of the eye itself. Shining a penlight into the pupil may reveal opacities or a color change of the lens even before visual symptoms have developed. An instrument called a slit lamp is basically a large microscope. This lets the doctor examine the front of the eye and the lens. The slit lamp helps the doctor determine the location of the cataract.
Some other diagnostic tests may be used to determine if cataracts are present or how well the patient may potentially see after surgery. These include a glare test, potential vision test, and contrast sensitivity test.
For cataracts that cause no symptoms or only minor visual changes, no treatment may be necessary. Continued monitoring and assessment of the cataract is needed by an ophthalmologist or optometrist at scheduled office visits. Increased strength in prescription eyeglasses or contact lenses may be helpful. This may be all that is required if the cataract does not reduce the patient's quality of life.
Cataract surgery—the only option for patients whose cataracts interfere with vision to the extent of affecting their daily lives—is the most frequently performed surgery in the United States. It generally improves vision in over 90% of patients. Some people have heard that a cataract should be "ripe" before being removed. A cataract is considered ripe or mature when the lens is completely opaque. Most cataracts are removed before they reach this stage. Sometimes cataracts need to be removed so that the doctor can examine the back of the eye more carefully. This is important in patients with diseases that may affect the eye. If cataracts are present in both eyes, only one eye at a time should be operated on. Healing occurs in the first eye before the second cataract is removed, sometimes as early as the following week. A final eyeglass prescription is usually given about four to six weeks after surgery. Patients will still need reading glasses. The overall health of the patient needs to be considered in making the decision to operate. However, age alone need not preclude effective surgical treatment of cataracts. People in their nineties can have successful return of vision after cataract surgery
Surgery to remove cataracts is generally an outpatient procedure. A local anesthetic is used and the procedure lasts about one hour. Removal of the cloudy lens can be done by several different procedures. The three types of cataract surgery available are:
- Extracapsular cataract extraction. This type of cataract extraction is the most common. The lens and the front portion of the capsule are removed. The back part of the capsule remains, providing strength to the eye.
- Intracapsular cataract extraction. The lens and the entire capsule are removed. This method carries an increased risk for detachment of the retina and swelling after surgery. It is rarely used.
- Phacoemulsification. This type of extracapsular extraction needs a very small incision, resulting in faster healing. Ultrasonic vibration is applied to the lens to break it up into very small pieces which are then aspirated out of the eye with suction by the ophthalmologist. A new liquid technique that its inventor says may one day replace ultrasound has been invented, but has not yet been proven in clinical trials.
A replacement lens is usually inserted at the time of the surgery. A plastic artificial lens called an intraocular lens (IOL) is placed in the remaining posterior lens capsule of the eye. When the intracapsular extraction method is used, an IOL may be clipped onto the iris. Contact lenses and cataract glasses (aphakic lenses) are prescribed if an IOL was not inserted. A folding IOL is used when phacoemulsification is performed to accommodate the small incision.
Antibiotic drops to prevent infection and steroids to reduce inflammation are prescribed after surgery. An eye shield or glasses during the day will protect the eye from injury while it heals. During the night, an eye shield is worn. The patient returns to the doctor the day after surgery for assessment, with several follow-up visits over the next two months to monitor the healing process.
The success rate of cataract extraction is very high, with a good prognosis. A visual acuity of 20/40 or better may be achieved. If an extracapsular cataract extraction was performed, a secondary cataract may develop in the remaining back portion of the capsule. This can occur one to two years after surgery. YAG capsulotomy is most often used for this type of cataract. YAG stands for yttrium aluminum garnet, the name of the laser used for this procedure. This is a painless outpatient procedure and requires no incision. The laser beam makes a small opening in the remaining back part of the capsule, allowing light through.
In a very small percentage (3-5%) of surgical cataract extractions, complications occur. Infections, swelling of the cornea (edema
), bleeding, retinal detachment
, and the onset of glaucoma have been reported. Some problems may occur one to two days, or even several weeks, after surgery. Any haziness, redness, decrease in vision, nausea, or pain
should be reported to the surgeon immediately.
Preventive measures emphasize protecting the eyes from UV radiation by wearing glasses with a special coating to protect against UV rays. Dark lenses alone are not sufficient. The lenses must protect against UV light (specifically, UV-A and UV-B). Antioxidants may also provide some protection by reducing free radicals that can damage lens proteins. A healthy diet rich in sources of antioxidants, including citrus fruits, sweet potatoes, carrots, green leafy vegetables, and/or vitamin supplements may be helpful. In 2004, research in England revealed that nonsteroidal anti-inflammatory drugs
(over-the counter pain killers such as aspirin
) may help decrease risk of cataracts by as much as 43%. When taking certain medications, such as steroids, more frequent eye exams may be necessary. Patients should speak to their doctors to see if medications may affect their eyes.
"Blacks May Have Higher Incidence of Cataract." Review of Optometry April 15, 2004: 12.
"Research Suggests Aspirin Helps Combat Cataracts." Health & Medicine Week June 21, 2004: 724.
Talsma, Julia. "Liquefication Device Provides Safe Removal of All Cataracts: Lens Emulsified with BSS Micropulses Using Reusable Titanium Handpiece With Smooth Polymer Tip." Ophthlamology Times June 1, 2004: 50.
American Academy of Ophthalmology. 655 Beach Street, P.O. Box 7424, San Francisco, CA 94120-7424. http://www.eyenet.org.
American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. http://www.aoanet.org.
The Lighthouse. 111 East 59th St., New York, NY 10022. (800) 334-5497. http://www.lighthouse.org.
Prevent Blindness America. 500 East Remington Road, Schaumburg, IL 60173. (800) 331-2020. http://www.preventblindness.org.
— Absence of the lens of the eye.
— A structure in the eye that contains muscles that will affect the focusing of the lens.
— Disease of the eye characterized by increased pressure of the fluid inside the eye. Untreated, glaucoma can lead to blindness.
— Surgical procedure to remove a cataract using sound waves to disintegrate the lens which is then removed by suction.
— The innermost layer of the eyeball. Images focused onto the retina are then sent to the brain.
— Inflammation of the uvea. The uvea is a continuous layer of tissue that consists of the iris, the ciliary body, and the choroid. The uvea lies between the retina and sclera.
Patient discussion about Cataracts
Q. What Is a Cataract? My father has cataract in his eye, which interferes a lot with his vision. What is cataract?
A. A senile cataract (or clouding of the eye), occurring in the aged, is characterized by an initial opacity in the lens, subsequent swelling of the lens and final shrinkage with complete loss of transparency. This condition as an effect on ones vision, and it is important to treat it early, as it becomes harder to treat as time goes by, and may eventually lead to blindness in that eye.
Q. What vitamin through diet shall I take to prevent cataract and how can I help my dad? My father recently had a cataract surgery. This was his second cataract surgery. After this surgery I got scared as what’s going wrong with my dad and he had the cataract the second time. As per the doctor, my dad must be short in vitamins in his diet. He has been given some vitamin tablets. I know that cataract is genetic. I guess I may also have cataract in my old age. What vitamin through diet shall I take to prevent cataract and how can I help my dad?
A. Yes, vitamins if not taken in required amount through diet may lead to vitamin deficiency. As deficiency in vitamin E -an antioxidant and vitamin B1 and B2 can lead to cataract. You must take them in required amount. Foods which have vitamin E are all vegetable oil, green leafy vegetables and egg. Cereals and fish are good source for vitamin B1 and vitamin B2 is surplus in milk and dairy products; eggs, cereals and green leafy vegetables.
Q. I had cataract surgery with iol implant, and ever since I have awful light sensitivity. Any ideas? I can't go into a "super store" without my sunglasses. My eyes ache at the end of the day.
My doctor says "I don't know!"
A. May sound a bit silly question, but have you tried to consult your ophthalmologist (eye doctor, e.g. the one that performed the operation) about it? Cataract surgery, although considered very successful, isn't problem-free. Primary physician may not have the necessary specialization to deal with these subjects.More discussions about Cataracts