Ruth Obadal, 72, a retired firefighter in Eugene, Ore., was tired of having to constantly switch glasses, one major reason she decided to have cataract surgery.
In addition to the inconvenience, she found it increasingly difficult to get crisp vision, even when fine-tuning her prescriptions. So she had the procedure in both eyes — each two weeks apart — in May. She is happy with the results. “Now, I don’t use glasses for anything,” she says.
Everyone who ages is vulnerable to developing a cataract in one or both eyes, a cloudy area in the eye’s natural lens that can cause vision to become blurry, hazy and less colorful. Cataracts result from normal changes in the eyes as people get older. At about age 40, the proteins in the lens begin to break down and clump together, causing the cloudiness. Over time, it worsens.
Sunlight during the day and nighttime glare from streetlights and cars can be uncomfortable, even painful, interfering with the daily tasks of life, such as driving a vehicle, especially after dark.
“I tell my patients that the time for surgery is when you can’t see what you need to do, whether it’s driving, reading the sports scores on bottom of your TV screen or seeing your mobile device,” says Amir Khan, an ophthalmologist at the Mayo Clinic. “We let the patient decide.”
By 2050, the number of Americans with cataracts is expected to double from 24.4 million to about 50 million, according to the National Eye Institute.
The greatest risk for developing a cataract is age, although other factors can raise the chances, among them having diabetes, smoking, alcohol, sun exposure, eye surgery and long term medicinal steroid use. More than half of all Americans 80 or older have cataracts, or have had surgery to remove them, according to the institute.
“We will all get cataracts if we are blessed to live long enough,” says Janine Clayton, an ophthalmologist and director of the Office of Research on Women’s Health at the National Institutes of Health, who says people with cataracts should have them removed if they disrupt the quality of life, or pose a danger.
“It’s important as you get older that you can still socialize — we want you to still drive at night — and still use your brain, reading and doing things that are visually demanding. It’s also good for your mental health. If you aren’t able to do what you like, you are more likely to become depressed. If you can’t drive, it could lead to isolation. You may mix up your pills if you can’t see right. It’s not just your eyes, it’s your overall quality of life.”
You can reduce the risk of developing cataracts by blocking the sun with sunglasses and a broad-brimmed hat, and quitting smoking, among other things, but surgery is the only way to get rid of them.
During surgery, the doctor removes the clouded natural lens and replaces it with a new artificial one, called an intraocular lens. “Think of it like an M&M,” Khan says. “We make an opening in the candy shell and scoop out the chocolate and leave the reminder of the shell behind. The implant — a contact lens with springy legs on it — we put back into the shell.”
There are different types of lens implants, a choice that should be discussed with the ophthalmologist, experts say. Typically, most lenses correct either for nearsightedness or farsightedness, which Medicare will cover. But there are others, such as multifocal lenses — Obadal’s pick — that correct sight for near, far and in-between. (Medicare typically doesn’t cover other types of lenses.)
Another option is to choose a different focus for each eye, one for distance, one for close-up, known as monovision. Khan discourages this option, unless a patient has worn monovision contact lenses in the past.
“Not everybody likes it,” he says, adding that often patients experience blurriness in the “distance” eye. “My happiest patients are those who’ve done it with contacts, and liked it.”
The surgery, which is among the most frequently performed, is considered safe, although — as with any surgery — there are always risks, such as bleeding or infection, which is why experts discourage operating on both eyes at the same time. There also is the remote chance of having a detached retina.
Nevertheless, “it’s one of the safest surgeries you can have,” Clayton says. “The risks are extremely, extremely low.” Full recovery takes from four to six weeks.
Not everyone will be able to forgo glasses entirely as Obadal did. Linda Brodsky, 63, a retired accountant from East Meadow, N.Y., had surgery in both eyes in July and was disappointed to find that she still needed glasses despite choosing a multifocal lens. “I was hoping to ditch them,” she says.
Khan says it’s important to have realistic expectations about the outcome.
“If the expectation is to never have to wear glasses then there may be disappointment,” he says. “Multifocal lenses are not for everyone and I suspect no more than 10 percent of people actually have one implanted.”
Also, “using a multifocal lens takes some adaptation and different brains adapt differently,” he adds.
Brodsky says she now sees more “floaters” in her vision, that is, spots resembling black or gray specks, strings or cobwebs. These result from age-related changes that occur as the jellylike substance (the vitreous) inside the eyes becomes more liquid and microscopic fibers clump and cast tiny shadows on the retina. Often, cataracts block floaters, which become visible after the cataracts are gone.
I had cataract surgery in both eyes about 13 years ago after a retinal procedure prompted the rapid growth of a small cataract in one eye, forcing me to quit driving at night after street and headlights turned into blinding starbursts. After the procedure, I decided to also have a cataract in my other eye removed.
My new lenses correct for distance, which means I still need glasses for reading and writing on the computer. More recently, I also began using a separate pair of distance glasses to better read subtitles and other print on television. Overall, my vision is sharper and colors are brighter. I sometimes sound like I’m pitching a laundry detergent when I describe whites as whiter, and blues as bluer — in short, I’m glad I did it.
Khan often jokes with his older patients that he can diagnose a cataract based on their birthdays alone, before he even examines their eyes. Nevertheless, there is good news.
“I tell patents: We don’t have replacement parts for everything in your body that ages, but we do for the lens in your eye,” he says.