Cataract Basics

Cataract Basics

Cataract Basics: 56 Things that you wish you knew before your cataract surgery

Waiting for cataract surgery is frustrating!

Waiting for cataract surgery is frustrating!

The most frustrating time for folks diagnosed with cataract is ... waiting for it to get worse!  Because cataracts generally progress slowly, there is always a gap between the initial diagnosis and when a cataract requires surgery.  It is frustrating to be told that “You cataract is worse.  It is the reason for your blurry vision but it is not yet enough for cataract surgery.”  

There are a number of factors at play here.  e.g. benefit vs. risk, wait lists, payor, driving requirements, visual demands, visual acuity.

It is not uncommon for folks to wish their cataracts worse on each visit!

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My eyesight is getting better?! How can I have a cataract?

My eyesight is getting better?!   How can I have a cataract?

Initial vision improvement with cataract is very common but counterintuitive.

Cataract development will often cause a shift in your prescription before the lens goes very cloudy.   This shift if often (but not always) towards nearsightedness.

Think about the range of all prescriptions like a number-scale with farsightedness on one side of the scale and nearsightedness on  the other side.  Zero/perfect is in the middle.  If you were quite farsighted for all of your life and your cataracts are causing a nearsighted shift… the shift cancels out some of your old prescription bringing you closer to zero/perfect.   You will see better without your glasses than perhaps you have in years!...  until of course the cataract gets denser and starts to cloud your vision.

Some eye care professionals refer to this shift as “second sight”.  Again, “second sight” occurs when the prescription shift caused by the cataract is opposite to your pre-existing Rx.

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Cataracts and Sandbags?

Cataracts and Sandbags?

Why are stories of sandbags exist with cataract surgery?

Many years ago, cataract surgery required a much larger incisions and had much greater risk.  Sandbags were used post surgically to keep a patient’s head immobilized for a period-of-time post-surgery.   This is a thing of the distant past but I am still asked about it!

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Did I get cataracts from my parents?

Did I get cataracts from my parents?

If you have a close relative that developed early-onset cataract not due to diabetes, there is likely more of a heredity influence.

If you are older, it is unlikely that your cataracts have been significantly influenced by heredity.  

A cataract the you are born with is called a congenital cataract.  Most congenital cataracts are insignificant to a child’s visual system’s development and are just watched for progression.  Rarely a congenital cataract needs to be treated however, if the clouded vision could arrest/slow vision system development (amblyopia) then surgery is considered.

 

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Can I take something or do something to slow my cataracts?

Can I take something or do something to slow my cataracts?

If you are diabetic, tight control of your sugar levels are recommended.   Otherwise – if you are not diabetic – there is honestly not much that you can do to slow cataract development. 

I have heard many remedies over the years from fish oil to bilberry and lutein.  There is nothing proven to slow cataract progression however a diet rich in antioxidant foods may help.

There is a study that shows that two drinks of wine per day (high antioxidant / high resveratrol (red wine)) delayed and reduced cataract development.  The age-adjusted, five-year incidence of any type of cataract was 32.2% among non-drinkers; however, only 13% of individuals who moderately consumed wine developed cataracts*

Sun protection is import for many reasons… however realistically, most of the sun damage has already occurred and wearing sunglasses will likely not slow your cataract development.  Sunglasses are always recommended and will help cataract-related glare symptoms.

 

* Sasaki H, Jonasson F, Suwa Y, et al. The protective effect of wine intake on five years incidence of cataractReykjavik Eye Study. ARVO May 2005. Abstract/Poster# 3840/B198.

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How fast will my cataracts advance?

How fast will my cataracts advance?

This is a tough question to answer without knowing the type of cataract.

Very very generally, if you are diagnosed with a cataract under 60 years of age or you are diabetic, it will likely progress more quickly (often 1-3 years to treatment).  If you are over 60 and the cataract is not related to injury, medication or inflammation, the cataract will generally progress more slowly (often 3+ years to treatment).

Your eye care professional will be hesitant to put a timeline on your cataract development but could guesstimate after an assessment.


It is uncommon but some cataracts advance very quickly and will need to be dealt with in only a few months.  If you wake up with poor vision or your symptoms have arisen vision quickly, the problem is unlikely to be related to cataract and requires urgent investigation by your eye care provider.

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Can my health influence my cataracts?

Can my health influence my cataracts?

Yes - There are many systemic conditions that can directly cause early-onset cataracts (e.g. diabetes). 

Some systemic conditions (e.g. autoimmune conditions) can cause eye inflammations that can lead to cataract.  Also, some medications used to treat systemic health conditions can themselves cause cataracts (e.g. prednisone).

Systemic illness and ocular health issues including cataract are important connections not be ignored.  Your eyes can reflect your general health in many ways.   Speak to your eye care provider about the connection.  If you are developing premature cataracts there are many tests that should be performed to rule out specific conditions.

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How is cataract diagnosed?

How is cataract diagnosed?

A cataract is diagnosed by a regulated health professional.   It can be observed in the lens of the eye with a hand-held ophthalmoscope or biomicroscope.

Cataracts are usually graded (0-4) on their density and the type is noted.  Sometimes dilating eye drops are required to better assess the type of cataract.

There is a danger in attributing vision loss solely to cataract without a full eye exam.   The eye is complex and often has concurrent issues (e.g. macular degeneration + cataract).  Only a full exam can sort out if vision loss is 100% attributable to cataract development.

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What kind of cataract do I have?

What kind of cataract do I have?

I find it most useful for patients to explain that there are cataracts that are age-related and there are cataracts that are related to other things (e.g. trauma, inflammation, diabetes, medications).   These types progress at very different rates with age-related generally slower.

It is probably of little relevance to most, but you can certainly ask your doctor exactly what type of cataract that you have (e.g. cortical, posterior sub-capsular).  Cataracts are typically graded on a 0-4 scale (4 being the most advanced).

Sometimes the type of cataract can guide eye care professionals to investigate systemic health conditions like diabetes or autoimmune conditions.

Your doctor won’t likely commit to a definite answer, but you can ask them what to expect as far as the speed of progression.

This brief post is not meant to be a clinical list of cataract types - just take away that [1] different types advance at different rates and [2] have different underlying causes and can be clues to a puzzle.

A commonly Google searched phrase is

   "What does a cataract look like?"

Because cataracts occur inside of the eye (not on the surface) - It is difficult to see a cataract with the naked eye unless it is very advanced.    In late stages, you may be able to see a whitish haze within the pupil of the eye.   (She the What is a cataract post).    Two conditions commonly confused as cataract because they are visible on the surface of the eye are: Pterygium (more information here) and Arcus Senilis (cholesterol deposits in the cornea).

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What are the common symptoms of cataract?

What are the common symptoms of cataract?

Folks experience different symptoms of cataract depending on the degree, location, one-side/both sides.  Your visual demands and other ocular issues also play a major role in visual symptoms.

The most common cataract-related symptoms that patients report are slowly increased glare and blurry vision.    There is not pain or irritation associated with cataract folks often report awareness like a film over the eye.

Constant cleaning of your glasses does not help!

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What is a cataract? A simple, non clinical description.

What is a cataract?  A simple, non clinical description.

There are a million medical, wordy descriptions of cataract and highly graphic surgical videos online but I try very hard in clinic to keep things SIMPLE!

Albeit casual, this is verbatim what I tell patients - as I doodle on my whiteboard many times per day - to explain what a cataract is…

Please view the video and then the transcript will make more sense.

Approximate Transcript “This is the side of your eye.  If you had your glasses on, your glasses would be out front here….   When you look at anything… like the ‘E’ on my chart… the light from the chart will first pass through your glasses and then hit the cornea… the front surface of the eye.   Inside your eye, there is the iris (the coloured part the you see in the mirror) and the pupil (the black hole in the middle).  Behind where you can see there is a lens.   The lens is responsible to focus this beam of light to the retina at the back of the eye.   So, if everything goes according to plan… the light from the ‘E’ should pass through your glasses, the cornea, the pupil, the lens and form a nice sharp image of a letter ‘E’ at the back of the eye.   However, when you have cataract, the light scatters as it passes through the lens.  The scattered light degrades the image and things are unclear.     The only way to get you to see better is to remove this cloudy natural lens and replace it with a clear artificial lens… then the light will again pass cleanly through and you will see a clear letter ‘E’."

Additional points:   
1] When you have cataract, it does not matter what we do with glasses out front because the light still gets mucked up when it hits the cloudy lens.
2] The new lens will have a different power than your old lens.   The surgeon’s goal will be to choose a new power which will have you seeing well in the distance without glasses. 

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