Sight For Sore E Cataracts Should Be Removed Only If They’Re Causing Problems

The blurred vision caused by cataracts is a common malady that will affect most people as they age. But despite this fact, there are still many misconceptions about cataracts and what causes them.

A cataract is simply a clouding of the normally clear lens of the eye; it is not a film over the eye. It can’t be spread from one eye to the other and it does not cause irreversible blindness.

The most common type of cataract is caused by aging, but cataracts can also be the result of medical problems such as diabetes, injuries to the eye, and long-term use of certain medications, such as steroids.

Symptoms of cataracts include a gradual blurring of vision, double vision in one eye, poor night vision, fading or yellowing of colors, and light sensitivity.

Once cataracts are diagnosed, what next? Optometrists and ophthalmologists recommend that seniors wait until they can no longer see well enough to do their normal activities before having surgery.

“Cataracts are a slowly progressive problem and just because you’re told you have one, (that) doesn’t mean that it’s ready to be removed,” says Spokane optometrist Mark Everett. “It should be removed when it’s causing problems for you.”

Until surgery is necessary, the recommended course of treatment is simply regular eye examinations and monitoring of the cataracts, says Spokane ophthalmologist Dr. Michael Cunningham. In fact, many cataracts will never develop enough to require surgery. “Most people make it through life without having anything done about it,” says Cunningham.

Cataract surgery itself is a short procedure that takes about 30 minutes. A small incision is made in the eye so an instrument called a phaco-emulsifier can be inserted. The instrument uses ultrasound to break up the lens and the pieces are gently suctioned out. When the cloudy lens has been completely removed, an artificial lens made of high-grade plastic or silicone is inserted.

The self-sealing incision requires no stitches and people can resume their normal activities the next day, with the exception of some activities such as golf or yard work that put pressure on the eye.

The surgery is relatively easy on patients, who are often awake during the procedure. The eye is numbed with an injection, topical anesthetic, or a combination of the two. The level of anesthesia is so light that some patients remain awake, while others simply doze off. But even those who are awake aren’t able to see much.

“Most people say that they see interesting reflections and colors,” says Cunningham. “They’re not seeing anything bothersome.”

After surgery, patients are given an injection of antibiotics in the eye to prevent infection. A metal shield is taped in place over the eye overnight and is worn while sleeping for the first week to prevent damage to the eye. Patients must also put antibiotic drops in their eye four times a day for six weeks to prevent infection.

The actual risk of infection is only 1 in 10,000, but infections can be so devastating to the eye that extraordinary precautions are taken to prevent them from occurring, says Cunningham.

“We take all these precautions - keeping things sterile and giving antibiotic injections and drops - because the eye doesn’t fight infection well if it gets established, and we do everything we can to prevent it,” says Cunningham.

Once the eye has healed, the amount of vision restored depends on the overall health of the eye. If the eye is healthy, patients should be able to see well with glasses. “If their retina is healthy and their nerve is healthy, they’ll get 20/15 or 20/20 vision,” says Cunningham. “They can manage well with just a regular pair of glasses.”

Donald Hall has been pleased with the results of his cataract surgery in February. Though his eye tested at 20/20 without glasses, he still must wear reading glasses to correct for the cataract in his other eye. But Hall doesn’t mind, he’s just happy to be reading again.

“It was getting to where it was hard to read,” says Hall, who runs a farm just outside of Colfax. “I’ve read a couple books since the surgery.”

“It’s just like when you’re a young person.”

Hall, 69, plans to have the cataract removed from his other eye next winter and is looking forward to it.

“I hope it come out as good as this one,” he says.

1. Facts about cataracts More than 12.9 million Americans age 40 and older have cataracts. More than 1.4 million cataract surgeries are performed each year. Medicare pays more than $3.4 billion per year for cataracts surgery. Cataract surgery is the most common surgical procedure performed on people in the Medicare system. The maximum allowable charge for the surgery is $805 for Medicare patients, which includes 90 days of post-operative care. Patients covered by other insurance programs may pay a different rate. Sources: The American Academy of Opthalmology; and “Vision Problems in the United States,” a 1990 study prepared by Prevent Blindness America.

2. Eye professionals Along with confusion about cataracts and what causes them comes the question of who to see about them. There are a variety of eye professionals in the community who specialize in different aspects of eye care. Ophthalmologists (M.D.) perform cataract surgeries. Typical training includes four years of medical school and four years of residency in ophthalmology. Ophthalmologists also perform routine eye examinations for prescription lenses. Optometric physicians (O.D.) perform eye examinations for prescription lenses. Typical training consists of four years at a college of optometry, with training in how to diagnose various eye diseases and vision disorders. An optometric physician is licensed by the state to provide primary eye care services. Opticians can manufacture and fit glasses and contacts. The amount of training can vary from state to state. In Washington, licensed opticians typically participate in a three-year apprenticeship program where they receive 6,000 hours of training before taking a licensing exam.