Definition of a cataract
Cataract is the opacification of the naturally transparent lens of our eyes. It is one of those things that often accompany us when we age. There is a point to make in the feature image of this post — Why do I choose to have a picture of balloons in the sky. What have they got to do with cataracts?
The answer is this: once upon a time in the past, I could enjoy the multicoloured things in my sight. The release of balloons is a good example. A flypast of jets on National Day is another example. I can see the details.
Once the cataract sets in, these brightly coloured balloons look faded. Worse, you may not make out these are ballooons if your cataracts have progressed to be severe enough. Your eyesight may be reduced to counting fingers if you have neglected going to seek attention earlier. What is often more treacherous is the slowly fading sight robs you of being able to see the things in front of you clearly as you are driving. Worse than that, you may not be able to conclude what is that dark patch in the road. Is it a depresson in the road surface or is it just a tarred area. You cannot tell.
Manifestations
So in my experience, the cataract slowly robs you of the clarity of things in front of you. It may be some years before you begin to run into such difficulties. What are the other common manfestations? There are 4 main features:
- Blurring of vision as I have described.
- Things appear faded
- Difficulty in making out what you are seeing, especially at night
- Glares when you look at the street lamps or the light of an oncoming car.
When should you consider surgery?
The standard answer is when the cataract becomes a disturbance in your daily activities. This is the practical endpoint.
What kind of lens?
The answer is it depends on what is the nature of your work. Assuming that you do not have other eye problems except for the cataract:
- Choose an intermediate lens if you use the computer a lot or have to look at computer screens of your students if you are an instructor.
- Choose a long distance lens, if you need to look at bus numbers a lot.
- Some individuals choose one eye to be fitted with a near distance lens, and the other with a long distance lens, assuming both eyes are normal except for cataracts. You are supposed to be “independent of glasses. But actually, if you do not have other eye problems, the cataract surgery also corrects your far sight and astigmatism, so there is a good chance you may not need glasses — just like me.
Next, assumming both eyers have cataracts, how do you go about deciding how to sequence the operations?
The standard answer is to operate on one eye at a time, with a gap of 2 to 4 weeks in between. The idea is for the operated eye to adapt to the new vision before operating on the other eye. Otherwise you may have a sense of imbalance in the short term. Can you operate on both eyes together? There are people who go for this way of treatment but usually it is one eye at a time. One indication of doing two eyes together is if the eye sight of both eyes are severely affected by the cataracts. Then the imbalance between the sight of the two eyes will be too big — and you will feel giddy.
First taste of post-operative experience?
It was glorious. The world never appeared so colourful and you are able to have a really clear definition of things, speaking of lived experience. Sadly, this nice brightness settled down to the usual sight after a month or so.
Take home messages
- You need to consider cataract surgery if the cataract(s) interfere(s) with your daily activties.
- Don’t delay when this stage is reached
- Discuss with your eye surgeon what kind of lens is suitable for you. If you have underlying eye disease eg diabetic retinopathy then it depends on how much eye sight one can expect to have post operatively.
- In the next post we will discuss if the eye sight begins to fade after a year, what is happening? See the eye surgeon again.
Dr LG Goh
Dr GOH Lee Gan is a retired Associate Professor in the Department of Family Medicine, National University Health System. He has an interest in learning and teaching how we can age well everyday (AWE).
