Cataracts

Overview: What is cataract?

A cataract is a disease of the eyes in which the lens becomes cloudy. Ophthalmologists also speak of a cataract. Cataracts become noticeable because vision deteriorates. Most people’s vision is blurred and hazy. They are also less able to perceive contrasts and ultimately can only distinguish between light and dark.

The name “cataract” comes from the fact that a gray coloration is visible behind the pupil when the lens becomes cloudy. In addition, many have a fixed gaze when the disease is advanced. The word “cataract” comes from the Greek and translates as “waterfall”. This is because doctors used to assume that the eye disease caused fluid to form in the eye.

In cataracts, the flexibility of the lens of the eye decreases and it becomes cloudy. The most important risk factor for this is age. But smoking, radiation, other diseases and a hereditary predisposition also play a role. Doctors can recognize the eye disease by means of various examinations, for example with a slit lamp.

The treatment usually consists of an operation in which an eye surgeon replaces the cloudy lens with an artificial lens. Most people regain their sight thanks to the operation. Without therapy, people can go blind. There are currently no alternatives to surgery.

Cataracts – frequency and age

Cataracts are a relatively common eye disease – especially with increasing age. It usually develops in the second half of life from the age of 50. The risk of cataract increases with age – hence the name “senile cataract”. Approximately 20 out of every 100 people between the ages of 65 and 74 suffer from cataracts. Among the over 74s, more than 50 out of 100 people are affected.

Cataracts are a particular problem in poorer developing countries – they are the main cause of blindness worldwide and can also affect younger people there. Experts estimate that out of 36 million blind people worldwide, more than one in three people lose their sight due to cataracts. In the richer industrialized countries, doctors can often reverse blindness – thanks to a short operation.

Cataracts: causes and risk factors

A cataract can have various causes. The most common reason is age. In the majority of cases (approx. 90 percent), cataracts are a symptom of old age and are therefore also known as senile cataracts.

There are also other risk factors:

• Some people have a hereditary predisposition to cataracts.
• Smoking probably increases the risk of cataracts.
• Radiation, for example UV light or X-rays
• Diabetes mellitus – permanently elevated blood sugar levels can also damage the eye.
• Malnutrition and poor living conditions, often in developing countries
• Eye inflammation
• Eye injuries
• Other eye operations
• Prolonged use of certain medications, such as the anti-inflammatory agent cortisone

Rarely, cataracts are present from birth, but the cause is not genetic. One example: If an expectant mother is infected with measles or rubella during pregnancy, the baby may be born with cataracts. Incidentally, there are effective vaccinations for both infectious diseases. And: Doctors examine every newborn baby thoroughly.

Symptoms: Cataracts interfere with vision

Cataracts gradually reduce vision. The symptoms are a decrease in visual acuity and blurred vision. Many people describe their vision as if they were looking through a veil, fog or frosted glass. Complaints occur early at dusk or more light is needed for reading.

The following additional symptoms may occur:

• The perception of contrasts deteriorates. After all, most people can only distinguish between light and dark.
• In addition, sensitivity to glare often increases, for example due to sunlight or car headlights. Many people therefore find driving at night very stressful. A ring of light is often perceived around headlights and lights (so-called halos).
• At an advanced stage, cataracts are already visually recognizable: the pupil appears grey due to the severe clouding of the lens. Without treatment, there is a risk of blindness.

Contrary to what many people might think, cataracts do not cause symptoms such as eye pain or burning eyes.

Perhaps a little curious is the following fact: some people with cataracts who previously wore glasses due to their long-sightedness can suddenly see better again without glasses when a cataract begins. The reason for this is that the refractive power of the lens changes as a result of the cataract. However, this improved vision is only short-lived. The strength of spectacle lenses changes at short intervals.

Cataracts: Diagnosis with us

The diagnosis of “cataracts” always begins with a consultation with the ophthalmologist to take a medical history. The following questions, for example, are interesting:

• What symptoms do you have, since when and how severe are they?
• How would you rate your eyesight and has it deteriorated quickly or slowly?
• Do you have any known underlying illnesses, for example diabetes mellitus?
• Do you suffer from eye diseases?
• Were there any injuries to the eye?
• Are you taking any medications? If yes: which ones and since when?
• Do you already have a cataract in your family?

This is usually followed by various eye tests to assess vision. It is important to rule out other eye diseases. Because a cataract is not always the cause of diminishing vision.

A very important diagnostic examination is the slit lamp examination. The slit lamp is an instrument that ophthalmologists use to diagnose many diseases. It consists of a powerful light source and a microscope. This allows the doctor to view the eye under high magnification and detect changes. The back of the eye (the retina) is also examined with the pupil dilated and special images of the area of sharpest vision (macula) are often taken using optical coherence tomography in order to rule out other diseases such as age-related macular degeneration. In some cases, a computer tomography or magnetic resonance imaging examination is also carried out.

Cataracts: prevention, early detection, prognosis

In the majority of cases, cataracts are a symptom of old age. And you have no influence on your age. This means that you cannot prevent age-related cataracts. Even if cataracts are hereditary, they cannot be prevented, as genes cannot be influenced either.

Special measures for the early detection of cataracts in the ophthalmologist’s practice are not known. As a general rule, therefore, always consult an ophthalmologist if your vision deteriorates or you have other eye problems.

There are various factors that increase the risk of cataracts – and you can address these. Some tips:

• Protect your eyes from UV radiation. Wear high-quality sunglasses when you go out in the sun.
• Wear safety goggles if your eyes could be at risk at work or during your leisure time. This protects against radiation, but also against eye injuries.
• Give up smoking – it’s best not to start in the first place. Otherwise, try to stop smoking. It has an overall positive effect on your health. Talk to your family doctor so that he or she can help you to stop smoking.
• Women should be vaccinated against rubella and measles before becoming pregnant To prevent your offspring from being born with cataracts.
• If you have to take cortisone for a long time – discuss with your doctor whether there are alternatives.

Progression and prognosis of cataracts

The course and prognosis of cataracts depend on whether they are adequately treated. An operation restores most people’s eyesight. You will then be able to see clearly again and distinguish contrasts. The prognosis after the operation is therefore favorable. Without treatment, there is a risk of blindness. In poorer developing countries in particular, many people go blind because they often cannot afford an operation.

Cataracts: treatment means surgery

Cataracts cannot be treated with medication. Some people can compensate for their reduced vision temporarily or even long-term with glasses or contact lenses. At some point, however, vision is reduced to such an extent that surgery is advisable. Doctors remove the cloudy lens and replace it with an artificial lens. Your surgeon will discuss the different types of lenses (monofocal lens, multifocal lens, extended focus lenses, toric lenses, spherical and aspherical lenses, UV and/or blue light filters) and surgical techniques (with and without femtosecond laser) with you. Some of these are self-pay offers, as basic insurance does not cover every lens or every surgical technique. After the operation, vision is restored and most people see better again permanently. Cataract surgery is the most common operation of all. It is considered to be very safe and effective.