“In Singapore, the percentage of elderly patients affected by cataracts is about 78.6%. The number of people affected by cataracts also increases as they get older (It affects 63.6% of people between 60 and 64 years, and 94.6% of people 75 years and older.)”*
A cataract is the clouding of the crystalline lens in the eye. This natural lens is usually clear and therefore enables light to pass through into the eye for clear vision.
The most common cause of cataracts is age-related changes in the eye. Some of the types of cataracts are subcapsular cataract, posterior subcapsular cataract, nuclear cataract and cortical cataract. As the eye ages, the lens material hardens and yellows. If the cataract is not removed, it will continue to become opaque and may cause blindness eventually. Cataracts can be treated through cataract surgery.
An eye with cataract usually experiences one or more of these changes:
These symptoms for cataracts in the eyes can adversely affect vision. Due to these changes, a person who has developed cataract may find daily activities inconvenient. Reading the newspaper and watching the television may become chores rather than pleasures. Night driving becomes difficult as visibility drops and the eye sees glare from street lamps and oncoming car headlights. When a cataract causes inconvenience to a person, we would recommend a cataract surgery.
A cataract may develop in one eye first, then the other. The onset of a cataract is usually due to ageing. An eye with high myopia, acute angle closure glaucoma and chronic anterior uveitis may also develop cataract prematurely.
Some other factors which can cause a cataract are:
More uncommon causes for a cataract are concussion, exposure to ionizing irradiation for ocular tumours and long-term intake of certain medications.
The single most effective method to restore vision due to a cataract is to undergo a cataract surgery. This involves the removal of the opaque lens and replacing it with an artificial intraocular lens (IOL).
The surgery typically takes 15-20 minutes per eye and is done as a day surgery. The eye is able to see clearly as soon as the next day after surgery. After resting for 5-7 days, the patient is able to return to work. Most daily activities can be resumed after 1-2 weeks’ rest.
Traditionally, most eye surgeons prefer to wait until the cataract is in the moderate to advanced stage before suggesting a cataract surgery. This is because the older methods of removing a cataract were more complicated. With the intracapsular and extracapsular cataract extraction procedures, bigger corneal incisions with stitching were required. This means a longer recovery period. Also, some patients may end up with residual astigmatism due to the corneal stitches.
The newer method for cataract surgery is phacoemulsification with IOL implantation. With this method, the corneal incision made is smaller of 1.8-2.2mm in length and does not require stitching. This translates to faster wound recovery and less discomfort to the patient after surgery. The doctor is also able to better correct myopia, hyperopia, astigmatism and presbyopia with various types of IOL after removing the cataract. Learn more about cataract surgery.
Traditionally, most eye surgeons prefer to wait until the cataract is in the moderate to advanced stage before suggesting a cataract surgery. This results in a very hard cataract which may require higher ultrasound energy to break up and remove the cloudy lens during the surgery. As the eye is a very delicate structure, some trauma may be induced to the inner structures when high energy level is applied.
In recent years, more patients and surgeons agree that a cataract can be removed even in the early to moderate stages. As a guide, one should consider undergoing a cataract surgery if the symptoms of cataracts begin to affectthe quality of vision adversely such that day-to-day activities can no longer be done with ease.
Greater reliance on technology and later retirement ages has increased the need for good vision in our daily lives. Undergoing a cataract surgery earlier also means restoring good vision sooner. With the availability of various types of lens implants, surgeons and patients can together make a better decision on the best-suited lens for each individual.
A cataract should not be removed at a hypermature stage also because the lens may start to leak inflammatory materials which can lead to a secondary glaucoma.
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