New lenses offer cataract patients clearer future

Sep 26 2007

You're reading and you notice 3's look like 8's or vice versa. When driving, you find yourself needing to be closer to road signs to make the words out clearly. The world just starts to look a little hazy.

But instead of needing new lenses for your glasses, it could be your eyes themselves that need new lenses, according to Women's Health Advisor of Weill Cornell Medical College. Cataracts, which simply refer to the clouding of the eye lens, are among those age-related conditions that greet most of us in retirement. Ophthalmologist Calvin Roberts, MD, of Weill Cornell Medical College, notes that most cataracts develop after age 65. More than half of all people 80 and older either have cataracts or have had cataract surgery, according to the National Institutes of Health (NIH).

While surgery remains the only option for ridding yourself of serious cataracts, your postoperative world provides a much brighter view than it did for cataract patients even just a few years ago.

“There are no alternatives to surgery, but there are new advances to the restoration process,” says Dr. Roberts. “We have lenses that will allow you to see at a distance as well as read without glasses. There are lenses that can correct astigmatisms. The options have become much-improved in the past couple of years.”

Better lenses

For many years, the intraocular lenses that were used to replace the body's crystalline lenses clouded by cataracts were made of a harder, more rigid plastic and were designed to give patients renewed clarity in their distance vision. The understanding was that they would simply need reading glasses.

“When you had to put in a plastic lens, your eye became a single-focus system,” Dr. Roberts says. “The new lenses have become multi-focused.”

The newer lenses, which debuted in 2003, can respond to the six muscles in the eye that control movement. So as a muscle moves up to focus on something close, the new lens will respond, Dr. Roberts says. Some new multi-focal lenses can be implanted to compensate for the ciliary muscle, which controls the shape of the lens to allow for changes in light distribution. As the ciliary muscle loses some of its ability to adjust to different distance ranges—think of how you hold a book a little farther away from your eyes than you used to—multi-focal lenses can help, because they are made with several focal zones to assist with a variety of distances.

New intraocular lenses are made of acrylic or silicone, and are therefore more flexible than their predecessors. The newer lenses also can be folded when they are surgically implanted, which means a smaller and faster-healing incision for the patient.

And just as newer contact lenses can correct astigmatisms, so too can the artificial lenses implanted during cataract surgery. The surgery itself lasts less than 15 minutes and post-operative discomfort is usually gone within two to three days. The NIH reports that more than 90 percent of patients who undergo cataract surgery have improved vision afterwards.

Onset of cataracts

Despite many years and millions of dollars spent on research, there remains no way to prevent age-related cataracts, Dr. Roberts says, though other types of cataracts may be avoided. Traumatic cataracts can form after serious eye injuries, underscoring the importance of wearing safety glasses in appropriate settings. Other “secondary” cataracts can develop in response to diseases such as diabetes or in reaction to medications such as steroids.

Cataracts form on the lens, which is located directly behind the iris, when proteins in the watery makeup of the lens start to clump together. The more they clump, the more they cloud your vision.

Symptoms include blurred or double vision or the sense that there's a film over your eyes. You might also find that a light that was once fine for reading is now too dim. You may also develop sensitivity to bright lights that were tolerated easily in the past.

“I tell people that they'll know before I know,” says Dr. Roberts. “When they start to see a difference in their vision, they should come in.”

Cataracts can be detected during an eye exam when the pupils are dilated. After the age of 60, comprehensive dilated eye exams should be scheduled every two years to look for other eye problems, such as age-related macular degeneration and glaucoma.

If the cataracts are mild or in their early stages, they may not have a pronounced effect on your vision. If so, your non-surgical options include new glasses, brighter lighting, magnifying glasses for reading, and non-glare sunglasses.
While cataract surgery is one of the most common surgeries in the country, with about 3 million performed annually, there are risks such as bleeding and retinal detachment, which is correctable if treated quickly.

Is prevention possible?

While age-related cataracts may be inevitable for many of us, there has been some research to support certain lifestyle choices that may help prevent or at least slow the progression of cataracts.

There is some debate about the links between cataracts and diet. However, the June 1, 2005 issue of the American Journal of Clinical Nutrition reported that of the 35,000 women in a decade-long study of how health is affected by diet, women who ate the most fruits and vegetables were 10 to 15 percent less likely to develop cataracts, after factoring out other risk factors such as smoking or family history.

The National Eye Institute recommends sunglasses to help prevent or delay cataracts, but there is little research so far to support the idea. Dr. Roberts, however, says that while sunglasses' role in cataract prevention may be unclear, they should be worn to protect your eyes against macular degeneration and other conditions worsened by too much exposure to ultraviolet rays.

“If there's enough sun to get a tan, you should wear sunglasses,” Dr. Roberts says.

WHAT YOU CAN DO

• Visit your eye doctor when you notice any vision problems, including blurred vision and sensitivity to light.
• Wear sunglasses that block UVA and UVB rays. Polarized lenses are best, as they reduce scattered light, which causes glare.
• If you need cataract surgery, talk with your doctor about temporarily stopping medications that might cause bleeding problems.
• If cataract surgery is needed in both eyes, plan to have two separate surgeries about four to eight weeks apart.