Ask an Expert: Cataracts and Your Aging Eyes
Dr. Christopher Kirkpatrick is a Comprehensive Ophthalmologist and Cataract Surgeon at the Eye Center of Northern Colorado. His specialties also include minimally invasive glaucoma surgery and medical management of a broad spectrum of eye disease, including macular degeneration, diabetes, and dry eye.
How does age affect vision?
There are a variety of age-related eye conditions that can affect vision in different ways. Age-related macular degeneration, glaucoma, and dry eye are all more common with age and do affect vision. However, the most common age-related change to the eye occurs in the lens of the eye.
This starts with a condition called presbyopia where the lens in the eye slowly becomes more rigid over time and gradually loses its ability to accommodate (the ability of the lens to thicken in response to the eye needing to see things up close). This typically starts for people in their 40s and they start to notice that they have hold things out further to read or start noticing the need for reading glasses. As the lens continues to age, not only does it harden, but it will slowly become cloudy and harder to see through – this is a cataract. This is a progressive spectrum of age-related changes to the lens in the eye termed dysfunctional lens syndrome that affects all humans with time.
How will I know if I have cataracts?
Most of the time, mild or early stage cataracts do not cause any symptoms. At this stage, your eye doctor can tell you if you have early stage cataracts by doing an eye exam. As the cataract progresses, you may start to notice visual symptoms – most commonly blurred, cloudy or hazy vision, decreased contrast or changes in color perception, or glare, halos or starbursts with bright lights or oncoming headlights.
What happens if cataracts are left untreated?
If left untreated, cataracts will continue to progress and become more cloudy. The symptoms of blur, glare and overall decreased quality of vision will continue to get worse gradually. If left untreated for a very long time and the cataract is very severe, this can lead to medical issues of the eye such as glaucoma or uveitis, but this is not common. Most of the visual symptoms caused by cataracts are reversible with cataract surgery even if the cataract is left untreated for many years.
What happens during cataract surgery?
Cataract surgery is done while you are still awake. This may seem scary to some people, but you will be given some mild sedating medication that can ease your anxiety. The eye is numbed with drops to make you very comfortable during surgery. The surgery takes about 10-15 minutes to complete. This procedure can be done completely by hand, but sometimes your surgeon will use a laser to complete part of the procedure.
Your surgeon will use very small instruments and a small ultrasound probe to break up (emulsify) and remove the cloudy cataract lens from the eye through a small (2.2 – 2.4 mm) incision. Once this has been removed, an artificial lens will be placed back into the eye. This is held in place by the structures in the eye that were holding the cataract. There are different options for this artificial lens including toric (astigmatism correcting) and multifocal (presbyopia correcting); some people have excellent vision after cataract surgery even without the need for glasses.
How will cataract surgery improve my vision? Will it improve the overall eye health?
Cataract surgery removes the cloudy and hazy cataract lens from the eye. It will improve the clarity of vision by placing a clear artificial lens back into the eye that will improve overall visual quality by removing the blur and glare caused by the cataract. Depending on which artificial lens is placed back into the eye after surgery, the vision can be focused for distance, near, intermediate or all of these distances simultaneously.
Cataract surgery can aid in improving eye health by lowering the pressure in the eye which can be helpful if you have a condition such as glaucoma. It can also help your eye doctor see to the back of the eye for more accurate examinations and treat conditions that affect the retina.
Is cataract surgery safe?
Cataract surgery is very safe. There is an approximately 1% chance that you may have a complication during cataract surgery. The good news is that even if you do experience a complication, many times these are treatable, and you still end up with good vision afterward.
What are the risks and side effects of cataract surgery?
Common risks and side effects of cataract surgery include swelling, bleeding, infection, inflammation, damage to other parts of the eye (retinal detachment, glaucoma, etc.), or dry eye. Depending on the type of artificial lens placed after cataract surgery, you may experience persistent halos with direct lights, or you may even experience blurred vision without corrective lenses. Again, there is a low risk of these events occurring and many times the side effects or complications are very treatable.
Do cataracts come back?
No, cataracts do not come back. The artificial lens that is placed after cataract surgery can develop haziness on the posterior capsule (what holds the artificial lens in place) behind it. This can happen any time from weeks to years after surgery. Some people refer to this as a secondary cataract because it comes from some remaining cataract lens cells, but this is not truly the cataract recurring. If this does happen, your ophthalmologist can perform a laser procedure called a YAG that makes an opening in the hazy posterior capsule and restores a clear path of vision to the back of the eye.
What do I need to do to prepare for cataract surgery?
Ask questions and inform yourself about the procedure and your options for artificial lens implants that are placed at the time of surgery. Think about your goals for after the surgery in terms of obtaining good quality vision at distance, near, or both independent of needing glasses or contact lenses. Some of the artificial lens implants used in cataract surgery can correct your vision to a very high degree without needing glasses at the focal distance(s) of your choosing. Think about if this is something that would be important to you and ask your surgeon about these options.
Prior to cataract surgery, some surgeons will have you use some medicated eye drops (anti-inflammatory or antibiotic) in the pre-operative period. Lubricating the surface of the eye with artificial tear drops is also an important step that everyone preparing for cataract surgery should consider. This helps the surface of the eye obtain the best contour and aids in obtaining the most accurate measurements that your surgeon will use to calculate which artificial lens to place during cataract surgery.
What is recovery time like?
Recovery time from cataract surgery is relatively minimal. The vision is typically mildly blurry for the first few days after surgery as a result of a mild amount of swelling in the cornea, but sometimes people see great the next day. There is typically only mild discomfort and irritation following cataract surgery. If you have an underlying dry eye, this can be made mildly worse temporarily and may need to be treated with topical artificial tears more frequently in the post-operative period. There may be mild activity restrictions for about a week following surgery such as no heavy lifting, strenuous activity, or bending.
In terms of medications following surgery – each surgeon has a slightly different post-operative regimen. Most surgeons will use antibiotic and anti-inflammatory drops following cataract surgery, but other surgeons will inject these medications at the time of surgery that may eliminate or reduce the need for drops after surgery.