Understanding Cataracts

Cataract = Degeneration of the Eye Lens

When the eye lens degenerates, instead of being clear, it becomes cloudy. This cloudiness causes the refractive power of light to be incorrect and also blocks light from entering the eye, resulting in blurred vision. This condition is called “Cataract”. Most people over 60 years old have slight cloudiness or early-stage cataracts, approximately 80% or more of cataract cases are due to aging, which is a natural degeneration of the body. The remaining 20% may be caused by other factors not related to aging, such as infants born to mothers who had rubella during the first three months of pregnancy, cataracts caused by severe eye trauma, or cataracts due to diabetes. Other eye diseases can also cause cataracts, such as chronic iritis or prolonged exposure to strong sunlight.

Additionally, regular use of certain medications for treating some physical diseases, such as steroids (Steroid) like Prednisolone, commonly used for chronic diseases like allergies, asthma, kidney disease, SLE, and arthritis, or self-purchased steroid eye drops, patients using these drugs regularly should be cautious as they may develop premature cataracts. Many allergy patients who self-medicate may gradually experience blurred vision from cataracts. Although cataracts caused by these drugs do not disappear after stopping the medication, progression can be slowed down.

Symptoms of Cataract

The main symptom of cataracts in the elderly is a gradual, slow blurring of vision over years without pain. Vision worsens in low light, but some types of cataracts cause blurred vision that worsens in bright light, such as sunlight, but vision nearly returns to normal in dim or twilight conditions. This is because in bright light, the pupil contracts, reducing the amount of light entering the eye, whereas in darkness, the pupil dilates, allowing more light in and improving vision.

Seeing double images, such as seeing two or multiple moons at night, even with one eye, occurs because the cloudy lens causes uneven refraction of light.

People over 40 years old usually need reading glasses, but if suddenly they can read without glasses, do not rejoice prematurely as this may indicate early lens degeneration causing a change in refraction, resulting in secondary myopia (nearsightedness) in old age, with blurred distance vision. If you experience this, you should see an ophthalmologist to check for early cataracts.

Seeing a white haze in the center of the pupil in fully mature cataracts is now less common because patients can access ophthalmologists more easily.

Can Cataracts Be Prevented?

Preparation for Seeing an Ophthalmologist

Visiting an ophthalmologist requires no worry, no need to stop medications, or fast from food or water. The examination is painless. You should not drive yourself or should bring someone to drive you because pupil dilation drops cause light sensitivity and blurred vision, especially for near vision, lasting about 5 hours. Pupil dilation is done to check for other eye complications. Some patients with chronic diseases such as diabetes, hypertension, or ischemic heart disease may be asked by some ophthalmologists to bring recent blood sugar results or to stop blood-thinning medications before cataract surgery.

Preparation Before Cataract Surgery

Generally, when the doctor decides surgery is necessary, a detailed eye examination is performed, including measuring eye pressure and checking the optic nerve to ensure it is still healthy. If the optic nerve is healthy, vision will improve after surgery, but if it is damaged, surgery will not improve vision.

The doctor will also perform a general physical examination to check for other diseases that may complicate surgery or recovery, such as diabetes, hypertension, anemia, or lung disease. These conditions must be well controlled before surgery.

Many people mistakenly believe that diabetic patients cannot have cataract surgery, which is incorrect. Diabetics can have surgery but must control their diabetes well to reduce the risk of postoperative infection. If there is eye inflammation such as stye, eyelid inflammation, or dacryocystitis, these must be treated before surgery because the eye is more susceptible to infection than other organs. Infection near the surgical site increases the risk of postoperative infection.

Blood-thinning medications do not always need to be stopped because the risk of bleeding during cataract surgery is very low, using only topical anesthetic drops. However, this depends on the ophthalmologist’s discretion.

Cataract Treatment Methods

Once diagnosed with cataracts and surgery is necessary, it is normal for patients or anyone to fear surgery. However, medical technology and advancements have made cataract treatment highly effective, restoring good vision. There are three surgical methods based on removing the cloudy lens and replacing it with an artificial lens.

Large incision cataract surgery (ECCE) is the oldest and still effective method. It remains economical and safe in countries without ultrasound cataract machines. The procedure starts with local anesthesia injection to numb the eye and prevent pain, then an 8-9 mm corneal incision is made to push out the cloudy lens and insert an artificial lens. The corneal wound is closed with very fine sutures smaller than an eyelash. This method is suitable for places without ultrasound cataract machines or for very hard cataracts that cannot be broken down by ultrasound. The downside is the large wound may cause astigmatism after surgery. The procedure takes 15-30 minutes depending on difficulty and surgeon skill.

Phacoemulsification (Ultrasound) is the best and most modern method today. It uses high-frequency ultrasound through a 1.8-3 mm corneal incision (size depends on the machine and surgeon skill). The lens is broken up and suctioned out through a very small wound. The procedure takes 5-30 minutes depending on difficulty and surgeon skill. No injection anesthesia is needed, only topical anesthetic drops. After lens removal, an artificial lens is inserted through the small wound. Because the wound is very small, no sutures are needed. Patients can use their eyes immediately after the pupil dilation effect wears off. The downside is the cost is slightly higher than large incision surgery. Very hard cataracts may not be suitable for this method and require more surgeon skill than large incision surgery.

Femto Laser Cataract surgery is a new method using laser light to segment the cataract lens into small pieces, similar to cutting a cake, then ultrasound is used to break up the segmented pieces. Only topical anesthetic drops are used, reducing complications in very hard cataracts. The downside is the very high cost and longer surgery time of 25-45 minutes because the patient must be moved from the laser machine to the ultrasound machine. The results are similar to ultrasound cataract surgery.

Complications of Cataract Treatment

Bacterial infection after surgery is a risk that cannot be completely prevented because the surgery involves an incision into the eye, allowing bacteria to enter despite best preparation. The chance is very low but possible. Symptoms include blurred vision, severe eye pain, redness, tearing, irritation, and light sensitivity. It usually occurs from the first day up to 7 days after surgery, mostly within 3-4 days. If untreated, it can cause vision loss.

Astigmatism causes blurred distance vision and double images, commonly seen after large incision surgery. It is not dangerous and can be corrected with glasses.

Allergic reactions may occur to eye drops, oral medications, or adhesive tape, causing red eyes and swollen eyelids. It is not dangerous and improves after stopping the allergen.

6 Warning Signs That May Indicate Cataracts