Cataract Surgery: A Change Of Lenses For Aging Eyes

By Jan Howard

A cataract is a clouding of the lens in the eye that affects vision. Dr Sarah R. Baroody, an ophthalmologist, of Eye Care of Danbury, LLC in Danbury, presented an overview of the causes of cataract and cataract surgery on November 8 at the Newtown Senior Center on Riverside Road.

Dr Baroody completed medical school at SUNY in Syracuse, N.Y., and received her ophthalmology training at Saint Louis University.

“A cataract is when the lens of the eye becomes cloudy or turns yellow and dull and becomes hard,” Dr Baroody explained. “It is not a film over the eye.”

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye. In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain. The lens must be clear for the retina to receive a sharp image.

Persons with cataracts will experience blurred vision in addition to being affected by bright lights at night or when walking into a sunny area, she said.

The cataract causes the light to become scattered. “It’s too much information,” Dr Baroody said. “The eyes can also see double or triple,” she added. Colors may seem faded.

The condition is painless, she said. “It would only be bothering your vision. It would not be hurting.”

Not everyone gets cataracts, Dr Baroody. However, if you live long enough, you will get cataracts. They occur mostly when people are in the 60s but can be symptomatic as early as the 50s. “By the time people are in the 70s, they have noticed cataracts,” she said.

Age-related cataracts develop in two ways. Clumps of protein reduce the sharpness of the image reaching the retina. When a cataract is small, the cloudiness affects only a small part of the lens. Cataracts tend to grow slowly, so vision gets worse gradually. Over time, the cloudy area may get larger, the cataract may increase in size, and vision may get duller or blurrier.

The clear lens may also slowly change to a yellowish/brownish color, adding a brownish tint to vision. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. If discoloration is advanced, a person may not be able to identify blues and purples.

In addition to age, other risk factors include certain diseases, such as diabetes, and medications taken for them, such as steroids, she said. Smoking and alcohol use can make them worse. An injury to the eye can cause cataracts to form rather quickly. Prolonged exposure to ultraviolet sunlight also puts a person at risk for cataract.

“Only surgery can help,” Dr Baroody said. “Since the lens is inside the eye, you have to take it out.”

Cataract surgery has changed over the last 20 to 30 years, she said. Years ago, a person had to be in the hospital for two weeks. Today, a patient is home half an hour after the surgery.

In the past, a large incision was necessary to take out the entire cataract, Dr Baroody said. In 1949, Dr Howard Ridley of the Royal Air Force made a contribution that revolutionized cataract surgery.

Previous cataract surgery removed the lens entirely. Dr Ridley discovered a new synthetic lens after testing fighter pilots who had plastic in their eyes as a result of combat during World War II. He found they suffered no ill effects from the plastic. However, Dr Baroody said, it took 20 years to begin using the synthetic lens.

Phacoemulsification, discovered by Dr Charles Kelman, also helped to revolutionize cataract surgery. During cataract surgery, tiny instruments are used to break apart and remove the cloudy lens from the eye.

“It breaks the cataract into little pieces and removes it as a liquid,” Dr Baroody said. “The incision is very small.”

Then, a plastic, acrylic, or silicone intraocular lens is implanted in the eye to replace the natural lens that was removed. “The synthetic lens is round, with two arms to hold it in place for the rest of your life,” she said.

Dr Baroody said some doctors put stitches in the eye, but the small wound heals itself.

Cataract surgery is one of the most common operations performed in the United States every year, with about one and a half million performed. The surgery is 95 percent safe, she noted.

“In my experience, there is a one percent chance of problems,” Dr Baroody said. These might include bleeding outside the eye or swelling either on the front or rear surfaces of the eye. There is a one percent risk of retinal detachment, she noted.

Monitoring by a physician includes postsurgical visits and antibiotic and steroid drops to prevent complications.

New glasses are often required. In about 90 percent of cases, people who have cataract surgery have better vision afterward.

When is the right time to have the surgery? “The answer should lie between you and your doctor,” she said. “There should be joint discussion.”

She suggested a question to ask oneself. “Does my vision or glare affect my daily life? That’s when you decide ‘I want to have it done,’” she said.

If a person has mild cataracts, it is not worth doing, Dr Baroody said. “Wait until it’s significant that it’s worth doing the surgery.”

Sometimes one eye is affected more than the other, she said.

Cataract surgery is a quick procedure, Dr Baroody said. A patient is given anesthesia at the hospital to make them sleepy and comfortable, plus a numbing eye drop is administered.

“Most people don’t feel anything,” she said. The cataract has no nerves so only the surface of the eyes is felt.

The patient must lay flat unless there are breathing or back problems, she said. He or she is then draped head to toe except for the eye. “There is a big microscope over the eye, but you don’t see the surgery or feel it happening.

“Some people fall asleep, others hear everything that goes on,” she said.

Following the surgery, Dr Baroody said, “People in the hospital will make sure you have something to eat or drink” before discharge.

“You need someone to drive you,” she cautioned.

According to a pamphlet from the National Eye Institute, by age 80, more than half of all Americans have either a cataract or have had cataract surgery. A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

The National Eye Institute is conducting and supporting studies focusing on factors associated with development of age-related cataract, including effect of sunlight exposure, vitamin supplements, which have shown varying results in delaying progression of cataract, and genetic studies.

To protect vision, wear sunglasses and a hat with a brim to block ultraviolet sunlight. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. Eat green leafy vegetables, fruit, and other foods with antioxidants.

A comprehensive dilated eye exam is recommended every two years if age 60 or older.