Cataract2020-09-16T11:11:47+00:00

Cataract

When your vision becomes yellowish and cloudy resulting in an inability to see clearly at any distance
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What is a cataract?

The onset of cataracts can be a slow and almost imperceptible change. Suddenly you might find yourself unable to drive or notice that your life has slowly shrunken over time.
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Who gets cataracts?

30% of people aged 65 years or older have visually impairing cataracts in one or both eyes[footnote]Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study[/footnote]

YOU HAVE BLURRY VISION, HALOS AROUND LIGHTS AND SEE FADED COLOURS

A cataract is a clouding of the lens in the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry vision, halos around light, trouble with bright lights, and trouble seeing at night. Left untreated, you will go blind.

STUDIES SHOW CATARACTS CAN AFFECT YOUR EMOTIONAL HEALTH

Losing your vision can substantially impair day-to-day routines and your enjoyment of leisure time. It may lead to a deterioration of mental health which renders you unable to work or pursue what once interested you. You are particularly vulnerable to low mood and depression, which affects 1 in 3 adults with vision loss.

DAILY IMPACTS OF LIVING WITH A CATARACT

You may find you participate less in social events. You may feel embarrassed by your deteriorating vision. You may feel anxious about losing your remaining eyesight. Falling and injuring yourself is more common. You find more difficulty with daily tasks which once felt routine.

MANY PEOPLE WITH CATARACTS FEEL LIKE A BURDEN ON OTHERS

Nobody wants to feel like they’re someone else’s responsibility. If you’re in otherwise good health, this new feeling of dependence can make you feel embarrassed and unhappy.

WHY WAIT FOR CATARACT SURGERY TO HAVE A POSITIVE IMPACT ON YOUR LIFE?

Literally from one day to the next, modern cataract surgery can have a life-changing impact for those whose life has been negatively impacted by cataracts. The yellowing is gone. The colours are clearer. Most importantly, it’s like you’ve got your independence back. And with the once-in-a-lifetime opportunity of refractive cataract surgery, you may just be able to become spectacle free.

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Vision correction enables people of all ages to experience a richer life without spectacles or contact-lenses

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Supplementary information about cataracts

In my expert hands, you certainly don’t need to know all of the information I’ve included in the toggles below. If you’d like to know how it all works, however, open them and learn more.

When light enters your eye, it passes through the transparent window at the front of the eye (the corneal lens) and the natural lens inside your eye. Both lenses work together to focus the world on the retina (the light-sensitive layer of cells at the back of your eye). The eye’s natural lens sits just behind your pupil, which is the black circle in the centre of your eye.

Cataract is the term we use to describe the changes that occur when the lens of the eye loses its transparency and changes from appearing like a crystal clear window to appearing like a misted window like frosted glass. The most common cause of this change is age, and medications and conditions like diabetes can also contribute. Cataracts usually start to develop in a person’s lens as they age. The opacity in the lens stops some of the light reaching the retina. This opacity can affect your vision, making it increasingly cloudy, blurry, or misty.

Cataracts usually start to develop in a person’s lens as they age. They stop some of the light reaching the retina. This can affect your vision, making it increasingly cloudy, blurry, or misty.

Risk factors for cataract development include:

  • diabetes or high blood sugar
  • steroid use (tablets, creams or inhalers)
  • ultraviolet light exposure (for example, sunlight)
  • smoking
  • eye diseases: uveitis, glaucoma
  • trauma to the eye
  • previous ocular surgery (for example, retinal detachment surgery)
  • genetic predisposition

Cataract symptoms and lifestyle impacts
Cataracts often develop slowly and painlessly. They can affect your vision and ability to do day-to-day tasks without you realising it. We can sometimes correct this gradual decline in sight with an up to date pair of glasses. More often than not, the glasses prescription continue to change, and the new pair of glasses is very soon obsolete.

The most common signs of cataract are:

  • frequent changes in the prescription of glasses
  • changing reading vision – either worsening in some people improving at the expense of the distance vision
  • blurry vision
  • difficulty reading in dim light
  • poor vision at night
  • glare and halos around lights, and
  • occasionally, double vision.

Cataract examination in London
The most important parts of your eye examination so far as cataracts are concerned is your level of vision with and without glasses and whether or not the vision can be improved with a new glasses prescription.

If I cannot improve your vision to the driving standard, then you’ll require cataract surgery if you wish to continue to drive. Even if the patient does not drive cataract surgery is still advisable because the driving test represents a threshold beyond which the cataract becomes advanced. As your cataract advances, the rate of visual deterioration increases and the risks of surgery also increases.

Other essential parts of the cataract examination

  1. An eye health assessment to ensure that cataract is the only eye condition present and that there are no other causes for poor vision. This is crucial in determining which lens implant to use and to manage your expectations.
  2. Biometry. Biometry is a particular test which we use to work out which lens implant to use in each patient’s eyes. Every patient needs a different strength or power of lens implant.
  3. Corneal topography to measure astigmatism. Correction of astigmatism during cataract surgery is essential to ensure good surgical outcomes. If you have significant astigmatism, then you’ll need a toric lens implant to give proper vision following surgery.

The final parts of the cataract examination relate to counselling you about:

Whether or not you will need glasses after surgery. I will determine this by the type of lens implant I recommend. Standard monofocal lens implants can correct the distance vision in patients who do not have astigmatism, but all of these patients will need reading glasses.

Patients with astigmatism will need glasses for both the distance and for reading if I don’t implant a toric lens. A toric monofocal lens will correct the distance vision if you have astigmatism, but you will still need reading glasses.

Finally, multifocal lens implants will enable you to see at all ranges without the need to wear glasses. If you have astigmatism and want to be completely glasses-free, then a toric multifocal lens implant will correct every aspect of your vision.

When do I recommend cataract surgery?
Mild cloudiness of the eye’s natural lens is a normal part of ageing. When cloudiness becomes sufficient to affect the vision or cause symptoms, I make the diagnosis of cataracts. Cataracts usually get slowly worse over time and the only treatment to permanently solve the problem and restore full vision is to remove them. The procedure is called cataract surgery.

Surgery isn’t necessary if your vision isn’t significantly affected and you don’t have difficulties carrying out everyday tasks. However many patients find the presence of a cataract worrying and find coping with the uncertainty of what will happen to their vision difficult.

In the past, there was a time when, for technical reasons, we would wait for a cataract to be ‘ripen’ or become ready for removal. That is most certainly not the case any more.

With modern cataract surgery, eye surgeons can remove a cataract at any stage. The advances in technology and particularly safety means that modern cataract surgery is a minimal risk procedure. We can even perform lens exchange procedures on patients before they develop a cataract to correct their vision and free them from needing glasses.

The cataract operation
Cataract surgery is a relatively straightforward procedure that usually takes 15 to 20 minutes. We usually carry it out as day surgery under local anaesthetic with some mild sedation, which means you’ll be awake during the procedure and can go home on the same day.

The cataract operation itself is a keyhole surgery, and I performed through 2 or 3 tiny incisions (no longer than 3mm) in the white of the eye. I then fragment the natural lens and remove it through the keyhole incision. After I remove the natural lens, I implant a folded-up, small plastic lens called an intraocular implant or intraocular lens through the keyhole incision. The plastic lens unfolds inside your eye after I place it in the correct position.

If you have cataracts in both eyes, I will discuss the option of operating on both eyes at the same time. If you have mild cataracts, then this is possible, and the vision typically takes 24 to 48 hours to clear, so surgery on both eyes on the same day is perfectly acceptable. If, however, you have medium to advanced cataracts I will typically operate on each eye a few weeks apart because your vision can take 3 to 7 days to clear following surgery. This gives the first eye time to heal and time for your vision to return to normal before having surgery in your second eye.

The risks of cataract surgery
When considering the risks of cataract surgery, it is essential you understand that not having surgery also has risks. The cataract will progress over time and when fully mature cataracts can result in total loss of vision.

The risk of permanent loss of vision in one eye after cataract surgery is 1 in 10,000 operations. The chance of this happening in both eyes is 1 in 12 million procedures. The most common cause of vision reduction after cataract surgery is an infection, but other rare reasons include retinal problems such as retinal detachment and bleeding under the retina

The risk of having reduced vision and needing a second operation to correct any problem is 1 in 500. The risk of having a minor issue that requires further treatment with eye drops is 1 in 100.

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Even more information about cataract

I frequently write articles and publish videos to answer people’s most common questions and keep them updated on the latest developments in vision correction. Find out more below…

Compare cataract with other relevant eye conditions

Eye conditions are frequently misunderstood, so here’s a quick overview of the ones I most commonly treat

ASTIGMATISM

Astigmatism is an imperfection in the shape of your eye’s cornea or lens. Usually, the cornea and lens are round or spherical like a football. In eyes that have astigmatism, the cornea and or lens of the eye are oval in shape like an egg. As a result, light rays focus on a blurred oval shape on the retina rather than as a single sharp image. Learn more about astigmatism…

Treatments for astigmatism

SHORT-SIGHTEDNESS

Short-sightedness is also known as Myopia.

Short-sightedness (or myopia) is an eye condition where the focusing power of the eye is too strong. For that reason, if you’re short-sighted, you need to wear negative power lenses to reduce the focusing power of the eye. Doing so brings the image of the world into focus on our retina. Learn more about short-sightedness…

Treatments for short-sightedness

LONG-SIGHTEDNESS

Long-sightedness is also known as Hyperopia and Hypermetropia.

Hyperopia or long-sightedness is an eye condition where the focusing power of the eye is too weak. For that reason, if you have long-sightedness, you need to wear positive power lenses to increase the focusing power of the eye and bring the image of the world into focus on our retina. Learn more about long-sightedness…

Treatments for long-sightedness

DRY EYE

The term “dry eye” covers many different eye conditions where an imbalance in the volume or quality of the tears results in inflammation and damage to the surface of the eye. Patients have varying degrees of dry eye symptoms from occasional discomfort and stinging to severe pain and inability to see. Learn more about dry eye…

PRESBYOPIA

Presbyopia is the eye condition which causes people aged 45 and older to need reading glasses. The ageing of the eye’s natural lens which stiffens and loses its ability to focus causes presbyopia.

Treatments for presbyopia

KERATOCONUS

Keratoconus is a condition where the cornea, the front window of the eye, becomes thinner, loses its strength and begins to warp out of shape progressively. Learn more about keratoconus…

Treatments for keratoconus

RECURRENT CORNEAL EROSION

Recurrent corneal erosion is a painful eye condition where there are episodes of severe pain on waking which resolve over a few days to a week only to reoccur again in the future. Learn more about recurrent corneal erosion…

Treatments for recurrent corneal erosion

  • Laser Phototherapeutic Keratectomy (PTK)

About the author

Mr Alex J. Shortt | Consultant Ophthalmic Surgeon

MB BCh MSc PhD FRCOphth PGDipCatRef

I’m Alex Shortt, a highly trained academic researcher and Consultant Ophthalmic Surgeon based in London’s famous Harley Street medical district. I trained and worked as a consultant for 14 years at London’s Moorfields Eye Hospital. I specialise in advanced technologies for correcting vision, including cataract surgery, implantable contact lenses and laser vision correction.

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