UNDERSTANDING
CATARACT
(7/17/17)- For additional information on the vision problems of the elderly please see our article “Ophthalmologists Seek to Deal with Vision Problems of the Elderly”
(3/23/16)- Visual acuity refers
to how sharp or clear a person’s vision is. Impaired visual acuity refers to
vision that is blurry, distorted, or otherwise not normal. Common causes of
impaired visual acuity include refractive error (nearsightedness or
farsightedness), cataracts, glaucoma, macular degeneration (loss of the center
of the field of vision), and presbyopia (farsightedness that occurs with
aging).
Vision impairment due to
cataracts, presbyopia, and age-related macular degeneration is common in older
adults. The March 1, 2016, issue of JAMA contains the updated USPSTF
recommendations on screening for impaired visual acuity in older adults.
(7/17/09)- Cataracts are just one of the many problems associated with the
aging process. The slowing down of the reflexes is another. Between weakening
of the eyesight and the decrease in reaction time, driving becomes a greater
safety issue for the elderly.
In a report issued in 2007 by the U.S. Government Accountability Office it was stated that "older drivers' fatal crash rate per licensed driver is lower than corresponding rates for drivers in younger age groups."
This lower rate of fatal crash accidents can be partially accounted for by the fact that older drivers put on fewer miles than do other drivers, and also older drivers tend to drive less in adverse weather conditions.
The report went on to state that, measured by miles traveled, older drivers "are more likely to be involved in a fatal crash than all but the youngest drivers."
A 2004 study in the Journal of the American Medical Association found that requiring people to show up for license renewals does help to reduce the crash rate. Researchers found that many older drivers who question their own driving ability decide on their own not to seek a new license out of fear that they will not pass the test if they show up.
Editor's Note: We at therubins owe our thanks to the individual who wrote this article exclusively for the "eye" section of this site. As most of our viewers know, we at therubins started this public interest non-profit site in memory of our mom. We have no advertisements on it, and its purpose is to help the elderly and their friends gain information about matters of key importance to them. It is a large effort on our part, but there are many areas of interest to seniors in which we do not have any experience or expertise at all. We therefore welcome the effort of the writer of this article, and wish to thank the individual for helping us strive towards that goal.
A cataract is a cloudy area in the lens of the eye. A normal lens is clear. It lets light pass to the back of the eye. Having a cataract is another normal part of the aging process. About 50% of Americans age 65-74 have cataract. Once over 75 years of age the risk of having a cataract increases to almost 75%. It is quite common to have a cataract in both eyes, but frequently one eye may be worse than the other because of the developmental speed of a cataract. The following are some of the telltale signals that a cataract is developing:
- Cloudy, fuzzy, foggy, or filmy vision.
- Changes in the way you see colors.
- Problems driving at night because headlights seem too
bright.
- Problems with glare from lamps or the sun.
- Frequent changes in your eyeglass prescriptions.
- Double vision.
- Better near vision for a while only in farsighted
people.
These symptoms may be signs of other vision problems as well. See your eye doctor so that he/she may determine the exact nature of your problem.
A cataract is diagnosed through a regular eye exam. The eye doctor will probably give you eye drops to enlarge your pupils. He will examine your eyes with a bright light to see if the lens is clear or not. The following tests may also be administered to test your sight and to evaluate how well you might see after the surgery:
- Glare test
- Contrast sensitivity test
- Potential vision test
- Specular photographic microscopy
It often is the case that a change in glasses, stronger bifocals, or the use of a magnifying glass may improve your vision. Just because you have a cataract does not mean it must be operated on immediately. On the other hand surgery may be required because a cataract is so large that it could cause blindness. If after consultation with your doctor you do decide on surgery there are some important facts for you to know about. Most people do not have to stay in the hospital overnight after you have had cataract surgery. You definitely will need someone to help bring you home after the surgery. The operating facility will not let you go home by yourself. There are 3 types of surgery to remove lenses that have a cataract:
- Extracapsular surgery. The eye surgeon removes the
lens, leaving behind the back half of the capsule (the outer covering of
the lens).
- Phacoemulsification. In this type of surgery, the surgeon
softens the lens with sound waves and removes it through a needle. The
back half of the lens capsule is left behind.
- Intracapsular surgery. The surgeon
removes the entire lens including the capsule. This method is rarely used.
A person who has cataract surgery will get an artificial lens to replace the lens that has been removed. A plastic disc, called an intraocular lens, is placed in the lens capsule inside the eye. It takes a few months for an eye to heal after cataract surgery. Other choices are contact lenses and cataract glasses. Your doctor will help you decide which choice is best for you. A cataract can not return since the lens has been removed. It is not that unusual for the lens capsule to become cloudy once again. The treatment for this condition is a procedure called YAG capsulotomy. The doctor uses a laser beam to make a tiny hole in the capsule to let light pass. This surgery is painless and does not require a hospital stay. Cataract surgery has a success rate of 95% in patients with otherwise healthy eyes. If you have a cataract in both eyes, most experts say it is best to wait until your first eye heals before proceeding with an operation on the second eye. You will be restricted in movement for a short period of time after the surgery, and practically speaking it takes several months for your eye to heal properly. Your eye doctor will advise you of your recovery timetable.
Here are some questions you might ask when you are faced with cataract surgery:
- Do I need surgery right away?
- If not, how long can I wait?
- What are my personal risks?
- What benefits can I expect?
- If I chose surgery, which type is best for me?
- Which lens replacement is best for me?
- What are the chances of developing cloudiness in the
lens capsule after cataract surgery?
- What are the benefits and risks of YAG capsulotomy?
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME".
Many thanks to AHCPR Publication No.93-0544
By Allan Rubin
updated July 18, 2017
To e-mail: hrubin12@nyc.rr.com or allanrubin4@gmail.com