Cataracts: Causes, Symptoms, and Treatment

Cataracts occur when the eye’s natural lens becomes cloudy, reducing the amount of light that reaches the retina. In some cases, this clouding also causes abnormal light refraction, leading to improper focusing. As a result, the retina receives insufficient light, causing blurred vision. Cataracts typically develop without inflammation or pain, and as the lens gradually becomes more opaque, vision progressively worsens. Although symptoms vary in severity, they usually develop slowly, and it may take months or even years before patients notice significant visual impairment.

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Symptoms of Cataracts

Common symptoms of cataracts include:

• Double vision

• Seeing halos around lights

• Cloudy or white opacity in the center of the pupil

• Blurred vision, often requiring brighter light for reading

Risk Factors for Cataracts

The primary risk factor for cataracts is aging, particularly in individuals aged 60 years and older. Other contributing factors include:

• Diabetes

• Alcohol consumption

• Prolonged exposure to sunlight

• Smoking

• Chronic eye infections

• Eye injuries

Treatment Options for Cataracts

In the early stages, when symptoms are mild, ophthalmologists may recommend regular monitoring. However, surgery is advised once cataracts significantly impair vision or daily activities.

Types of Cataract Surgery

Phacoemulsification (Small-Incision Surgery)

This technique uses ultrasound energy to break the cloudy lens into small fragments, which are then removed through a small incision measuring approximately 2.5–3 mm. No sutures are required. The procedure typically takes 15–30 minutes, and recovery is rapid. It is suitable for soft to moderately hard cataracts.

Large-Incision Surgery

This method involves making a larger incision to remove the lens in one piece, followed by suturing. The procedure usually lasts 30 minutes to 1 hour and is recommended for hard or very mature cataracts.

Both procedures are usually performed under local anesthesia, either with eye drops or an injection around the eye. For patients who are anxious, uncooperative, or unable to remain still, general anesthesia may be considered.

Additional Recommendations Before Surgery

• Elderly patients (≥ 60 years) or those with chronic medical conditions should consult an internist prior to surgery.

• Patients taking blood-thinning medications should consult their physician and may be advised to discontinue these drugs at least 7 days before surgery, if appropriate.

Types of Intraocular Lenses (IOLs)

• Monofocal IOL

A standard single-focus lens that provides clear distance vision. Reading glasses are typically required for near tasks.

• Multifocal IOL

Designed to address presbyopia, these lenses use advanced technologies such as apodized diffractive or refractive designs to provide both near and distance vision. Approximately 80% of patients can perform daily activities, such as reading or driving, without glasses. However, multifocal IOLs may not be suitable for patients with retinal diseases, diabetes-related eye complications, or glaucoma.

• Toric IOL

Specifically designed to correct astigmatism caused by uneven corneal curvature, improving distance vision. Glasses are still needed for near vision.

• Multifocal Toric IOL

An advanced option that combines astigmatism correction with multifocal functionality, offering clear vision at multiple distances while addressing cataracts.

Postoperative Care

• Wear an eye shield while sleeping to protect the operated eye from rubbing or accidental injury.

• Avoid bending, coughing forcefully, or sneezing heavily, as these actions may affect lens positioning.

• Keep the eye dry and avoid dusty environments for at least 1 month to reduce infection risk.

• Sleep on your back and avoid pressure on the operated eye, especially during the first day.

• Use prescribed eye drops as directed and attend all follow-up appointments.

• Wear sunglasses to protect the eyes from bright sunlight and environmental pollutants.

• Maintain good control of chronic conditions such as diabetes and follow medical advice closely.

Benefits of Cataract Surgery

• Significant improvement in vision and overall quality of life

• Easier diagnosis and treatment of retinal diseases due to improved visibility of the retina

Risks of Delaying Cataract Surgery

• Progressive vision loss and reduced quality of life

• Difficulty in diagnosing or treating underlying retinal conditions, such as retinal detachment, macular scarring, intraocular bleeding, or diabetic retinopathy

Potential Complications During and After Surgery

• Infection (<1%)
  Maintaining proper hygiene and avoiding dusty environments can reduce this risk.

• Lens Dislocation (<1%)
  This may occur due to weak lens support, very hard cataracts, or excessive patient movement during surgery. Additional surgery may be required if this occurs.

• Severe Bleeding (approximately 1 in 1,000 cases)
  This rare complication may lead to permanent vision loss and is often irreversible.

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