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Cataracts – What to Expect

Cataracts – the origins and what to expect

The English language has many words that share different meanings, but few are as dissimilar as “cataract” … what could a massive waterfall possibly have in common with a medical condition of the eye?

The origin of both is the Greek word kataraktes which means something that is rushing or swooping down. This was later transferred to Latin in the form of cataracta which referred more specifically to a waterfall and also a flood gate or a portcullis.

From about the middle of the sixteenth century, English doctors began to use the same word – as a simile for something that was blocking light from entering the eye – for the condition of the lens  becoming increasingly opaque. An even older expression for this medical complaint was “web in the eye” and one school of thought relates this to the “portcullis” connection. However, consultant ophthalmologist, Jaheed Khan, favours the “waterfall” reference.

“As water gushes down a precipice it turns white, and what cataracts refer to is the whitening of the lens of the eye. Young people generally have very clear lenses but, as we get older, they become misty – so, as a result, the light doesn’t pass through the lens properly, instead it scatters. A consequence of this scattering of light is that the vision fails to focus properly on the retina.

“It is a progressive condition which takes several years to develop. It is usually age-related although there are other rarer causes like the use of steroid medicines, or trauma to the eye. Very occasionally babies are born with cataracts.”

However cataracts are most common in older people. By the age of 80 more than half the population of the western world will have a cataract or have had cataract surgery. There is no upper age limit for treatment – Jaheed Khan has operated on a patient of 102.

Those with cataracts will first notice a deterioration in their vision most commonly experiencing difficulty in appreciating colours and changes in contrast, driving, a blur when reading, recognising faces and coping with the glare of bright lights.

The condition might first be spotted by an optician and then an eye doctor would carry out a detailed eye test, including dilating the pupil to examine the clarity of the lens.

“In the early stages it might have a slight haze to it, later it might become brown and, in very dense cataracts, the lens will eventually become white. Then surgery will be required – there is no other treatment for cataracts.

“It is a fairly delicate operation. It is small incision surgery with a microscope. We have to remove the lens within the bag in which it sits. This bag, a very fine film, remains in the eye.  We then put an artificial lens (an intraocular lens or IOL) into the bag and unfold it within the eye where it will remain – nice and clear – forever … and the vision is restored.”

Can the artificial lens replacements IOL’s be corrective?

“Yes, we generally take the opportunity to correct any refractive error. The majority of our patients have clear distance vision and will just need reading glasses afterwards. If a patient wants to be glasses free, we have a range of vari-focal lenses providing good vision for distance and near. Depending on the degree, we can also correct astigmatism.” These are called Premium Lenses and cost a little more.

How is the operation for the patient?

“The vast majority have it under a local anaesthetic… and most cope with that very well. During the operation all they will feel is the eyelid being pulled open and a bright light shining in the eye (we use a microscope and light to operate). It is completely painless, but you might be aware of just some touching around the eyelids during the procedure.

“Afterwards, depending on the anaesthetic and how long it takes to wear off, vision will be improved by day two. It won’t completely settle down until a couple of weeks after surgery. During this time the patient will use anti-inflammatory and anti biotic drugs.

“The wearing of a clear shield at night is recommended – just to make sure that the patient doesn’t rub or knock the eye inadvertently. My advice is to hold off sport for a week or two as you don’t want to transmit any strain to the eye or risk of knocking it. It is also not recommended to wear eye make up and to be extra careful with shampooing the hair for the first five days post surgery.

“We don’t operate on both eyes at the same time. In order to minimise the risk of infection, we would recommend waiting three or four weeks between operations.”

With the IOL in place, can cataracts develop in the future?

“No, a cataract cannot come back. However, sometimes the eye tissue (bag) can become a bit opaque and blur the vision. This is quite rare and happens in less than 10% of cataract patients. If it does happen we can clear the build up at the back of the lens which will restore the vision to what it was. A cataract cannot form on the artificial lens itself.

What are the advantages of having cataract surgery privately?

The main advantage of private health care is that you can be certain of getting an experienced consultant operating on you. Your care will be customised to your needs with much stricter monitoring post surgery. The private patient can decide when, where and how they want their treatment. Customised vision correcting IOL’s are not available on the NHS.

Currently it is necessary to wait until you have very poor vision (6/12 or 20/40) before you can qualify to have cataract surgery on the NHS – and it is possible to have a dense cataract and still be able to read down the eye chart quite successfully.

Can anything be done in the way of self-help to prevent cataracts from forming?

“Not really. There has been some indication that ultra-violet light – sunlight – can cause cataracts, but the evidence is a little bit weak. That said, it is always sensible to protect your eyes with sunglasses anyway. “

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