June is Cataract Awareness Month

Cataracts are a common eye condition that affects people over 40 and newborns. It is the leading cause of blindness worldwide, but also the most treatable if caught early with a procedure that has an over 95% success rate. 

This month is Cataract Awareness Month, a time to raise cataract awareness and educate people about one of the leading causes of treatable vision loss in the United States.

History of Cataract Awareness Month

Cataract Awareness Month was pioneered by the organization Prevent Blindness. It was established in 1908 when a community of doctors realized that 30% of cases of blindness in children were highly preventable or treatable, but no actions were being taken. Prevent Blindness, a trailblazer in the eye-care industry went on to spearhead and get many legislations approved that would aid in preventing eye diseases in infants and age-related vision problems in adults. 

The U.S. Centers for Disease Control and Prevention (CDC) estimates that around 30 million Americans suffer from cataracts. This figure is projected to grow to 39 million by 2032. This is alarming because cataracts are highly treatable, yet people continue to suffer through them due to a lack of knowledge.

Cataracts are an eye condition where the lens of one or both eyes becomes covered with cloudy areas. This impedes vision because the light entering your eyes is prevented from being bent by the lens of your eye due to the cloudy film covering it. Symptoms of cataracts include seeing halos around lights, faded colors, blurry vision, and trouble driving, reading, or doing other tasks. Many people also suffer from depression and anxiety due to the stress they are facing because of their failing eyesight. The most successful treatment for cataracts is surgery whereby the doctors remove the damaged lens and replace it with an artificial one. You can also prevent cataracts by regularly getting your eyes checked.

What is Cataract?

Cataract is the most frequent cause of age-related loss of vision in the world.(Klein, 1992) As defined by the National Eye Institute, a cataract is a clouding of the lens in the eye that affects vision. (Li, 2009) The cloudiness, typically a result of changes in the proteins and fibers that make up the lens, causes images to be blurred when light is scattered on the opaque lens. (AOA, 2016) Symptoms of cataracts include blurred or hazy vision, reduced intensity of colors, increased sensitivity to glare, increased difficulty seeing at night, and changes in the eye’s refractive error. Common causes include aging, diabetes mellitus, use of certain drugs, smoking, alcohol consumption, unprotected exposure to ultraviolet radiation, and nutritional deficiency.

The common treatment for cataracts is the prescription of eyeglasses or surgery to remove and replace the lens with an artificial one. In the U.S., more than one million cataract surgeries are performed each year and more than half of Americans over the age of 80 are living with cataracts. (Desai, 2013) With the aging United States population, cataract is expected to become an increasing health burden, especially for populations of lower socioeconomic status. (Desai, 2013)

Most cataracts develop in people over age 55, but they occasionally occur in infants and young children or as a result of trauma or medications. Usually, cataracts develop in both eyes, but one may be worse than the other.

The lens is located inside the eye behind the iris, the colored part of the eye. Normally, the lens focuses light on the retina, which sends the image through the optic nerve to the brain. However, if the lens is clouded by a cataract, light is scattered so the lens can no longer focus it properly, causing vision problems. The lens is made of mostly proteins and water. The clouding of the lens occurs due to changes in the proteins and lens fibers.

Types of Cataracts

The lens is composed of layers, like an onion. The outermost is the capsule. The layer inside the capsule is the cortex, and the innermost layer is the nucleus. A cataract may develop in any of these areas. Cataracts are named for their location in the lens:

• A nuclear cataract is located in the center of the lens. The nucleus tends to darken with age, changing from clear to yellow and sometimes brown.
• A cortical cataract affects the layer of the lens surrounding the nucleus. The cataract looks like a wedge or a spoke.
• A posterior capsular cataract is found in the back outer layer of the lens. This type often develops more rapidly.

Causes and Risk Factors

Most cataracts are due to age-related changes in the lens of the eye that cause it to become cloudy or opaque. However, other factors can contribute to cataract development, including:

• Diabetes mellitus. People with diabetes are at higher risk for cataracts.
• Drugs. Certain medications are associated with cataract development. These include:
• Corticosteroids.
• Chlorpromazine and other phenothiazine-related medications.
• Ultraviolet radiation. Studies show an increased chance of cataract formation with unprotected exposure to ultraviolet (UV) radiation.
• Smoking. There is possibly an association between smoking and increased lens cloudiness.
• Alcohol. Several studies show increased cataract formation in patients with higher alcohol consumption compared with people who have lower or no alcohol consumption.
• Nutritional deficiency. Although the results are inconclusive, studies suggest an association between cataract formation and low levels of antioxidants (for example, vitamin C, vitamin E, and carotenoids). Further studies may show that antioxidants can help decrease cataract development.
• Family History. If a close relative has had cataracts, there is a higher chance of developing a cataract.

Rarely, cataracts are present at birth or develop shortly after. They may be inherited or develop due to an infection (such as rubella) in the mother during pregnancy. A cataract may also develop following an eye injury or surgery for another eye problem, such as glaucoma.

Symptoms of Cataracts

Cataracts generally form very slowly. Signs and symptoms of a cataract may include:

• Blurred or hazy vision.
• Reduced intensity of colors.
• Increased sensitivity to glare from lights, particularly when driving at night.
• Increased difficulty seeing at night.
• Change in the eye's refractive error, or eyeglass prescription.

How are Cataracts Diagnosed?

Cataracts are diagnosed through a comprehensive eye examination. This examination may include:

• Patient history to determine if vision difficulties are limiting daily activities and other general health concerns affecting vision.
• Visual acuity measurement to determine to what extent a cataract may be limiting clear distance and near vision.
• Refraction to determine the need for changes in an eyeglass or contact lens prescription.
• Evaluation of the lens under high magnification and illumination to determine the extent and location of any cataracts.
• Evaluation of the retina of the eye through a dilated pupil.
• Measurement of pressure within the eye.
• Supplemental testing for color vision and glare sensitivity.
• Further testing may be needed to determine how much the cataract is affecting vision and to evaluate whether other eye diseases may limit vision following cataract surgery.

Using the information from these tests, your doctor of optometry can determine if you have cataracts and advise you on your treatment options.

Cataract Treatment

Cataract treatment is based on the level of visual impairment they cause. If a cataract minimally affects vision, or not at all, no treatment may be needed. Patients may be advised to monitor for increased visual symptoms and follow a regular check-up schedule.

In some cases, changing the eyeglass prescription may provide temporary vision improvement. In addition, anti-glare coatings on eyeglass lenses can help reduce glare for night driving. Increasing the amount of light used when reading may be beneficial.

When a cataract progresses to the point that it affects a person's ability to do normal everyday tasks, surgery may be needed. Cataract surgery involves removing the lens of the eye and replacing it with an artificial lens. The artificial lens requires no care and can significantly improve vision. Some artificial lenses have the natural focusing ability of a young healthy lens. Once a cataract is removed, it cannot grow back.

Two approaches to cataract surgery are generally used:

Small-incision cataract surgery 

This involves making an incision in the side of the cornea (the clear outer covering of the eye) and inserting a tiny probe into the eye. The probe emits ultrasound waves that soften and break up the lens so it can be suctioned out. This process is called phacoemulsification.

Extracapsular surgery

This requires a somewhat larger incision in the cornea so that the lens core can be removed in one piece. The natural lens is replaced by a clear plastic lens called an intraocular lens (IOL). When implanting an IOL is not possible because of other eye problems, contact lenses and, in some cases, eyeglasses may be an option for vision correction.

As with any surgery, cataract surgery has risks from infection and bleeding. Cataract surgery also slightly increases the risk of retinal detachment. It is important to discuss the benefits and risks of cataract surgery with your eye care providers. Other eye conditions may increase the need for cataract surgery or prevent a person from being a cataract surgery candidate.

Cataract surgery is one of the safest and most effective types of surgery performed in the United States today. Approximately 90% of cataract surgery patients report better vision following the surgery.

Preventing Cataracts

There is no treatment to prevent or slow cataract progression. In age-related cataracts, changes in vision can be very gradual. Some people may not initially recognize the visual changes. However, as cataracts worsen, vision symptoms increase.

While there are no clinically proven approaches to preventing cataracts, simple preventive strategies include:

• Reducing exposure to sunlight through UV-blocking lenses.
• Decreasing or stopping smoking.
• Increasing antioxidant vitamin consumption by eating more leafy green vegetables and taking nutritional supplements.
• Researchers have linked eye-friendly nutrients such as lutein and zeaxanthin, vitamin C, vitamin E, and zinc to reducing the risk of certain eye diseases, including cataracts.

Fast Facts About Common Eye Disorders

• Approximately 12 million people 40 years and over in the United States have vision impairment, including 1 million who are blind, 3 million who have vision impairment after correction, and 8 million who have vision impairment due to uncorrected refractive error.
• As of 2012, 4.2 million Americans aged 40 years and older suffer from uncorrectable vision impairment, out of which 1.02 million are blind; this number is predicted to more than double by 2050 to 8.96 million due to the increasing epidemics of diabetes and other chronic diseases and our rapidly aging U.S. population.
• Approximately 6.8% of children younger than 18 years in the United States have a diagnosed eye and vision condition. Nearly 3 percent of children younger than 18 years are blind or visually impaired, defined as having trouble seeing even when wearing glasses or contact lenses.
• The National Institute for Occupational Safety and Health (NIOSH) reports that every day about 2,000 U.S. workers sustain job-related eye injuries that require medical treatment. However, safety experts and eye doctors believe the right eye protection can lessen the severity or even prevent 90 percent of these eye injuries.
• An estimated 93 million adults in the United States are at high risk for serious vision loss, but only half visited an eye doctor in the past 12 months.
• The annual economic impact of major vision problems among the adult population 40 years and older is more than $145 billion.
• Vision disability is one of the top 10 disabilities among adults 18 years and older and one of the most prevalent disabling conditions among children.
• Early detection and timely treatment of eye conditions such as diabetic retinopathy have been found to be efficacious and cost-effective.
• 90% of blindness caused by diabetes is preventable.
• Vision loss causes a substantial social and economic toll for millions of people including significant suffering, disability, loss of productivity, and diminished quality of life.
• National and state data show that more than half of adult Americans who did not seek eye care are due to a lack of awareness or costs; which is often exacerbated by a lack of adequate health insurance.
• More than 70% of survey respondents from the National Eye Health Education Program (NEHEP) 2005 Public Knowledge, Attitudes, and Practices survey consider that the loss of their eyesight would have the greatest impact on their day-to-day life; however, less than 11% knew that there are no early warning signs of glaucoma and diabetic retinopathy.

The Burden of Vision Loss

According to a 2015 CDC research, a total of 10.2 million people were blind, and approximately 3.22 million people in the United States had vision impairment. In addition, 8.2 million people had vision impairment due to uncorrected refractive error. By 2050, the number of these conditions is projected to double to approximately 2.01 million people who are blind, or have vision impairment of 20/200 or worse. 

During the next three decades, the population of adults with vision impairment and age-related eye diseases is estimated to double because of the rapidly aging U.S. population. In addition, the epidemic of diabetes, as well as other chronic diseases, will contribute to an increasing population of people who experience vision loss.

Why We Should Support Cataract Awareness Month

The ability to see the world clearly and in all its glory is something we shouldn’t take for granted. Millions upon millions of cells perform complex operations in our eyes to allow us the gift of sight. We should take care of it and appreciate our glorious vision for what it is.

Science has not only explained to us how intricately our eyes can work, but it has also revealed to us the many ways we can repair and treat them in case things go south. Medical advancements have ensured that about 80% of all eye diseases are treatable and can be prevented. The only condition being we take the necessary steps to appreciate and care for them.

There’s always light at the end of the tunnel. Everything might seem dark now, but soon things will start changing for the better. We can keep hope alive by continuing to educate ourselves and others. The more awareness there is around cataracts, the more hope can be spread.

Sources:

https://www.cdc.gov/visionhealth/basics/ced/fastfacts.htm

https://www.cdc.gov/visionhealth/risk/burden.htm

https://www.cdc.gov/visionhealth/vehss/data/studies/cataract.html

https://nationaltoday.com/cataract-awareness-month/