Cataracts: A Beginner's Guide

Quick summary

Cataracts develop naturally over time. In fact, more than half of Americans age 80 or older either have a cataract or have had cataract surgery. Except in the most developed countries, cataracts are the leading cause of blindness worldwide. If your parent has a cataract, it means he has a cloudy area on the lens of his eye. How will cataracts affect your parent's vision, and how can you help him cope?

The good news about cataracts

With surgery, they can be reversible.

What happens with cataracts

A cataract is a clouding of the eye's lens. Light passes through the lens (located behind the iris and the pupil) to the retina, which sends an image to the brain. If the lens isn't clear, the image reaching the retina will be blurry.

This clouding happens over time. The eye's lens is made up of protein and water, and when protein cells break down and clump together on the lens they form a cataract, causing blurred vision. If the cataract gets larger, it clouds more of the lens, making vision increasingly difficult. The lens may also become thicker and more rigid, and it may change from clear to a yellow-brown that tints what your parent sees.

Cataracts are classified according to where they occur in the lens, and the type affects the symptoms your parent will experience.

• If he has a nuclear cataract, for example, it's forming in the center of the lens.
• A subcapsular cataract appears at the back of the lens.
• A cortical cataract occurs on the edges of the lens (but eventually sends streaks to the center of the lens).

Vision loss from age-related cataracts is most common in people over age 60, though age-related cataracts can form much earlier. Some experts think the lens changes over time because of free radicals (from smoking and ultraviolet light, for example) as well as from general wear on the protein fibers.

Your parent may have a cataract in one or both eyes, though it's most likely that he'll develop cataracts in both eyes.

Risk factors for cataracts

• Age This is the biggest risk factor.
• Eye injury Trauma to the eye (from a hard blow, cut, or puncture) can cause a cataract to form, sometimes years later.
• Heredity Those whose relatives have had cataracts are more likely to develop them.
• Certain medications Steroids, for example, have been linked to cataract formation.
• Certain lifestyle choices High alcohol consumption and smoking are known to increase cataract risk.
• Some surgeries Surgery for retinal detachment, for example, can increase risk.
• Certain health conditions Diabetes and high cholesterol, for example, increase risk.
• Exposure to radiation and sunlight Exposure to some kinds of radiation and ultraviolet rays increase risk.

What the world looks like to your parent

Imagine looking out a cloudy pane of glass. That's much like the lens of an eye with a cataract -- the picture your parent sees is blurry. And the dirtier the glass (or more clouded the lens), the duller the picture.

Early on your parent may not detect a difference in his vision, but if the cataract progresses, he may notice haziness. In addition to blurred vision, your parent may become sensitive to glare (though he'll also need brighter light to see) or experience poor night vision or double vision.

He may need frequent changes in his glasses or contact prescription, and he may see a halo around lights. Objects may appear to have a yellow or brown cast, and he may have trouble distinguishing colors like blues and purples. Eventually he may have trouble reading.

To see an image as it might appear to someone with a cataract, go to the National Eye Institute website.

Methods of treating cataracts

No medication is available for the treatment of cataracts. In most cases, however, a simple surgical procedure can reverse vision loss. Cataract surgery is one of the most common and safe surgeries performed in the United States, and it improves the vision of about 90 percent of those who undergo it.

The most common cataract procedure is phacoemulsification, or small-incision cataract surgery, in which the doctor inserts a small ultrasound device into the eye. The ultrasound waves soften the lens and break it up so that it can be removed by suction. The other method, called extracapsular surgery, involves making a larger incision on the side of the cornea. The doctor removes the cloudy part of the lens in one piece and then finishes removal of the lens by suction.

Once the cloudy lens is removed, it's usually replaced with an artificial lens, called an intraocular lens (IOL). If your parent can't have an artificial lens (because he has another eye disease, for example), then glasses or a soft contact lens will be used. If both eyes need cataracts removed, the eye surgeon will do the surgery on one eye at a time, usually about a month or two apart.

Your parent's cataract diagnosis doesn't necessarily mean he needs surgery right away, though. If his vision is only a bit blurry but he can still read, drive, and perform his ordinary tasks, he may be able to get along fine for a while. And delaying the surgery normally won't make it more difficult later or cause any long-term damage.

Ways to help your parent deal with cataracts without surgery:

• Make sure that his eyeglass or contact lens prescription is as accurate as possible.
• Help him purchase antiglare sunglasses.
• Experiment to see what kind of lighting is best for him at home. Generally, increasing the lighting or using brighter lighting is beneficial, although glare may bother him.
• See if a magnifying glass helps him with his reading.
• Encourage him not to drive at night.

Some experts believe that antioxidants -- like selenium, vitamin A, and vitamins C and E -- can play a role in stemming cataract development. Ask your parent's eye doctor what she thinks.