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Cataracts

Overview

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. Cataracts usually develop in both eyes, but sometimes they only affect one. Most cataracts occur as a result of getting older, usually sometime after age 40.

Cataracts are the most common cause of vision loss worldwide, but they are treatable.

Causes of cataracts

As we age, the proteins that make up the eye's natural lens can clump together. These clumps are the cataracts and are what cause the cloudiness. Over time, they may grow larger and cloud more of the lens, making it harder to see.

The lens inside the eye works much like a camera lens, focusing light onto the retina for clear vision. It also adjusts the eye's focus, letting us see things both up close and far away.

Water and protein make up most of the lens of the eye. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers worldwide have identified factors that may be related to cataract development. Besides advancing age, cataract risk factors include:

  • Ultraviolet radiation from sunlight and other sources

  • Diabetes

  • Hypertension

  • Obesity

  • Smoking

  • Prolonged use of corticosteroid medications

  • Statin medicines used to reduce cholesterol

  • Previous eye injury or inflammation

  • Previous eye surgery

  • Hormone replacement therapy

  • Significant alcohol consumption

  • High myopia

  • Family history

One current theory is that oxidative changes in the human lens may be the cause of cataracts. Studies have shown that fruits and vegetables high in antioxidants may help prevent some types of cataracts.

Cataract symptoms

A cataract starts out small and, at first, has little effect on your vision. Visual symptoms can take months to years to become noticeable. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass. 

Cataracts can progress at a different rate in each eye, resulting in visual symptoms in one eye and normal vision in the other. You may also notice the following symptoms with cataracts:

  • Light from the sun or a lamp seems too bright or glaring.

  • Your eyes feel more sensitive to light.

  • Oncoming headlights cause more glare than before when driving at night.

  • Visual halos around bright lights.

  • Double vision.

  • Seeing at night or in low light is more difficult.

  • Colours may not appear as bright as they once did.

  • Blurry, cloudy, hazy or dim vision.

To the outside viewer, an advanced cataract can cause the pupil to appear light gray instead of black.

The type of cataract you have will affect exactly which symptoms you experience and how soon they will occur. If you think you have a cataract, see an optician for an exam to find out for sure.

Types of cataracts

There are many cataract types, but a few are much more common than the others.

  • Nuclear cataracts are the most common form of cataract. These form in the center of the eye’s lens, gradually worsening and affecting vision.

  • Cortical cataracts usually are spoke-like opacities that begin near the edge of the lens and grow toward its center. These make you experience more light glare, making night driving particularly difficult.

  • Congenital cataracts are lens opacities that are present at birth in one or both eyes. They may be very small, with little effect on vision, or more severe.

  • Trauma-induced cataracts can form anywhere on the lens and often develop into a flower-petal or “rosette” shape.

  • Posterior subcapsular cataracts develop at the central back surface of the lens. These types of cataracts tend to develop faster than the others. Symptoms usually affect your vision around bright light and colours.

Cataract treatment

When symptoms begin to appear, you may be able to improve your vision for a while using:

  • New glasses.

  • Strong bifocals.

  • Magnification glasses.

  • Appropriate lighting or other visual aids.

Other treatment options for cataracts that have progressed may include cataract surgery.

If cataracts start to affect your quality of life, then your optician may suggest surgery. This is generally seen as a low-risk and effective way to restore your vision.

Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

Cataract surgery is very successful in restoring vision. It is the most frequently performed surgery in the United States, with more than 2 million Americans undergoing cataract surgery each year, according to Prevent Blindness.

Diagnosing cataracts

Opticians can use different tests to diagnose cataracts.

  • Slit-lamp exam: A slit lamp is a large, binocular microscope with a bright light source that’s mounted on a small table. It enables your optician to closely examine your eye under high magnification (including checking the lens for cataracts).

  • Retinal exam: First, an optician will dilate your eyes with eye drops, causing the pupils to slowly open. This gives them a much better view inside your eye. The optician then examines the retina and optic nerve in the back of your eye. A dilated eye exam also provides the best view of any cataract formation on the lens.

  • Refraction: During a refraction, your optician determines the degree of your refractive errors and the eyeglass prescription that provides your best possible visual acuity. If your glasses prescription has changed and your vision can no longer be corrected to 20/20, it’s possible you may have a cataract developing.

Cataracts don’t always require treatment after they’re diagnosed, especially if they aren’t bothering you. Initially, a simple change of your eyeglass prescription may restore acceptable vision.

Preventing cataracts

Currently, there is no known way to stop cataracts from developing. However, if you can limit some of the risk factors listed above, it may slow their rate of progression. Ways to limit cataract risk factors can include:

  • Wearing sunglasses during the day to reduce your eyes’ exposure to the sun’s UV radiation.

  • Quitting smoking.

  • Eating a healthy diet and maintaining an exercise regimen.

  • Managing and reducing the effects of coexisting conditions like diabetes or hypertension.

  • Getting frequent eye exams to ensure any developing cataracts get diagnosed early.

Gary Heiting, OD, and Judith Lee also contributed to this article.

Cataracts. Prevent Blindness. Accessed April 2021.

Age-related cataract is associated with type 2 diabetes and statin use. Optometry and Vision Science. August 2012.

Diet, vegetarianism, and cataract risk. The American Journal of Clinical Nutrition, May 2011.

Prevalence and risk factors for cataract in diabetes: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study, report no. 17. Investigative Ophthalmology & Visual Science. December 2010.

Hormone replacement therapy in relation to risk of cataract extraction: A prospective study of women. Ophthalmology. March 2010.

Dietary carotenoids, vitamins C and E, and risk of cataract in women: A prospective study. Archives of Ophthalmology. January 2008.

Alcohol consumption and risk of cataract extraction: a prospective cohort study of women. Ophthalmology. April 2007.

Prospective study of dietary fat and risk of cataract extraction among U.S. women. American Journal of Epidemiology. May 2005.

Diabetes, hypertension, and central obesity as cataract risk factors in a black population: The Barbados Eye Study. Ophthalmology. January 1999.

Sunlight exposure and risk of lens opacities in a population-based study: The Salisbury Eye Evaluation Project. The Journal of the American Medical Association (JAMA). August 1998.

A prospective study of alcohol consumption and risk of cataract. American Journal of Preventive Medicine. May/June 1994.

The Lens Opacities Case-Control Study: Risk factors for cataract. Archives of Ophthalmology. February 1991.

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