ADULT OPHTHALMOLOGY: CATARACT 

Cataract is a very common eye condition that mostly affects people in their 60s onwards, although it can sometimes occur in younger adults too. 

Cataract affects the lens – the part of the eye that helps filter light onto the retina at the back of the eye, which in turn sends signals to the optic nerve, enabling us to process vision. In a healthy eye, cells within the lens are clear, but cataract develops when the cells begin to change and start clumping together, resulting in clouding. This causes vision to become blurred, cloudy and misty. Usually both eyes are affected, though not necessarily at the same time. 

Cataract symptoms are usually mild to begin with. You might notice that reading has become more difficult, or that driving in the dark is tricky due to increased glare from streetlights and car headlamps – this is because cataract often leads to an increased sensitivity to bright lights too. Colours can also begin to appear more faded and washed out. 

Cataract doesn’t generally cause any pain or irritation, but the clouding gets progressively worse over time and without treatment, cataracts will eventually lead to blindness. 

The causes of cataract include: 

Exactly what causes the cell changes within the lens to occur in the first place isn’t entirely understood, but a number of risk factors have been recognised. Age is the biggest risk factor, which is why the condition is often called ‘age-related cataract’. Many people will begin developing cataracts from their 60s onwards. Aside from age, these are the main risk factors for adult cataract: 

  • Family history. If your parents and grandparents had cataracts, there is a high likelihood that you will also develop the condition.
  • Diabetes. People with both type 1 and type 2 diabetes are known to be more at risk of a number of eye conditions, including cataract. 
  • Smoking. People who smoke are recognised as having a higher chance of developing cataract. 
  • Eye injury. A previous injury to the eye can sometimes lead to cataracts developing.
  • Steroid use. Short-term use of steroid treatments isn’t usually a concern, but people who have a long-term history of steroid treatments (either steroid injections or drops) are more at risk. 
  • Other eye conditions. People who already have another eye condition like glaucoma, high myopia, retinal degenerations etc. will often be more prone to getting cataract too. 

Treatment of cataract:

The only way to successfully treat cataract is with cataract surgery. At present, it isn’t possible to prevent or reduce the progression of cataract with eye drops or any other treatments. However, cataract surgery is one of the most frequently performed surgeries in the world and has very high success rates. 

The surgery removes the clouded lens and replaces it with an artificial one, which means any associated sight loss is completely restored. The surgery can be carried out at any point after diagnosis, as the timescale has no bearing on the success of the procedure – Mr. Jain will be happy to talk you through the procedure very thoroughly and help guide you on deciding whether it’s the right time for you.

Cataract surgery is usually carried out with local anaesthetic, applied either with drops or an injection – this means you’ll be awake but won’t feel any pain at all. Mr. Jain will also talk you through exactly what’s going to happen, so you know what to expect and feel as relaxed as possible. Using local anaesthetic also means less side-effects and much less time in hospital, as you’ll be able to go home shortly afterwards. In some cases sedation or even general anaesthetic can be used, at the patient’s request.

A very small incision will be made at the front of the eye, through which the clouded lens will be removed. A new lens (made from a very soft special type of plastic or acrylic) is then carefully inserted. Artificial lenses are designed to remain in place permanently, so the likelihood of needing further surgery on the same eye is extremely low. 

You’ll need to wear a dressing to protect the eye for the first 24 hours or so, and there may be some mild soreness after the anaesthetic wears off. We’ll ensure you have all the advice you need about aftercare before you go home. Aside from this, recovery from cataract surgery is generally very quick. Some people notice a complete improvement in their vision after just a day or two, while for others it may take a couple of weeks for the full benefits to be apparent. 

All surgical procedures carry a degree of risk. These are generally very uncommon but Mr. Jain will discuss all possible risks and side-effects with you before going ahead with the procedure, to ensure you are fully informed and know what to expect. It’s natural to have concerns and questions before eye surgery and we’ll do our best to ensure you feel prepared and reassured.

General risks include bleeding and infection, and in very rare cases, an adverse reaction to the new lens. Risks may be slightly higher in people with other co-existing eye conditions. The vast majority of the time, the benefits of cataract surgery far outweigh any risks and the procedure is very successful.

Risks of cataract surgery:

All surgical procedures carry a degree of risk. These are generally very uncommon but Mr. Jain will discuss all possible risks and side-effects with you before going ahead with the procedure, to ensure you are fully informed and know what to expect. It’s natural to have concerns and questions before eye surgery and we’ll do our best to ensure you feel prepared and reassured.

General risks include bleeding and infection, and in very rare cases, an adverse reaction to the new lens. Risks may be slightly higher in people with other co-existing eye conditions. The vast majority of the time, the benefits of cataract surgery far outweigh any risks and the procedure is very successful.

Benefits of cataract surgery:

Cataract surgery replaces the clouded lens, so any sight loss due to the condition is completely restored. The treatment is permanent and the new lens should last the rest of your life.

Out of hours aftercare:

Mr. Jain is always happy to receive calls if a patient is having difficulties after surgery. Call his secretary or the hospital at which the surgery was carried out and they will give him your contact details. If you have any further questions, please feel free to send us an email.

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Mr Saurabh Jain

Saurabh Jain Is a Consultant Ophthalmic Surgeon and Clinical Director of services at the Royal Free London NHS Foundation Trust.