Cataracts.

How the Eye Works.

The diagram above shows the main parts of the eye.

• The cornea is the clear covering of the front of the eye.
• The sclera is the "white part" of the eye.
• The iris is the "colored part" in the center of the eye that works like a round muscle, expanding and contracting to control the amount of light coming in.
• The pupil is the "black center" of the eye, simply a hole created by the iris.
• Behind the pupil is a clear lens that directs light to the back of the eye.
• At the back of the eye are light-sensitive nerves called the retina.
• The center of the retina is called the macula.
• Behind the macula, the optic nerve takes nerve impulses to the brain where they translated and understood as "vision."

The eye itself does not actually do the seeing. Rather, the eye acts as a messenger that delivers light "messages" to your brain. Your brain translates these messages into something you understand as vision, allowing you to maneuver within your environment without bumping into things and to enjoy our lovely Arizona sunsets.

In regards to cataract surgery, our primary focus is on the lens inside the eye, called the "crystalline" lens, held inside a suspended bag, called the posterior capsule.

Similar to a Camera.

Your eyes functions similar to the parts of a camera. Both the camera and your eye have an internal lens that focuses an image onto a film. The retina can be compared to camera film, consisting of a thin layer of photosensitive cells.

If the lens of a camera were smudged or scratched, the pictures would turn out blurred. Similarly, as the crystalline lens in your eye becomes cloudy and yellowed with a cataract, your picture of the world is blurred and discolored.

Two Lenses — One Inside, One Outside

The eye is a TWO lens system. The first lens is the cornea and the second is the crystalline lens. Light travels through the cornea and through the crystalline lens, bending as it goes through each one, to concentrate upon the retina at the back of the eye. The retina collects the variations in light transmission and sends that to the brain. The brain then translates this into an image of whatever is in front of you, allowing you to "see" it. The conscious part of your mind within your brain does the actual seeing — it's almost miraculous how it happens!

A perfect lens is transparent, meaning it is absolutely clear. If either lens (the cornea or crystalline) is not clear and the light rays are unable to pass through it completely, the retina collects inaccurate information. The image sent to the brain is then difficult to translate and what we experience is cloudy or blurry images. This could happen if you were to get oil in your eye that temporarily coated the cornea. Or, if your crystalline lens got cloudy, as is the case in forming a cataract.

Normal Aging of Your Eyes.

A clouding of the eye's internal lens.

Cataracts are a natural part of aging. Almost everyone reaching their mid-sixties has some form of a cataract in one or both eyes. Cataracts do not cause irreversible blindness. They do not spread from one eye to the other. They are not a growth that covers the surface of the eye, a tumor or a disease, but simply a change in the clarity of the natural lens. Most people who develop cataracts are older, although they may happen for various reasons at any age.

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What Causes Cataracts?

As with most things that occur in the human body, the exact cause is unclear. People have been getting cataracts as far back as medical history has been recorded, so this is not a modern phenomenon. Simply by living long enough, everyone eventually gets cataracts. Cataracts are as much a part of aging as getting wrinkles or gray hair.

Very occasionally, people are born with cataracts, and sometimes a cataract develops in an eye after a significant trauma, usually from an impact of some sort, especially from small round objects like a racquetball or golf ball (wear protective goggles when near these sports!). Exposure to excessive X-rays, intense heat or possibly too much sunlight may also cause cataracts. Smokers tend to have a higher occurrence of cataracts than non-smokers. Other contributing factors may include family history, previous eye surgery, puncture wounds, medications such as corticosteroids, chronic inflammation known as uveitis, diabetes, or even laser vision correction. However, aging seems to be the main culprit.

How Do Cataracts Develop?

anterior cortical cataract looks like a star mature or "ripe" cataract

The lens is made of mostly water and protein molecules that arranged in a special manner to create a clear window-like partition, which allows light to pass through.

As we get on in years, these protein molecules begin to clump together, resulting in a gradual clouding of the lens. This cloudiness grows denser until no light can pass through the lens.

Not all cataracts develop the same. The most common type involves an even clouding of the entire lens. Others may develop in only one area and then spread out from there.

Cataracts may take years to form or they may occur rapidly within a few months. And, while cataracts can affect both eyes at the same time, they may each develop at a different rate.

Long ago, the gradual development of a cataract was referred to as "ripening" — a ripe cataract was completely opaque (with no light going through it). Surgeons used to wait until a cataract was ripe before removing it, and then it was excised through a large incision in one piece with no replacement. Patients gained light perception and the determination of hand-movements only. Eventually, very thick "cataract glasses" evolved, allowing people to gain a measure of functionality.

This is no longer the case. Cataract surgery is now performed whenever the patient's vision is impaired enough to interfere with normal functioning. Modern cataract surgery involves a tiny incision and the lens is pulverized into powder as it is suctioned gently from the eye, and replaced by an artificial lens. Patients now have the option of accommodating Premium Lens Implants and Astigmatism Correction.

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normal vision	cataract

What Are The Symptoms?

Common cataract symptoms include poor night vision, a bothersome glare produced by bright lights, painless blurring of vision, and a fading or yellowing of colors.

As this usually develops slowly over a period of years, it might not be noticeable, with little or even no perceived effects for quite some time. However, eventually, vision becomes a little blurred, like looking through a smudgy piece of glass. You might notice that you are becoming more nearsighted, or experience double vision (even with one eye covered). Light from the sun or a lamp might cause an uncomfortable glare, and when you drive at night, the oncoming headlights may seem overly irritating, causing you to stress over making your way safely. It becomes harder to read and do other normal tasks, and you may go through a series of changes in your eyeglass prescription.

cloudiness, glare and double vision

Colors may not appear as brilliant as they once did. People might comment on the fact that you are now wearing brighter clothing, heavier make-up, or your hair is dyed an unfamiliar hue. These are all very natural, normal compensations for viewing your world through cloudy-yellowed cataracts.

You don't have to be a senior citizen before noticing these symptoms. People can have age-related cataracts in their forties and fifties, although those are most often in the beginning stages and rarely affect vision. It is typically during the mid-sixties when vision becomes impaired enough to cause interference and strongly suggest having cataract surgery.

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How Are Cataracts Detected?

Although you may think you have a cataract, there is only one way to know for sure, by having an eye examination by a qualified ophthalmologist. If you are over sixty years old, you should have an eye examination at least once every two years. Once each year is not too much.

Your eye exam should absolutely include dilating your pupils. This means drops are put into your eyes that make your pupils open up, or enlarge temporarily in a fixed position. The pupil is the internal opening between the front and back of the eye, like a tiny window that you look through. Minute muscles make the iris close or open, thus controlling the amount of light coming in.

A cataract can be detected without dilating the pupils, but dilating the eyes allows plenty of light onto the back of your eye, which is essential for finding potential problems. Getting a good view of the retina and optic nerve is used for early detection of eye diseases such as glaucoma and macular degeneration.

When Should Cataracts Be Removed?

Just having a cataract does not mean that you must undergo surgery. Even if your ophthalmologist finds a cataract, you may not need to have it removed for several years. In fact, you might never need cataract surgery. A change in your eyeglass prescription may satisfactorily improve vision for a while. Magnifying lenses or stronger lighting may facilitate daily activities. However, if your cataracts interfere with your everyday activities, such as reading or driving, you do not have to put up with them.

The time to consider cataract surgery is highly individual. As a rule, when your vision falls below 20/40, you will notice a significant impact on daily functioning. To what degree will vary from person to person. A pilot, for example, may require surgery in the earliest stage of cataract development, while someone with considerably lesser demands might not be bothered by a much denser development.

Eventually, safety considerations may be a factor, as a developing cataract steadily limits a person's involvement in a normal, independent lifestyle. Cataracts can be hazardous when they substantially interfere with your ability to see street signs, traffic lights or freeway exits, drive at night, step off curbs or steps, recognize faces, cook, iron, read medicine labels, or write checks, and sign binding documents.

As this is a highly individual matter, it is one you should discuss with your physician. By having your vision tested regularly, you can gather enough information to make an informed decision.

Are Cataracts Harmful To Your Eyes?

Leaving a cataract in the eye is not harmful except in very rare situations. In most cases, surgery can be postponed for as long as the patient desires, or not done at all. The only side effect would be the less clarity of vision. Over time, cataracts do increase in size and hardness, and if the cataract is very advanced, the surgery can be more difficult to perform. However, even then, the result is usually very good.

How Are Cataracts Treated?

Cataract surgery is the only way to remove a cataract. Cataract surgery requires removing the cloudy lens and replacing it with a new clear implantable lens, called an intraocular lens (IOL) or lens implant.

Patients with beginning cataracts, may notice that their vision is sometimes improved by using different eyeglasses, magnifying lenses, or even stronger lighting. These options do not really treat the problem of the crystalline lens becoming clouded. There are no medications, eye drops, exercises, or glasses that will cause cataracts to disappear.

Your cataract needs to be removed when it interferes with your everyday activities, such as driving, reading, or watching TV. It is important that you and your eye surgeon make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you have cataracts in both eyes, your surgeon will remove them one at a time in order to achieve the best possible results.

Sometimes, it is necessary to remove a cataract, even if it doesn't seem to cause problems with your vision, if it prevents a thorough examination of the retina or optic nerve, or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.

Click on the following links to learn more about CATARACT SURGERY.

Premium Intraocular Lens Implants and the Correction of Astigmatism, in conjunction with IOL Power Calculations are advancements in cataract surgery that East Valley Ophthalmology has actively participated in developing.

The eye specialists of East Valley Ophthalmology perform advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient with information needed to fully understand their condition and to achieve their best possible visual outcome.

If you would like further information, please call our office at:

480-981-6111

East Valley Ophthalmology

Eye Doctors - Mesa, Arizona

If you or a family member or friend have not had a recent routine eye examination, have a specific eye condition that needs addressing, or are looking for an eye specialist or professional eye consultant please take a moment to Request an Appointment.