Cataracts

A cataract — a clouding of the lens inside the eye — is a common eye condition, especially among seniors. Most cataracts generally occur as part of the aging process. According to the American Society for Cataract and Refractive Surgery (ASCRS), more than half of all Americans over age 60 have cataracts.

Risk Factors for Cataract

No one knows for sure what causes age-related cataracts, but oxidative stress caused by unstable molecules called free radicals appears to play a significant role. Smoking and ultraviolet (UV) radiation are two sources of free radicals, and both have also been associated with a greater risk for cataracts.

Besides advancing age, smoking and long-term exposure to UV rays from the sun, other risk factors for cataract development include:

• Previous eye injury or inflammation
• Exposure to other types of ionizing radiation
• Diabetes
• Prolonged use of corticosteroids
• Previous eye surgery

Cataract Symptoms

Common cataract symptoms include:

• Blurred vision
• Poor night vision
• Glare and halos around lights at night
• "Ghost images" around objects
• Sensitivity to light
• Colors appearing less vivid or "washed out"
• The need for frequent changes to your glasses prescription
• The need for brighter light when reading

Typically, cataracts do not cause discomfort, eye redness, itchiness or a foreign body sensation (a feeling that something is "in" the eye). These symptoms may suggest an eye problem of some other sort, but they are not associated with cataracts.

Cataract Surgery

The only effective treatment for cataracts is cataract surgery.

During cataract surgery, the cloudy natural lens is removed and is then replaced with an artificial intraocular lens (IOL) to restore vision. The surgery takes only about fifteen minutes and usually is performed under local anesthesia.

In most cases, the timing of your cataract eye surgery is up to you. Factors include the severity of the lens opacity, how quickly it is worsening and how much it affects your visual acuity and daily activities.

If you have only a mild cataract that was detected during a routine eye exam, you may not notice any vision problems associated with it. In such cases, your eye doctor usually will recommend monitoring the cataract with routine eye exams and will not recommend cataract surgery until the cataract becomes bothersome.

It's impossible to predict how quickly a cataract will change. Between exams, it's a good idea to check your vision one eye at a time by looking at a familiar distant object outside your home. If your vision in the eye with the cataract changes suddenly, see your eye doctor immediately to see if cataract surgery is indicated.

Intraocular Lenses

When the time comes for cataract surgery, you must decide what type of intraocular lens (IOL) you want. Make sure you have adequate time to discuss your IOL options with your cataract surgeon prior to your cataract removal.

Intraocular lenses available for use in cataract surgery include:

Aspheric IOLs

An aspheric IOL gradually changes curvature and power from its center to its periphery, to more closely mimic the non-spherical shape of the eye's natural lens. Aspheric IOLs reduce spherical aberration — a common optical error that can occur after cataract surgery with a spherical IOL — and may provide sharper vision, especially for night driving and other visual tasks in low light.

Toric IOLs

A toric IOL corrects astigmatism as well as nearsightedness and farsightedness. If you have a significant amount of astigmatism prior to cataract surgery, a toric IOL may reduce your need for prescription glasses after surgery.

Accommodating IOLs

An accommodating IOL has the ability to shift position slightly inside your eye during focusing effort, reducing your need for reading glasses after your cataract surgery. Crystalens (Bausch & Lomb) is one brand of accommodating IOL for cataract surgery.

Multifocal IOLs

A multifocal IOL has more than one lens power, so it can help you see better at all distances and may reduce your need for reading glasses after cataract surgery. Multifocal IOLs approved for cataract surgery in the United States include AcrySof IQ ReSTOR (Alcon), ReZoom (Abbott Medical Optics) and Tecnis Multifocal IOL (Abbott Medical Optics).

Cataract Surgery Risks

Though cataract surgery complications are rare, you should be fully aware of all cataract surgery risks before you sign the consent form for surgery.

Possible cataract surgery complications include:

• Infection
• Dislocation of the IOL
• Elevated eye pressure that could lead to glaucoma
• Detached retina
• Swelling of the cornea
• Droopy eyelids (ptosis)

Ask your surgeon to discuss the risk of all possible cataract surgery complications prior to surgery. Also, if you experience any sudden change in your vision or the appearance or comfort of your eye after cataract surgery, contact your eye doctor or your surgeon immediately.

Recovering from Cataract Surgery

Cataract surgery is one of the safest and most frequently performed surgical procedures in the United States. Complications are rare, and significant complications occur in less that one percent of cataract removal procedures.

Post-operative discomfort usually is minimal, and most people can return to their normal routine within a few days.

Your cataract surgeon will prescribe medications for you to use after surgery to keep your eye comfortable and to prevent infection and inflammation during your cataract surgery recovery.

Cataract surgery generally is performed on an outpatient basis, so someone can drive you home that day shortly after the procedure. Medicated eye drops will be applied after the procedure and your eye will be covered with a protective shield. You must wear the eye shield at bedtime for several nights to keep you from rubbing or bumping your eye during sleep.

You may see better immediately after your cataract operation, but generally it takes six to eight weeks for your eyesight to reach its best level of visual acuity. For best vision, you may need eyeglasses after cataract surgery. But many people are pleased to find they can perform many tasks quite well without glasses after cataract surgery. This is particularly true if you choose multifocal IOLs to reduce your need for reading glasses.

The Cost of Cataract Surgery

Your cataract surgery cost depends on many factors, including the type of vision insurance or medical insurance you have, the surgeon you choose, the type of intraocular lens you choose and the amount of your post-operative care that is included in the cataract surgery fees.

According to a leading eyecare industry analyst, the mean cost of cataract surgery performed in the United States in early 2009 was just under $3,400 per eye (for a person with no insurance coverage). Cataract surgery with an accommodating IOL or a multifocal IOL cost approximately $4,000 per eye.

Medicare and many other insurance programs cover most of the cost associated with basic cataract surgery. But if you choose a premium IOL like those noted above, you typically must pay the added cost for these lenses yourself.

More About Cataracts and Cataract Surgery

For more information about cataracts and cataract surgery, including answers to your specific questions about your eyes, schedule a comprehensive eye exam with your optometrist or ophthalmologist.