Cataracts are cloudy areas in the lens of the eye. They normally develop over the course of a person’s life and nearly everyone over 60 years of age has some degree of cataract formation. When cataracts impair vision, it is time to trade in the clouded lens for a crystal clear replacement.
When I explain cataract to my patients, I tell them that cataract is not a disease that only a few people get, like glaucoma or macular degeneration. Rather, it is an aging change that gets everyone eventually. Cataract is merely clouding of the lens of the eye – just like brown or blonde hair will turn gray, and smooth skin becomes wrinkled, so too will a clear lens become cloudy.
In most people, cataracts start developing around age 60, and the average age for cataract surgery in the United States is 73. However, changes in the lenses of our eyes start to affect us in our 40’s. When we are young, the lenses in our eyes have two basic qualities: (1) they are very transparent, and (2) they are very flexible. While our lenses lose transparency throughout our 60’s and beyond, they lose the other quality, flexibility, much earlier. A baby’s lens is as soft and flexible as a bag of honey, a middle-aged person’s lens is more like a gummy-bear, and once we’re 60, our lenses are as inflexible as a piece of plastic or glass. This loss of flexibility is why we start to need bifocals when we’re in our 40’s, and we get progressively more and more dependent upon stronger and stronger bifocals over the next 2 decades. Once we’re 60, our lens is as hard as it is going to get, and now will start to lose that other quality, its transparency. This loss of transparency results in clouding of the lens, and we call that cataract. As you can see, cataract is really the continuation of a process that started decades before.
Modern cataract surgery involves removing the clouded natural lens and implanting a clear replacement lens. The standard replacement lens delivers vision in best focus at a single distance (far distance is most common). Most patients who receive a standard lens require glasses for reading and other near activities. When astigmatism is present, patients require glasses for clarity at both far and near distances.
For some cataract patients, freedom from glasses and contact lenses is important. Associated Eye Care offers the latest advanced technology lens implants. Multifocal and Extended Depth of Focus lenses reduce reliance on reading glasses while maintaining excellent distance vision. Toric lenses improve clarity and reduce the need for glasses by correcting astigmatism.
Most patients with early cataracts may not have a lot of symptoms. As cataracts worsen, many people will complain of increased glare while driving at night, the fact that colors look muddied or washed out, or that things just don’t look as sharp as they used to. It is not uncommon for patients’ glasses prescriptions to change as cataracts develop, and the treatment for early cataracts is often to just prescribe a new pair of glasses.
Many patients do not notice that their cataracts worsen for two reasons. First, cataracts develop slowly so their effects on a person’s vision is gradual and not very dramatic. Second, cataracts most often affect the lenses in a person’s two eyes similarly, so when they compare the vision in one eye to the other, they often cannot tell that anything is amiss. For these reasons, we recommend everyone have a full, dilated eye examination every year starting around age 55.
Patients will often ask me about when their cataracts will become “ripe”. The concept of a “ripe” cataract goes back to the type of surgery that was done in the mid-1900’s. At that time, the cataractous lens was removed from the eye as a single, intact piece, like removing the pit from an avocado. It was beneficial for the cataract to be very hard so that the surgeon could remove it without it breaking up into small pieces, and the term “ripe” was adopted for this reason.
Starting in the 1980’s, the technique of cataract surgery changed to phacoemulsification, where the cataractous lens is broken up (emulsified) within the eye, and removed in microscopic pieces. Because the lens is broken down in this way, it is no longer advantageous for the surgeon to wait until it is very hard, and so we have gone away from describing a cataract in terms of its “ripeness”. In the 21st Century, we recommend cataract surgery according to a patient’s complaints. I tell my patients that in the old days, surgeons would tell patients when it was time for cataract surgery, while now surgeons wait for our patients to tell us when it is time for cataract surgery.
Some patients will put off cataract surgery for years or even decades after symptoms have developed because they have a fear or aversion to having the procedure done, or they just don’t recognize that their vision has diminished. Although delaying cataract surgery for too long can cause glaucoma or inflammation within the eye, or make eventual cataract surgery technically more difficult to perform, it is rare for cataracts to develop this far in modern industrialized countries.
Don’t just take our word for it! Hear from our patients.
