What is a cataract?

A cataract is a normal aging change that happens to every person in the world if they live long enough. While some cataracts can be from different types of diseases or certain medication use, the vast majority of cataracts are related to simply getting older.  

The eye has a natural lens inside of it which bends light and helps that light reach the visual cells in the retina. As the lens of the eye becomes older with time, it becomes cloudy. This normal process of lens aging is then called a cataract. The lens of the eye becomes more opaque and less clear. Therefore, less light is able to penetrate through it.

What causes cataracts?

As mentioned, cataracts are caused simply by aging or getting older, in the vast majority of people. Some people may get cataracts in their late 40s and some may not develop them until their late 50s. The rate of progression of a cataract is very unique to the individual it affects. There is no way to predict how fast a cataract may advance once it shows up. Mild early cataracts may remain stable for years before affecting a person’s vision. In other cases, cataracts may progress over the course of a few months and start causing symptoms in patients. The best way to monitor this is to see your eye doctor at six to twelve month intervals once you have been diagnosed with a cataract. 
 
While aging is the most common cause of a cataract, there are other less common causes as well. Some of these include steroid use by the patient, diabetes, cataracts related to certain diseases, and also trauma or surgery. If you have had trauma or surgery to the eye, cataracts will typically develop in two years following the event.

Cataract eye drops 

Are there eye drops that can help a cataract? No, taking eye drops does not help improve blurry vision from a cataract. As of 2021 research, there are currently no eye drops that can help to cure or reverse a cataract. The only definitive treatment for cataracts is having cataract surgery. Because developing a cataract is part of the normal course of aging in all individuals, cataract surgery is the most commonly performed surgery in the world.  

Signs of cataracts and symptoms of cataracts

Signs of a cataract include a gradual decrease in vision and in some cases of very advanced cataracts the patient or the doctor may be able to see a whitish change inside the pupil. If this is observed, this likely means the cataract is very advanced and most patients would notice significant vision changes before this would be observed without a microscope. Other signs of a cataract in the doctor’s office include subtle color changes of the lens itself and this is typically seen at the slit lamp microscope in an ophthalmologist's office.

How do you know if you have a cataract?

Symptoms of a cataract as reported by patients include blurry vision, seeing double with one eye only, and having difficulty driving at night due to oncoming headlights and light sensitivity. Patients may also feel like they are looking through a foggy car windshield. Objects may appear to be less colorful when compared between the eyes if the cataract in one eye is worse than the other.

Cataract treatments

The only approved and scientifically backed treatment for a cataract that is affecting a person’s vision is to have it surgically removed. Cataract surgery is very commonly performed and typically does not take longer than 30 minutes per eye, and in some cases can even be as quick as 15 minutes. It is most common practice to have surgery done on one eye and then do the second eye a few weeks later. There are some hospitals that will allow you to have both eyes done on the same day, but this is uncommon. For most healthy patients cataract surgery is done in an outpatient surgery center. This means you go into the surgery center in the morning, have your surgery, and then you will be able to go home later that day. If you have any concerning medical issues, your surgeon and anesthesiologist may advise you to have your surgery done in a hospital setting. After your cataract surgery, you will need to take eye drops to prevent infection from the surgery as well as help to reduce inflammation from the surgery. Inflammation after surgery is very normal and it is important to take the eye drops as directed by your doctor to have good healing and good vision after cataract surgery.

Can cataracts come back?

You may be wondering, “Can cataracts come back after surgery?” The answer is no. Cataracts do not recur once they are removed. Remember that a cataract is an aging change of the lens of the eye, and during cataract surgery, the natural lens of the eye is removed and an artificial lens is placed. The artificial lens is not subject to aging and can not develop a cataract.  
 
In some cases, a film could develop behind the artificial lens and this is called a posterior capsular opacification, abbreviated as PCO. If this happens to you, it is simple to manage inside your ophthalmologist’s office. A PCO is easily treated through a quick one to two minute in-office laser procedure that is typically painless. Developing a PCO is sometimes called having a “secondary cataract” but it is not a cataract in the true sense of the word. There are many different reports regarding the development of PCOs, and the studies show it can occur in anywhere from 10 to 50% of patients anywhere from several weeks to several years after surgery.  \

 

 
Sources: 
 
https://www.aao.org/eye-health/diseases/what-are-cataracts 
 
https://www.taylorfrancis.com/chapters/edit/10.3109/9781420020977-28/types-morphology-causes-cataracts-joseph-costello-jerome-kuszak 
 
https://pubmed.ncbi.nlm.nih.gov/17662433/ 
 
https://jamanetwork.com/journals/jamaophthalmology/fullarticle/422987