Cataract: symptoms, causes and treatment

A cataract is a condition where the eye's natural, clear lens becomes cloudy. The lens, located behind the iris and pupil, focuses light onto the retina to create a sharp image. When the lens loses its transparency, light passage is impaired, leading to a decrease in visual acuity and quality. Cataracts typically develop in both eyes, though the progression rate can differ between them.

The most common cause of cataracts is the natural aging process, with changes in the lens structure usually occurring in people over 60. However, cataracts can also develop due to other factors, including eye injuries, certain eye diseases, systemic conditions like diabetes, prolonged use of specific medications (e.g., steroids), and congenital or hereditary conditions. Additional risk factors may include excessive sun exposure, smoking, and obesity.

Cataract symptoms usually develop gradually. In the early stages, the vision decrease may be mild and unnoticed. As the cataract progresses, symptoms become more prominent and include blurry or hazy vision, difficulty reading, and distorted color perception, making colors appear less vibrant. Many experience increased glare from sunlight, bright lights, or car headlights at night, making night driving challenging. Occasionally, people with cataracts may experience a temporary improvement in near vision, a phenomenon known as 'second sight'.

Cataract diagnosis is made through a comprehensive eye examination by an ophthalmologist. The examination includes a detailed assessment of the lens using a slit lamp, which allows the doctor to observe the degree and location of the cloudiness. Additionally, the doctor will perform a visual acuity test and an examination of the retina to rule out other causes of vision loss. It is important to note that a cataract examination does not require special preparation, but eye drops to dilate the pupils are often used, which may cause temporary blurry vision and light sensitivity.

In the early stages of a cataract, when symptoms are mild, vision can sometimes be improved by updating eyeglass prescriptions. However, the only treatment that can remove a cataract and significantly improve vision is surgery. There are no eye drops, medications, or exercises that can eliminate cataracts or prevent their development. The decision on the timing of surgery is made individually, based on the extent of interference with the patient's daily functioning and in consultation with the ophthalmologist.

Cataract surgery is a common and relatively safe surgical procedure in which the cloudy natural lens is removed and replaced with a clear artificial intraocular lens. The artificial lens is intended to remain in the eye for life. It usually does not need replacement, but a further procedure may be needed if a problem such as lens displacement develops. Various types of intraocular lenses are available, including monofocal, multifocal, and toric lenses (for astigmatism correction). The choice of lens type is made based on the patient's individual needs, lifestyle, and eye condition, and is discussed with the surgeon before the operation. Before surgery, measurements of your eye help the team select an appropriate artificial lens. You may still need glasses for reading or distance afterward, depending on the chosen lens and your eye condition.

After cataract surgery, medical follow up is necessary to ensure proper healing and monitor for potential complications. It is important to adhere to the doctor's instructions regarding the use of eye drops and follow up visits. Months or even years after the surgery, some people experience a gradual blurring of vision, similar to the original cataract symptoms. This is a very common condition called posterior capsule opacification (sometimes known as a 'secondary cataract') and can often be treated with YAG laser in the clinic after examination and discussion of its benefits and risks. However, if you experience a sudden and significant decrease in vision, severe eye pain, acute redness, or the sudden appearance of many flashes of light or 'floaters' in your field of vision, you should contact an ophthalmologist promptly. These symptoms are not typical of advanced cataracts and may indicate other conditions requiring immediate treatment.