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Cataract Surgery: I See, Said The Blind Man
by Marjorie Dorfman

What are cataracts and why do they affect our sight? Why are they so prevalent among the aging? Read on, even if your vision is 20/20 because someday, when you aren’t looking, this could happen to you.

As someone who has had cataract surgery performed on both eyes, I suppose I am somewhat of an authority on this sensitive subject. I don’t fall within the norm, as I had my surgery when I was in my early forties. According to today’s statistics, most cataracts begin to form about age fifty. I am not surprised, however, as throughout my life there have been few things that I have done which would be considered as falling within the norm. At the time, my doctor informed me that more and more people were developing cataracts in the earlier stages of their lives for reasons as yet unknown. The cause for mine was never really determined. After a series of tests the only thing I could trace it to was an accidental blow over my eye I received from banging into my bathroom door. (It was in the middle of the night when I was too groggy to notice that not only was there a door before me, but also one which was closed.)

About half the population develops a cataract by age 65 and nearly everyone over seventy-five has at least one. Infants can have congenital cataracts, but these are usually related to the mother having German measles, chickenpox or some other infectious disease during pregnancy. In rarer cases, they can also be inherited.

In any case, surgery of any kind is always a pretty scary venture, and when I had my cataracts done, I was given the choice of an injection in the eye or anesthesia.

An injection in the eye! And I am a writer of horror fiction!

"Knock me out," I screamed, just in case they didn’t hear me. "Knock me out!"

For those of you who are wondering what a cataract is, allow me to shed some light on the matter (even though when you have one, light is the last thing you can count on). A cataract is a cloudiness of the eye’s natural lens, which lies between the front and back area of the eye, behind the iris and the pupil, (nowhere near the devil and the deep blue sea). This clouding interferes with the ability to see clearly. (Its intellectual counterpart, thinking clearly, unfortunately is not a procedure that can be corrected surgically.) The great majority of cataracts are the result of aging, which causes chemical changes in the natural lens of the eye and interferes with its clarity.

Think of the lens of the eye as similar to that on a camera, focussing light onto the retina at the back of the eye. The lens, which is composed of mostly water and protein, adjusts the eye’s focus. This protein is precisely arranged (by The Great Arranger in the Sky) so that the lens is always clear and light can pass through it, almost like an internal window cleaner. During the aging process, some of the protein may clump together and start to cloud a small area of the lens. This, my friends, is a cataract and over time, it may grow larger and cloud more of the lens, making it more and more difficult to see.

There are three types of cataracts. The nuclear variety, which is caused by the natural changes in the aging process, develops in the nucleus of the lens and is commonly seen as it forms. A cortical cataract, which forms in the cortex of the lens, gradually extends its spokes from the outside of the lens to the center. These are common in diabetics. The subcapsular cataract may also develop among diabetics. (Aren’t Diabetics lucky! They have their own choices of cataracts!) In this case, the cataract begins at the back of the lens. If you are about to ask which type I had, I couldn’t say. All I know is that I was just about legally blind in one eye before I realized the problem and did something about it.

Having been there twice, I can describe what happens very clearly. A cloud suddenly passes over your eye when you least expect it. It doesn’t bring April rain or even Mayflowers, but rather a sudden grayness and the inability to focus clearly. Bright sunlight makes it worse and I used to feel like a vampire, rejuvenated by the darkness of the night. I can remember once waiting several minutes to cross a street on a sunny day because I wasn’t sure whether the light had changed or not. I only crossed when I saw others doing so. I once fell down some stairs in my parent’s house because my depth perception was so distorted they looked unfamiliar, taking on alien stair dimensions (whatever that was.)

There is, at present at least, no way to eliminate a cataract other than by surgically removing it. The procedure is performed under a microscope to provide a magnified view of the eye. A small incision is made and the front surface of the cataract is opened to allow access to the clouded tissue inside. That portion is then removed and replaced with a clear, plastic intraocular lens (IOL). New lenses are being developed all the time to make surgery less complicated for surgeons and the lenses more helpful to patients. One new IOL allows vision at all distances, rather than just one. Still another blocks the passage of both ultraviolet and blue light rays, which research indicates can cause damage to the retina.

Many people with cataracts can see quite well and are not in need of surgery. It is only when the cataract interferes with functioning by impairing vision that surgery becomes necessary. It is almost always an outpatient procedure, except in my case when the administration of anesthesia required me to stay overnight. (If I had another eye to consider, I probably would do it the same way.) Procedures have improved however, and the eye is always well numbed and a mild sedative swirls one away to a land beyond sailing ships and cottony clouds, if only for a little while.

More than one million cataract surgeries are performed each year in the United States and it is considered one of the safest and most successful procedures in all of medicine. More than 95 per cent of patients experience substantially improved vision (myself included) within four to six weeks, and the chance of complications is small. Eyedrops accelerate the healing process and prevent infection. Almost everyone will need a new glasses prescription after surgery, although it may only be needed for distance or reading depending on the choice of the implant’s power.

Many studies suggest that exposure to ultraviolet light is associated with cataract development. For this reason, many eye care professionals recommend wearing sunglasses and a wide-brimmed hat to lessen exposure to the sun. Other studies suggest that people with diabetes are at high risk for developing cataracts. I must say that I am among them, but when I developed my cataracts I did not have the disease. (Once again there’s the norm and me rolling around outside of it.)

Still other studies claim that a diet high in antioxidants, such as beta-carotene (Vitamin A), selenium and vitamins C and E, may forestall cataract development. Increased salt intake, however, may increase the risk. (It is not known what throwing some over the shoulder will accomplish.) Other factors include cigarette smoke, air pollution, and heavy alcohol consumption. There have been many studies, but still more are needed for conclusive answers.

So be prepared as the boy scouts always say, for cataract formation can happen to you when you least expect it. (Who says getting older isn’t suspenseful?) If you are anything like me, it may happen before. There’s little you can do either way except realize that this too will pass, just as a rain cloud across the horizon; that is, if you can still see the horizon.

Did you know . . .

Copyright 2005