Prevention and Treatment

Primary Prevention

Senile cataracts are part of the normal aging process therefore their occurrence is not preventable. Recently, some evidence suggests that ultraviolet radiation may be a significant contributing factor to cataract formation. This finding requires more study. If this evidence is supported, primary prevention may include protective sunglasses to decrease absorption of ultraviolet rays. Many agents are frequently advertised to delay, prevent, or reverse cataract formation. None has proven successful.

The incidence of most traumatic cataracts is preventable. Persons working in environments with exposure to heat or metals or those participating in such sport activities as racquetball should be encouraged to wear protective safety goggles.

Secondary Prevention

Because cataracts can occur in conjunction with systemic disorders, such as diabetes mellitus, hypoparathyroidism, and galactosemia, persons with these conditions should have their disease closely monitored to prevent cataract formation.

Surgical Treatment

Operative management is the only method for treating cataracts. Unlike most other damaging diseases of the eye, vision loss from cataract can be restored by surgical removal of the cataract. Even patients who are in their 90s can undergo cataract surgery with good results. Between 90% and 95% of all cataract operations are successful. The decision as to when to remove the cataract depends on the general health of the patient and how much the cataract interferes with the person’s activities.

It was previously thought that a cataract had to become mature or “ripe” before it could be extracted, that is, separated from the lens capsule. Now cataracts are removed whenever the person’s activities of daily living or when the cataract may lead to other eye complications such as glaucoma.

Cataracts are usually removed using a local anesthetic. The most popular method of cataract removal is the extracapsular cataract extraction (ECCE). In this method, only the anterior portion of the lens capsule plus the capsule contents are removed, using techniques such as irrigation and aspiration or phacoemulsification (ultrasonic vibration to break up the lens). Cataracts can also be removed within their capsule (intracapsular cataract extraction) using a freezing (cryo) probe that adheres to the surface of the lens.

Corrective Lenses

Because the lens or lens content has been removed, something is needed to replace the lost focusing power. The intraocular lens is most commonly used. When this is not possible, cataract glasses or contact lenses are necessary. The intraocular lens is the primary form of lens replacement today because is works on vision correction to near 20/20.

There are two types of intraocular lens implants being used. The anterior chamber is placed in front of the iris and is supported by it. It is being used following an intracapsular cataract extraction or when the lens capsule cannot support a lens. The posterior chamber lens is placed behind the iris and is supported by the posterior portion of the lens capsule that was left in place. It is not dependent on the pupil or iris for support and rarely moves out of position. It is most frequently used type of lens implant since the lens position most close approximates the natural lens and magnification is minimized.

Cataract glasses are the least desirable but are used for persons who cannot wear contact lenses. Loss of depth perception and some peripheral vision make adjustment difficult. In addition, cataract glasses tend to magnify objects, making them appear closer than they actually are. The final pair of glasses is not prescribed until vision has stabilized several months after cataract surgery.