When the light rays focus well on the retinal surface, we see clearly. When they focus a little in front of the retina, or behind it, we notice blurriness (that’s nearsightedness and farsightedness, respectively).

The lens is flexible and in normal, clear vision, tiny muscles change the convexity/concavity of its shape, to allow us to focus well at all distances. It’s composed of water and protein arranged so as to keep it very translucent, allowing the light to pass through unimpeded to the retina. As We Age

The lens gradually changes with the years. The arrangement of protein and water changes so that some of the protein clumps up together, creating a slight blockage to the light rays. This is a cataract, and they start small, growing very slowly, and causing the light rays to scatter as they pass through it. This makes them unable to focus on the retina and we experience blurriness and over-brightness. If left untreated for long enough, the cataract can extend throughout the lens, causing loss of vision.

The earlier a cataract is diagnosed and treated, the better we can retain our vision. Three kinds of cataracts
· Nuclear cataracts – begin to form in the center of the lens, spreading outwards, caused by aging of the lens
· Cortical cataracts – begin to form at the edge of the lens and extends inwards, often caused by diabetes
· Subcapsular cataracts – begin to form at the back of the lens, and most often diagnosed in diabetics, people on high doses of steroids, those with retinitis pigmentosa, or with severe farsightedness.
Causes of cataracts
Research is ongoing as to causes. We don’t know yet why aging should cause a cataract to form, or what other factors might contribute.
· Some studies have pointed to ultraviolet light, so that some eye doctors suggest we wear sunglasses and a shady hat to protect our eyes
· Other studies suggest cosmic radiation as a contributing cause, as it seems that airline pilots more often develop cataracts
· People with diabetes experience eye changes caused by impaired blood circulation, which are better understood. But they also more often get cataracts, as do people on steroids, tranquilizers and diuretics, for various medical conditions. It’s unknown as yet whether the medical conditions or the drugs are contributing more to cataracts.
· Other studies have pointed to:
· Excess salt
· Heavy use of alcohol
· Smoking
· Lead
Symptoms of cataracts With all three types of cataracts, the symptoms are mild at first. You may notice them only in one eye.
· Blurriness or cloudiness
· Diminished brightness of color
· Glare from light sources, especially at night
The symptoms slowly increase over time. But deteriorating vision is need not be an accompaniment to aging. A good eye doctor will be able to determine which type of cataract you have and advise you about cataract surgery. Cataract surgery

This is the most often-performed surgery in the U.S. and almost all people who have it done achieve excellent vision. It’s an outpatient procedure.
· Your eye surgeon will examine your eyes to determine the right power for the intraocular lens (IOL) he’ll implant for you. The IOL is made of very lightweight plastic.
· A local anesthetic is given and a relaxing medication if you’d like one.
· Using a microscope, the surgeon makes a tiny incision.
· Ultrasound may be used to first break up the natural lens so it can be removed more easily, or sometimes it’s removed as is. The lens’s rear membrane (posterior capsule) is left intact.
· The IOL is gently inserted and the incision closed. Dissolvable stitches may be used.
· Afterwards, your surgeon will give you an eye shield and you can go home the same day.
In some cases, the posterior capsule becomes cloudy after cataract surgery. This makes your vision blurry again, but it can be treated with a laser. The eye surgeon makes a small opening in the capsule to allow light to reach the retina as it should. In very few cases are there any complications. Most people can see much more clearly, and are very pleased, although some may still need glasses.

Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only one way to achieve clear vision again is through cataract surgery.This surgery has continued to evolve over the past several years, often leading the way for our medical colleagues. Years ago ophthalmologists were the first to utilize microsurgery techniques. The microscope came into use for the cataract surgery nearly 20 years ago. Ophthalmologists also pioneered the use of lasers for surgery.

Cataract surgery has continued to require a smaller and smaller incision over the years. About 10 years ago, the average cataract incision was nearly 11 or 12 millimeters. Now with phacoemulsification, the cataract is removed with a vibrating handpiece. This requires an incision no more than 3 millimeters (1/8 inch).

Flexible lens implants can be folded in half and can be passed through an incision nearly as small as the phacoemulsification needle itself. As the incision has shrunken, the need for sutures has diminished. In the great majority of cataract surgeries, no sutures are required.

The advantages of this new small incision surgery are quite significant. Because the wound is smaller, the eye is more stable. Therefore, the customary restrictions against bending or heavy lifting are dramatically shortened. We now tell patients that these limitations need only last 3-4 days. After this time, the patient can resume normal activity.

Another major advantage of the small incision is that it causes much less distortion of the vision. Patients have found that their vision recovers quite well in just several days.

Typically, we still wait 3-4 weeks before we order glasses to be sure that the prescription is as accurate as possible. The number of office visits required following cataract surgery has also dropped. We now see patients the first day, the first week and in 1 month following cataract surgery.

Another very significant advance in cataract surgery has been our ability to combine the small incision cataract surgery with a glaucoma procedure. This combined operation enables us to take care of both problems in certain patients. With the double operation, however, the visual recovery and necessary postoperative visits are both prolonged.

A final, very exciting advance in cataract surgery has been the use of topical anesthesia.

Previously, patients were given an injection of anesthetic agent behind the globe. This injection would paralyze the eye muscles and prevent movement of the eye. Patients tolerate this type of anesthesia very well and we give it in such a way that the injection is painless. However, very occasionally, patients can develop a small hemorrhage from the injection. Another disadvantage is that the eye has to be patched following the injection because it is anesthetized.

With topical anesthesia, we administer local anesthetic drops into the eye prior to the surgery. The drops provide very adequate anesthesia to the anterior portion of the eyeball, and the surgery can be performed pain-free. Additionally, the patient can continue to move their eye and can sometimes even help with the surgery by looking in certain directions for the surgeon. The patient does not require a patch following the procedure, and they can leave with just a pair of regular sunglasses.