Cataracts

Cataracts are a clouding of the lens of the eye which can cause reduced vision and glare around lights and can deteriorate over time. 

Cataract surgery is a common day case procedure that replaces the cloudy cataract lens with a new, artificial lens to improve sight. 

Surgery is recommended if your vision problems are interfering with your daily life activities and quality of life, preventing you from doing the things you love, hobbies etc.

What are cataracts?

From birth, our eyes have a clear lens which is made up of a unique balance of water and protein working in tandem to allow light to pass through the eye. As we age, the quality of the protein degrades and can gather together in clusters. This makes it harder for the light to pass through the protein, and consequently the lens causing a cataract which reduces vision and makes things a bit blurrier.

What do cataracts look like?

How a cataract looks to the person with a cataract

• Cloudy or hazy vision
• Blurred vision – vision is generally less sharp
• Double vision – where you can see two or more images of a single object, in one of your eyes
• Sensitivity to glare or bright sunlight or car headlamps
• Dull colours – colours start to look more faded, washed out and yellow tinted
• Glare / halos around light sources
• Clean glasses feel dirty or like they need cleaning

How the eye looks to others:

• In the early stages, the eye may look normal externally, and only an eye examination can reveal the clouding with the lens
• When advanced, the cataract itself over time is often visible as a white or cloudy spot in the centre of the eye’s pupil

Types of Cataracts

There are many different types of cataracts, each affecting different parts of the eye's lens and developing for different reasons. The main types are:

• Nuclear Cataract - Form in the centre (nucleus) of the lens. The most common type of cataract, typically associated with aging and may cause the lens to become yellow or brown over time, affecting colour perception. Nuclear cataracts occur with age, and develop very slowly over many years. You may not notice a difference to your vision until the condition has progressed for some considerable time.
• Cortical Cataract – Forms in the lens cortex that surrounds the nucleus of the eye Begin in the outer edges (cortex) of the lens and gradually extend inward Often look like white, wedge-shaped streaks or spokes around the edges They tend to cause glare and problems with night vision and have an issue with telling how far away an object is, or telling different colours apart.
• Subcapsular Cataract - Forms at the back of the lens, just behind the lens capsule. More common in people who have diabetes, use steroids, or who have severe near-sightedness. Unlike nuclear cataracts, these tend to develop quickly over a matter of months, affecting the vision much faster.
• Congenital Cataract - Present at birth or develop during childhood, often due to genetic conditions, infections, or trauma. This type of cataract doesn’t always affect vision, but if they do, they’re usually treated early to avoid long-term vision issues.
• Traumatic Cataract – May vary in appearance based on the nature and location of the injury. Traumatic cataracts result from an eye injury, sometimes they appear immediately after the injury but can develop years later.

There are also particular types of cataracts that can affect young children, but the occurrence is rare. Congenital cataracts are usually present when a baby is born, or juvenile cataracts may be diagnosed in older babies and children. For babies and children, it is vital to spot cataracts early in order to avoid severe long-term complications, including blindness.

Are cataracts painful?

Cataracts are generally not painful, in most cases. The clouding of the lens caused by cataracts doesn’t produce any physical discomfort in the eye. Symptoms primarily involve gradual changes in vision, such as blurriness, increased glare sensitivity, and dimming colours.

In advanced cases, the eye might become sensitive to light, which can feel uncomfortable in bright environments.

Cataracts symptoms

When cataracts first develop you may not be aware of any issues with your eyesight. However, as a cataract progresses, it will begin to distort the light that passes through the lens into the back of your eye. It is then you will begin to notice problems with your vision – you will start experiencing cataract symptoms.

Cataract symptoms include:

• Cloudy vision
• Blurred vision and/ or double vision
• Halos around lights and glare from lights
• Difficulty seeing at night
• Difficultly discerning contrasts of colour and depth
• Colour changes - You may find that colours appear dull and washed out or they acquire a yellow or brown tinge. People with cataracts frequently have trouble telling the difference between blues and purples.

What causes cataracts?

Cataracts develop when proteins in the eye’s lens break down and clump together, causing clouding of the lens. Here are common causes and contributing factors:

• Aging – The most common cause, as people age the proteins in the eye naturally break down.
• Smoking - Cigarette smoke releases chemicals that can damage the lens, increasing the chance of cataracts.
• Genetics - Family history can develop the risks of cataracts.
• Taking steroids for a long period of time
• Alcohol consumption – Heavy drinking over a long period of time
• Eye trauma or injury – Which may appear immediately after the injury or several years later
• Eye conditions such as glaucoma increase the risk of developing cataracts
• UV Radiation - Exposure to UV light
• Medical conditions such as diabetes - Having diabetes can cause cataracts to develop faster and in earlier life. It is thought that excess blood sugar due to diabetes can make your eye lens become cloudy and form a cataract.

Cataract risk factors

Risk factors for developing cataracts fall into four main groups which are environmental, lifestyle, medical, and genetic.

Environmental risk factors - Trauma, UV radiation
Lifestyle risk factors - Smoking, alcohol, ageing
Medical risk factors - Steriod use, diabetes, radiotherapy, eye surgery and eye inflammation
Genetic risk factors - Family history and certain genetic conditions

How are cataracts diagnosed?

A vision chart is used to measure visual acuity and detect any reduction in vision.

Slit lamp ocular examination is done to confirm presence of cataracts and exclude other causes of reduced vision by checking the retina after pupil dilation.

OCT scan is done to exclude retinal pathology.

Biometry is done to measure the length of your eye and curvature of the window of your eye so that lens implant power can be calculated.

How to prevent cataracts

There are a lot of different factors which can increase your risk of cataracts, whilst some are unavoidable such as age and underlying health conditions, the majority can be prevented with a change of lifestyle. There are three straightforward ways in which you can combat the causes of cataracts whilst also improving your quality of life.

• Eating a balanced diet - Studies have shown that people who develop diabetes carry a greater risk of getting cataracts at a later stage in life, so maintaining a healthy level of blood sugar with a healthy, balanced diet is essential. Ensuring you eat varied meals which top up your vitamin levels is another key way to help avoid developing cataracts, so upping your intake of fruits and vegetables is advisable. If you’re concerned you’re not getting enough vitamins within your diet then you can opt to take vitamin supplements to help address specific deficiencies.
• Stop smoking -It’s well known that smoking is detrimental to your health for a whole variety of reasons, but one of the lesser known impacts it can have is on your eye health. As highlighted by research by the RNIB, heavy smokers (classified at 15 or more cigarettes a day) will have a greatly increased risk of developing cataracts than non-smokers due to damage to tissues in the eye. It can also create further issues due to the link between smoking and diabetes – another factor which can contribute to developing cataracts – and increase the number of free radical molecules which accelerate aging and can prevent essential nutrients and vitamins from food being absorbed.
• Protect your eyes from the sun - When the weather breaks out in brighter spells, it’s only natural to take to the garden to soak up some rays and make the most of any sunny skies. But sun damage is something we sometimes forget about, and we do have to be careful with how much UV we expose ourselves to. While we have suncream to help manage the effects of the sun on our skin, we can forget about how UV rays can also damage our eyes. Wearing sunglasses with a good level of UV protection helps reduce the potential damage to your eyes, reducing the risk of developing cataracts.

Living with cataracts

Here are some helpful tips for individuals living with cataracts to manage their daily activities and improve their quality of life while awaiting treatment or surgery.

• Corrective lenses - Ensure up to date spectacles are worn
• Reading - Use extra lighting when reading, magnifiers can also help when reading or reading from a computer tablet so that the font size can be enlarged
• Protect your eyes - Use of sunglasses if glare is a problem in bright light
• Limit nighttime driving – When night driving is required, use night driving glasses to help improve glare at night
• Take extra care when taking stairs or walking on uneven surfaces (use walking stick), organise your home to reduce clutter and tripping hazards like rugs or cords

Treating cataracts

Surgery is the most effective treatment for cataracts and is usually recommended if your vision problems are interfering with your daily life activities and quality of life, preventing you from doing the things you love, hobbies etc.

Here are Ramsay we treat patients with many eye conditions. Our skilled ophthalmologists use the best practices and offer the latest treatments including cataract surgery based on your individual needs and diagnosis. 

Find out more about cataract surgery which is offered across our hospitals here.