If you’ve noticed your vision becoming blurry, colors appearing faded or nighttime driving becoming increasingly difficult due to headlight glare, you’re not alone. You may be among the 20.5 million Americans grappling with cataracts — a natural, age-related condition that clouds the lens of the eye and diminishes visual clarity.
To see clearly, the lens in each eye must be transparent. But after the age of 40, lens proteins start to deteriorate, clump, and form hazy areas in the line of vision. This process can worsen with time: By the age of 80, half of Americans have debilitating cataracts.
Certain factors increase the risk of developing early cataracts: medical conditions like diabetes and glaucoma, smoking, the use of steroid medication or family history.
Cataracts are usually diagnosed during an eye exam by an optometrist (a clinician who provides primary vision care), or an ophthalmologist (a medical doctor specializing in eye surgery). After checking your visual acuity — the standard eye chart test — the clinician dilates each pupil with eye drops, then inspects the eyeball’s interior with a binocular microscope called a slit lamp. Cataracts appear as white streaks or patches; sometimes the whole lens is milky.
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You may have to live with your cataracts if your visual impairment is mild. Your provider will update your glasses prescription, and check your eyes every six to 12 months to monitor progression. In the meantime, using a brighter light for reading helps, keeping your back to the lamp to avoid glare. A magnifying glass is handy for fine print. Avoid nighttime driving, too—motorists with cataracts have more car accidents.
When cataracts interfere with daily activities—and often one eye is worse—the treatment is surgical. The procedure is simple, painless and takes only 15 minutes. With the patient lightly sedated, the doctor applies anesthetic eyedrops then makes a tiny incision in the eyeball with a scalpel. The cataract is fragmented with ultrasound and the pieces suctioned out with a vacuum; then the synthetic, permanent intraocular lens (IOL) is slipped into place. Cataract surgery is 97% successful: A majority of patients have clear vision and notice brighter colors within a few days. If both eyes are involved, the surgeries are generally performed one to two weeks apart.
Laser surgery may also be offered: some physicians prefer its enhanced precision. Medicare Part B pays up to 80% of the cost of either procedure—an average of $4,000 per eyeball for the traditional approach. Laser surgery adds a minimum of $1,000 per eye.
A majority of patients choose monofocal IOLs to replace their natural lenses. These are covered by Medicare, but because the lenses are designed to focus at a specific distance, close work requires reading glasses. Multifocal IOLs, similar to trifocals, make readers unnecessary—but they are not covered by Medicare or private insurance and cost up to $4,000 per lens.
To lower your risk of cataracts, wear sunglasses and a brimmed hat to protect your eyes from the sun’s damaging ultraviolet rays. Eat a diet rich in vitamin E, omega-3 fats, lutein and zinc: choose foods like green vegetables, nuts and whole grain cereals. Use protective eyewear when operating power tools or engaging in sports like basketball or baseball: Eyeball injuries can lead to cataracts.
Any sudden change in eyesight is an emergency. Contact your ophthalmologist immediately or go to the nearest emergency room if you experience flashes, new floaters or abruptly blurred vision. Immediate treatment may be crucial to preserving your vision.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York State.
