What to Know About Cataracts and Cataract Surgery

Diagnosis

If you have a constellation of these symptoms, see a doctor for an eye exam. Experts recommend that people over age 65 get checkups every year or two; those younger should have their eyes checked at least once every two years — more if they have certain health issues. “If you’re on corticosteroids, you should have regular eye exams,” says Dugan. “You might not even be aware that it is starting to affect their vision.”

Cataracts are usually identified by a thorough exam that includes a visual acuity test, where you read letters of varying sizes off an eye chart. This measures the sharpness and clarity of your vision, and how well you can see at various distances.

You’ll also be given a dilated eye exam, in which drops are used to dilate and widen the pupils, offering the physician a clearer view of the back of your eye. Your doctor will then use a slit-lamp microscope to look for signs of cataracts, as well as examine the retina and optic nerve for signs of eye damage and other problems such as glaucoma.

Treatment

When cataracts are in their early stages, patients can find some relief with new eyeglass prescriptions, brighter lighting, antiglare sunglasses or magnifying lenses. But once the cataract progresses and symptoms are interfering with the activities of daily living — reading, driving, watching TV — then surgery to remove the cataract is the only alternative.

“Don’t get fooled by scams,” says UCLA’s Bartlett. “I’m constantly seeing ads for eye drops that purport to get rid of cataracts. The only treatment to remove cataracts is surgical.”

Before surgery, your surgeon may have you see your family doctor to have a thorough medical exam to make sure you’re stable enough for surgery, says Ravi Goel, a New Jersey eye surgeon and clinical spokesperson for the American Academy of Ophthalmology. Certain heart and lung conditions, as well as dementia, may make patients poor candidates for surgery.

Surgery — what to expect

Preparations: A week before surgery, your doctor will test your eyes to measure the curve of the cornea and the size and shape of your eye. The information will help the surgeon choose which type of artificial lens — known as an intraocular lens (IOL) — is right for you. You may also need to temporarily stop taking certain medications. If you have cataracts in both eyes, each eye will be treated at a separate time to allow for healing.

Procedure: The surgery itself, which usually takes less than 30 minutes, is generally done on an out-patient basis under local anesthesia that numbs the nerves in and around the eye. The procedure involves removing the cloudy lens and replacing it with a clear, plastic one. The eye surgeon makes a tiny cut in the cornea, the clear dome-shaped surface that covers the front of the eye. A tiny probe is inserted through the cut. Using ultrasound, the probe breaks up the cloudy lens into very small pieces, which are suctioned out.

The artificial lens is inserted through the cut and positioned inside the lens capsule, which holds the new lens in place. Sometimes, the cut in the eye will need a stitch, but it is normally small enough to heal on its own. The operation can be done using traditional surgical tools, or it may be laser-assisted.

Refractive surgery:

While you’re under the knife, the surgeon can also do what is called refractive surgery, a procedure that corrects vision issues, such as nearsightedness or astigmatism. But note that insurance and Medicare don’t cover these added procedures.

Typically, out of pocket costs start at $1,000 per eye for astigmatism and $2,000 for multifocal implants, according to Dugan of the Wills Eye Hospital.

Complications: After surgery, most people’s vision improves quickly and colors will be more vivid. They can resume their normal activities when they get home, although they may need to wear a patch over the eye. Itching and mild discomfort are normal and eyes may be sensitive to light and touch. But within a day or two, unpleasant aftereffects should diminish. For a week or so after surgery, patients will need to use eye drops to help with healing and decrease the risk of infection, and may wear an eye shield or eyeglasses to protect their eyes.

As with any surgery, there is a possibility of complications, such as infection, bleeding, inflammation, double vision and high or low eye pressure. In rare instances, retinas can become detached. However, these problems can usually be treated with prompt medical attention. Occasionally, the eye tissue that encapsulates the IOL can cloud the new lens — a condition that is called after-cataract, which can develop months or even years after the surgery. This normally can be corrected with a laser.

Prevention

If you smoke, stop; limit alcohol consumption and keep diabetes under control. When you’re outside, wearing a hat and sunglasses with UV400 or 100 percent UV protection to block harmful ultraviolet sunlight may help delay their onset. “Long-term exposure to UV light does increase risks,” says Shahzad Mian, an eye surgeon at the Kellogg Eye Center at the University of Michigan in Ann Arbor. “People who live in equatorial climates get more advanced cataracts and at a younger age because of the more intense sunlight.”

Doctors recommend cutting out sugary carbohydrates and consuming green, leafy vegetables, fruit and other nourishing edibles that contain natural antioxidants because many believe oxidative damage from sunlight and environmental exposures damages the lens of the eye.