Cataracts affect the natural lens in your eye. When we are young, the lens is clear and focuses light to create a clear, crisp image. In our 50s, the lens begins to yellow, develops vacuoles and/or spokes, and can become cloudy. A cloudy lens is called a cataract, which naturally occurs with age, similar to how our hair turns grey. There are different kinds of cataracts (ex. nuclear, cortical), which are defined by where the cloudiness occurs in the lens. These lens changes happen to everyone at varying rates and ages. Aside from age, corticosteroids and diabetes can contribute to the formation of cataracts. Cataracts cause clouding of your vision because light becomes scattered from the lens opacities, which can cause decreased vision, decreased colour vision and increased glare. Even when your doctor gives you a perfect prescription, your vision will not be as clear as it used to be because of your cataract.
Figure 1A. Changes to our natural lens. Shown in this figure is the formation of a nuclear cataract. A nuclear cataract forms deep in the central zone of the lens. The far left lens is of someone at age 20 and towards the right, the lens ages in increments of 10 up until age 70. After age 50, the lens yellows naturally with age and can cause decreased quality to your vision.
Figure 1B. Changes to our natural lens. Shown in this figure are different grades of cortical cataracts. From left to right shows least advanced to most advanced. Cortical cataracts are characterized by spoke-like opacities that occur in the periphery of the lens.
Figure 1C. Changes to our natural lens. Shown in this figure are different grades of posterior subcapsular cataracts, from left to right shows least advanced to most advanced. Posterior subcapsular cataracts form at the back of the lens.
What is the solution to cataracts?
Cataract surgery is an outpatient procedure that takes approximately 15 minutes per eye and you go home the very same day. Typically one eye is done and within weeks the other. You will need to see the doctors at the Toronto Eye Clinic 4 weeks after your surgery for a follow up appointment.
What type of lens implant should I get?
Your eye doctor at Toronto Eye Clinic will discuss the options with you so that together you can decide which option is best suited for your needs.
- Spherical Lens Implant
Usually the surgeon will try to correct your previous prescription by putting your prescription into this lens implant. After the procedure, you will require little to no glasses prescription for your distance vision. You will still require glasses to read and to use the computer. For most patients, this is the best option.
- Astigmatic Lens Implant
This option is for patients with mild to moderate astigmatism. However, the placement of the lens must be very precise, and any shift in the lens implant can cause decreased vision and require you to wear glasses. Sometimes, the lens capsule that holds the lens implant can contract with time, which can cause a shift in the lens implant and cause decreased vision quality.
- Monovision Lens Implant
For people who wish to be less dependent on glasses at distance and near, one eye is corrected for distance and one eye is corrected for near vision. Your brain learns to choose which eye to use for each distance. For very fine reading you may need additional help with a pair of reading glasses. With monovision, your depth perception is decreased because of the imbalance in vision between your eyes. Monovision implants are not a good option if you regularly perform tasks that require fine depth perception, such as driving.
- Multifocal Lens Implant
This is another option for people who wish to be less dependent on glasses at distance and near. However, many patients experience glare in dark conditions, such as driving at night, which can be very bothersome.
When should you get your cataracts removed?
With the advancements in surgical techniques and technology, cataract surgery is a day procedure with a quick recovery time of approximately 2-3 days. It is one of the safest, most commonly performed surgical procedures. There are risks associated with any type of surgical procedure, however the risks of retinal detachment and retinal swelling (cystoid macular edema) are small, and the benefits far outweigh the risks. Your surgeon will discuss with you the risks and benefits of cataract surgery. In the past, doctors would only refer for cataract surgery when the cataracts were ‘mature’ or ‘ripe’ because it was a more invasive procedure with a long recovery time. Presently, if you feel that your quality of life is being affected by your vision, your eye doctor can discuss with you whether or not it is a good time for cataract removal. You will notice that your vision, contrast sensitivity and colour vision will be much improved after the procedure.
Remember to return to The Toronto Eye Clinic for regular ocular health checks, even after your vision has improved from cataract removal