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Cataracts

A cataract is an opacity of the lens of the eye. The body's natural lens is similar to an onion, with many layers. These layers contain protein and as the proteins clump together, they cover the lens and make it difficult to see clearly. Cataracts are generally seen in the older population, but they can occur at any age, even birth. By age 60, over half of the population has some symptoms of cataracts due to the natural aging process.

Cataracts are painless but if left untreated can lead to blindness. Cataract surgery is done on an outpatient basis with little or no downtime afterwards. The surgery is performed by a medical doctor known as an ophthalmologist, who specializes in surgery of the eye. The aftercare or postoperative care can be administered by an ophthalmologist or an optometrist.

Symptoms of Cataracts

There can be a myriad of symptoms when a person develops a cataract.  It is common for vision to be blurry, as though you are looking through a foggy window. Color vision changes occur in which the brightness of colors fade, especially blue and green. Patients with cataracts also experience difficulty in reading small print. They also feel like they need brighter light or possibly a new glasses prescription. Double vision or vision that seems like halos around the letters also occurs, as well as sensitivity to light.

Causes of Cataracts

The exact physiological cause of cataracts is unknown, but there are many risk factors. Aging and trauma are known to cause cataracts. A blunt trauma or injury to the eye can cause a cataract at any age. The effect of aging on the cells of the lens contributes to cataracts usually after age 60. There is also a direct correlation between the sun's UV rays and certain radiation exposures that contriibute to cataract growth. Smoking is a big risk factor for developing cataracts as well.

Poor nutrition can add to the risk of developing cataracts. Lack of vitamin C has been shown to increase the genesis of cataract formation. Some prescription medicines, especially prednisone, can cause cataracts. Diabetes and other chronic disease processes are also factors in cataract formation. Finally, there are genetic factors that contribute to a cataract.

Treatment of Cataracts

The standard of care for the treatment of cataracts is typically surgery. Cataract surgery, which is an outpatient procedure, removes the protein accumulation from the eye by replacing the cloudy natural lens with an artificial lens. This artificial lens, known as an IOL or intraocular lens, will have your prescription, which in most cases, makes you less dependent on glasses. Lens technology has evolved over the years to also accommodate prescriptions for astigmatism and bifocal prescriptions. Cataract surgery is one of the most commonly performed surgeries in the United States, and it has a success rate of over 98%.

There are many types of cataracts that form on the eye, with different levels of density. This can affect the post-operative care of cataract patients. After cataract surgery, it might be necessary to use a laser to clear an after-cataract membrane that can occur weeks to months after the procedure. This treatment uses a YAG laser and is a painless, low risk, in-office procedure. Most patients can return to work or normal activities within days after the procedure. Your doctor will likely prescribe eyedrops to prevent infection and swelling.

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Recent Findings

New technology in cataract surgery includes a bladeless customized procedure that allows for faster healing and clearer vision after the procedure. This computer assisted surgery uses a laser to make the incisions. The laser also divides the cataract efficiently so that the surgeon can remove the old lens and replace it with a new state-of-the-art IOL ( Intraocular lens). This technology uses a femtosecond laser which emits cool pulses of energy. This technology has been used for decades in LASIK surgery for the correction of myopia or nearsightedness. This form of cataract surgery now allows the procedure to be more precise, and reproducible.

Citations
1. What is a cataract? Educational website release. Triadeye.com. January 13, 2013.
2.Bladeless cataract laser surgery. LenSX press release. October 4, 2012.

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Ask Dr. Stewart Your Eye Care Questions

What can be expected during a contact lens fitting?

A patient can expect to have a different experience when having a contact lens fitting. In addition to the eyeglass exam, questions will be asked to determine which contact lens will work best for them. Will they want to leave the lenses in their eyes overnight or will they remove them every day? Will they wear them only occasionally or will they be for everyday use? Do they want a contact lens that they throw away every day or do they want a contact lens that they have to clean and disinfect? If the patient is over age 40 and has a compromised ability to see up close, how will they see up close with their contact lenses? Will they wear readers over their distant contacts, or will they wear multifocal contacts, or will they wear monovision?

Are some people more prone to having Dry Eyes than others?

Experiencing dry eye symptoms is more common as we grow older, particularly in people 50 years of age and older. Hormonal changes in women who are experiencing menopause or who are post-menopausal. Inflammation in our body can affect the tear gland's ability to produce tears. Eye or health conditions such as glaucoma, diabetes, lupus, rheumatoid arthritis, and Sjogren's Syndrome can be associated with Dry Eyes. Environmental conditions such as dry winter air, dry indoor heated air, working on the computer, and wearing contact lenses can cause Dry Eyes.

Are there advantages to single-use contact lenses? What are they?

Single-use daily wear contacts are convenient to the patient and a healthy recommendation from their eye doctor. At the end of the day, the patient only has to dispose of the contacts. There is no need to take the contacts out to clean and disinfect them. The patients time and money spent on solutions and caring for them are eliminated. Not to mention that the next time they wear a contact, they will be wearing a brand new contact! The single best recommendation your eye doctor can make is to recommend single-use daily wear contacts. They are the healthiest contact that can be worn. The contact lens pathology issues of wearing the same contact for two or four weeks such as neovascularization, microcystic edema, and bacterial infections are greatly reduced.

What is an eye infection?

Your eyes can get infections from bacteria, fungi, or viruses. Eye infections can occur in different parts of the eye and can affect just one eye or both. Two common eye infections are conjunctivitis (also known as pink eye) and lid styes which are swollen lid bumps that can also be painful. Common signs of an eye infection are pain, itching, or a sensation of a foreign body in the eye, photosensitivity, redness or small red lines in the white of the eye, discharge of yellow pus that may be crusty upon awaking, and tears.

What happens during a typical Diabetic Eye Exam?

Your Eye Doctor will evaluate the back of your eye called the Retina to check for leaking blood vessels. Diabetic retinopathy occurs when elevated blood sugars damage the walls of the blood vessels. The vessel walls may thicken, leak, develop clots, close off, or grow balloon-like defects called microaneurysms.

My eyes tear all the time. Why do you call it Dry Eyes?

Your eyes have extra tears because your eyes produce extra tears to combat irritation and dryness. A better way to describe Dry Eyes is tear film instability, which refers to the composition of your tears not being in the proper composition. Stopping eyes from producing extra tears is a goal in the treatment of Dry Eyes.

At what age should my child have his/her eyes examined?

If you ask 10 different Doctors you will get 10 different answers. Newborns have their eyes checked in the birthing ward for starters. From birth to age 5 their eyes are growing. At age 5 is a good time to schedule a regular eye examination, however, if any unusual eye behavior is observed under age 5 an eye exam should be scheduled at that time. Unusual eye behavior such as eye squinting, a head tilt, or having to get close to see.