Our eyes work like cameras, as they consist of three main components which are the glass mirror (cornea), film of the camera (retina) and the lens (also known as the lens in our eyes). When we see an object, light will travel through the cornea and pass through the lens, which then bends the light to help the fovea (the most sensitive part of our retina) focus. The image captured in our retina is then delivered to the brain, which then interprets what we see.

What is a cataract and what causes it?
The lens in our eyes is a clear and transparent structure that can change its shape and thickness to stay focused on moving objects. As we grow older, our lens can become cloudy, causing vision to be blurred. This is also known as cataract. The process of getting cataract typically begins in those aged around 40, when normal proteins in the lens start to break down. By around the age of 60, we will start to have some cloudiness in our lenses and start to have problems with our vision a few years later. It is important to note that cataract can also occur in younger patients as it can be caused by underlying medical illnesses such as diabetes mellitus, previous eye injuries, eye surgery, radiation therapy, strong family history with congenital cataract and long-term steroid usage.

Are there different kinds of Cataracts?
Cataracts vary depending on the location of opacity in the lens. The most problematic cataract is when the opacity involves the lens capsule, especially in the posterior. This is because the posterior capsule of the lens works as a nodal point where light will be focused in this region. Hence, patients with this type of cataract will experience glariness and blurred vision earlier, compared to other types of cataracts.

What are the symptoms?
Most common symptoms in patients are blurry vision, and seeing colours as faded or yellow instead. Another common symptom of cataract is when patients frequently increase their spectacle’s power within a short duration, meaning their vision is getting blurred at a faster rate than before. Some patients may also experience difficulty seeing well at night or have double vision with one eye. Patients with Posterior Subcapsular Cataract will experience extra sensitivity towards light or glare, such as sunlight or light beams from oncoming cars during the night.

Treatments available for cataract
Cataract is a part of our natural aging process, and the only treatment for it is through cataract surgery. Currently, there aren’t any medications, eye drops or tablets to reverse or treat this problem. However, correctly powered spectacles can help in improving vision to a degree, while waiting for the ideal time for cataract surgery. Patients however don’t have to wait until the cataract becomes mature, as they can opt to undergo cataract surgery early if their quality of life is greatly affected. It is advisable for you to consult your ophthalmologist as the decision between surgery and powered spectacles will vary based on individual needs.

Cataract surgery can be done in two ways, i.e., Phacoemulsification (small incision surgery) or Extracapsular Cataract Extraction (ECCE). In Phacoemulsification, a small incision around 2.2-2.75mm will be made so that the cataract can be cut into small pieces and extracted into a small probe using an ultrasound machine. Then an intraocular lens (also known as an artificial lens) will be implanted through the incision. In ECCE, a larger cut is made to allow removal of the cataractous lens in one piece, and for direct intraocular lens implantation. Vision recovery and visual rehabilitation in the eye is faster with Phacoemulsification, compared to ECCE.

What can I do to avoid getting cataracts?
Cataracts will occur in everyone as it is part of the natural aging process. Although we can’t prevent cataract formation as we grow older, we can reduce the likelihood of it occurring at younger ages by preventing any injury or trauma to our eyes. It is important to wear goggles or any type of eye protector while participating in high-risk activities such as hammering, welding, cutting grass or playing badminton. Patients who frequently use eye drops or take supplements should find out whether it contains steroids as it can contribute to early onset of cataracts. It is also advisable to have a healthy diet, exercise frequently and keep a regular body weight to prevent diabetes mellitus. Patients with diabetes or a family history with congenital cataract should seek advice from their Ophthalmologist.

Dr Nurull Bahya bt Suliman
Consultant Ophthalmologist,
Sri Kota Specialist Medical Centre