An Eye Surgeon Explains Everything You Ever Wanted To Know About Cataracts

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From when they happen to how they get removed.

They say the only certainties in life are death and taxes, but if you live long enough, there’s another thing we can add to that list: cataracts. 

It’s an ailment common enough that everyone has heard of it — and most likely had a family member experience it. And eventually, it’ll happen to just about all of us. The good news is cataracts are extremely treatable, and in some cases, the surgery can actually make your vision better than it was before that pesky cloudiness ever showed up. 

We know “surgery” can be a scary word, but this one is about as easy as it gets, according to Neda Shamie, MD, an ophthalmologist and eye surgeon who specializes in cataract and refractive surgery and corneal transplants. She’s been in practice for 20 years (with the last five spent at the Maloney-Shamie Vision Institute in Los Angeles), and she’s performed this procedure thousands of times, so she really knows her stuff.

Below, Dr. Shamie walks us through what’s actually happening with our vision as cataracts appear, how the treatment works, and at what age we can expect this to become a problem.

First, what exactly are cataracts?

Dr. Neda Shamie: Cataracts occur during the natural aging of the lens of the eye. When we’re young, that lens is clear and has focusing power, and we take it for granted. But as we get older, your natural lens becomes cloudy over time. That’s a cataract. Nearly every person who lives long enough — past age 80 — will develop cataracts, so most of us have had a grandparent or parent who has had cataract surgery. 

What are the early symptoms of cataracts?

One of the first telltale signs is when someone says that when they’re driving at night, the lights of oncoming traffic flare out, or they’re not able to see the street signs very clearly. A lot of people comment on having difficulty reading unless they have extra light, or they may notice that the white walls they freshly painted a few years ago are starting to look a little yellow because the clouding of the lens tends to have a yellow tint. And because it happens gradually, a lot of people don’t really notice it. They assume it’s part of the aging of the eye, but what they don’t understand is that it is most definitely manageable and treatable. 

How can someone tell the difference between the natural degradation of their vision and the development of cataracts?

If someone has to wear glasses to see distance, they may notice that year after year, their prescription changes. That in itself can be part of aging. But when cataract ensues, new prescription glasses won’t necessarily improve your vision. So someone who is developing cataracts may notice that their prescription has changed, but they weren’t able to see as clearly with that new prescription as they did the last time they had their glasses changed. Cataracts aren’t just a change in your prescription, it’s also that clouding of the vision. 

At what age does this usually start to happen to our eyes?

Typically, most people past age 80 have significant cataracts. But patients are noticing their cataracts sooner than they did in generations past. Our TVs are crisp and high definition, so we want our life and what we see around us to be high definition. We just tend to be a lot more sensitive to the aging of our bodies and our vision.

I have had patients complaining about cataracts as early as age 50. It’s not that unusual that very early signs of cataracts can impact someone who’s highly functioning, like someone who’s a golfer or who goes out for runs at night and really relies on crisp vision. Our grandparents who weren’t as active and youthful as we are at our age now may not have noticed it until much later.

Are there any conditions or parts of our lifestyle that might predispose someone to getting cataracts?

There are people who come in much younger, as early as age 20 or 30, if they have had severe diabetes or have a history of medical conditions that required the use of steroids. Also, someone who’s highly near-sighted tends to develop cataracts sooner. And then there’s a whole textbook-worthy list of more rare associations, but those are the top three that I see a lot of in my clinic.

Since cataracts are a natural part of aging, is there anything we can do to prevent them?

That’s a challenge to some degree, but there is some evidence that UV protection can potentially prevent the early onset of cataracts. So wear your sunglasses, your hats, and your UV protection — it’s good for your skin and it’s good for your eyes. You should also avoid steroids if you’re not required to take them for a medical condition. 

Tell us about the surgery to treat cataracts.

It’s the most common surgery done in the United States, and in our practice, we perform more than 1,000 cataract surgeries a year. Essentially, the surgery entails removing the cataract and replacing it with a new lens implant that will give you clarity of vision. It’s a very simple and painless outpatient procedure that takes anywhere from 15 to 20 minutes. It doesn’t require general anesthesia — it’s just local anxiolytics to take the edge off, kind of a twilight anesthesia. You’ll have very minimal discomfort, and within a day or two, your vision is about 80 to 90 percent improved. As with any surgical procedure, there may be risks involved, so you should talk to your doctor, and you can get more information right here.

We don’t let patients drive themselves home on the day of the procedure — not because of the surgery itself, but because of the anesthesia. We have patients ask a family member or friend to pick them up, or they can Uber home. And then the recovery is quite rapid. Within a week you’ll have full recovery of vision. You will have to use antibiotic, anti-inflammatory eye drops, but that’s usually very short-term. 

The surgery truly can be life-changing for a lot of patients. It can not only improve the quality of your vision but you can also potentially gain other benefits from the advanced lens technology available to us.

What are some of those other benefits?

In surgery, we’re replacing that cloudy lens with a new lens implant, which takes away the cloudiness and the yellowing effect of the cataract. But now, there’s more than just the benefit of clearing your vision — there’s also the opportunity to get you out of glasses.

There are two advanced lenses I love to offer my patients: One is called PanOptix, which is a multifocal lens, and the other is Vivity, which is an extended-range lens. So for anyone who wears glasses for distance or reading, or if you have progressive or multifocal glasses, there’s the opportunity with these lenses to give you excellent 20/20 vision at a distance, but also the ability to read or work on a computer without glasses. 

For a patient in their 50s or 60s to be seeing better than their children or grandchildren who have to wear glasses, it’s life-changing. It offers the freedom to get up and go. You don’t always have to be fumbling for your reading glasses. It’s incredibly energizing. I have patients in their 70s who say, “After my cataract surgery, I feel active again.”

Is there any risk of cataracts coming back after you’ve had them removed?

The cataract itself doesn’t come back, but what can potentially happen is there’s a layer behind the cataract that we leave in place, but sometimes that layer can get cloudy. That happens in less than 30 percent of patients who have cataract surgery. But in lay terms, that’s what “my cataract came back” really is. There’s an in-office treatment for it. It’s a quick laser treatment that’s covered by insurance, and it takes less than a minute to do. It’s painless and minimally risky, and within a day, the vision recovers.

Anything else you’d say to someone who’s struggling with cataracts?

The most important thing to mention is that you shouldn’t let your visual deterioration hinder you from living your full life. With the advanced technology available now and the minimal risk involved with surgery, there’s no reason to delay optimizing your vision. You’ll see that when your vision is the best it can be, your outlook and your sense of usefulness will also be elevated. I’ve seen it over and over again with my patients. The most common complaint I hear from them is, “Why did I wait so long?”

The information provided on this site isn’t intended as medical advice and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.