What Is The First Sign Of Cataracts?

What Is The First Sign Of Cataracts?

Cataracts happen to every person at some point in their life. It is a natural part of the aging process. You may be curious as to what the first signs of cataracts are. This can vary depending on the individual person, but typically it is some disturbance of your vision. In early cataracts, you will not be able to see the cataract in a mirror. This only happens in very late stage cataracts. In the earliest stage of cataracts, when a patient has a trace cataract, there may be no symptoms at all. Let's take a look at some early signs of cataracts that patients may notice. Experiencing eye glare is a common symptom of cataracts. What is eye glare? Glare is when a person looks at a light and sees halos (circles) or streaks around the light. Patients with glare have trouble seeing in bright light. This symptom of cataract may be particularly noticeable when you are driving and you have difficulty looking at the headlights coming towards you. A specific type of cataract, called a cortical cataract, is more likely to cause eye glare than a nuclear sclerotic cataract, which is another type of cataract. Glare is also a common symptom of a posterior subcapsular cataract.Patients can have multiple types of cataracts at the same time. Many patients who have cortical cataracts are also likely to have nuclear sclerosis as well. Posterior subcapsular cataracts are also associated with steroid use.In addition, to difficulty with dealing with bright lights, patients with early cataracts can have difficulty in low light also. This may be most noticeable when you are driving at night.Contrast sensitivity reduction is also a common early symptom of cataracts, and can happen in any type of cataract.All cataracts will cause blurry vision eventually, but in most cases, this is not the first sign of a cataract. The exception to this is in the case of posterior subcapsular cataracts which tend to cause blurry vision quicker than sclerotic nuclear cataracts. Blurry vision in nuclear sclerotic cataracts can happen for two reasons. The first reason is that the cataract itself is becoming denser and therefore becoming more difficult to see through. The other reason is that a nuclear cataract can sometimes cause a patient's prescription to change. This means that the glasses or contacts you once saw clearly in are no longer working for you. In some cases, an ophthalmologist can fit you for a new pair of glasses that still corrects you to very good vision, but in other cases, cataract surgery may be the only way to see better.The earliest signs of cataracts can be subtle such as difficulty with glare, trouble with contrast, or difficulty seeing in low light situations. Blurry vision that is present all the time tends to happen later. The best way to be evaluated on if you have a cataract is to see an eye doctor. Sources:Mäntyjärvi M, Tuppurainen K. Cataract in traffic. Graefes Arch Clin Exp Ophthalmol. 1999 Apr;237(4):278-82. doi: 10.1007/s004170050233. PMID: 10208259.https://pubmed.ncbi.nlm.nih.gov/10208259/Palomo-Álvarez C, Puell MC. Capacity of straylight and disk halo size to diagnose cataract. J Cataract Refract Surg. 2015 Oct;41(10):2069-74. doi: 10.1016/j.jcrs.2015.10.047. PMID: 26703281.https://pubmed.ncbi.nlm.nih.gov/26703281/Cho YK, Huang W, Nishimura E. Myopic refractive shift represents dense nuclear sclerosis and thin lens in lenticular myopia. Clin Exp Optom. 2013 Sep;96(5):479-85. doi: 10.1111/cxo.12064. Epub 2013 May 23. PMID: 23700989.https://pubmed.ncbi.nlm.nih.gov/23700989/
3 min read
Cataract Surgery Lens Options

Cataract Surgery Lens Options

Developing a cataract in both eyes is a normal part of aging. Because of this, cataract surgery is the most commonly performed surgery across the world. In order to see clearly after cataract surgery, the ophthalmologist must place an artificial lens inside the eye. This is because the natural lens of the eye is removed during cataract surgery. Most patients who have surgery for cataracts will have an artificial lens placed inside the eye. There are many choices when it comes to cataract lens options. Because each patient is different in their needs and their lifestyle, the best lens for cataract surgery may be different for different people.If you are a patient with a high level of astigmatism, the best cataract lens for astigmatism is a toric lens. Toric lenses for cataract surgery correct both the sphere part of a prescription as well as an astigmatic component to your prescription. If you are looking at your glasses prescription you will see 3 numbers if you have astigmatism. Here is an example: -2.00-3.00 x 90. In this example the -2.00 is the sphere correction and the -3.00 is the cylinder or astigmatism correction. The number 90 is the axis of the astigmatism, and it is a number between 1 and 180. Astigmatism prescriptions always have an axis associated with it. This axis helps the cataract surgeon to determine the position that the toric lens must be placed in during cataract surgery. Cataract surgery with toric lenses is typically not fully covered by insurance. Usually a patient's insurance will pay for the cataract surgery and a basic lens, but not an upgraded toric lens. Depending on the degree of your astigmatism, a toric lens may be a very worthwhile upgrade for you, and may give you the ability to see clearly in the distance without a pair of glasses. Typically vision after cataract surgery will be clear for distance vision, but not for up close or reading. When having the discussion on lens options for cataract surgery, it is important to know that the lens you choose has an affect on this. Multifocal lenses are a great option for many patients who do not want to wear reading glasses after having cataract surgery. Multifocal lenses, as the name implies, allows a patient to focus at multiple distances. Not every patient tolerates multifocal lenses, so it is important to make an informed decision with your ophthalmologist. These lenses are also usually not covered by insurance. Insurance will usually cover the cost of basic surgery but not the upgrade in the lens.The standard lens for cataract surgery is usually covered by insurance. If you do not have a high level of astigmatism and are willing to wear reading glasses after cataract surgery, this may be the right option for you. A standard lens in cataract surgery will correct the sphere part of a patient's prescription, which in the example above is the -2.00 number. Toric lenses will correct both the sphere and cylinder (astigmatism) correction. In general, cataract surgery is very quick and takes, on average, 20 minutes. If you have a very dense lens, it may take longer, or if you have a very soft lens it could be shorter than 20 minutes. The answer to this question more specifically depends on a few other factors including the lens choice. If you are choosing a lens that is toric, the surgeon will need to ensure that the toric lens is placed at the correct axis. The marking of the eye and the rotation of the lens to the correct position could take an extra couple minutes. In some cases, a cataract surgeon will advise you to have cataract with laser. The laser allows for more precision in the first part of the cataract surgery. The surgery can not be done entirely by laser, but it may be a good option for certain patients. If you have laser assisted cataract surgery, then the procedure could take a few extra minutes since you will need to be moved from one machine which does the laser to then the operating scope where the surgeon will complete the surgery.If you are having an additional procedure, such as a glaucoma procedure, alongside cataract surgery, this could add anywhere from 10 minutes to an hour to your cataract surgery time. Ask your doctor what they anticipate the operating time to be. The general options for choosing a lens in cataract surgery vary between those covered by insurance and those that are not. If you have a strong astigmatism prescription, consider an upgrade to toric lens to help you see clearly. If you want to see clearly at all distances after your surgery, choose a multifocal lens. Always remember to discuss the details with your ophthalmic surgeon since each case is different.Sources:Sachdev MS. Commentary: Toric intraocular lens alignment: Going markerless. Indian J Ophthalmol. 2020 Apr;68(4):587-588. doi: 10.4103/ijo.IJO_1877_19. PMID: 32174574; PMCID: PMC7210851.https://pubmed.ncbi.nlm.nih.gov/32174574/Zhou F, Jiang W, Lin Z, Li X, Li J, Lin H, Chen W, Wang Q. Comparative meta-analysis of toric intraocular lens alignment accuracy in cataract patients: Image-guided system versus manual marking. J Cataract Refract Surg. 2019 Sep;45(9):1340-1345. doi: 10.1016/j.jcrs.2019.03.030. PMID: 31470944.https://pubmed.ncbi.nlm.nih.gov/31470944/
5 min read
Can Cataracts Come Back

Can Cataracts Come Back After Surgery?

You may read about something called a secondary cataract. Because of this terminology, many people wonder, "Can cataracts come back?" The scientific answer is no. Once a cataract is surgically removed from your eye, it can not return. You can not get a cataract twice in the same eye. There are other things that can happen which may require further intervention by your doctor but it is not possible for the cataract to return. In order to understand this, let's first talk about what a cataract is.A cataract is a normal aging change of the eye's natural lens. Most people in the world are born with a natural lens in each eyeball. This lens focuses light onto the retina so that you can see. As a person gets older and ages, the lens ages also. This causes the lens to become less clear. This makes a person's vision also less clear. In order to remove the cataract, the natural lens of the eye is removed and a new artificial lens is placed inside the eye. Because the cataract is removed in its entirety there is no way for it to come back. The new artificial lens does not age the way your natural lens ages, so the new lens can not develop a cataract. If a patient has blurry vision after cataract surgery, there could be a few things going on.The first is that there may still be inflammation inside the eye. Inflammation in the eye after cataract surgery is normal. Your ophthalmologist will give you eye drops to take to reduce this inflammation. Sometimes the inflammation can linger longer than expected and it can cause blurry vision.There can also be some swelling in the retina after cataract surgery. This is more likely to happen to you if you are a diabetic. It is also more likely to happen if your diabetes is not well controlled. There are medications that can help to reduce this swelling.After cataract surgery, your prescription is likely to change, so your blurry vision could be due to this. One to two months after cataract surgery, your doctor can give you a new eyeglasses prescription.Another common occurrence after cataract surgery is the development of something called a posterior capsular opacification. This is what people mean when they talk about a secondary cataract. It is a bit of misnomer, however, because it is not actually the same as a cataract. A posterior capsular opacification happens behind the artificial lens in a part of the eye called the capsular bag. The posterior capsule of this bag becomes hazy due to cellular proliferation of lens epithelial cells after cataract surgery. Luckily, there is a quick solution to this. The eye surgeon who performed your cataract surgery can also perform a laser to eliminate this opacification. While it is a relatively safe procedure, there is a small risk of retinal problems after this laser so it is important to chat with your ophthalmologist about the risks and benefits of having it done. Can you get cataracts twice in the same eye? No. Once surgically removed, a cataract can not come back. If part of the cataract was left behind during surgery, it may need a second procedure to remove it, but a new cataract will not form. A PCO, or posterior capsular opacification, may form and this can be lasered by a Board Certified Ophthalmologist. While a PCO is often referred to as a secondary cataract, it is not the same thing as a cataract since it is not an aging change of the lens and happens in a different part of the eye called the posterior capsule.Sources:Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, Ram J, Auffarth GU. Eradication of Posterior Capsule Opacification: Documentation of a Marked Decrease in Nd:YAG Laser Posterior Capsulotomy Rates Noted in an Analysis of 5416 Pseudophakic Human Eyes Obtained Postmortem. Ophthalmology. 2020 Apr;127(4S):S29-S42. doi: 10.1016/j.ophtha.2020.01.026. PMID: 32200823.https://pubmed.ncbi.nlm.nih.gov/32200823/Wormstone IM, Wormstone YM, Smith AJO, Eldred JA. Posterior capsule opacification: What's in the bag? Prog Retin Eye Res. 2021 May;82:100905. doi: 10.1016/j.preteyeres.2020.100905. Epub 2020 Sep 22. PMID: 32977000.https://pubmed.ncbi.nlm.nih.gov/32977000/
4 min read
Cataract In Eye

What Is A Cataract In The Eye?

Cataracts are a clouding of the lens inside the eye.  A cataract is what eye doctors call the lens of the eye when it becomes cloudy and difficult to see through. Each eye can develop a cataract at the same time or at different times. Cataracts cannot spread from one eye to the other eye.In most cases, a cataract is caused by simply getting older. It is usually an age-related disease, and it will happen to every single person if they live long enough. There are some other causes of cataracts, such as trauma to the eye and diabetes, but these are not as common as cataracts that are caused by aging. The lens of the eye is responsible for focusing the light which enters the eye onto the retina. That information is then sent via the optic nerve to the brain for processing.  When the eye’s natural lens develops a cataract, it obscures the light and makes vision blurry. Left untreated, cataracts may progress and lead to decreased vision or even blindness. As expected, the most common complaint when a person has a cataract is blurry vision.Depending on the cause and type of cataract, the progression and severity of cataracts can vary. Around age 40, the proteins that make up the lens in the eye start to break down, leading to the formation of cataracts. Although age is the most common risk factor for cataracts, some other common risk factors are exposure to ultraviolet light, radiation exposure or radiation treatment, smoking, excessive alcohol consumption, diabetes, previous invasive eye surgery, traumatic eye injury, genetics, and taking steroid medications. It is estimated that about 95 million people are affected by cataracts (1). 36 million people are blind worldwide, and 13.5 million are blind due to cataracts (2,3). It is the leading cause of preventable blindness in low and middle income countries. Around age 50, about 5.22% of people have cataracts. As people continue to age, that number increases to about 15.45% at age 60, and 36.49% at age 70. By the time people are 80, around 68.30% of people have cataracts(4).Cataracts will begin as cloudy or blurry vision and with time, vision will continue to decrease. Some types of cataracts will also develop a yellow or brown tint which may distort color vision. People also may experience difficulty seeing at night, and may have increasing trouble with nighttime driving due to glare or seeing halos around headlights or stop lights. Sometimes people may experience frequent changes in their glasses prescription and may also experience a phenomenon known as myopic shift due to cataracts. With myopic shift, or “second sight of the elderly”, people may start to realize they no longer need their reading glasses. However, this is not due to an improvement in their sight, but rather a progression of their cataracts which changes the way the light focuses in the eye.Some cataracts may progress very slowly and cause little to no decrease in vision. In these cases, it is acceptable to delay invasive treatment and continue to monitor the progression of the cataract with yearly eye exams until it becomes visually significant. Waiting too long, however, may lead to complications like lens-induced glaucoma and a more difficult cataract extraction surgery. Therefore, when a cataract has matured to the point where decreased vision causes difficulty with daily activities, it may be advised to undergo surgery by an Ophthalmologist. In this surgery, the cloudy lens is taken out and replaced with a new artificial lens.  Thankfully with technological developments and advances in surgical techniques, cataract surgery has become one of the most common surgeries performed worldwide with good outcomes with low rates of complications.
4 min read
What Does Medicare Cover In Cataract Surgery

What Does Medicare Cover In Cataract Surgery?

Cataract surgery cost can be a cause of concern for many people. If you have health insurance, you are in luck. Most health insurances, including Medicare, will cover the cost of basic cataract surgery. Medicare will cover the surgeon's fees, the cost of a basic intraocular lens, and the fees for the place in which you have the cataract surgery. This will usually also include the fees for the anesthesiologist. This is the second doctor that is involved in your care during cataract surgery after the cataract surgeon. The amount of coverage for the surgeon's fees, the lens, and the surgery center will depend on your specific Medicare coverage and if you have secondary health insurance or not. There are also certain upgrades that are available that Medicare may not cover but many people do choose to get these upgrades. More about these upgrades and their benefits are discussed below.The most common cause of cataracts is the aging of your body's natural lens. Because cataracts are a part of the normal aging process, the majority of people who get cataracts are older. Therefore, many of these patients will be eligible for Medicare coverage. If you happen to get a cataract when you are younger, it is important that you have commercial insurance. If you are uninsured and develop a cataract, the cost for cataract surgery can be almost $5,000 per eye if not more. The cost for cataract surgery includes many different things. The first part of the cost for cataract surgery is the cost of the two doctors involved in your care. The first doctor is your ophthalmologist who is your cataract surgeon. The surgeon's fee will include not only the surgery itself but also the testing that is required before surgery. There is important pre-operative testing before cataract surgery that helps the ophthalmologist figure out which lens needs to be implanted into the eye. Additionally, after surgery, a patient will have several post-operative visits. The cost for cataract surgery includes the visits before the surgery, the surgery itself, and the post-operative visits with the eye doctor. Another cost related to cataract surgery is the anesthesia that is required. Every patient will need some level of anesthesia in order to be comfortable during cataract surgery. An anesthesiologist is a doctor that will give you medicine to make you comfortable during the surgery. The anesthesiologist will also monitor your vital signs like heart rate and breathing to make sure you are stable during the procedure.The second major cost is related to where the surgery is done, and the type of staffing and equipment that will be involved. This is likely to be more expensive than the cost of the doctors. If you are generally a healthy person with minimal medical problems, is is likely that you can have cataract surgery done as an outpatient. This means that you do not require admission to a hospital for your surgery. Outpatient surgery centers are the most common place where people have cataract surgery done. If someone has many medical problems they may need to have inpatient surgery. This means they will be an inpatient at a hospital and will likely need to stay at the hospital the night before and maybe even the night after the surgery. As expected, inpatient cataract surgery is far more expensive than outpatient cataract surgery. Finally, the last major cost in cataract surgery is the cost of the lens. Because the natural lens of the eye is being removed from the eye, an intraocular lens must be placed into the eye. This lens is made in several different powers so that it can be closely matched to what your eye needs. There are many different types of lenses. The ones that are generally covered by insurance tend to be less expensive than specialty lenses like toric lenses or multifocal lenses. A toric lens is a special intraocular lens that corrects a patient's astigmatism. It is typically not covered by Medicare or by any medical insurance. A patient that wants a toric lens will have to pay an additional $1500-$2000 for this lens to be placed in the eye. In addition to the cost of the lens itself, a toric lens requires the surgeon to rotate the lens to a specific axis. This means extra time and work for the surgeon. The cost of this is built into the upgrade. Toric lenses can be very valuable to people with high degrees of astigmatism. For these patients, upgrading to a toric lens could mean not having to wear glasses for distance vision. It is important to talk to your doctor about whether cataract surgery with a toric lens is right for you. A multifocal IOL is another specialty lens that is typically not paid for by Medicare or any other health insurance. This lens is special because it has multiple distances at which it can correct vision. That is why it is called a "multi" "focal" lens. Most lenses that are covered by Medicare are those lenses that can only focus light at distance. This means they are single vision lenses. They provide clear vision at distance only. Many patients choose to pay for an upgrade to a multifocal IOL (intraocular lens) because it means they do not have to wear reading glasses. This means they are essentially free from wearing glasses. The cost of a multifocal IOL upgrade can be anywhere from $2500 to $5000 per eye. Cataract surgery can be assisted with laser. Cataract surgery can not be done entirely with a laser. If your doctor is able to use a laser for cataract surgery, there are some added benefits of increased precision and accuracy. The surgical time and healing time may also be shorter when a laser is used in certain steps of cataract surgery. Remember that laser-assisted cataract surgery is not done in all patients, and the majority of patients have very good outcomes in cataract surgery. If it is available to you, it is something to discuss. with your doctor. For some patients who may be more high risk or have a history of previously complicated eye surgery, laser-assisted cataract surgery may be something to consider seriously.Medicare will cover the basic costs of cataract surgery and a single vision intraocular lens. If a patient wants a multifocal lens, a toric lens, or cataract surgery that is assisted by laser, they will have to pay additional fees. The cost of these fees will vary depending on the doctor and the type of upgrade the patient wants.
6 min read
Cataract Causes

What Causes Cataract?

Most cataracts are caused by aging. A cataract is a natural clouding of the lens of the eye that happens to everyone with time. Every eye has a lens that is located right behind the iris (or the colored part of the eye). The natural lens of the eye helps to focus the light to the back of the eye and create a clear image. Over time, usually due to aging and sometimes from other causes, the lens can become cloudy. This change is called a cataract.  It affects the way the light is focused to the back of the eye and, therefore, affects the eye’s ability to see a clear image. There are several different factors that can cause a cataract to form. The most common reason for cataract formation is aging. Over time the lens becomes cloudy and develops a yellow color. This is typically a very slow process that happens over many years or even decades. These cataracts are called nuclear cataracts or nuclear sclerosis. This change in the lens causes a very gradual blurring of the vision and often leads to a yellow tint to the vision. Due to the slow, progressive change symptoms are often not noticeable until they start interfering with daily activities.  Other common symptoms include glare from bright sunlight or headlights when driving at night and need for more light with fine vision like reading. Factors that have been found to contribute to formation of nuclear cataracts are UV exposure, smoking and previous eye surgeries.  A posterior subcapsular cataract (PSC) is another type of cataract. This occurs when a haziness forms on the back side of the lens and causes many of the same symptoms as nuclear cataracts including blurred vision, glare with lights and need for better lighting. PSC often forms much faster than nuclear cataracts and patients often notice progressive worsening of the vision over months or years. PSC cataracts can occur as a result of aging but can also be associated with other medical conditions including diabetes, use of oral steroids, and other eye diseases such as retinitis pigmentosa. Trauma to the eye or head is another cause of cataract formation.  Unlike other types of cataracts, traumatic cataracts often form instantly or very quickly after the injury and cause a dramatic decrease in vision.  Traumatic cataracts can form after both blunt trauma (such as a fist or fall) and after trauma which penetrates the eye (for example, from a knife or nail).  Damage to other ocular structures at the time of injury can sometimes increase risk of complications during removal of traumatic cataracts.Cataracts can also form prior to or shortly after birth and these are called congenital cataracts. These cataracts are less common than the cataracts which present in adults, however, they can interfere with important eye development in the first few years of life and lead to permanent vision loss if not corrected. Congenital cataracts are sometimes associated with other medical conditions, however, they can also be inherited or appear without a known cause.  Treatment for cataracts requires cataract surgery which removes the clouded natural lens of the eye and replaces it with an artificial lens implant. This surgery is performed in a surgery center or hospital as an outpatient, meaning the patient is sent home the same day as surgery.  Significant vision improvement is commonly noticed after cataract surgery and some people are eligible for upgraded lens implants which reduce glasses dependence after surgery.  An evaluation with an ophthalmologist will determine if cataracts are affecting vision in a significant way to need cataract surgery.SourcesBasic Clinical Science Course (BCSC) of the American Academy of Ophthalmology. Section 11. 2006 - 2007Cataract in the Adult Eye: Surgery and Diagnostic Procedures. Preferred Practice Patterns.American Academy of Ophthalmology. September 2006
4 min read
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