This month we will discuss cataracts to recognize Cataract Awareness Month. Each month is dedicated to a certain health topic or eye condition and observed by the American Academy of Ophthalmology.

What are cataracts and their causes?

Cataracts form when proteins break down in the natural lens of the eye. Usually the lens is clear but over time, the proteins make it cloudy. This occurs gradually and happens to everyone as part of the natural aging process, usually beginning around the age of 40. Cataracts grow at different rates for each person. Sometimes, they can affect one eye more than the other.

Other causes of cataracts include the use of steroids, diabetes, prolonged sun exposure, and an injury to the eye. Congenital cataracts are present at birth and children can also acquire cataracts after birth. Our discussion will focus on cataracts in adults.

What are the symptoms of cataracts?

The most common symptom is blurry or cloudy vision. If left untreated for a long period of time, cataracts can lead to blindness. Other symptoms include increased glare, sensitivity to sunlight, difficulty with night vision, and faded color perception. Some cataracts do not cause any symptoms.

How are cataracts diagnosed?

A comprehensive exam including checking the vision and dilating the eyes is needed to diagnose cataracts and assess the effect on the vision. The dilated exam allows doctors to look at the lens and determine how advanced the cataract is. Cataracts may look different from each other depending on which layer of the lens is affected and the cause of the cataract. For instance, a cataract caused by diabetes looks different from one caused by an eye injury.

The white arrow in this photo shows an age-related cataract called nuclear sclerosis. It looks green and becomes increasingly brown with time. The black arrow points to white spokes, known as cortical cataracts, that can cause more glare.

Photo of nuclear sclerosis and cortical cataracts. Image Source¹

The arrow here points to a posterior subcapsular cataract. It has a lacy pattern and is in the back of the lens. This patient also has nuclear sclerosis.

Photo of posterior subcapsular cataract. Image Source¹

How are they treated?

There are three main ways to treat cataracts:

Observation: If a cataract is not causing any symptoms, they are safe to leave alone. Most cataracts in the early stages can be monitored and some may never require treatment.

Glasses: Since the most common symptom is blurry vision, this can often be improved with an updated pair of glasses. Magnifying glasses may also help.

Surgery: In adults, this is the final option if the other treatments are not working. Most patients are able to tell if it is time to have surgery when their lifestyle is affected (difficulty driving, reading, etc.). Occasionally, cataracts require surgery as an immediate treatment. For instance, if the eye pressure is affected, it may be dangerous to leave the cataract alone. Surgery involves removing the cataract and replacing it with a man-made lens to allow a person to see. The standard lens corrects only for distance vision and a multifocal lens corrects for both reading and distance. Once removed, cataracts do not return.

Other things to do:

1. Be sure to have an eye exam annually, especially if you are over the age of 65.
2. Quit and do not start smoking. Smoking is known risk factor for the development of cataracts.
3. Wear sunglasses that block UV light to protect the eyes from the sun.
4. Keep brighter lights in reading areas.
5. Take care of other medical conditions, especially diabetes.
6. Carefully consider and discuss cataract surgery with us if you feel that they are affecting your daily activities.

Please keep in mind there are no other approved treatments; cataracts can only be removed with surgery. Research is being done, but at this time, there are no medications that prevent or stop cataract growth. This includes both eye drops and pills.

Return next month for a new topic!