Often, adults at home complain about blurry vision, especially when in bright light. Those close to them must take care and observe symptoms carefully because this may be one of the warning signs of “cataracts,” a common disease in the elderly. If left untreated, it can lead to blindness.
Getting to Know Cataracts
Cataracts are a condition where the eye’s lens becomes cloudy, preventing light from entering the eye normally or reducing the amount of light passing through, resulting in decreased vision, unclear images, and possible changes in color perception. It is mostly found in people aged 50 and above or those with congenital abnormalities from maternal rubella infection during pregnancy.
Observable Symptoms of Cataracts
- Typically, the main symptom of cataracts in the elderly is a gradual, slow clouding 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, yet vision may be almost normal in dim or twilight conditions. This is because in bright light, the pupil contracts, reducing light entry, whereas in darkness, the pupil dilates, allowing more light in and clearer vision.
- In people over 40 who normally need reading glasses, suddenly being able to read without glasses should not be celebrated as improved vision. This may indicate early lens degeneration causing changes in refraction, resulting in secondary myopia (nearsightedness) with unclear distance vision. If this occurs, an eye doctor should be consulted to check for cataracts.
- Seeing double images, such as two or multiple moons at night, even with one eye, due to uneven refraction changes caused by the cloudy lens.
- Seeing a white haze in the center of the pupil in fully mature cataracts, which is now less common due to easier access to ophthalmologists.
6 Warning Signs of Cataracts
- Blurry, hazy, or dim vision that gradually worsens.
- Difficulty seeing distant objects clearly, increased nearsightedness requiring frequent changes of glasses.
- Poor vision in bright light.
- Double vision in one eye.
- Color perception changes, especially yellow hues.
- Frequent eye pain.
Cataracts and Treatment…
It is normal to feel afraid when hearing the word surgery after being diagnosed with cataracts. However, medical technology has advanced greatly, making cataract treatment effective and able to restore good vision. There are three surgical methods based on removing the cloudy natural lens and replacing it with an artificial intraocular lens.
- Large incision cataract surgery (ECCE) is a long-established, effective, economical, and safe method, especially in countries without high-frequency ultrasound cataract removal machines. The procedure starts with local anesthesia injection to numb the eye and prevent pain, followed by an 8-9 mm corneal incision to push out the cloudy lens and insert an artificial lens. The corneal wound is closed with very fine sutures. This method suits places without ultrasound machines or very hard cataracts that cannot be emulsified by ultrasound. The downside is a large wound that may cause astigmatism after surgery. Surgery time is 15-30 minutes depending on difficulty and surgeon skill.
- Phacoemulsification (Ultrasound) is the best and most modern method today, using high-frequency ultrasound through a 1.8-3 mm corneal incision (size depends on machine and surgeon skill). The lens is emulsified and suctioned out through a very small wound. Surgery takes 5-30 minutes. Local anesthetic eye drops are sufficient without injections. After lens removal, an artificial lens is inserted through the small incision, which usually does not require sutures. Patients can use their eyes immediately after the pupil dilation effect wears off. The downside is slightly higher cost than large incision surgery. Very hard lenses 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 lens into small pieces, similar to cutting a cake, followed by ultrasound emulsification of the segmented pieces. Only local anesthetic eye drops are used, reducing complications in very hard cataracts. The downside is very high cost and longer surgery time of 25-45 minutes because patients must be moved between laser and ultrasound machines. The results are similar to ultrasound alone.
How to Prepare for an Eye Exam
If you want to have a cataract exam, there is no need to worry. The exam does not require fasting or stopping medication. The procedure is painless. However, you should not drive yourself and should bring someone to drive you because pupil dilation drops cause light sensitivity and blurred vision, especially near vision, for about 5 hours. Pupil dilation is necessary to check for other eye diseases. Patients with chronic conditions 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 medication before cataract treatment.
Preparation Before Cataract Surgery
Generally, when the doctor decides surgery is necessary, a detailed eye exam 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. If damaged, surgery will not improve vision. The doctor will also perform a general health check to identify any conditions that may complicate surgery or recovery, such as diabetes, hypertension, anemia, or lung disease. These conditions must be well controlled before surgery.
However, many people mistakenly believe that diabetics cannot have cataract surgery. This is incorrect. Diabetics can have surgery but must control their diabetes well to reduce the risk of post-surgical infection. If there is eye inflammation such as a stye, eyelid infection, or tear sac infection, these must be treated before surgery because the eye is more susceptible to infection than other organs. Infection near the surgical wound increases the risk of post-surgical infection.
Regarding blood-thinning medication, patients do not always need to stop these drugs because the risk of bleeding is very low with local anesthetic eye drops. However, this depends on the ophthalmologist’s discretion.
The eyes are like a gateway to the world, allowing us to live effectively and happily. Do not neglect eye care, especially as you age. Eyes naturally deteriorate over time. Therefore, regular annual eye exams with a specialist ophthalmologist are important to help preserve your vision for life.
“Cataracts can be cured. Prevention is possible with regular annual eye exams.”
Dr. Jirapol Suphokwech
Ophthalmologist, Phyathai 3 Hospital