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Dr. Fowler Discusses Cataracts

The next common age-related eye condition that we’re going to talk about tonight is cataracts. How many people here have cataracts or have had cataract surgery? Wow! More than half the room. So most of you know that a cataract is just a fancy term for a cloudy lens. That’s all it is. The lens sits right behind the colored part of your eye and as it ages over time it gets cloudy. When it becomes cloudy, light can’t pass through it, and if light can’t get to the back of the eye then you can’t see.

When an ophthalmologist does cataract surgery, they simply take out the old, cloudy lens and put a new, clear lens in its place, and then you can see again. Thirty years ago, this procedure was a pretty big deal. It took nearly an hour to complete and you had to stay in the hospital for several days after, with a sandbag over your eye, to ensure that the eye healed properly. But now, thanks to advances in technology and surgical technique, it is the most commonly performed surgery in the world. Most cataract procedures are completed within ten to fifteen minutes and most patients go home within a few hours after the surgery. Within a week or so, you can resume all normal activities and you will see like you haven’t seen in years. It truly is a remarkable process.

Cataract surgery and recovery are still evolving today. Who here had to use eye drops after their surgery? Almost all of you. Well, during my training in Indianapolis ten years ago, I had the privilege of working with a surgeon who helped pioneer a procedure where different combinations of medications were injected into eyes during cataract surgery so patients wouldn’t need to put drops in their eyes afterward. Why did he do this? Well – number one – it is hard to remember to put three or four different types of drops in your eyes at three or four different times of the day or week. Number two – the drops are very, very costly and most cataract patients are on a fixed income. And, number three – even if you can afford the drops and remember to put them in your eye at the right time, it’s still hard to get them in your eye! This surgeon in Indianapolis used a combination injection of a steroid and an antibiotic to help control inflammation and prevent infection after surgery, and it worked great. Over the last couple of years, many of the ophthalmology groups in Kentucky have also added this technique to their procedures and are having great results, as well.

A little bit more about cataracts. 24 million Americans over the age of 40 currently have cataracts, and more than 50% of Americans will have cataracts by the time they are 80 years old. There are two things that cause the majority of all cataracts throughout the US – age, and exposure to the sun. One you can avoid – one you can’t. As age and cataracts progress over time, vision gets worse and glare becomes a problem for most people – especially when driving at night – especially when it’s raining or snowing. Daytime light sensitivity also becomes problematic as cataracts progress.

Most people start getting cataracts in their 40s and 50s, but they don’t usually get cataract surgery until they’re between 65 and 85. Many of my 50-60-year-old patients do have some degree of nighttime glare or daytime sensitivity where their vision isn’t perfect, but they don’t yet need surgery, and I tell them that they are experiencing the “tweener” stage of cataract progression. If you remember your tween years – I’ve got two of them right now (one is 11 and the other is 13) – you go through a lot of changes. You aren’t a kid anymore, but you certainly aren’t an adult either. The same thing is true for these patients and their cataracts. In many cases, their vision isn’t perfect, but they’re not quite ready for surgery either – they’re in between.

So what do we do about it? Well, for starters, we change the glasses prescription. We try to bend light around the cataract to help you to see as clearly as possible. If that works, then we update your prescription. Another thing that is helpful is brighter indoor lighting. One other possible solution is eye drops. A lot of money is currently being put into research to develop an eye drop that can reverse cataract formation. Now, I won’t get into the mechanics or the molecules or anything like that, but there are some promising results. In fact, it’s quite possible that by the time I need cataract surgery twenty or thirty years from now, all I will do is put a drop in my eye and it will reverse the cataract to a point where I won’t actually need surgery. For now, though, if changing the glasses doesn’t work and brighter lighting doesn’t work, the only way to get rid of a cataract is through surgery. But like I said earlier, it is the most commonly performed surgery in the world today, and it’s not nearly as big of a deal as it used to be.

[QUESTION] – I’ve heard that some people get cataracts a second time. Is that true?

[RESPONSE] – Great question. That is true – kind of. When an ophthalmologist is doing cataract surgery, and they remove the lens from the eye, they leave a little bit of tissue in the eye to support the new lens when it is placed in the eye. This tissue prevents the lens from falling into the back of the eye and also keeps it in place so the patient can see clearly after the surgery.

Unfortunately, in about 33% of patients, that little piece of tissue becomes cloudy between six months and three years after the surgery, and that is what some people call a secondary cataract. But the procedure to remove it is much simpler than the initial cataract surgery, and I’ve actually done this procedure on several patients. You just go into the exam room and sit down at a microscope that has a special laser attached to it. The doctor then focuses the laser on the cloudy tissue and zaps it a few times until it falls off, then you never have any issues with it ever again.

[QUESTION] – I’ve heard that some people are born with cataracts. Is that true?

[RESPONSE] – Yes, I’m glad you brought that up. It doesn’t happen very often but you can be born with cataracts. I’ve had some patients that come to me at two years old, three years old, four years old – their parents say they run into walls or they aren’t seeing things like other kids their age. Sometimes I look into their eyes and I see cataracts.

The best way to prevent cataracts is to get regular eye exams and to wear sunglasses and a hat outdoors to protect yourself against the sun. And again, eating a balanced diet with lots of fruits, vegetables, vitamin C, and vitamin E, is also helpful.