Cataract surgery can restore vision

A patient has drops put into his eyes prior to his cataract surgery.

Cataract is the leading cause of blindness in South Africa, responsible for about 50% of blindness. It is primarily a disease affecting elderly people. In older people, cataracts are so common that they are regarded as a normal part of the aging process. In fact by age 65, about half of the human population has a cataract, and by age 75, almost everyone has a cataract. Though cataracts affect millions of people, being diagnosed with one is not a reason to despair. Cataract surgery is available and can clear your vision.

Through advances in both cataract surgery and intraocular lenses (IOLs), more people are experiencing full restoration of their vision than before. It is estimated that about 98% of patients who have this surgery have a complication-free experience that results in improved vision.

Cataract is a clouding of the natural lens inside the eye. Contrary to what many think, a cataract is not a "film" over the eye. Rather it is a gradual thickening of the lens that causes the lens to become so clouded that light is either distorted or cannot reach the back of the eye for transmission to the brain. In its early stages, a cataract may not cause a problem. The cloudiness may affect only a small part of the lens. However, over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

The most common symptoms of cataracts include blurry or dim vision, colours appearing faded, poor night vision, halos appearing around lights and sensitivity to bright lights.

Surgery is the only effective treatment

A cataract needs to be removed when vision loss interferes with your everyday activities such as driving and reading. For an early cataract, vision may improve by using different glasses, magnifying lenses or stronger lighting. If initial measures do not help, surgery is the only effective treatment. During such surgery, usually done on an outpatient basis, the natural lens of the eye that has been damaged by a cataract is surgically removed and replaced with a clear artificial lens, or intraocular lens (IOL).

In 1994, the World Bank identified cataract surgery as one of the most cost effective of all health interventions and the most cost effective surgical intervention. The economic burden of blindness in South Africa is estimated to be over US$1 billion (about R7 billion) per year. The social and economic burden of blindness warrants that eye care, and particularly cataract surgery, be a priority, specifically since blindness caused from cataracts is avoidable, given adequate medical intervention.

With Eye Care Awareness Week taking place from the 6 - 10 October this year, sponsorship from private companies such as Alcon Laboratories, in collaboration with the and operating time and theatre space donated by ophthalmologists will mean that vital cataracts operations are going to be performed countrywide on thousands of needy patients, many of whom have been on a waiting list at public hospitals for a very long time.

Making inroads into the backlog

These initiatives will help make inroads into the backlog of patients needing this sight saving surgery and take some of the pressure off already overburdened healthcare system. State hospitals are working hard to cope with the growing demand for cataract surgery, and knowing just how successful this operation can be, and the life changing effects it can have on patients, is a vital reason that companies such as Alcon, a leading eye care company that has been operational in South Africa since 1977, get involved.

When a cataract is small, you may not notice any changes in your vision. Cataracts tend to grow slowly, so vision gets worse gradually. While age-related cataract is the most common form of this condition, cataracts can also develop in people who have certain other health problems, such as diabetes, or eye injuries. Some babies can also be born with cataracts, or develop them in childhood.

Cataract fact sheet

What is a cataract?
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

The lens is made mostly of water and protein. The protein is arranged to let light pass through and focus on the retina. Sometimes some of the protein clumps together. This can start to cloud small areas of the lens, blocking some light from reaching the retina and interfering with vision. This is a cataract2.

In its early stages, a cataract may not cause a problem. The cloudiness may affect only a small part of the lens. However, over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

What is the lens2?
The lens is the part of the eye that helps focus light on the retina. The retina is the eye's light-sensitive layer that sends visual signals to the brain. In a normal eye, light passes through the lens and is focused on the retina. To help produce a sharp image, the lens must remain clear.

What are the different types of cataract?
• Age-related cataract: Most cataracts are related to aging.
• Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.
• Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems, such as diabetes. In addition, cataracts are sometimes linked to steroid use.
• Traumatic cataract: Cataracts can develop soon after an eye injury, or years later.

Who is at risk for cataract?
The risk of cataract increases as you get older. Other risk factors for cataract include:

• Certain diseases such as diabetes.
• Personal behaviour such as smoking and alcohol use.
• The environment such as prolonged exposure to sunlight.

What are the symptoms of a cataract?
• Cloudy, fuzzy, foggy, or filmy vision.
• Changes in the perception of colours.
• Problems driving at night because headlights seem too bright.
• Problems with glare from lamps or the sun.
• Frequent changes in your eyeglass prescription.
• Double vision.

These symptoms can also be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

How is a cataract detected?
Cataract is detected through a comprehensive eye exam that includes:

1. Visual acuity test. This eye chart test measures how well you see at various distances.

2. Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

3. Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

How is a cataract treated?
The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

How do I decide to have surgery?
Most people have plenty of time to decide about cataract surgery. Your doctor cannot make the decision for you, but talking with your doctor can help you decide.

Tell your doctor how your cataract affects your vision and your life. Read the statements below, see which ones apply to you, and tell your doctor if:

• I need to drive, but there is too much glare from the sun or headlights.
• I do not see well enough to do my best at work.
• I do not see well enough to do the things I need to do at home.
• I do not see well enough to do things I like to do (for example, read, watch TV, sew, play golf, play cards, and go out with friends).
• I am afraid I will bump into something or fall.
• Because of my cataract, I am not as independent as I would like to be.
• I cannot see well enough with my glasses.
• My eyesight bothers me a lot.

You may also have other specific problems you want to discuss with your eye doctor.

What happens in cataract surgery?
The natural lens of the eye that has been damaged by a cataract is surgically removed and then replaced with a clear artificial lens. During the surgery, usually done on an outpatient basis, a tiny incision is made in the eye and the cataract-damaged natural lens is removed through the incision. An artificial lens is then inserted through the same incision.

Most patients have significantly improved vision after the procedure. In fact, 98% of patients have a complication-free experience that results in improved vision. You will not feel or see the new lens. If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.