Cataracts Unveiled: Understanding Symptoms, Surgery, And Recovery

Introduction

A cataract is a disease of the eye caused by the clouding of the lens, which is a nearly transparent structure behind the iris (coloured part of the eye). This clouding prevents the passage of light rays through the lens to the retina which is located in the back of the eye.  

Cataracts progress gradually and are one of the leading causes of blindness around the world. This disease mostly affects older individuals but can be seen in adults and young people as well. There have also been some rare cases of congenital cataracts in newborns. Progression of cataracts may eventually turn the lens opaque, thereby interfering with day-to-day activities. Cataracts can be successfully treated with refractive glasses in earlier stages or surgery in advanced stages.

Understanding cataracts

A cataract is the clouding of the typically clear lens of the eye. People with cataracts have to see through cloudy lenses of the eye, which is like looking through a foggy window. Cloudiness of vision leads to difficulty in routine activities such as reading, driving, or seeing facial expressions in people. Cloudy vision affects only a small part of the lens in the initial stages of cataract. It might be difficult to notice any changes in the vision in these early stages. 

Additionally, certain cataracts can temporarily improve close-up vision. Since cataracts grow slowly, worsening of eyesight may progress at a slow rate. As a cataract

grows larger, it leads to cloudiness in a large part of the lens and vision loss.

Causes of cataract

Cataracts mainly happen after 40 years of age because of the natural breakdown of the Crystallin protein in the lens of the eye. The exact cause of cataracts is still unknown.

Risk factors

There are more risk factors, other than ageing, that may lead to cataracts, including:

• Smoking
• Family history of cataracts
• Excessive consumption of alcohol
• A serious eye injury 
• Excessive exposure to sunlight
• Steroid use
• Radiation treatment, specifically on the upper part of the body
• Living in high-altitude regions 
• Health problems like diabetes, atopic dermatitis etc.¹
• A diet deficient in vitamins and antioxidants

Symptoms

The most common symptoms of cataracts include:

• Cloudy or blurry vision
• Lights appearing too bright
• Halo or glare seen around lights
• Poor night vision
• Double vision
• Change in color vision, colors appear faded²
• Need to change eyeglass prescriptions too often
• Distorted vision in either of the eyes

Symptoms may vary from person to person. It may be difficult to notice any changes in vision in the early stages of cataract. Cataract symptoms may look like any other eye condition. It is essential to talk to a healthcare provider for a proper diagnosis, in case any of the above symptoms are observed.

Diagnosis of cataract

Doctors will review the complete medical history of the patient along with the symptoms, followed by an eye exam. A comprehensive eye exam may include:

• Visual acuity test: This test uses an eye chart or a viewing device with letters that get smaller to test the vision. One eye is tested at a time, while the other eye is kept closed. With this test, the eye doctor determines if the patient has 20/20 vision or has trouble seeing.
• Slit lamp or eye structure exam: This examination enables the eye doctor to observe the structures at the front of the eye. Known as a slit lamp examination, it uses an intense line of light, similar to a slit, to light up the eye’s structures. The doctor can view these structures in small sections due to the design of the spilt, facilitating the identification of abnormalities or irregularities.
• Retinal exam: A retinal exam enables the eye doctor to look at the retina (back of the eyes). The eye doctor uses eye drops to widen the pupils, which makes it easier to see the retina. The doctor uses either a slit lamp or a special device, called an ophthalmoscope, to examine the lens and check for any signs of a cataract.

Treatment 

Surgery is the only way to treat cataracts. However, small changes at home or at work, such as using bright lights, anti-glare sunglasses, magnifying lenses for activities like reading, and switching to new prescription glasses, can help in managing cataracts during the early stages. 

In advanced stages when reduction in visual acuity affects routine activities, like driving and reading, these actions are no longer helpful and surgery is required.

Cataract surgery

Cataract surgery is one of the most commonly performed surgeries, known for its safety and effectiveness. The procedure usually takes 25 to 30 minutes. Outpatient surgery is performed under local anaesthesia. Before surgery, individuals with general health conditions, such as diabetes, hypertension, etc, require proper management for better results. During the surgery, the surgeon replaces the cloudy lens with a clear lens. 

In the case of bilateral cataracts, surgery for each of the eyes is done 6 to 12 weeks apart to allow recovery of one eye at a time. In low-risk patients, the doctor may recommend treating both eyes on the same day. This surgery is called immediate sequential bilateral cataract surgery (ISBCS) and is only recommended after a discussion with the patient.³ 

For a few days after surgery, it is common for patients to experience soreness. Recovery typically spans a few weeks but vision improves much sooner.

The risk of complications after surgery, albeit low, has been observed in some cases. Some complications include:

• Bleeding or infection
• Blurring of vision or loss of vision in the treated eye
• Detachment of retina⁴

Recovery from surgery

After the surgery, the patient may feel stickiness around the eye, itchy, or uncomfortable. Eyes may water more than usual. For most patients, vision improves 1 to 3 days after surgery. However, full recovery may take 3 to 10 weeks. Doctors may send the patient home with an eye bandage, patch, or clear shield. Eye drops may be given to aid in the healing process. After the eye heals, patients may still need to wear glasses, especially for reading.

At home care 

Proper rest is essential for recovery. Patients are advised to get enough sleep. Strenuous activities like biking, jogging, and weight lifting should be avoided. Swimming and gardening should also be avoided for 1 to 2 weeks after surgery. It is recommended to wear sunglasses for at least a year after surgery.

Medicine 

Any medications stopped prior to the surgery should be restarted only after proper consultation with the doctor. The doctor’s instructions should be followed for using eye drops or pain medications if needed.

Patient education

Patients should be educated about the causes, symptoms, risk factors, treatment options, and surgical complications of cataracts. Post-surgery, patients should be advised to visit the eye doctor for regular follow-ups where visual acuity test and slit-lamp examinations will be performed to test for vision impairment or surgical complications, if any. The patient should be encouraged to wear sunglasses outdoors to protect the eyes from harmful ultraviolet rays. Additionally, patients should be recommended to undergo a comprehensive systemic evaluation to rule out any systemic disease which may impact treatment outcomes.

Conclusion

Cataracts represent a significant challenge to vision, affecting individuals of different ages and backgrounds. Being one of the leading causes of vision problems worldwide, it is important to understand the symptoms, risk factors, and treatment options for cataracts. While cataract surgery stands as a safe and effective solution, it is essential to consider the overall health of the patient along with potential complications. Patient education plays a pivotal role in ensuring optimal outcomes, including post-operative care and regular follow-ups. Regular comprehensive systemic evaluations and preventative measures, such as wearing sunglasses outside, can aid in minimising the impact of cataracts on vision and overall eye health. to fully recover. Rest, avoidance of strenuous activities, adherence to medication and the use of sunglasses are crucial. Patients should restart medications under medical guidance and closely follow instructions for optimal healing.

Summary

A cataract is a clouding of the lens of the eye (the clear part of the eyes that helps to focus light). Cataracts are common as one gets older. During the early stages, it may be difficult to notice the signs and symptoms. However, as cataracts develop, eyesight may become cloudy, blurry, or unclear leading to trouble reading or doing routine activities. Colours may seem faded. In the early stages, vision loss caused by a cataract can be managed with the use of prescription eyeglasses, a magnifying glass, or stronger lighting. Over time, cataracts can lead to vision loss. Cataract surgery is one of the safest and most effective operations for correcting vision problems caused by cataracts. Post-eye surgery recovery entails temporary discomfort and vision changes, typically improving within days but it may take weeks.