Cataracts: when the fog sets in - To Your Health

Nation's Business, Oct, 1994 by Marcia Levine Mazur

When Jacob Leonard stepped outside his Washington, D.C., home one day last winter, objects seemed to radiate a dazzling light.

A mystical experience? No. A cataract.

But cataracts don't always announce themselves so dramatically. Peggy Abbott of Bear, Del. began having trouble with glare and distance vision seven years ago. Then she found that her glasses needed to be changed more frequently. "I was changing lenses every six months," she recalls, "but it got to the point where even that didn't help." Abbott, too, had a cataract.

That word--Latin for waterfall-- reflects the old notion that cataracts are caused by an abnormal flow of liquid through the eye. Doctors now consider cataracts part of aging. Other symptoms include blurred or distorted vision, a yellowish tinge to objects, and an increased need for light in order to see well.

When we're young, the lenses in our eyes are clear; light passes through easily. But as we age, the lenses become clouded; light has difficulty getting through. That clouding of the lens is called a cataract.

Although children occasionally get cataracts, the condition is mainly a problem for people over 60. In fact, we have a 50 percent chance of developing a cataract when we're between 65 and 74, with the likelihood increasing to 70 percent once we pass 75. Dr. Donald Schwartz of Long Beach, Calif., spokesman for the American Academy of Ophthalmology, puts it this way: "If we all lived until we reached 120, we would all have cataracts."

In addition, eye injuries, long-term unprotected exposure to sunlight, certain medications, and diseases such as diabetes increase chances for a cataract.

When a cataract is discovered in an eye, there is probably one in the other eye as well. Surprisingly, though, the cataract in one eye may develop slowly while the one in the other eye develops quickly. Most cataracts do progress, however, and with time, most cause decreased vision.

Fortunately, cataracts are easily detected by an ophthalmologist. And there is generally no rush to remove them. The time to take out a cataract is when it interferes with normal life.

But once that time comes, there's only one answer: surgical removal of the clouded lens, which has become an outpatient procedure. Today, a patient might sign in at 9 a.m., have the surgery performed under local anesthesia by the ophthalmologist, and be home by noon. There's little discomfort, except for

slight eye irritation for about a week.

Abbott recalls her cataract operation: "I was sort of awake. I saw pink and blue lights, but there was no pain. It took about half an hour, and then they brought me back to the room, sat me up, and gave me toast and coffee."

Once, such an operation meant weeks in bed with weights stationed on each side of the head to keep it from moving. That's because sutures weren't small enough to sew up the opening where the lens had been removed. Patients had to lie flat until the eye healed, and the use of eyeglasses with thick lenses was required thereafter. But no more.

Today, thanks to an unusual legacy of World War II, the lens is replaced. Schwartz tells of a British ophthalmologist, Harold Ridley, who noticed that pilots sometimes got fragments of windshield plastic in their eyes during battle. "But, surprisingly," Schwartz says, "their eyes didn't reject the plastic." And so plastic replacements for cloudy lenses were introduced.

Now, they are called intraocular lenses (IOLs). The IOL, a tiny, lightweight plastic disc, is permanent. And it produces a realistic, undistorted image. The great majority of cataract-clouded lenses removed today are replaced by IOLs.

But a problem remains. Because the IOL is not a natural lens, it can't adjust its focus for near and distant images. That means a pre-surgery decision has to be made.

Dr. John Millwater, Leonard's ophthalmologist, explains: "The patient and doctor have to decide where the IOL lens should have its best correction, either near or at a distance. And that depends on a number of factors, including the status of the vision in the other eye." Because the focus of the IOL must be corrected, people who have had cataracts' removed must still wear regular eyeglasses.

While this type of surgery, like any other, has its risks, the American Academy of Ophthalmology reports that cataract surgery is 90 to 95 percent successful.

For free information on cataracts, send a stamped, self-addressed envelope to: Inquiry Clerk, Cataract Surgery Brochure, American Academy of Ophthalmology, P.O. Box 7424, San Francisco, Calif. 94120-7424.