I went to my eye doctor today. For many years, I was going regularly for eye exams. When I was in my 30s, I underwent several eye surgeries in an attempt to correct my lazy eye. It wasn't the easiest to find a new doctor each time I moved out of the area, but I did my best. I would typically get contacts and glasses. However, I wasn't able to go to an eye doctor over the last four years, until today. This time only to get glasses.
The optometric technician had me read the eye chart, measured my eye pressure, used the autorefractor and dilated my pupils before bringing me to the exam room with the doctor.. After looking into my eyes with a bright light, the doctor told me I had cataracts in both eyes. He then used the phoropter machine, does this or this look better—only once on each eye! Neither looked better! My glasses will be ready in about two weeks.
I knew the basics of cataracts, but I wanted to find out more. Hence, this post. However, if, after reading the information I compiled, you have concerns about your vision or symptoms, it is important to consult with a qualified optometrist or ophthalmologist for personalized advice and treatment. This information is purely for educational purposes.
What Are Cataracts?
Cataracts occur when the clear lens of the eye becomes cloudy, leading to vision impairment. This cloudiness results from the clumping of proteins in the lens, which prevents light from passing through effectively. Cataracts can affect one or both eyes but do not spread from one eye to the other.
According to the World Health Organization (WHO), cataracts are the leading cause of blindness globally, accounting for 51% of all cases of blindness. In the United States, cataracts affect more than 24 million adults over the age of 40. Women account for 60% of cataract cases worldwide. In some developing countries, the prevalence of cataracts is significantly higher due to limited access to surgery and healthcare.
Age
Cataracts are strongly associated with aging. While they can develop at any age, they are primarily seen in older adults. The lens of the eye naturally changes over time, becoming thicker and less flexible. These age-related changes contribute to the formation of cataracts.
Early Onset (Under 40 Years Old):
Cataracts can develop in younger individuals due to specific causes.
Genetics: A family history of early cataracts increases the risk.
Trauma: Eye injuries can cause early cataract formation.
Medical Conditions: Diabetes, prolonged use of corticosteroids, and certain infections can trigger cataracts at a younger age.
Middle Age (40-60 Years Old):
The early stages of cataract development often begin after the age of 40.
At this stage, cataracts may not cause noticeable symptoms.
Many people in this age group are still unaware they have cataracts until they have an eye exam. It is recommended to have an eye exam every two years.
Older Adults (60 Years and Above):
After age 60, cataracts become more common and are more likely to cause significant vision impairment. Individuals should get an eye exam every year.
By age 75, approximately 50% of people in the U.S. have cataracts or have undergone cataract surgery.
By age 80, the percentage rises to around 70-75%.
As we age, the proteins in the lens of the eye break down and clump together, causing cloudiness. This process accelerates after 60, making cataracts a leading cause of vision impairment in older adults. Early attention can make a difference in treatment options.
Gender
Research indicates that women are slightly more likely to develop cataracts than men.
Hormonal Changes: After menopause, women experience a decrease in estrogen levels. Estrogen may have a protective effect on the eye, reducing oxidative stress.
Postmenopausal women are at higher risk due to the loss of this protection.
Life Expectancy: Women tend to live longer than men, and cataracts are more likely to develop with age. As a result, more women reach the age where cataracts are prevalent.
Access to Eye Care: In some countries, women may have less access to healthcare services, delaying cataract diagnosis and treatment.
Cultural and Regional Differences: In certain cultures, gender roles may influence the likelihood of seeking eye care. Studies have found that women in some regions are less likely to undergo cataract surgery compared to men, even when they have similar levels of vision impairment.
Detailed Symptoms of Cataracts
It is important to stay aware of any changes in your vision, as cataracts often develop slowly. If you experience any of the listed symptoms, consulting an eye care professional can help determine the next steps in managing your eye health. Early detection can help manage the condition and determine the best course of action, including whether cataract surgery is right for you.
Blurred or Cloudy Vision: Cataracts cause the lens of the eye to become cloudy, preventing light from passing through clearly. This creates a blurred or foggy effect, similar to looking through a frosted or dirty window.
Vision may be slightly hazy and might not seem significant at first.
Over time, the cloudiness worsens, making it harder to see objects clearly, especially in low light.
Sensitivity to Light and Glare: People with cataracts often find themselves more sensitive to light, especially bright or harsh light sources.
The sun can cause discomfort and make outdoor activities challenging.
Headlights from oncoming traffic can create a blinding glare, making it difficult to drive safely at night.
The cloudy lens scatters light instead of focusing it directly on the retina, increasing glare and sensitivity.
Difficulty Seeing at Night: Cataracts reduce the amount of light that reaches the retina, making it harder to see in dim or dark environments.
Colors and details become harder to distinguish at night.
The difference between objects and their background is less noticeable, increasing the risk of accidents.
Fading or Yellowing of Colors Cataracts can cause colors to lose their vibrancy. Everything may start to look dull, faded, or even yellowish. The proteins that clump together to form the cataract can also cause a yellow or brown tint in the lens, which distorts the perception of colors.
In the early stages, you may notice subtle changes, like whites appearing slightly off-white.
When cataracts are in the advanced stages, colors like blues and purples may become harder to distinguish.
Double Vision in One Eye (Monocular Diplopia): Double vision, or seeing two images of the same object, can occur in the affected eye. This is known as monocular diplopia because it happens even when the other eye is closed.
Regular double vision (binocular diplopia) disappears when one eye is closed. Cataract-related double vision doesn’t.
Letters may appear stacked or shadowed, making reading challenging.
Frequent Changes in Eyeglass Prescriptions: As cataracts develop, your vision fluctuates. You may need new glasses or contact lenses more frequently.
Some people experience a temporary improvement in near vision, known as "second sight," before their vision deteriorates again.
You may feel like your glasses are never "just right," despite changing prescriptions regularly. This can be frustrating and expensive.
Halos Around Lights: Halos appear as bright rings or circles around light sources, especially at night.
Common around streetlights, car headlights and lamps.
This symptom can make night driving particularly dangerous, as halos can obscure the road and other vehicles.
The clouding of the lens causes light to scatter, creating the halo effect.
Vision Dimming or Dullness: Many people with cataracts describe their vision as looking dim, as if they’re wearing sunglasses indoors.
You may struggle to read in normal lighting
Find it difficult to see details in photos or screens.
Color Perception: Everything might look "grayed out" or lacking vibrancy.
Eye Strain and Headaches: As your vision worsens, you may squint more or struggle to focus, leading to eye strain and headaches. Common triggers include prolonged reading, using digital screens, and driving, especially at night.
Types of Cataracts
Most Common Type
Nuclear Cataracts: The are the most common type of cataract worldwide. It primarily affects people over the age of 60 and is closely linked to the natural aging process. This type develops in the center of the lens (nucleus) and can cause nearsightedness (myopia) in its early stages. Over time, it leads to more significant vision impairment, including blurred vision and difficulty distinguishing colors. Because aging is a universal factor, nuclear cataracts are the most frequently diagnosed type across all populations.
Other Types of Cataracts
Cortical Cataracts: These cataracts start at the outer edges of the lens and gradually move inward. They are common but not as prevalent as nuclear cataracts. People with diabetes and those with prolonged UV light exposure are at higher risk. Symptoms include glare, halos around lights, and light sensitivity, which can interfere with night vision.
Posterior Subcapsular Cataracts: This type forms at the back of the lens and tends to develop more quickly than other types. It is less common but can affect younger individuals, especially those taking steroids or with diabetes. Symptoms include difficulty seeing in bright light, glare issues, and problems with reading or close-up work.
Congenital Cataracts: These are rare and usually present at birth or during early childhood. They are often linked to genetic factors or infections during pregnancy. Early detection and treatment are crucial to prevent vision impairment or blindness.
Causes and Risk Factors
Aging: The primary cause of cataracts, as proteins in the lens break down over time.
Genetics: Family history can increase the risk.
Medical Conditions: Diabetes, obesity, and high blood pressure increase the risk.
Lifestyle Choices: Smoking, excessive alcohol consumption, and poor diet.
Environmental Factors: Prolonged UV exposure damages the lens.
Medication Use: Long-term use of corticosteroids.
Eye Injuries or Surgeries: Trauma to the eye or previous eye surgeries
Diagnosis
An ophthalmologist can diagnose cataracts through through a comprehensive eye exam, which typically includes asking about your vision symptoms, medical history, and then using a slit lamp to closely examine your eye's lens while your pupils are dilated with eye drops, allowing them to assess the size and severity of any cataracts present
Visual Acuity Test: Measures clarity of vision.
Slit-Lamp Examination: Provides a magnified view of the eye structures.
Retinal Examination: Examines the back of the eye after pupil dilation.
Treatment Options
In early stages, stronger lighting, anti-glare sunglasses, and updated eyeglasses can help. Cataract surgery is the most effective treatment with a success rate of over 95%. Surgery involves replacing the cloudy lens with an artificial one. Most patients experience improved vision within a few days, though full recovery can take weeks.
Phacoemulsification (Phaco): The most common procedure. The surgeon uses ultrasound to break up the cloudy lens, which is then replaced with an artificial intraocular lens (IOL).
Extracapsular Surgery: A larger incision is made to remove the lens, typically used in more advanced cases.
What Cataract Surgery Involves
Pre-Surgery Preparation: Includes a thorough eye exam and measurements to determine the appropriate lens implant. Typically an outpatient surgery, the procedure lasts about 15-30 minutes. The cloudy lens is removed, often using ultrasound energy, and replaced with an intraocular lens (IOL). Complications and risks are rare but may include infection, swelling, or retinal detachment.
Benefits of Surgery
Restores clear vision
Improves quality of life and independence
Reduces the risk of falls and accidents, particularly in older adults
Can correct some refractive errors (like nearsightedness, farsightedness, and astigmatism) through the choice of IOLs.
Whether you need glasses after cataract surgery depends on the type of IOL you receive and your specific vision needs. Cataract surgery can correct vision issues like nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. During the procedure, the eye’s natural, cloudy lens is replaced with an artificial intraocular lens (IOL). The type of IOL chosen determines what vision problems can be corrected.
Basic monofocal IOL: Corrects vision at a single distance, either near or far.
Multifocal IOL: Allows for clear vision at multiple distances, reducing the need for both reading and distance glasses.
Toric IOL: Used to correct astigmatism, a condition caused by an irregularly shaped cornea.
Accommodating IOL: Can adjust focus for both near and far distances, mimicking the natural lens of the eye.
Cost of Surgery
The cost of cataract surgery per eye can vary depending on factors like location, surgeon's fees, and whether the procedure is done in a hospital or outpatient setting. On average, in the U.S., the cost typically ranges from $3,000 to $5,000 per eye. This price usually includes the procedure, the surgeon’s fee, anesthesia, and follow-up visits.
However, additional costs may apply depending on the type of intraocular lens (IOL) chosen. For instance, a standard monofocal IOL is generally included in the cost.
A premium lens like multifocal or toric IOL may add extra costs, ranging from $1,000 to $3,000 per eye. It’s a good idea to check with your insurance provider, as many insurance plans, including Medicare, cover the basic cost of cataract surgery if it’s deemed medically necessary.
Closing Thoughts
Cataracts are a natural part of aging for many, but early detection and treatment can significantly improve quality of life. Modern surgical techniques provide a safe and effective solution. By understanding the risks and options available, individuals can take proactive steps toward maintaining clear vision. Awareness, early diagnosis, and access to care are crucial in preventing cataract-related blindness worldwide.
I am glad I went to the eye doctor, and thankful for those that made it possible so early in the year. After learning all this information about cataracts, I would be surprised if I didn't develop cataracts. According to age, gender, and risk factors, I am a prime candidate. Having monocular vision may be a blessing in disguise—I wonder if they would install a standard, but different, IOL in each eye. One for distance and one for near vision—allowing me to function similarly to how I did with contacts.
Mark 8:25
"Once more Jesus put his hands on the man’s eyes. Then his eyes were opened, his sight was restored, and he saw everything clearly."
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