Cataract

Definition
A cataract is a clouding of the normally clear lens of your eye. Looking through
a cloudy lens is like trying to see through a frosty or fogged-up window. Cloud
ed vision can make it more difficult to read, drive a car — especially at night — or
see the expression on a friend's face. Cataracts commonly affect distance visio
n and cause problems with glare. They generally don't cause irritation or pain.
Most cataracts develop slowly and don't disturb your eyesight early on. But as t
he clouding progresses, the cataract eventually interferes with your vision. Ear
ly on, stronger lighting and eyeglasses can help you deal with vision problems.
But if impaired vision jeopardizes your normal lifestyle, you might need surgery
. Fortunately, cataract removal is generally a safe, effective procedure.
Symptoms
A cataract usually develops slowly and causes no pain. At first, the cloudiness
may affect only a small part of the lens (a clear, elliptical structure near the
front of each
eye) and you may be unaware of any vision loss. Over time, however, as the catar
act grows larger, it clouds more of your lens and distorts the light passing thr
ough the lens. Eventually, this impairs your vision because of overall blur or i
mage distortion. Signs and symptoms of cataracts include:
Clouded, blurred or dim vision Increasing difficulty with vision at night S
ivity to light and glare Halos around lights The need for brighter light for rea
ding and other activities Frequent changes in eyeglass or contact lens prescript
ion Fading or yellowing of colors Double vision in a single eye
If you have a cataract, light from the sun, lamps or oncoming headlights may see
m too bright. Glare and halos around lights can make driving uncomfortable and d
angerous. You may experience eyestrain or find yourself blinking more often to c
lear your vision. Cataracts don't typically cause any change in the appearance o
f your eye. Pain, redness, itching, irritation, aching in your eye or a discharg
e from your eye aren't signs or symptoms of a cataract, but may be signs and sym
ptoms of other eye disorders. A cataract isn't dangerous to the physical health
of your eye unless the cataract becomes completely white, a condition known as a
n overripe (hypermature) cataract. This can cause inflammation, pain and headach
e. A hypermature cataract requires removal if it's associated with inflammation
or pain.
Causes
A cataract can develop in one or both of your eyes. However, in most cases — excep
t for those caused by injury or trauma — cataracts tend to develop symmetrically i
n both eyes. A cataract may or may not affect the entire lens. When your eyes wo
rk properly, light passes through the cornea (the protective dome of clear tissu
e over the front of your eye) and the pupil (the hole in the center of your eye)
to the lens. The lens is located just behind the iris (the colored part of your
eye) and the pupil. It's shaped thicker in the middle and thinner near the edge
s. Tiny ligaments, which are bands of tough tissue fiber, hold it in place. The
lens focuses light that passes through the cornea and pupil, producing clear, sh
arp images on the retina — the light-sensitive membrane on the back inside wall of
your eyeball that functions like the film of a camera. As a cataract develops,
the lens becomes clouded, which scatters the light and prevents a sharply define
d image from reaching your retina. As a result, your vision becomes blurred. The
lens: Its makeup and its changes The lens consists of three layers. The outer l
ayer (capsule) is a thin, clear membrane. It surrounds a soft, clear material (c
ortex). The harder center of the lens is the nucleus. If you think of the lens a
s a piece of fruit, the capsule is the skin, the cortex is the fleshy fruit and
the nucleus is the pit. As you age, the lenses in your eyes become less flexible
, less transparent and thicker. The lens is made mostly of water and protein fib
ers. The protein fibers are arranged in a precise manner that makes the lens cle
ar and allows light to pass through without interference. With aging, the compos
ition of the lens undergoes changes and the structure of the protein fibers brea
ks down. Some of the fibers begin to clump together, clouding small areas of the
lens. As the cataract continues to develop, the clouding becomes denser and inv
olves a greater part of the lens. A cataract can form in any part of the lens. T
ypes of cataracts Cataracts occur in three types:
Nuclear. A nuclear cataract occurs in the center of the lens. In its early stage
s, as the lens changes the way it focuses light, you may become more nearsighted
or even experience a temporary improvement in your reading vision. Some people
actually stop needing their glasses. Unfortunately, this so-called second sight
disappears as the lens gradually turns more densely yellow and further clouds yo
ur vision. As the cataract progresses, the lens may even turn brown. Seeing in d
im light and driving at night may be especially troublesome. Advanced discolorat
ion can lead to difficulty distinguishing between shades of blue and purple. Cor
tical. A cortical cataract begins as whitish, wedge-shaped opacities or streaks
on the outer edge of the lens cortex. As it slowly progresses, the streaks exten
d to the center and interfere with light passing through the center of the lens.
Problems with glare are common for people with this type of cataract. Subcapsul
ar. A subcapsular cataract starts as a small, opaque area just under the capsule
of the lens. It usually forms near the back of the lens, right in the path of l
ight on its way to the retina. A subcapsular cataract often interferes with your
reading vision, reduces your vision in bright light and causes glare or halos a
round lights at night.
Scientists don't know exactly why a lens changes with age. One possibility is da
mage caused by unstable molecules known as free radicals. Smoking and exposure t
o ultraviolet (UV) light are two sources of free radicals. General wear and tear
on the lens over the years also may cause the changes in protein fibers. Other
causes of cataracts Age-related changes in the lens aren't the only cause of cat
aracts. Some people are born with cataracts or develop them during childhood. Su
ch cataracts may be the result of the mother having contracted German measles (r
ubella) during pregnancy. They may also be due to metabolic disorders. Congenita
l cataracts, as they're called, don't always affect vision, but if they do they'
re usually removed soon after detection.
Risk factors
Everyone is at risk of developing cataracts simply because age is the greatest r
isk factor. By age 65 about half of all Americans have developed some degree of
lens clouding, although it may not impair vision. After age 75, as many as 70 pe
rcent of Americans have cataracts that are significant enough to impair their vi
sion. Factors that increase your risk of cataracts include:

Age Diabetes Family history of cataracts Previous eye injury or inflammation Pre
vious eye surgery Prolonged use of corticosteroids Excessive exposure to sunligh
t Exposure to ionizing radiation Smoking
When to seek medical advice
An eye specialist can detect and track the development of cataracts during routi
ne eye exams. Have your eyes examined:

Every two to four years until age 65 and every one to two years at age 65 and ol
der Anytime you develop new eye problems
If you experience any signs and symptoms of cataracts, see your eye doctor. An e
ye doctor can diagnose cataracts with the help of a careful eye exam.
Tests and diagnosis
The only way to know for sure if you have a cataract is to have an eye examinati
on that includes several tests:
Visual acuity test. Acuity refers to the sharpness of your vision or how clearly
you see an object. In this test, your eye doctor checks to see how well you rea
d letters from across the room. Your eyes are tested one at a time, while the ot
her eye is covered. Using a chart with progressively smaller letters from top to
bottom, your eye doctor determines if you have 20/20 vision or less acute visio
n. Slit-lamp examination. A slit lamp allows your eye doctor to see the structur
es at the front of your eye under magnification. The microscope is called a slit
lamp because it uses an intense line of light — a slit — to illuminate your cornea,
iris, lens and the space between your iris and cornea. The slit allows your doc
tor to view these structures in small sections, which makes it easier to detect
any small abnormalities. Retinal examination. In this procedure, your eye doctor
puts dilating drops in your eyes to open your pupils wide and provide a bigger
window to the back of your eyes. Using a slit lamp or a special device called an
ophthalmoscope, he or she can examine your lens for signs of a cataract and, if
needed, determine how dense the clouding is. Your eye doctor will also check fo
r glaucoma and, if you have blurred vision or discomfort, check for other proble
ms involving the retina and the optic nerve. Dilating drops usually keep your pu
pils open for a few hours before their effect gradually wears off. Until then, y
ou'll probably have difficulty focusing on close objects, while your distance vi
sion is generally less affected. With your pupils open this wide, you may want s
unglasses for your trip home, especially if it's a bright day. Also, it may be s
afer to let someone else do the driving.
If you have a cataract, you can discuss treatment options with your eye doctor.
If — in addition to having a cataract — you have other eye conditions that limit you
r vision, such as macular degeneration or advanced glaucoma, removing the catara
ct may not improve vision, and cataract surgery may provide disappointing result
s.
Treatments and drugs
The only effective treatment for cataracts is surgery to remove the clouded lens
, which usually includes replacing the lens with a clear lens implant. Sometimes
cataracts are removed without reinserting implant lenses. In such cases, vision
can be corrected with eyeglasses or contact lenses. Cataract surgery is success
ful in about 95 percent of all cases. In the past, people were advised to wait u
ntil their vision had deteriorated to about 20/200, which would seriously impact
their vision. Today, because surgical techniques have improved and the risks fr
om cataract surgery are much lower, surgery is generally recommended when catara
cts begin to affect your quality of life or interfere with your ability to perfo
rm normal daily activities. Surgery is done on only one eye at a time. It's gene
rally done on an outpatient basis, usually with local anesthesia. Recovery is fa
st. You can often resume your normal
daily activities beginning the night of your surgery. You may be able to start d
riving again the day after surgery, after your postoperative checkup. Cataracts
can't be cured with medications, dietary supplements, exercise or optical device
s. In the early stages of a cataract when symptoms are mild, a good understandin
g of the condition and a willingness to adjust your lifestyle can help. Some sel
f-care approaches, such as using a magnifying glass to read or improving the lig
hting in your home, may help you deal with the effects of having a cataract.
Lifestyle and home remedies
You can try a few simple approaches to deal with symptoms of cataracts until you
decide to have surgery:

If you have eyeglasses or contact lenses, make sure they're the most accurate pr
escription possible. Use a magnifying glass to read. Improve the lighting in you
r home with more or brighter lamps, for example, lamps that can accommodate halo
gen lights or 100- to 150-watt incandescent bulbs. When you go outside during th
e day, wear sunglasses to reduce glare. Limit your night driving.
Self-care measures may help for a while, but as the cataract progresses, your vi
sion may deteriorate further. When vision loss starts to interfere with your eve
ryday activities, consider cataract surgery.
Prevention
Regular eye exams remain the key to early detection. If you're over age 65, sche
dule eye exams at least every other year. Although most cataracts occur with age
and can't be avoided altogether, you can take steps to help slow or possibly pr
event the development of cataracts:

Don't smoke. Smoking produces free radicals, increasing your risk of cataracts.
Eat a balanced diet. Include plenty of fruits and vegetables in your diet. Eatin
g lots of fruits and vegetables may have a modest effect in preventing cataract
development, though this hasn't been definitively proved. Protect yourself from
the sun. Ultraviolet light may contribute to the development of cataracts. Whene
ver possible, wear sunglasses that block ultraviolet B (UVB) rays when you're ou
tdoors. Take care of other health problems. Follow your treatment plan if you ha
ve diabetes or other medical conditions. If you have a chronic illness, it's esp
ecially important that you take other preventive steps, such as wearing UVB-bloc
king sunglasses when outdoors and not smoking.
Researchers are continuing to explore new ways to prevent and treat cataracts, s
uch as developing medications that would reduce or eliminate the need for surger
y. But, until
such a treatment exists, your chances of fully restoring your vision with catara
ct surgery are excellent if you have no other eye diseases.