One of the few things guaranteed in life is: if we all live long enough, we will get cataracts. They are a by-product of birthdays. The three vision concerns we worry about as we have birthdays, other than needing glasses, are cataracts, glaucoma & macular degeneration. The prevalence of Macular Degeneration is 1.5% for the US population over the age of 40; for Glaucoma, the prevalence is around 2% and for cataracts it is significantly higher, reaching levels around 50% by age 80.

Simply put, when we are born the natural lens in the eye is crystal clear and as we age it gets cloudy showing signs of early lens changes by the time most of us reach our 50’s. A cataract is the clouding of the natural lens which, ultimately, blocks light from getting properly focused on the back of the eye (the retina).

As the cataract worsens it affects both the quality & quantity of our vision. For example, if we go to renew our driver’s license in Maryland, we need corrected (that’s with glasses or contact lenses) vision of 20/40 or better to drive at all times. A cataract will frequently reduce the quantitative measurement below the 20/40 level. However, before that ever happens there are many qualitative affects of the beginning of a cataract.

Daily tasks like reading become much more challenging, requiring brighter room lighting than ever before. The contrast of the newspaper seems to get worse every month. Contrast in general gets less and less discernable especially at night. Driving into the rising or setting sun becomes extremely difficult. Glare becomes more of an issue. Those bright halogen headlights and bright streetlights are extremely uncomfortable. All of this is due to light entering the eye and scattering throughout the back of the eye as it hits the cloudy natural lens.

At this point in time, the only remedy is cataract surgery which has become one of the most frequently provided elective surgical procedures in the US ( over 3 million per year) and one with the fewest complications. The clouded natural lens is surgically removed through a very small incision and replaced with an artificial intraocular lens (IOL). Each IOL has a specific prescription selected for each patient with the typical goal being the best possible distance vision without glasses. Reading glasses for up close are then needed but the quality of vision is dramatically improved.

There are IOLs now available that can correct astigmatism that you may have had all your life. Also, Multifocal and Accommodating IOLs are available that can provide BOTH distance and near vision without having to rely on reading glasses.

The actual surgery is typically performed in an out-patient surgical facility and you are usually home in time for lunch and enjoying clear and crisp improved vision within days. There are eye drops required before and after the surgery to ensure the very best results and you are usually back to your (new and improved) daily routine within just a few days. Of course, everyone responds and heals differently, so expect some variation to the healing process.

We often wonder about how one might prevent cataracts. Studies show that if we take steps early in life we may be able to delay the onset of visually disabling cataracts but we can never truly prevent them. Delaying the onset includes protection from ultraviolet light (proper quality sunglasses and hats with brims), possibly a baby aspirin and certain anti-oxidants though the jury is still out and, just recently, a new study showing a lower incidence of cataracts amongst those on a strict vegetarian or vegan diet.

In summary, with cataracts and all the other birthday-related eye disorders it is critical to have regular (at least annual) eye examinations with your regular eye doctor.

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