How to Diagnose and Treat Cataracts

If your vision is a bit cloudy lately and driving at night is getting tricky, it's time to check if you have cataracts. Your doctor will help you figure out what's going on and may suggest surgery or other ways to clear up your foggy view.

Diagnosis

To find out if you have cataracts, your doctor will want to know all about your symptoms. She'll ask if things look blurry or hazy or if the glare from lights bothers you, especially at night.

Your doctor will look closely at your eyes and may do some tests:

Visual acuity test. This is a fancy way of saying "eye chart exam." Your doctor will ask you to read letters from a distance to find out how sharp your vision is. First you'll try it with one eye, then the other.

Slit-lamp exam. This uses a special microscope with a bright light that lets your doctor check different parts of your eye. She'll look at your cornea -- the clear, outer layer. She'll also examine the iris -- the colored part of your eye -- and the lens that sits behind it. The lens bends light as it enters your eye so you can see things clearly.

Retinal exam. Your doctor puts drops in your eyes to widen your pupils -- the dark spots in the middle that control how much light gets in. This lets her get a good look at the retina -- the tissue around the back of your eyes -- and also a better view of the cataract.

Manage Symptoms Without Surgery

Surgery is the only way to treat cataracts, but you may not need it right away. If you catch the problem in an early stage, you might be able to get by with a new prescription for your glasses. A stronger lens can make your vision better for a while.

If you have trouble reading, you might try a brighter lamp or a magnifying glass. If glare is a problem for you, check out special glasses that have an anti-glare coating. They can help when you drive at night.

Keep close tabs on how your cataracts affect the way you see. When your vision troubles start to get in the way of your daily routine -- especially if it makes driving dangerous -- it's time to talk to your doctor about surgery.

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Types of Surgery

There are several kinds of operations for cataracts, but they all have one thing in common: Your surgeon takes out the cloudy lens that keeps you from seeing clearly and replaces it with an artificial one.

You might feel a little squeamish about the idea of an operation on a sensitive spot like your eye. But it's a very common procedure, and it doesn't hurt. During the surgery, you'll have medicine called local anesthesia to numb your eye. You’ll be awake, but you won't feel anything.

It usually takes about 15 to 20 minutes, and you don't need to stay overnight in a hospital. If you have cataracts in both eyes, your doctor will wait until your first eye heals before she does surgery on the second.

Small-incision surgery. You may also hear your doctor call this phacoemulsification. Your surgeon makes a tiny cut on your cornea. She'll put a small device in your eye that gives off ultrasound waves that break up your cloudy lens. Then she takes out the pieces and puts in your new, artificial lens.

Large-incision surgery. This isn’t done as often, but doctors sometimes suggest it for larger cataracts that cause more vision trouble than usual. It's sometimes also called extracapsular cataract extraction. Your surgeon takes out your clouded lens in one piece, then swaps it out for an artificial one. You'll probably need a little more time to heal from this surgery than from the small-incision type.

Femtosecond laser surgery. In this operation, your surgeon uses a laser to break up the lens. As with the other types, once this is done, she'll put in the new lens. Your doctor may suggest this if you also have an astigmatism, a curve of your cornea that makes your vision blurry. Your surgeon can treat that problem during the cataract surgery by using the laser to reshape your cornea.

After Your Surgery

For most people, recovery goes smoothly. How long it takes depends on which type of surgery you get. But in general, you'll notice your vision gets much better a few days afterward. After about a week or two, you can go back to doing all the things you enjoy.

As with any surgery, though, there are risks. It's rare, but you could have an infection or bleeding. There's also a chance your retina could pull away from the tissues at the back of your eye. This is called a "detached retina."

Some people have an issue after cataract surgery called posterior capsule opacification (PCO). Your vision may get cloudy again because the capsule in your eye that holds the artificial lens in place gets thicker. A type of laser surgery called YAG can fix the problem.

WebMD Medical Reference Reviewed by Brian S. Boxer Wachler, MD on April 19, 2018

Sources

SOURCES:

Stanford Health Care: "Cataract Symptoms."

Mayo Clinic: "Cataracts."

American Optometric Association: "Cataract."

National Eye Institute: "Facts About Cataract."

NYU Langone Health: "Surgery for Cataract in Adults."

Cleveland Clinic: "Cataracts and Lens Implantation in Cataract Surgery: Management and Treatment."

UpToDate: "Cataract in adults."

American Academy of Ophthalmology: "What Is Astigmatism?" "Astigmatism Symptoms," "Cataract Surgery," Cataract Diagnosis and Treatment," "Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery," "Retinal Detachment: What Is a Torn or Detached Retina?"

Royal National Institute of Blind People: "Posterior capsule opacification -- why laser treatment is sometimes needed following cataract surgery."

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