What is cataract? What are the causes, symptoms, and treatments for cataract?

Cataract, one of the most common age-related conditions in human life, can also be described as a curtain falling over the eyes. Although this curtain may appear at different ages, it often causes vision problems anytime after the age of 40 and increasingly in older age. In the past, cataracts were treated surgically using larger incisions and stitches. Today, however, they can be treated with smaller incisions and without the need for stitches. Specialists from the Ophthalmology Center at Akfa Medline University Hospital have provided information about cataracts.

WHAT IS CATARACT?

A cataract occurs when the natural lens behind the pupil, which provides vision, loses its transparency and becomes cloudy. The eye provides clear vision through the refraction and transparency of its structures — the cornea and the lens. In other words, the loss of transparency of the lens and the formation of cuts are called cataract. Cataract is one of the main causes of curable blindness.

WHAT ARE THE SYMPTOMS OF CATARACT?

Cataract appears as a slight clouding and hardening of the eye lens in people aged 55–60. The first symptoms of cataract are described by patients as a decrease in color brightness and quality of vision. Cataract is a problem that is accompanied by symptoms. In the early stages, it causes such symptoms as reduced quality of vision, increased discomfort from car headlights, inability to see details in twilight or foggy weather. Patients with cataract perceive colors mainly in pastel tones.

Conditions that are symptoms of cataract can be listed as follows:

• Discomfort from light;
• Glare;
• Eye strain, headache;
• Inability to see far or near;
• Blurred vision;
• Change in eyeglass prescription;
• Decreased night vision;
• Loss of depth perception;
• Better near vision without glasses;
• Faded colors;
• Difficulty driving;
• Difficulty reading newspapers, magazines, books;
• Smoky, foggy vision.

WHAT CAUSES CATARACT?

A cataract occurs when the natural lens behind the pupil, which provides vision, loses its transparency and becomes cloudy. Based on the anatomical structure of the eye lens, there are three types of cataracts. The type that begins in the core of the eye is called “nuclear cataract,” the one that starts in the cortex is called “cortical cataract,” and the type that begins in the capsule is called “capsular cataract.” By type of occurrence, cataract is divided into two parts.

Congenital cataract is the loss of transparency and clouding of the lens on one or both sides, observed from birth. Congenital cataracts can be caused by infections the mother had during pregnancy or medications taken, and sometimes there may be no cause at all.

Senile cataract is manifested by a gradual decrease in vision in patients older than 50–60 years. The risk of developing cataract is 60% higher in patients with diabetes. In this group of patients, rapidly progressing cataracts can become a serious problem for the eye already at the age of 30–40. Also, steroid drops used in the treatment of uveitis (inflammation of the vascular layer of the eye) increase the risk of cataract formation. In addition, diseases that cause premature aging such as myopia and Down syndrome can also lead to cataracts. Patients usually consult an ophthalmologist complaining of “blurred or smoky vision.” This condition significantly worsens vision over time. Symptoms include glare from incoming lights especially at night, difficulty reading, trouble recognizing faces and watching TV, seeing object colors in darker or duller tones, reduced need for glasses, and curved appearance of straight edges.

HOW IS CATARACT DIAGNOSED?

First, the ophthalmologist collects a detailed medical history of the patient. Then the examination begins. Cataract is diagnosed through a biomicroscopic examination performed by the ophthalmologist.

HOW IS CATARACT TREATED? HOW IS CATARACT SURGERY PERFORMED?

Cataract is a disease treated surgically. The operations involve either “intracapsular cataract extraction” or the more commonly performed “extracapsular cataract extraction” techniques. In extracapsular extraction, planned extracapsular surgery (lens implantation) and phacoemulsification (commonly called sutureless laser surgery) are used. In patients whose surgery has been delayed, white mature cataracts can be seen in the pupil area. Surgical intervention offers options based on the patient's need for distance, near, or intermediate vision. The surgery is performed with one of the appropriate intraocular lenses, based on the patient's preference and overall health. In cases of strong astigmatism, special lenses are inserted into the eyes.

In recent years, significant innovations have taken place in cataract surgery. Thanks to premium intraocular lenses, patients can enjoy a more comfortable life after cataract removal than before, and with multifocal intraocular lenses, they can see clearly both near and far without glasses. The most commonly used method is the phaco method, widely known as laser surgery. In this operation, the hardened cataract is broken up, removed, and replaced with an intraocular lens. The surgery is performed through an incision smaller than 2 mm. The fact that this method is sutureless, painless, and uses only drop anesthesia provides great advantages to the patient. If the patient is emotionally calm, all cataract surgeries are performed without needles and under drop anesthesia. This process takes about 20–30 minutes. After cataract surgery, the patient can return to normal life within 2–3 days.

For people with cataracts, there are multifocal and trifocal smart intraocular lens options, which are inserted into the eye during surgery and provide clear vision at both near and far distances. With these lenses, the need for glasses after surgery is eliminated. Furthermore, even in the absence of cataracts, in cases of severe refractive anomalies, a clear intraocular lens can be surgically removed and replaced with a suitable smart intraocular lens. This way, quality vision can be achieved at all distances without glasses.

FREQUENTLY ASKED QUESTIONS ABOUT CATARACT

When is it appropriate to perform cataract surgery?

In older methods, it was common to wait for the cataract to mature, since these techniques had relatively higher risks. Therefore, it wasn't recommended for eyes that still had good vision. But now, with the phaco method, the risk is minimized. Additionally, with mature cataracts, it's harder for ultrasound to break the cataract, increasing surgery time. Therefore, we prefer not to wait for maturity. I usually leave the decision to my patients. There are many differing opinions. A patient should consider surgery when they feel their vision is insufficient or they experience discomfort.

How does cataract surgery correct vision problems?

In cataract surgery, the cloudy natural lens is replaced with an artificial lens that is equivalent to the natural lens, allowing proper focusing of light entering the eye. Patients are then typically given reading glasses for near vision. These new-generation multifocal intraocular lenses offer smooth transitions between optical foci for distance, intermediate, and near (reading) vision. This allows postoperative patients to live without the need for glasses at any distance.

Is sunlight effective in causing cataracts?

Cataracts typically develop due to age-related degradation of the proteins in the lens of the eye. The most common cause is sunlight exposure. Additionally, different types of cataracts can arise from various causes, including heredity, obesity, severe diarrhea, low socioeconomic status, excessive smoking, alcohol consumption, reduced estrogen levels in postmenopausal women, and excessive salt intake.

How long does cataract surgery take?

While cataract surgeries can vary depending on the patient's condition, the duration of the operation also varies accordingly. The phaco method generally takes about 20–30 minutes.

What happens if I don’t undergo cataract surgery?

If cataracts are not treated, vision may be completely lost. Additionally, it may lead to glaucoma and eye displacement. A cataract that is not treated in time may cause various complications if surgery is performed later.