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FAQ: Cataracts and Cataract Surgery

What is a cataract?

A cataract is a cloudiness of the eye’s natural lens, which lies directly behind the pupil.

What causes cataracts?

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

No one knows for sure why the eye’s lens changes as we age, forming cataracts. Besides advancing age, cataracts can also be caused by injury, chronic diseases and prolonged use of corticosteroid medication and smoking.

Can cataracts cause blindness?

Yes – if left untreated, cataracts cause continual loss of vision, eventually leading to legal blindness or even total blindness. Visual outcomes of modern cataract surgery are so good that a person who was legally blind prior to surgery often is able to see well enough to drive without eyeglasses after surgery.

When should cataract surgery be considered?

For best results from cataract surgery, it’s generally recommended to have the surgery performed before the cataract causes low vision or legal blindness. Advanced cataracts that cause severe vision loss are more difficult to remove and increase the risk of cataract surgery complications.

Are cataracts found only in older people?

Most cataracts develop slowly over time and affect people over age 50. About half of the U.S. population has a cataract by age 65. Nearly everyone over age 75 has at least a mild cataract in one or both eyes. In rare cases, infants can have congenital cataracts. These usually are related to the mother having German measles, chickenpox, or another infectious disease during pregnancy; but sometimes they are inherited.

My doctor says I have a cataract, but he wants to wait before removing it. Why?

Mild cataracts often cause little or no vision problems. Your doctor is probably monitoring your cataract to see if it worsens and more significantly affects your vision or lifestyle before recommending surgery. Some cataracts never reach the stage where they need to be removed. But if your cataract worsens and you begin to have trouble seeing clearly for driving and other everyday tasks, it’s probably time to consider cataract surgery.

Is cataract surgery serious?

All surgery involves some risk.

However, cataract surgery carries a very low risk and is one of the most rewarding and commonly performed surgical procedures.

How is a cataract removed?

A small incision is made in the front surface of the eye with a scalpel or diamond blade. A circular hole is then cut in the front of the thin membrane (anterior capsule) that encloses the eye’s natural lens. Typically the lens is then broken into smaller pieces with an ultrasonic device. Then it can be removed easily from the eye. Once the entire lens is removed, it is replaced with a clear implant called an intraocular lens (IOL) to restore vision. In most cases, the eye heals quickly after surgery without stitches.

What is a “secondary cataract”?

In a minority of cases (perhaps 20-30%), months or years after cataract surgery, the posterior portion of the lens capsule that is left inside the eye during surgery for safety reasons becomes hazy. This causes the vision to become blurred again. This “secondary cataract” (also called posterior capsular opacification) usually can be easily treated with a less invasive follow-up procedure called a YAG laser capsulotomy. In most cases, this 15-minute procedure effectively restores clear vision.

My grandfather had cataract surgery years ago, he had to wear thick glasses afterwards. Is this still necessary?

Rarely does anyone have to wear thick, heavy spectacles after cataract surgery these days. Most modern cataract procedures replace your eye’s natural lens with an IOL that often can correct your distance vision to 20/20. In many cases, your cataract surgeon can choose an IOL that will provide functional vision without any spectacles at all except perhaps for reading glasses.

What are the possible side effects of cataract surgery?

As with any surgery, pain, infection, swelling and bleeding are possible, but very few people experience serious cataract surgery complications. In most cases, complications or side effects from the procedure can be successfully managed with medication or a follow-up procedure.

To reduce your risk for problems after cataract surgery, be sure to follow the instructions your surgeon gives you and report any unusual symptoms immediately.

Are you awake during cataract surgery?

Most cases are done under local anaesthesia so, typically you are awake during cataract surgery.

This eliminates risks associated with general anaesthesia (being “put to sleep”) and enables your surgeon to communicate with you during your procedure. If this idea of being awake during surgery concerns your, fear not – you will be given oral medication before the procedure so you are fully relaxed and feel no discomfort.

The medication typically makes it difficult for most patients to remember their experience in the surgical suite after the brief 15 to 20-minute procedure has been completed and they are in the recovery area.

Some cases need to be done under full general anaesthesia and with modern anaesthetics this is very safe too.

Within a short period of time after your procedure, you will be able to leave the surgery center, but you should not drive after surgery. You should have someone with you to drive you home.

Can cataract surgery be performed on both eyes at the same time?

If you have cataracts in both eyes, surgery typically is performed on one eye. Then a few days or a few weeks later, it’s performed on the other eye. This approach allows the first eye to recover and your vision in that eye to stabilise before surgery is performed on the fellow eye. That said, modern cataract surgery is very safe and effective, and the rate of cataract complications is very low. This has led to some surgeons to begin offering simultaneous bilateral cataract surgery (SBCS) – in other words, cataract surgery performed on both eyes on the same day.

Cataract surgeons who support the idea of SBCS point out that a significant percentage of cataract surgeries in some European countries are performed in this fashion with no increased rate of complications. Also, advantages of same-day surgery on both eyes include lower costs, fewer office visits, faster recovery of binocular vision for driving and other critical tasks, and a quicker return to normal living.

Dr Clive Novis

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HIDDEN IN PLAIN SIGHT: How the Covid-19 Pandemic is damaging children’s vision

Eye doctors had planned to celebrate 2020 as the year of vision (as in seeing 20/20). Instead, it will be known as the year that worsened the world’s vision for decades to come.

Scientists are attributing this latest health issue – one that is hidden in plain sight – to the pandemic. Rates of myopia, also known as nearsightedness or shortsightedness, have been increasing worldwide for decades. Half of the world’s population is predicted to be myopic by 2050.

The length of time children spend viewing digital screens has been exacerbated by a massive increase in remote schooling, direct contributing to further increases in childhood myopia.

Home-schooled children of the COVID-19 era are at risk of becoming the visually compromised population of tomorrow.

A recent study of more than 120,000 children in China demonstrated that six- to eight-year-olds who were in lockdown for the first six months of 2020 are more myopic than their counterparts from previous years.

MYOPIA RISKS

For a child with myopia, distance vision is blurry while near vision remains clear. In the past, the increase in myopia diagnoses from year to year was given little thought, since it was correctable with glasses or contact lenses. However, eyecare professionals now know that the younger a child becomes myopic, the higher their prescription may eventually become, and high prescriptions are bad news for eyes.

There is an established link between high myopia and increasds lifelong risk of devastating eye diseases. Someone who has a prescription of more than six corrective units, or diopters, (a prescription of -6.00) has a 90 percent likelihood of being visually impaired by the age of 75.

A number of eye conditions are more prevalent in highly myopic adults including cataract, glaucoma, retinal detachment, retinal degeneration and other ocular diseases that can have a lifelong impact on their vision. These complications typically happen in later life, so concern for children may seem irrelevant or premature. However, there are other more immediate effects of high prescriptions.

A child or teenager with a fairly high prescription will be visually debilitated when not wearing their glasses or contacts, making them totally dependent on their vision correction. As an example, someone who has 10 diopters of myopia sees anything beyond half an arm’s length as blurred. And don’t think that laser vision correction will save the day once they’re old enough. That degree of myopia may leave them ineligible or subject to a less successful outcome.

SCREEN TIME

The question then turns to what causes myopia in the first place and what can be done about its onset and progression.

The biggest factor that can’t be changed is parental myopia. A child is extremely likely to become myopic if both parents are myopic.

One factor that is modifiable is the amount of time children spend on “near tasks”, those that involve viewing things closer than 40 centimeters from their eyes.

Extended periods of time spent focused on short distances is contributing to myopia increases. Digital screens have been targeted as the reason, but is it the electronic display itself or that a child holds a tablet or phone very close for extended periods? While there is some debates, the short focusing distance is the more like culprit.

Even with the digital onslaught, all is not lost. Parents and caregivers can help prevent children from becoming nearsighted and slow down the rate at which the condition progresses.

SIMPLY SPENDING MORE TIME OUTSIDE CAN DELAY THE ONSET OF MYOPIA.

Direct sunlight plays a part, as well as the long-range focusing while playing outdoors. Restricting screen time is an option with optometrist-endorsed recommendations relating to screen time for children. For children schooled at home where limits are not practical, ensure that the screen is not being held or positioned too close to a child, encourage regular breaks and use the 20-20-20 rule: look 20 feet (seven meters) away every 20 minutes for 20 seconds.

Some researchers have found that children who go to bed later are more likely to be myopic – an added incentive for parents who are looking for reasons to call it a night.

A child’s myopia usually continues to progress until around the age of 16,but about 10 percent of myopic patients’ vision keeps worsening into their early 20’s.

TREATMENT AND PREVENTION

Many options exist for vision correction, but more importantly, there are an increasing number of options available to slow down the progression of myopia and reduce the risk of developing sight-threatening complications in later life. They range from contact lenses and glasses specifically designed to slow down myopia progression to precisely formulated eye drops.

These can be discusses with your eyecare practitioner, who will recommend the best path based on each child.

More than anything else, do not assume a child can see well. There is no substitution for an examination with an eyecare professional. The pandemic has already caused widespread hardship. By acting now, parents can minimize its impact on the vision and ocular health of generations to come.

Debbie Jones, University of Waterloo

Kate Gifford, Queensland University of Technology

Source: THECONVERSATION.COM

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Wiley-X premium sunglasses now available

Founded on supplying military forces and law enforcement personnel with top-of-the-line ballistic eyewear, Wiley X continues to hold safety as their priority, adopting this approach for their entire line and building eyewear with the highest levels of protection available. We import this range directly from Wiley-X abroad.

Hunting or shooting – every person should wear safety eyewear. This collection will sharpen your vision and provide protection from misfires, tree branches, stray bullets, or clay particles, while enhancing your overall performance.

Styles are available in different lens variations of one, two and three lens packages combining ballistic protection and optical perfection with versatile and adjustable frames. Most Wiley X hunting and shooting styles have a rubberized nose bridge adjustable to any nose size and shape. Dock and lock the T-Peg™ elastic strap to the temples and stop worrying about losing your eye protection no matter the terrain.

Wiley X provides an unparalleled level of vision protection, optical performance and versatility.

Sunny days, playing at the seaside – whether you are a passionate angler or a skilled windsurfer, polarized sunglasses are the inevitable water sport accessory you need.

To land the perfect catch and to perform your best on the water, polarized sunglasses should be worn. Wiley X polarized sunglasses will support your vision and block annoying glare off the water and other light reflecting surfaces.

Whether enjoying water sports, fishing, surfing, or sailing, Wiley X provides you the best performance eyewear for your chosen activity.

Sports in the great outdoors work up a sweat. Whether you hike, climb, paddle, cycle or run, Wiley X offers bold designs with premium protection according to European EN.166 safety standards, which means durable frames and shatterproof lenses.

Gear up with snug fitting frames with or without the Wiley X patented removable soft foam (Facial Cavity™ Seal), various frame and lens colors, and high performing polarized lenses guaranteeing a model for everyone and for any lifestyle.

When you play hard, your eyewear better too.