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Cataracts: From Causes to Treatment

The diagnosis of cataracts - around half of those aged between 52 and 64 in Germany have to deal with this - even though they do not notice any visual disturbances. In people aged 65 and over, the number of those affected even rises to 90 percent.[1] Overall, cataracts are the most common cause of blindness worldwide.

If you are also affected by cataracts, then we can anticipate one thing to put your mind at ease: the rescue operation has long been routine.[2] The microsurgical intervention usually takes no longer than 20 minutes and only leaves a cut a few millimeters long in the cornea.

In our article you can find out what cataracts are, their causes and which treatment steps you have to take.

What is the cataract?

The cataract, technically also called cataract, is a gradual clouding of the lens that increasingly hinders clear and sharp vision. Cataracts usually affect both eyes, but sometimes they become ill at different times. A distinction is made between acquired and congenital cataracts; both forms can be hereditary. In the case of congenital cataracts, a distinction must also be made between damage acquired during pregnancy and hereditary circumstances.

The eye disease exists in different forms, of which the old age cataract occurs most frequently.

  • Old age
  • Cataract from injury
  • Cataract from birth
  • Cataracts in systematic diseases such as diabetes
  • Cataracts from exposure to radiation (e.g. infrared or X-rays)
  • Cataracts from medication such as cortisone

What you need to know about our eye lens in connection with cataracts: It is transparent, which is why we can see a clear picture. And it's soft and elastic so that our eye muscles can move it. Only in this way is it possible for us to see things clearly both near and far away. These properties are regulated by the inner lens fluid. If there is an accumulation of fluid in our eye lens, cataracts begin. As a result, the clouding of the lens of the eye gradually increases, so it often takes a while for those affected to see more difficult.

The most common complaints include:

  • Deterioration in the perception of contrasts, as a result of which vision becomes blurred
  • Sensitivity to glare due to diffuse refraction of light
  • Seeing double and triple images
  • Slowing down of the light-dark adaptation
  • Restriction of spatial vision
  • Perception of a glow around objects (also known as halo vision)

Do these symptoms sound familiar? For example, do you have problems seeing clearly when driving at dusk or in bad weather? The way to the ophthalmologist will provide you with information. Do not be afraid, because: Once the lens opacity has reached a late stage, the eye can even go blind. On the other hand, if you discover cataracts in good time, the chances of recovery are very good.

Causes of cataracts

The causes of cataracts cannot always be precisely determined. As mentioned above, lens opacification occurs most frequently with increasing age. But children can also get cataracts. There are even infants who are already born with cataracts, which can be attributed to complications during pregnancy - for example, if the mother was affected by rubella or mumps during pregnancy. The use of certain medications, including cortisone, and many types of radiation can also promote cataracts.

Common causes of cataracts:

  • High age
  • Inadequate nutrition
  • Metabolic defects
  • UV light
  • Infrared light
  • Radioactive beams
  • X-rays

You can easily test for yourself how high your risk of disease is. Check how many of the points listed apply to you, including those related to your lifestyle:

  • Do you smoke?
  • How much is your alcohol consumption?
  • Do you have injuries to your eye?
  • Do you have diabetes?
  • Are you nutritionally deficient?
  • Do you work in a job where you work with hot materials, for example on a blast furnace?

The first step to successful cataract treatment: diagnosis

Anyone who complains about cataract symptoms should seek the way to an ophthalmologist. This examination also includes the doctor's routine look at your general vision and other eye diseases. After a general discussion, the doctor will examine your eye with the slit lamp microscope. This device enables the fundus to be viewed with up to 40x magnification. In order for the pupil to reveal the relevant parts of the eye, namely the lens, cornea and anterior chamber, it must be opened wide. It's less dramatic than it sounds; all you get for this is eye drops that dilate your lens.

Your ophthalmologist uses the switching lamp to determine where the opacity is in the lens and what type of cataract it is. If the cataract is already well advanced, the clouding of the eye lens can actually be seen with the naked eye. Cataracts are diagnosed on the basis of the opacity of the lens and classified into one of four stages, according to which the treatment is then directed:

  • Initial clouding of the lens of the eye: The visual acuity is hardly or not impaired; surgery is not necessary.
  • Advanced opacification of the lens of the eye: Ophthalmologists usually recommend surgery.
  • Mature cataract: The lens is completely affected by the opacity; surgery is clearly the next step.
  • Overripe cataracts: The clouded lens of the eye is swollen and liquefied, causing it to enlarge. An operation is unavoidable and required immediately. Otherwise there is a risk of a glaucoma.

In the case of newborns who are already born with a cataract, this is determined as part of the U2 examination.

The diagnosis of cataracts does not necessarily indicate a disease of the eyes. It can also be a harbinger of other diseases, which is why skin and muscles should also be examined and a blood test done. In this way, metabolic disorders such as diabetes or skin diseases can also be detected.

Cataract treatment: preparation for the operation

In Germany alone, around 800,000 cataract operations take place every year[1] - a number that confirms that this is a routine intervention. And the chances of recovery for those affected are good: 90 percent of all patients then have at least 50 percent, and many even over 100 percent of their original visual performance, provided there are no other eye diseases.[2] The surgical process is based on a simple principle: Doctors replace the clouded eye lens with an artificial lens, usually made of acrylic or silicone. This is usually done under local anesthesia and on an outpatient basis. The aim is to achieve visual acuity after the procedure that is almost as good as the patient had before the disease. Many sufferers even see better after the treatment than they did before the disease.

If it is only about cataracts, you as the patient alone decide in consultation with your attending physician when the operation should take place. The most important thing is how much the cataract is already affecting your everyday life and that you decide to have an operation before the cataract turns into a glaucoma. For example, it is often working people who drive a lot for work or who have to look closely at the computer every day who choose the time for the operation sooner rather than later. Others, on the other hand, find the gradual loss of visual acuity less disturbing and are even amazed when they say at their next ophthalmologist appointment: "Your visual acuity has dropped drastically."

Planning is different if your child has a congenital cataract. Here the operation is performed as early as possible so that the child can learn to see properly from the start.

Once the decision for cataract surgery and the timing has been made, the next step is to determine the values ​​for the artificial lens. The refractive power of this lens must correspond exactly to that of the natural lens so that you can see clearly. To do this, the ophthalmologist measures the length of your eye using ultrasound and determines the refractive power of the cornea.

Our advice: Get particularly good advice on this and get a second opinion, because if you use special lenses with additional benefits such as blue light filters or multifocal lenses, your health insurance company will not be able to cover the costs.

Operation cataract: this is how it works

For now, it should be said: Doctors usually never operate on both affected eyes at the same time, but always first one eye and then the other. First, the eye is locally anesthetized by means of drops or a syringe in the neighboring skin, before the first step of the operation takes place:

  • Step 1: An incision 2 to 3 mm long is made in the cornea (tunnel cut). The cut is so fine that it doesn't have to be sewn.
  • Step 2: The nucleus of the lens capsule and the cortex of the lens are opened. The ophthalmologist then uses ultrasound to liquefy the lens. The lateral and rear lens capsules are left standing and the liquid is sucked off to make room for the artificial lens.
  • Step 3: The folded artificial lens is now pushed through the tunnel incision into the capsular bag, where it unfolds to its actual shape and size. The lens is provided with small holding brackets on the sides, which help to stabilize the artificial lens in the right place.

The graphic provides an overview of the essential steps involved in cataract surgery.

By the way: If cataract treatment is required in your case, you are entitled to reimbursement from your statutory health insurance. Not only the costs for the operation, but also for preliminary and follow-up examinations are covered by the health insurance companies. Before the procedure, find out from your treating doctor about the treatment and the type of artificial lens and then make sure that your health insurance company will cover all of the costs.

What are the risks of cataract surgery?

The fact is: cataract surgery is one of the most common procedures in Germany. But that doesn't give you a rock-solid guarantee, because complications can never be completely ruled out. In the following, we will list the most common complications that occur during or after the operations:[1]

During the procedure:

  • The lens capsule is injured: This happens in around 20 out of 1,000 procedures
  • The iris or the eyeball are injured: This happens in around 1 to 5 out of 1,000 procedures

After the procedure:

  • Retina swells: This happens in around 20 out of 1,000 procedures
  • The lens shifts: Happened in around 2 to 10 out of 1,000 procedures
  • The retina is peeling off: Happened in about 2 to 10 out of 1,000 procedures
  • The inside of the eye becomes inflamed: This happens in about 1 in 1,000 procedures

People with other eye diseases and when anesthesia is injected into the skin next to the eye are at greater risk of complications. Fortunately, most complications are not likely to cause permanent damage. Temporary complaints can usually be remedied with medication, in the worst case with a new operation.

This is how it continues after the cataract treatment

Regardless of whether you are allowed to go home a few hours after the procedure or remain in the clinic for observation, the eye is closed with an ointment bandage. This remains on the eye until the next day. Your cooperation is required in the first four weeks after the operation. Because by taking anti-inflammatory eye drops regularly, you are contributing to the rapid healing of the eye. Your ophthalmologist will monitor the healing process with several examinations until a cure can usually be said after six to eight weeks. If the operation on the second eye is still pending, the ophthalmologist will usually suggest an appointment around four weeks after the first operation in order to take into account any complications in the healing of the first eye.

After the operation: life without glasses, right?

The doctor calculates the refractive power of the artificial lens that will be used during the operation for you individually. In fact, a previously existing ametropia can be corrected in this way. This means: The artificial lens can be adjusted, for example, so that a previous myopia is compensated for by the new lens. What it cannot do, however: achieve the same close-up focus as a natural, young eye lens can. Older people in particular cannot correct their presbyopia with an artificial lens, which is why reading glasses are still necessary.

Ask yourself the question: Do I want to see in the distance, near or in the immediate intermediate area without glasses? Because if the artificial lens is adjusted according to myopia, you may be able to read without glasses, but you will need glasses for the distance. Consult with your ophthalmologist before the operation and decide together which lens is right for you and what additional costs you may have to face.

Please note: Nobody can guarantee you the result of the calculated refractive power of the new artificial lens. Many factors play a role here (measurement accuracy, manufacturer, quality of the eyes, etc.) that cannot always be influenced. That means: Regardless of what you choose, your eyesight will improve, but nobody can promise you freedom from glasses.

What you should know about the course of the disease and the prognosis

  • The cataract progresses gradually, which is why the eyesight slowly deteriorates.
  • If no treatment takes place, the affected eyes can become completely blind as a result.
  • An operation is a reliable and promising treatment measure.
  • Those affected regain between 50 and 100 percent of their visual acuity after the procedure.
  • If the cataract is based on another eye disease (e.g. glaucoma) or is caused by another disease, the prognosis is worse.
  • Artificial lenses usually last a lifetime, which means that they cannot become cloudy or wear out.

References

  1. https://www.tk.de/techniker/service/gesundheit-und-medizin/behandlungen-und-medizin/augenverbindungen/operation-des-grauen-stars-2016008
  2. http://cms.augeninfo.de/nc/hauptmenu/presse/statistiken/statsitik-katerakt.html
  3. https://www.netdoktor.de/krankheiten/grauer-star/operation/
  4. http://cms.augeninfo.de/nc/hauptmenu/presse/statistiken/statsitik-katerakt.html
  5. http://www.woche-des-sehens.de/infothek/zahlen-und-ffekten/blindheit-und-sehbehinde-weltweit/#c205