Welcome to our latest post, "The Top 10 Questions People in Edmonton Ask Us About Cataracts." Cataracts are among the most common eye conditions worldwide, particularly as we age. Despite this, they remain shrouded in mystery for many people, leading to various questions, concerns, and misinformation. As optometrists, we routinely get questions about what causes cataracts, how they impact vision, and the available treatment options. Today, we've compiled a list of the top 10 questions our patients frequently ask us about cataracts. We aim to help you better understand this condition, dispel any misconceptions, and guide you toward making informed decisions about your eye health.

#1 What are cataracts, and what causes them?

Cataracts are among the most common causes of vision loss, particularly among older Edmontonians. They are characterized by the clouding of the natural lens inside the eye. To better understand this, envision the eye as a camera where the lens focuses light onto the retina, much like film, producing clear, sharp images. A healthy eye lens is clear or transparent, allowing light to pass through unobstructed. However, with age or due to certain medical conditions, the proteins within the lens can begin to clump together, forming a small, cloudy area known as a cataract.

Cataracts develop slowly and painlessly, with the visual symptoms often going unnoticed until they've significantly progressed. As a cataract develops, it clouds more of the lens, making it increasingly harder for a person to see. Symptoms might include:

• Blurry or hazy vision.

• Less vibrant colour perception.

• Increased sensitivity to glare.

• Difficulty seeing at night.

So, what causes cataracts? 

The most common cause is aging. As we age, the proteins in the eye lens can start to degrade, leading to the formation of cataracts. Other factors that can accelerate the development of cataracts include prolonged exposure to UV radiation, Type 1 and Type 2 Diabetes, hypertension or high blood pressure, obesity, smoking, and the excessive consumption of alcohol. Some types of cataracts can also be congenital, meaning they are present at birth or form during childhood, often due to genetic factors or intrauterine infections. It's also worth noting that certain medications, like corticosteroids like prednisone, previous eye surgery, and eye injuries, can increase the risk of developing cataracts.

#2 What are some of the common signs and symptoms of cataracts?

Cataracts, by nature, are often stealthy in their development, making gradual vision changes that may not be immediately noticeable. However, understanding the common signs and symptoms can be crucial for early detection and management. Let's look into some tell-tale signs that could suggest the onset or progression of cataracts.

One of the earliest and most common symptoms people notice is blurred vision. Things might seem less clear or defined, like looking through a fogged-up window. This blurriness can't be corrected with glasses or contact lenses and often leads to difficulty performing routine tasks like reading or driving, especially at night.

Another common sign of cataracts is increased difficulty seeing in dim or low light. This is because cataracts block how much light can get to the back of the eye. People with cataracts might find it challenging to navigate in poorly lit environments or notice that they need more light to read than they did before. You might find yourself turning on the lights around the house or drive with your high beams on in the car. 

Cataracts can also affect one's perception of colours. Colours may seem faded or yellowish, like an old photograph that's lost its vibrancy. This happens as the clouded lens blocks light and reduces the vibrancy and contrast of colours. Cataracts also look yellow, which means that they add a yellow filter over everything. 

Light sensitivity is another frequent complaint among those developing cataracts. They might experience an uncomfortable glare or a "halo" effect around bright lights, such as oncoming headlights when driving at night or sunlight reflecting off surfaces. This glare can be disconcerting and sometimes even painful, making it hard to drive or spend time outdoors without sunglasses.

Furthermore, some people with cataracts may experience double vision in the affected eye, seeing two images instead of one. However, this symptom typically occurs when a cataract is at a specific location in the eye lens and might resolve as the cataract enlarges.

Finally, a surprising symptom of cataracts is a temporary improvement in near vision for typically farsighted individuals. This phenomenon, often called 'second sight,' occurs as the cataract changes the eye's refractive index. However, this temporary improvement in near vision disappears as the cataract develops.

Cataract symptoms can vary widely depending on the cataract's type, location, and progression. Therefore, regular eye examinations are crucial, particularly for those over 60, to promptly identify and address potential eye health issues. Remember, if you notice any significant changes in your vision, booking an eye exam with one of our optometrists is always a good idea. 

#3 How is a cataract diagnosis made?

Detecting cataracts early is crucial to managing the condition and preserving vision. For this reason, routine eye examinations performed by an optometrist or ophthalmologist are essential. These eye exams are more than just determining if you need glasses or contact lenses; they involve comprehensive testing to identify eye health issues, including cataracts. So, let's take a closer look at how an optometrist diagnoses cataracts during an eye exam.

The eye exam starts with a thorough review of your medical history. We will ask you questions about your vision and any symptoms you've been experiencing, such as blurriness, difficulty seeing at night, or light sensitivity. We will also inquire about any family history of eye conditions, your lifestyle, and any medications you are currently taking, as these can all influence eye health. It's important to be truthful about your medication usage, as many medicines can cause complications during cataract surgery if we're unaware. 

Next, a vision test is conducted, typically involving an eye chart with letters decreasing in size, to measure how well you can see from various distances. This test helps determine the sharpness or clarity of both your distant and near vision.

We then use a device called a slit lamp, or biomicroscope, to examine the structures at the front of your eye, including your eye's lens. The slit lamp magnifies the eye, allowing our optometrist to visualize any changes in the eye's lens, such as cloudiness or opacities that indicate the presence of a cataract. This instrument provides a highly detailed view of the eye, aiding in detecting early signs of various eye diseases.

Our optometrist will perform a dilated eye exam in almost all cases where we suspect cataracts. They'll administer special drops to temporarily enlarge your pupils. This process provides a clearer view of the back of the eye, including the retina. It also allows us to see the complete lens structure to determine the type and extent of your cataract formation. A dilated eye exam is also crucial to ensure no other more serious cause for your vision problems, and it should always be performed before you are placed on a waitlist to see a cataract surgeon. 

Another test that might be used is called glare testing. This test evaluates how well you can see in bright light, mimicking the glare of sunlight or car headlights. People with cataracts often find their eyes more sensitive to bright light, making glare testing a valuable tool in cataract diagnosis. At Helio Optometry eye care clinic, we will sometime do this with our Bailey-Lovie eye charts to get a better understanding of the visual impact your cataracts might be having on your vision.

Finally, a potential acuity meter (PAM) test may be used to measure the potential visual improvement after cataract removal. This test provides an estimate of how well you might be able to see once the cataract is removed and can be particularly useful when contemplating surgery. PAM meters, however, are becoming less common, and we no longer use one in our eye clinic. Instead, we perform a detailed examination of your retinal health using special imaging devices such as optomap ultra-widefield and 3D OCT scans, which give us a better understanding of your retinal health. 

Remember, an early diagnosis often opens up more options for managing a condition. Therefore, if you're experiencing any vision changes, schedule an appointment with your optometrist. Even in the absence of symptoms, regular eye exams are essential, especially as you age, for maintaining optimal eye health.

#4 Does having cataracts mean I will Go Blind?

One of the most common concerns we hear from cataract patients is the fear of inevitable blindness. This concern is understandable, given that cataracts cause a progressive, usually gradual, decrease in vision. Statistically, cataracts are also the number one cause of vision loss worldwide. However, the good news is that vision loss from cataracts is preventable and reversible with eye surgery.

Cataracts develop when the eye's natural lens, located behind the iris, becomes clouded. This clouding can lead to a range of symptoms, from a slight blurring of vision to significant vision impairment. Left untreated, advanced cataracts can indeed cause severe vision loss and, in extreme cases, blindness. But it's essential to emphasize that this condition is treatable and does not lead to irreversible blindness for most people. 

Cataract surgery, the only definitive treatment for cataracts, is one of Canada's most commonly performed and successful eye surgeries. This procedure involves removing and replacing the clouded natural lens with an artificial intraocular lens. In the hands of an experienced surgeon, the cataract surgery is safe and effective, with a high success rate of improving vision. Most people notice a significant improvement in their vision following cataract surgery, often enabling them to return to their normal activities with improved sight.

Of course, like any surgery, cataract surgery carries risks, including infection and inflammation. However, these complications are rare, and when they do occur, they can usually be successfully managed with medications or additional procedures.

Furthermore, the decision to have cataract surgery isn't usually urgent and can often be delayed until the decrease in vision significantly interferes with your daily activities. Many people with early-stage cataracts manage well with non-surgical strategies like using stronger eyeglasses, magnifying lenses, or brighter lighting. The important thing to remember is to visit your optometrist regularly so they can continually evaluate the progression and make sure that things don't advanced so far that you have significant visual symptoms. 

#5 What are the different types of cataracts, and how do they affect my vision differently?

Cataracts, characterized by a clouding of the lens in your eye, are not all created equal. They come in various forms, each with distinct causes, characteristics, and effects on vision. Understanding the different types of cataracts can provide valuable insights into this widespread eye condition and its impact on your sight.

Firstly, we have age-related cataracts, the most common type. As the name suggests, these cataracts develop as part of the natural aging process. They are further categorized into three types based on their location in the lens - nuclear cataracts form in the center (nucleus), cortical cataracts occur in the outer layer (cortex), and posterior subcapsular cataracts develop at the back of the lens. Nuclear sclerotic cataracts (NSC) often start with a temporary improvement in reading vision but progress to impairing vision as the lens turns yellow and hardens. Cortical or spoking cataracts can cause glare and problems with depth perception, while posterior subcapsular cataracts (PSC) can progress rapidly and cause significant vision loss. 

Next are congenital cataracts, which are present at birth or form during early childhood. These cataracts may be genetic or caused by an intrauterine infection or trauma. They can be small and may not affect vision, but if they're large or centrally located, they may need to be surgically removed to prevent visual impairment. Our optometrists will screen for congenital cataracts in your child's early eye exams, as left undetected and treated, the eye may become amblyopic.

Traumatic cataracts form after an injury to the eye. The progression of this type of cataract can be unpredictable. Some traumatic cataracts develop shortly after an injury, while others may take several years to appear.

Secondary cataracts are caused by other medical conditions or treatments, such as diabetes or exposure to certain medications like corticosteroids. They can also develop after surgery for other eye conditions, like glaucoma.

Finally, radiation cataracts can develop due to exposure to some types of radiation. While this is less common, certain professions or treatments may increase the risk of radiation cataracts.

#6 At what stage should I consider cataract surgery?

Deciding the right time to have cataract surgery can be a complex decision, filled with questions and uncertainties. After all, it involves your precious eyesight. However, the good news is that cataract surgery is a common and generally safe procedure that can effectively restore vision loss due to cataracts.

Firstly, it's important to understand that cataracts typically develop slowly and may not significantly affect vision in the early stages. Many people with early cataracts manage well with non-surgical strategies such as using stronger glasses, magnifying lenses, or brighter lighting. So, when your eye doctor tells you that you have early signs of cataracts, it doesn't mean that you need cataract surgery right away.

However, as cataracts progress, they can start to interfere more seriously with daily activities and impact the quality of life. Significant vision loss is the most common reason people choose to have cataract surgery or that your optometrist recommends that you have a consultation. 

This can be vision loss that affects your ability to do everyday tasks such as reading, driving, recognizing faces, or doing any activity that requires clear vision. If your cataracts prevent you from living your life how you want to, then it might be time to consider surgery.

Next, your profession or lifestyle can play a role in this decision. If your job or hobbies require precise vision, or if you drive a lot, particularly at night, you might need to consider cataract surgery sooner. Similarly, if you're highly active and enjoy activities that require good depth perception, like golf or tennis, cataracts could interfere with your ability to participate in these activities, nudging you towards considering surgery.

Your overall health and other eye conditions can also influence the timing of cataract surgery. Cataracts can sometimes make it difficult for your optometrist to examine the back of your eye to monitor or treat other eye conditions, like diabetic retinopathy or age-related macular degeneration. In such cases, having the cataract removed earlier may be beneficial.

It's also worth noting that, unlike other eye conditions, there's no need to rush into cataract surgery. Cataracts are usually not harmful to the eye, so you typically have time to weigh the pros and cons. On the other hand, there's also no benefit to waiting until the cataract 'ripens' or becomes 'mature.' In fact, waiting for the cataract to become too advanced can make the surgery more complex and potentially riskier.

In conclusion, the decision to have cataract surgery is personal and largely depends on how the cataracts affect your quality of life. An open and detailed discussion with your optometrist or ophthalmologist can help you make an informed decision. They can provide advice based on the specifics of your condition, your vision needs, and your lifestyle. 

Remember, the goal of cataract surgery is to help you live your life with the best vision possible, so don't hesitate to share your concerns and ask questions to guide this important decision.

#7 What does cataract surgery involve, and how long does it take?

When facing the prospect of cataract surgery, patients often have questions about the procedure. How is it done? How long does it take? What should I expect? 

These questions are natural and understanding the process can help ease any anxiety about the operation.

Cataract surgery is performed by an ophthalmologist, a medical doctor specializing in eye care and eye surgery. The goal of the procedure is to remove the clouded natural lens of the eye (the cataract) and replace it with a clear, artificial lens known as an intraocular lens (IOL).

Before the surgery, you will be given eye drops to dilate your pupil and local anesthetic drops to numb your eye. In some cases, a mild sedative may also be given to help you relax. Cataract surgery is typically an outpatient procedure, which means you can go home the same day.

The surgery usually takes 10 to 30 minutes, not including pre- and post-operative preparations. 

The most common technique used today is called phacoemulsification, or "phaco". During phaco, the surgeon makes a small incision in the eye's front surface (the cornea) and inserts a tiny probe. This probe emits ultrasound waves that soften and break the lens into small pieces. These pieces are then suctioned out of the eye.

Once the cataract has been removed, the surgeon inserts the artificial lens into the empty lens capsule of the eye. This lens is folded to allow it to pass through the small incision, and once inside, it unfolds and takes up its position. The incision is so small that it often doesn't require stitches – it usually heals on its own over time.

After the surgery, you will spend a short amount of time in a recovery area for observation. Your eye may be covered with a protective shield or patch to prevent you from rubbing it. You should never use a pressure patch over your eye unless directed by your surgeon, as this can increase the risk of an eye infection. You will be given specific aftercare instructions to follow at home, including how to use eye drops to help heal and prevent infection.

It's important to note that while the surgery is quick, the appointment can take several hours. This includes time for pre-operative preparation, such as dilating your pupil, administering the local anesthesia, and going over the surgical plan, as well as post-operative recovery and discharge instructions. If you have any questions or you need clarification about what to do, please feel free to have the doctor or nurse review everything with you. 

#8 What are the risks and complications associated with cataract surgery?

Cataract surgery is one of the most commonly performed and successful surgeries worldwide, with millions of procedures conducted each year. The operation has a high success rate and can significantly improve your quality of life by restoring lost vision. However, as with any surgical procedure, cataract surgery is not entirely without risks. Understanding these potential risks and complications can help you make an informed decision about undergoing the procedure.

Firstly, it's important to note that most people undergo cataract surgery without experiencing any significant complications. Modern cataract surgery techniques, including phacoemulsification (where the cataract is broken up by ultrasound and removed), are minimally invasive and have revolutionized cataract surgery, making it safer and more efficient.

However, complications, while rare, can occur. One of the most common complications is posterior capsule opacification (PCO), also known as secondary cataracts. PCO occurs when part of the lens capsule, which is left in place to hold the artificial lens, becomes cloudy after surgery. PCO can cause blurry vision and glare, similar to the symptoms of original cataracts. It's estimated to affect about 1 in 3 eyes after surgery and usually develops within the first five years after cataract surgery. The good news is that PCO can be easily and safely treated with a quick, painless laser procedure called a YAG capsulotomy. Your optometrist will be able to diagnose this and make the necessary referrals should it occur. 

Another possible complication is a retinal tear or retinal detachment, where the retina at the back of the eye pulls away from its normal position. This is a serious condition that can lead to vision loss and requires urgent treatment. People with high degrees of myopia (nearsightedness) are at a higher risk for retinal detachment after cataract surgery. The general risk of developing a retinal tear or retinal detachment post-cataract surgery is approximately 1% within the first five years after surgery. 

Infection, known as endophthalmitis, is another risk, although it's rare. Swift treatment with antibiotics is required to manage this potentially severe infection. Your surgeon will typically prescribe antibiotic eye drops before and after surgery as a preventive measure. It is vital that you take these medications as prescribed. Your optometrist may also prescribe special lid hygiene wipes or sprays if you have a large amount of blepharitis or bacteria buildup along your eyelids. These lid wipes and sprays are usually used for at least two weeks before your cataract surgery. 

Other potential complications can include swelling or edema, both of the cornea (the clear front part of the eye) and the retina, increased eye pressure, and bleeding inside the eye. These conditions can usually be treated effectively with medication or additional procedures.

In rare cases, the artificial lens implant might be misplaced, or the lens capsule might be unintentionally damaged, which might require a second operation to correct. Very rarely, a condition called "toxic anterior segment syndrome" can occur, causing severe inflammation that usually resolves with treatment.

While these complications may sound concerning, remember that they are infrequent, and most can be effectively managed. Your surgeon will take every precaution to minimize these risks, and advances in surgical techniques and equipment have made cataract surgery safer.

Before the procedure, discuss these potential risks with your eye surgeon. They can provide more detailed information based on your condition and help you understand what to expect. If you notice any changes in your vision after surgery, contact our office or the cataract surgeon's office immediately. With careful attention to aftercare instructions and close communication with your optometrist and ophthalmologist, cataract surgery can offer significant benefits and a successful return to clear vision.

#9 How long is the recovery process after cataract surgery, and what can I expect?

Undergoing cataract surgery can significantly improve your vision and quality of life. However, the journey doesn't end there. Understanding the post-surgical recovery process is just as important, and knowing what to expect can help you confidently navigate this phase. 

Cataract surgery is an outpatient procedure, meaning you can return home the same day.

Directly after the surgery, you'll spend a short amount of time in the recovery room for observation. It's important to arrange transportation home, as you won't be able to drive immediately following the procedure. Your eye may be covered with a patch or protective shield when you leave the hospital, and you may experience some discomfort, blurry vision, or watery eyes - all of which are normal and expected.

The first few days post-surgery are crucial for recovery. You'll need to use prescribed eye drops to prevent inflammation and infection, and you must avoid activities that could put undue pressure on your eye, such as bending over or heavy lifting. Most people find that their vision begins to improve within a few days of surgery, but it can take a few weeks for your vision to stabilize completely. At the very minimum, we recommend that people take 2-3 days off, but ideally, 7 days away from work is a reasonable expectation. Talk to your eye doctor about your work, and they can make a recommendation for you to discuss this with your employer. 

As part of the recovery process, you'll have a series of post-operative check-ups with your optometrist or ophthalmologist to monitor your progress and ensure your eye is healing well. These appointments are typically scheduled for one day, two weeks, and six weeks after surgery.

The first post-operative exam is usually scheduled for the day after surgery, but sometimes it might be on the same day as the surgery. This initial check-up is incredibly important, even if you feel your eye is healing well. During this visit, your eye doctor will remove the eye patch, examine your eye to ensure it's healing correctly and address any symptoms or concerns you might have.

The next appointment usually happens two weeks after your surgery. By this time, the inflammation caused by the operation should have significantly reduced, and your eye should be well on its way to healing. Your optometrist will again examine your eye, checking for any complications and assessing how your vision is improving.

The six-week post-operative exam is a crucial milestone in your recovery process. By this point, your eye should have healed substantially, and your vision should be largely stable. This appointment provides an opportunity to assess the long-term result of the surgery, check the position and condition of the implanted lens, and address any residual refractive error. If needed, your optometrist can now prescribe new eyeglasses or contact lenses, as your vision should have stabilized enough to ensure the prescription is accurate.

While this timeline serves as a general guide, remember that every individual's recovery process is unique. Your eye surgeon will provide personalized advice based on your specific circumstances and needs.

After cataract surgery, the healing and recovery process is paramount, and certain activities should be avoided to ensure a successful recovery. It's important not to rush back into your usual routines too quickly, as this could lead to complications. For the first few weeks after surgery, avoid strenuous activities and heavy lifting, as these can increase blood pressure in the veins and arteries of the eye, potentially causing complications. Swimming and using a hot tub should also be avoided, as exposure to water can increase the risk of infection. It's crucial to steer clear of dusty environments and to not rub your eyes, to keep irritants out. Similarly, protective eyewear should be used to shield the eye from wind and bright sunlight. When sleeping, you might be advised to wear an eye shield to prevent accidental rubbing. Driving should be avoided until your optometrist confirms that your vision meets the legal requirement for driving. Finally, while returning to work a few days post-surgery is generally okay, this can depend on your job type. Jobs that require heavy physical labour or expose the eyes to potential harm may require a more extended recovery period. Following these guidelines can help protect your eyes and facilitate a smooth recovery after cataract surgery.

#10 Are there lifestyle changes or precautions I can take to slow the progression of cataracts?

While cataracts are often associated with aging and are considered a natural part of getting older, there are proactive steps you can take to slow their progression and prevent needing cataract surgery.

First and foremost, diet plays a crucial role in eye health. Numerous studies suggest that certain nutrients and dietary practices can help delay cataract progression. Antioxidant-rich foods such as dark, leafy greens, citrus fruits, and other fruits and vegetables high in vitamins C and E are believed to be beneficial. Omega-3 fatty acids found in fish like salmon and tuna may also promote eye health. Avoiding excessive salt and foods high in sugar and unhealthy fats can also contribute to healthier eyes. Hydration is equally important, so be sure to drink enough water throughout the day.

Another significant lifestyle factor is smoking. Smoking generates free radicals, which can harm the lens cells and contribute to the formation and progression of cataracts. So if you smoke, making an effort to quit can reduce your risk. Similarly, limiting alcohol consumption can also play a role, as heavy drinking has been linked to an increased risk of cataracts.

Protecting your eyes from excessive sunlight is also essential. Ultraviolet (UV) radiation from the sun can speed up the development of cataracts. Wearing sunglasses that block 100% of UVA and UVB rays and a hat with a brim when outdoors can help protect your eyes.

Regular exercise is beneficial for overall health, and that includes eye health. Regular physical activity like walking, swimming, or cycling can lower your risk of developing cataracts. Maintaining a healthy weight also seems to protect against cataracts.

Chronic conditions such as diabetes and high blood pressure can increase your risk of cataracts. If you have a chronic condition, proper management is key. Regular check-ups and following your doctor's advice can help you manage your condition and reduce your cataract risk.

Your eyes, like the rest of your body, benefit from ample rest. Giving your eyes a break, particularly if you spend a lot of time looking at digital screens, can help prevent strain. Regularly following the "20-20-20" rule – every 20 minutes, look at something 20 feet away for 20 seconds – can help.

In conclusion, adopting a healthy lifestyle can go a long way in maintaining your eye health and potentially delaying the progression of cataracts. While these measures can't guarantee you'll avoid cataracts entirely, they can help slow the onset and progression. As always, it's important to consult with your optometrist or ophthalmologist to get personalized advice for your eye health. Your journey to better eye health starts with Helio Optometry. Contact us today to learn more.