Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. In fact, there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration and diabetic.
Types of cataracts include:
• A subcapsular cataract occurs at the back of the lens. People with diabetes, high farsightedness or retinitis pigmentosa, or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract.
• A nuclear cataract forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are associated with aging.
• A cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.
Cataract Symptoms and Signs
A cataract starts out small and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting.
A cataract may make light from the sun or a lamp seem too bright or glaring. Or you may notice when you drive at night that the oncoming headlights cause more glare than before. Colors may not appear as bright as they once did.
The type of cataract you have will affect exactly which symptoms you experience and how soon they will occur. When a nuclear cataract first develops, it can bring about a temporary improvement in your near vision, called "second sight."
Unfortunately, the improved vision is short-lived and will disappear as the cataract worsens. On the other hand, a subcapsular cataract may not produce any symptoms until it's well-developed.
What Causes Cataracts?
The lens inside the eye works much like a camera lens, focusing light onto the retina. It adjusts the eye's focus, letting us see things clearly both up close and far away.
The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.
But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.
No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually identifying factors that may cause cataracts — and information that may help to prevent them.
Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye care practitioners recommend wearing sunglasses and a wide-brimmed hat to reduce your exposure.
Other types of radiation may also be causes. For example, a 2005 study conducted in Iceland suggests that airline pilots have a higher risk of developing nuclear cataract than non-pilots and that the cause may be exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at risk from cosmic radiation.
Other studies suggest people with diabetes are at risk for developing a cataract.
The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish the effect of the disease from the consequences of the drugs themselves.
Some eye care practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk.
Other risk factors include cigarette smoke, air pollution and heavy alcohol consumption.
Treatment:
Although surgery is the only remedy for cataracts, it is almost never an emergency. Most cataracts cause no problem other than reducing a person's ability to see, so there is no harm in delaying surgery.
Early cataracts may be managed with the following measures:
• Stronger eyeglasses or contact lenses
• Use of a magnifying glass during reading
• Strong lighting
• Medication that dilates the pupil. (This may help some people with capsular cataracts, although glare can be a problem with this treatment.)
Progression of Cataracts. Patients and their families usually have plenty of time to carefully consider options and discuss them with an ophthalmologist. There is no constant rate at which cataracts progress:
• Some cataracts develop to a certain point and then stop.
• Even if a cataract does progress, it may be years before it interferes with vision.
• Very rarely do people need immediate cataract surgery.
