Let’s put cataracts in focus
Every year, some 28 million cataract surgeries are performed around the world — that’s about 60,000 every day! — and in the U.S., it’s 4 million annually.
Cataract surgery is the most common surgical procedure and one of the safest, with a 99% success rate, yet cataracts remain the most common cause of vision loss, and the most treatable.
The nonprofit Prevent Blindness designated June as Cataract Awareness Month and is providing informational resources for patients and professionals at preventblindness.org. Let’s do a quick rundown on what cataract is, what causes it and the benefits and risks of treatment.
Most people think of cataracts as only affecting the elderly, but symptoms and vision loss from cataracts can start as early as age 40. The likelihood of developing cataracts doubles in your 50s and doubles again in your 60s. By the age of 80, more than 50% of Americans have cataracts. (Shakespeare knew what was happening. In “As You Like It,” he characterizes the seventh stage of life as “sans eyes,” among other senses.)
As we age, the proteins and fibers located in our eyes’ natural lenses begin to break down. When this happens, the lens starts to cloud and we may find things out of focus, have difficulty with close-up work and experienced diminished vision in low light. Headlights and streetlights may appear to have halos around them.
Besides the mere act of aging, factors that hasten cataracts include smoking, long-term exposure to UV rays from the sun, certain diseases (like diabetes), eye inflammation, maternal German measles, long-term steroid use and eye diseases. And yes, there is a hereditary factor. Babies can even be born with them.
There’s no pain associated with cataract, and their development can be so gradual that you don’t realize what’s happening. It’s likely that the only way you’ll know you have them is by getting an annual vision exam. At some point, your eye doctor is likely to tell you it’s time to get them treated.
Surgery is the only effective treatment. A French doctor back in 1747 is credited with developing a method of cataract removal, but I certainly wouldn’t have wanted to be one of his patients!
Today’s cataract surgery has evolved into a brief outpatient procedure that may take place in a doctor’s office, but more often in a surgery center or hospital. Using a laser, the surgeon makes a tiny slit in the cornea and then uses phacoemulsification to dissolve the clouded lens and make it easier to remove.
The surgeon then implants a new, clear lens. A lot of patients opt for intraocular lenses that correct their vision for distance, like driving, and close vision, like for reading, though it’s likely glasses will still be needed. These single-vision lenses are covered by Medicare and most Medicare Advantage Plans. Toric lenses, which correct astigmatism, require several thousands of dollars in out-of-pocket costs, however.
Sounds easy enough. What could possibly go wrong?
Well, some medical conditions such as advanced macular degeneration, a detached retina or severe illness, preclude some people from having cataract surgery. And, as with any surgery, there are potential complications though they are extremely rare — a few 10ths of a percent of all surgeries. Some things to watch for:
Infection: This may cause sensitivity to light, pain, redness or vision problems. It’s treatable with antibiotics.
Inflammation and swelling: A little is normal, but if there’s more than is normal, it’s treatable with eye drops.
Detached retina: With cataract surgery, there’s a slightly higher chance that the retina pulls away from the back of the eye. This is an emergency that could cause vision loss. If you feel as if a curtain has fallen over part of your eye, have new floaters or see flashes of light, see your eye doctor immediately.
Lens fragments: When the cloudy lens is removed, some pieces may fall into your eye and get left behind. Small ones aren't a problem, but bigger ones can be. Surgery may be required.
But it’s also risky to ignore cataracts. When left to their own devices, cataracts become denser and further impair vision. They may become more difficult to remove and more likely to cause complications during surgery.
People who have had cataract surgery often remark afterward that they didn’t realize how impaired their vision had become.
Hold on to that thought. It’s a life-changing procedure, especially for those having a hard time seeing clearly as they age.
• Teri (Dreher) Frykenberg is a board-certified patient advocate. A critical care registered nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her book, “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” is available on Amazon. She is offering a free phone consultation to Daily Herald readers; email her at teri@northshorern.com.