Cataracts

A cataract is a clouding of the eye's lens that causes blurred vision over time

Symptoms
Risk Factors
Diagnosis
Treatment
Prevention

Cataract is a clouding of the eye’s lens that gradually leads to blurred vision. Patients often describe it as seeing through a curtain or a foggy window, which is why the condition is also commonly referred to as a ‘curtain over the eye.’

Cataracts usually develop slowly and, if left untreated, can lead to vision loss. The condition typically affects both eyes, although one eye may be more severely affected than the other.

Symptoms

Cataracts develop slowly and in the early stages usually proceed without symptoms or vison disturbances. Initially, the clouding covers only part of the lens, and the patient may not notice a difference in vision. Later, the entire lens begins to cloud, and the first symptoms appear:

Blurred vision
Reduced vision at night & needing brighter light for reading
Sensitivity to light
Frequent changes in eyeglass prescription
Eye irritation from light and glare
Unclear and dull colors, sometimes fading or yellowing
Double vision in a single eye

Risk factors:

It is most common in older people and is the leading cause of preventable blindness worldwide. The main cause of cataracts is the aging process. Every second person over 65 is at risk, but the “curtain” can appear even at age 40.

Often, cataracts develop slowly and, if left untreated, can lead to VISION loss. The disease usually affects both eyes, with one potentially being affected to a greater degree than the other.
Besides age-related, cataracts can also be congenital. In some cases, it’s hereditary, but it can often be caused by infections during pregnancy – rubella, herpes, or toxoplasmosis. This is why an examination by an ophthalmologist in the first year after a baby’s birth is mandatory.
A strong impact, cut, or intense heat can also damage the eye’s lens and provoke so-called traumatic cataracts at any age.

Other reasons you may get cataracts include:

having parents, brothers, sisters, or other family members who have cataracts
having certain medical problems, such as diabetes
having had an eye injury, eye surgery, or radiation treatments on your upper body
having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays
using certain medications such as corticosteroids, which may cause early formation of cataracts.
smoking

Diagnosis

To diagnose “cataract,” along with standard tests for measuring prescription and eye pressure, VISION clinic conducts a thorough examination with the latest generation biomicroscope. This allows the ophthalmologist to examine the structures in the front part of the eye in great detail at multiple magnifications, making it easier to detect even small abnormalities.

Before removing the clouded lens, specialized examinations must be performed. These include:

Lens calculation
Key to good patient VISION is the precise calculation of the replacement lens. VISION specialists work with the most modern optical biometer – “Lenstar 900.” It is the first optical biometer that can measure the position of the lens to be inserted. This means the apparatus most precisely determines the ideal implant for each patient.If the cataract is in a very advanced phase – the lens is very cloudy, the examination can be done with an ultrasound biometer. VISION is equipped with the most modern such device from the French “Quantel Medical” – “Aviso.”
Endothelial cell examination
Eye surgery, like other surgical interventions, exposes the posterior surface of the cornea, called the endothelium, to some risk. It is believed that even with the most precise intervention, about 10% of the cells in this layer die. And when their number falls below the critical level, the cornea becomes opaque and VISION is affected. Therefore, before cataract removal surgery, it is good to examine the number of endothelial cells – so doctors have assurance that the risk of surgery is measured. At VISION clinic, this happens in a moment – with the modern specular microscope “Perseus.”
Retina examination
Before removing the “curtain,” it is important to rule out retinal disease. The reason is that because of VISION impaired by cataracts, problems with the posterior eye segment often remain hidden. But to be resolved, the “curtain” must first be removed, as treatment cannot be successful with opaque eye structures. At VISION, the examination is done with a latest generation device – the optical coherence tomographer (OCT) “Optovue,” which makes a 3D “live” slice of the posterior eye segment – painlessly and without contact.
Cornea examination
A useful examination before cataract surgery is the examination of corneal curvatures – keratometry, as well as the assessment of the quantity and quality of the tear film. At VISION, these are done in seconds and with one device – the “Sirius,” unique to Bulgaria, from the well-known manufacturer of lasers for ophthalmology “SCHWIND.” The revolutionary technique (simultaneous tomograph and topograph) makes the most detailed imaging of the cornea possible.

Treatment

A cataract cannot be removed with medication or corrected with glasses. The only effective treatment is surgical removal of the clouded lens and its replacement with an implant – an intraocular lens (IOL). Cataract surgery is routine and is the most commonly performed surgical procedure in the world.

The operation to remove the natural lens and implant an artificial one takes only a few minutes. The patient is awake but feels no pain, as anesthetic eye drops are used. There are several methods for removing the clouded natural lens and replacing it with an artificial one.

Phacoemulsification – The method by which tens of thousands of patients have been successfully operated on at VISION ensures faster recovery and better control of intraocular pressure. Phacoemulsification is the most modern and safest method of cataract surgery.
In this procedure, the clouded natural lens is fragmented using ultrasound and carefully removed through a microscopic incision, after which a new, clear intraocular lens is implanted in its place.

Extracapsular extraction – This approach is used for very advanced cataracts. The surgeon removes the entire lens while leaving the posterior part of the lens capsule intact. The procedure requires a larger surgical incision and sutures, and carries a risk of postoperative astigmatism.

Intracapsular extraction – This method is used only in very rare cases, when there is “weakness” in the eye’s supporting structures. The entire lens capsule is removed and a different type of specialized lens is implanted.

Immediately after cataract surgery, your vision may be blurry while the eye adapts. Within just a few days after the operation, you will see more clearly and colors will appear brighter.

If you have cataracts in both eyes, your doctor will schedule the second surgery based on individual assessment.

Secondary cataract

About 20-30% of patients develop a secondary cataract (posterior capsule opacification). However, it is not a complication of the operation, but occurs naturally. This occurs when the back of the lens capsule, which is left in place to hold the IOL, becomes cloudy. Treatment involves a simple, painless laser procedure called YAG laser capsulotomy that creates an opening in the clouded capsule to restore clear vision. Vision improves within hours.

Types of cataract lenses

After removing the clouded lens, it is necessary to place an artificial transparent lens in its place. Choosing the most suitable artificial intraocular lens is key to good VISION after surgery. The well-prepared specialists from VISION will help you decide what type to choose – depending on your lifestyle and the individual characteristics of your eyes. In Bulgaria, the cost of implants is not covered by health insurance.

Lenses are of several types – according to the material from which they are made, the design, and the optics. Monofocal lenses require reading glasses after surgery, with multifocal ones you can achieve complete independence from them, and toric ones also correct astigmatism.

Rigid lenses – in recent years, doctors and patients avoid them because they do not fold and their placement involves a larger incision during surgery, slower recovery, and the appearance of astigmatism after the procedure. After their implantation, prescription of reading glasses is necessary. Nevertheless, rigid lenses are the only alternative for some patients. And the “ARTISAN Aphakia” model from the Dutch “Opthtec” has proven itself among cataract patients as reliable and comfortable.
Soft lenses – can be folded when placed in the eye, which makes implantation more gentle for the patient. There are mono-, multifocal, and toric models. Most often, VISION patients choose intraocular lenses from the American “Johnson & Johnson VISION” – one of the world leaders in the industry.

Care

Use sunglasses with good UV filter to protect your eyes from the sun
Eat properly and in a balanced way. A healthy diet that includes fruits, vegetables, and whole grains may reduce the risk of developing cataracts
Avoid smoking and drinking alcohol
If you suffer from diabetes, control the disease
For early forms of cataracts, take eye vitamins sold in pharmacies. They slow down the clouding of the lens and the need for surgery

Prevention

It is recommended that people over 40 who have a family history with this diagnosis do not miss preventive examinations by an ophthalmologist
Quitting cigarettes can slow the development of cataracts

Frequently Asked Questions

Usually, VISION normalizes within 2-3 days after surgery. For some people, however, the process by which the brain adapts to the changes takes weeks. And, depending on the type of intraocular lens the patient has chosen, glasses may also need to be prescribed after surgery.

Patients should be careful in the following few weeks after surgery and avoid getting soap in their eyes.

Cataract surgery carries minimal risks for the patient. Normally, patients might experience itching or mild pain for up to several days after surgery. However, there may be some complications, such as displacement of the artificial lens, infection in the eye (endophthalmitis), inflammation (uveitis), increased pressure in the eye, edema in the central part of the retina, etc. In these cases, a specialist should be consulted.

Most eye specialists recommend cataract surgery when VISION is reduced to 30%. Specialists at VISION Eye Clinic will conduct a thorough examination with the latest generation biomicroscope and examine the structures in the front part of the eye in great detail at multiple magnifications. This can detect abnormalities at the beginning of diseases.

Surgery is still the only way to treat cataracts. At this time, there is no scientific evidence that eye drops can cure age-related cataracts.

To recover quickly after cataract surgery, it is good to take the following measures in the first few weeks:

Do not allow soap or shampoo to get into your eyes
Do not drive in the first few days after surgery
Avoid intense exercise and activities that require lifting weights for several weeks to reduce the chances of increasing eye pressure
Do not apply eye makeup
Wearing sunglasses will not only help with sensitivity to light but will also protect the eyes from dust and dirt
Avoid swimming and do not direct water jets directly at the eye