Simple, Painless Cataract Surgery Clears the Fog

One of the unfortunate but common aspects of getting older is blurry vision due to cataracts that cloud the lens at the rear of the eye.

But thanks to advances in medicine, treatment of cataracts has become much easier and less painful, says Bhavna Sheth, MD, an ophthalmologist at The Eye Institute of the Medical College of Wisconsin and Froedtert Hospital and Associate Professor of Ophthalmology at the Medical College. The increasing ease of working with cataracts should allay many fears about the pain and discomfort involved in old procedures, she says.

Living in a Fog
"A cataract is the gradual clouding of the natural lens at the back of the eye, so it is unable to focus light, and your vision gets blurry," explains Dr. Sheth. The clouding is thought to be caused by a buildup of proteins and water on the lens.

"The result of a cataract, patients tell me, is the sense of looking at things through a fog, or seeing through a dirty windshield," Dr. Sheth says. "There may also be symptoms like glare from bright lights such as headlights, difficulty reading, or difficulty seeing enough distance to drive safely."

While cataracts often affect people over 60, they can occur at any age, even among babies who have a congenital problem. Conditions such as diabetes and the use of steroids (now common in treating ailments like asthma and arthritis) may contribute to the development of cataracts. Eye injuries and radiation treatments are other factors contributing to cataracts, says Dr. Sheth.

Three Types, Varied Symptoms
Cataracts occur in three principal types, defined by their location on the lens. The nuclear variety causes a generalized blurring of vision across the lens. The cortical type produces a set of blurry "spokes" on the lens. The posterior subscapular version of a cataract generates a great deal of glare.

When a cataract starts to interfere with the vision required for daily activities like reading, driving, work, or hobbies, then tests are called for. At that point the patient and ophthalmologist can use the test results to determine the seriousness of the cataract and which course of treatment is best.

Often, a change in the glasses prescription will be sufficient," says Dr. Sheth. "In other cases, the use of tinted lenses or sunglasses will make a big difference in overcoming the cataract's effects."

Surgery Typically Less Than 20 Minutes
Cataracts that significantly impair vision might require surgery to overcome. However, "It's up to the patient to decide upon surgery," Dr. Sheth emphasizes. "Unlike other medical procedures, the patient can usually determine if and when they want cataract surgery. Only rarely does the doctor insist."

One enormous factor changing the way that patients view cataract operations is the painlessness and simplicity of modern procedures. In the relatively recent past, cataract surgery could be painful and recovery fairly lengthy, with plenty of discomfort.

"But now cataract surgery is a day surgery," notes Dr. Sheth. "We most often use just a 'topical' or local anesthetic, and are usually done in less than 20 minutes."

Despite the brevity of the cataract surgery, minor miracles are performed in that short span of time. "We typically make an incision and remove the lens. Then we replace the lens by inserting an implant made of acrylic or silicone, based on measurements we've done beforehand."

There is a very high rate of success, with complications occurring less than 5% of the time. Still, "Because of that threat, we always want to see how much a cataract affects day-to-day activities before we move ahead with surgery." These complications, although rare, could include bleeding or swelling, retinal detachment, or infection.

Although cataracts often seem to be an uncontrollable part of aging, patients can take a few simple steps to make cataracts less likely, says Dr. Sheth. Giving up smoking eliminates a major risk factor for cataracts. Wearing UV-blocking sunglasses when outdoors is another important protective step. Finally, a well-balanced diet with plenty of green vegetables is also vital.

While there is much discussion of certain vitamins being helpful, the evidence thus far is not clear.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.