The symptoms of an early cataract may be improved with eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.
A cataract needs to be removed only when vision loss interferes with everyday activities, such as driving, reading, or watching TV. The individual and their eye care professional can make this decision together. Once the individual understands the benefits and risks of surgery, they can make an informed decision about whether cataract surgery is right. In most cases, delaying cataract surgery will not cause long-term damage to the eye or make the surgery more difficult.
Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90% of cases, people who have cataract surgery have better vision afterward. Approximately 2.7 million Americans undergo cataract surgery.
If an individual needs cataracts removed from both eyes, surgery usually will be done on only one eye at a time. An uncomplicated surgical procedure lasts only about 10 minutes. However, the individual may be in the outpatient facility for 90 minutes or longer because extra time will be needed for preparation and recovery. At least a few days to weeks typically will be needed between surgeries, so that the first eye has the chance to heal and be evaluated in a follow-up exam for any possible problems.
Due to improvements in technology, most eye doctors use cataract surgery at an earlier stage of development rather than waiting until the cataract is advanced and very dense.
There are two types of cataract surgery. An eye doctor can explain the differences and help determine which is best.
Sometimes a cataract should be removed even if it does not cause problems with vision. For example, if the individual has diabetes, it may be best to remove a cataract before vision is affected.
Phacoemulsification, or phaco: During phacoemulsification surgery, a small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. An eye doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery."
Extracapsular surgery: During extracapsular surgery, an eye doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.
After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of the eye. Light is focused clearly by the IOL onto the retina, improving vision. The individual will not feel or see the new lens.
Some individuals cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, soft contact lens, or glasses that provide high magnification, may be suggested.
Risks of cataract surgery: As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, the doctor may ask the individual to temporarily stop taking certain medications that increase the risk of bleeding during surgery, such as aspirin, warfarin (Coumadin®), and dietary supplements such as ginger (Zingiber officinalis)and garlic (Allium sativum). After surgery, the individual must keep the eye clean, wash their hands before touching the eye, and use the prescribed medication, including antibiotics to help minimize the risk of infection and anti-inflammatory drugs to decrease inflammation. Serious infection can result in loss of vision. Other risks include retinal detachment and cystoid macula edema (see the complications section of this monograph for more information).
What to expect before, during, and after surgery: A week or two before surgery, an eye doctor will perform some tests, including measuring the curve of the cornea and the size and shape of the eye. This information helps the doctor choose the right type of IOL. The individual may be asked not to eat or drink anything 12 hours before surgery.
At the hospital or eye clinic, drops will be put into the eyes to dilate the pupil. The area around the eye will be washed and cleansed.
The operation usually lasts less than one hour and is almost painless. Many individuals choose to stay awake during surgery. Others may need to be put to sleep for a short time. If the individual is awake, they will have an anesthetic to numb the nerves in and around the eye.
After the operation, a patch may be placed over the eye. The individual will be told to rest for a while. A medical team will watch for any problems, such as bleeding. Most individuals who have cataract surgery can go home the same day. The individual will need someone to drive them home.
Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. The eye may be sensitive to light and touch. After one or two days, moderate discomfort should disappear. Eyes drops for itching may be prescribed by a doctor.
For a few days after surgery, a doctor may ask the individual to use antibiotic eyedrops to help healing and decrease the risk of infection, such as ciprofloxacin (Cipro®). Also, ketorolac (Toradol®) eye drops may be prescribed to be placed in the eye to decrease inflammation. The individual will need to wear an eye shield or eyeglasses to help protect the eye and avoid rubbing or pressing on the eye. When the individual is at home, it is recommended by healthcare professionals to try not to bend from the waist to pick up objects on the floor and not to lift any heavy objects. Straining and bending may cause pressure in the eyes and damage the eye. The individual can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. A doctor will schedule exams to check on the progress.
Individuals can normally return quickly to many everyday activities, but their vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. The individual must ask a doctor when driving can be resumed. Headaches, dizziness, and blurry vision may occur.
If an IOL was placed in the eye, colors may appear very bright. The IOL is clear, unlike the natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, the individual will become accustomed to improved color vision. Also, when the eye heals, new glasses or contact lenses may be needed.
If sight has been lost from cataract or cataract surgery, it is important to ask an eye care professional about low vision services and devices that may help improve the remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
Beta-carotene: Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Study results of beta-carotene supplementation for cataract prevention are conflicting. Further well-designed clinical trials are needed before a conclusion can be drawn. Supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this effect. In those who smoke, beta-carotene may increase cardiovascular death, including heart attack.
Bilberry: Bilberry (Vaccinium myrtillus) is a close relative of the blueberry. Bilberry extract has been used for a number of eye problems, including the prevention of cataract worsening. At this time, there is limited scientific information in this area. Bilberry may increase bleeding in sensitive individuals, such as those taking blood thinning medications including warfarin (Coumadin®) and aspirin.
Kinetin: Kinetin is a chemical analogue of cytokinins, a class of plant hormones that promotes cell division. Kinetin is found in both plants and animals. Side effects of cataract surgery may include pain, infection, swelling, bleeding, or retinal detachment. The use of kinetin during cataract surgery may lower adverse effects associated with cataracts. More research is needed in this area.
Lutein: Lutein and zeaxanthin are found in high levels in foods such as green vegetables, egg yolk, kiwi fruit, grapes, orange juice, zucchini, squash, and corn. For some commercially available supplements, lutein is extracted from marigold petals. Human study has not found a benefit of lutein supplementation on visual performance in people with cataracts. More information is required.
Riboflavin (vitamin B2): Riboflavin is a water-soluble vitamin that is involved in vital metabolic processes in the body, and is necessary for normal cell function, growth, and energy production. Small amounts of riboflavin are present in most animal and plant tissues. It has been suggested that low riboflavin levels may be a risk for developing cataracts, or that riboflavin supplementation may be beneficial for prevention. Additional evidence is needed before a clear conclusion can be drawn.
Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Preliminary research reports that selenium supplementation may affect the development of cataracts. Further research is needed before a clear conclusion can be drawn.
Thiamin: Thiamin, also known as thiamine and vitamin B1, is a water-soluble B-complex vitamin. Preliminary evidence suggests that high dietary thiamin intake may be associated with a decreased risk of cataracts. Further evidence is necessary before a firm conclusion can be reached.
Vitamin A: Vitamin A is a fat-soluble vitamin, which is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids such as retinal and retinoic acid are found in animal sources such as liver, kidney, eggs, and dairy produce. Carotenoids like beta-carotene (which has the highest vitamin A activity) are found in plants such as dark or yellow vegetables and carrots. Vitamin A has been suggested to prevent cataract formation. Carotenoids such as beta-carotene, lutein, and zeaxanthin may decrease the risk of severe cataracts. There is not sufficient evidence to form a clear conclusion at this time. Vitamin A should only be used within the recommended dietary allowance, because vitamin A excess, as well as deficiency, have been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations.
Vitamin E: Vitamin E is a fat-soluble vitamin with antioxidant properties. There is conflicting evidence regarding the use of vitamin E to prevent cataracts. Although some studies across populations have suggested some protective effects (which may take up to 10 years to yield benefits), other studies in humans report a lack of benefits when used either alone or in combination with other antioxidants. Additional research is necessary before a clear conclusion can be reached. Vitamin E may increase bleeding in sensitive individuals, such as those taking blood thinning medications including warfarin (Coumadin®) and aspirin.
Traditional or theoretical uses lacking sufficient evidence
Integrative therapies used in cataracts that have historical or theoretical uses but lack sufficient clinical evidence include: acupuncture, chelation (EDTA) therapy, coleus (Coleus forskohlii), copper, detoxification therapy, dogwood (Cornus spp.), eyebright (Euphrasia officinalis), fenugreek (Trigonella foenum-graecum), ginkgo (Ginkgo biloba), green tea (Camellia sinensis), holy basil (Ocimum sanctum), honey, lycopene, niacin (vitamin B3), onion (Allium cepa), pantethine, quercetin, rehmannia (Rehmannia glutinosa), rosemary (Rosmarinus officinalis), turmeric (Curcuma longa) and curcumin, and vitamin O (oxygen).
prevention and self‑management
Eye examination: Most cataracts occur with age and cannot be prevented. Regular eye exams are the key to detecting cataracts early enough for successful treatment. It is best to have routine eye checkups every two to four years after age 40 and every one to two years after age 65.
Diet modification: Eating a healthy diet full of fruits and vegetables helps to ensure that enough vitamins and minerals are consumed for use by the body and eyes. Some that are especially important to eye health include vitamin A, vitamin C, vitamin E, and zinc. Drinking fluids in small amounts over the course of a day can help individuals with increased intraocular pressure (IOP). Drinking a quart or more of any liquid within a short time may increase eye pressure. Limiting caffeine to low or moderate levels may be helpful.
Smoking produces free radicals that cause oxidation to body tissues including the eyes. Smoking increases the risk of cataracts.
Ultraviolet light may contribute to the development of cataracts. Whenever possible, wear sunglasses and sunscreen when outdoors. Anti-glare sunglasses and those with ultraviolet (UV) protection are recommended by healthcare professionals.
Control health conditions: Other health conditions, such as diabetes, may increase the risks for cataract development. Making sure blood sugar levels are controlled is important for eye health.