The Eye Practice

Cataracts are quite common but...

Did you know that at least 50 million people around the world lose vision as a result of cataracts, annually?

If cataracts are detected early they can be treated and vision restored. Left undetected, would mean permanent vision loss.

So, what are cataracts? Basically, when a cataract develops, there is a loss of transparency on the lens of the eye. It is like a clouding effect on the lens of the eye. This limits the amount of light that can pass through the lens to the retina. Over time, as cataracts progress, less light can pass through the lens and you slowly yet painlessly lose vision. This can often occur as a natural result of aging, but all too often it is found in younger people.

Why?

One risk factor is smoking! Compared to non smokers, smokers of 20 cigarettes or more per day are twice as likely to develop cataracts. The more cigarettes smoked per day, the higher the risk.

Studies show that cigarettes contribute to the formation of cataracts in two ways.

1. Free radicals found in tobacco smoke attack the eye directly, potentially damaging lens proteins and the fiber cell membrane in the lens.*

2. Smoking reduces the body's level of antioxidants and certain enzymes which may help remove damaging protein from the lens.**

Smoking has been associated with a myriad of negative ocular health effects including Age Related Macular Degeneration and Dry Eyes.

As eye care professionals we strongly recommend that smokers seek help to stop smoking. Health campaigns have certainly improved public awareness on the connection between tobacco and visual impairment, so if you are a smoker and  concerned about your ocular health, come in and see one of our highly trained optometrists for a comprehensive eye health evaluation.

*McCarty CA, Nanjan MB, Taylor HR. Attributable risk estimates for cataract to prioritize medical and public health action. Invest Ophthalmol Vis Sci 2000;41:3720–25.

**Shalini VK, Luthra M, Srinivas L et al. Oxidative damage to the eye lens caused by cigarette smoke and fuel smoke condensates. Indian J Biochem Biophys 1994;31:261–66.

Cataracts have affected humans, maybe since the homosapien first walked the earth.  Even the ancient Egyptians, 2000 odd years BC have documented in hieroglyphics and have left surgical tools assumed designed for cataract surgery in tombs.

We now go forward some 4000 years and cataracts are still very prevalent.  In fact if you live long enough you are bound to get one.

In third world countries sadly, cataract still represents the most common cause of blindness, even though we are used to it being a relatively benign procedure to fix them here.

The biggest contributor to cataract is one's age - can't do much about that. Diabetes,long term use of steroids, trauma to the eyes, long term exposure to ultraviolet light, smoking and significant alcohol consumption are also contributors to cataract formation.

Currently other than removing the lens of the eye surgically and replacing it with an artificial one, there is no other treatment.

Wouldn't it be great if there was something that could prevent the development of cataracts.  For a while now it has been known that a protein called Calpain is implicated with cataract development.  An Adelaide based scientific company seems to have developed an eye drop that inhibits the protein.  Human studies still have some time to go but if this great technology comes to fruition the leading eye disease in the world could be a thing of the past.

Getting an eye drop to be effective in the eye and also penetrate the lens is not as easy as it sounds.  There are very complex chemistry pathways that need to be understood and overcome.  These need to be proven in animal models and then transferred safely into human use.  This is a very slow and tedious process.  One might question the need to even develop such a novel eye drop.  After all cataracts are so easy to fix with very few side effects using surgical procedures.  In fact surgical procedures have the advantage of being able to correct any vision problem the patient might have due to wearing glasses for distance vision blur.

Possibly the eye drop to inhibit Calpain and ultimately stop or slow down the development of cataracts might have little use in a society like Australia that has access to sophisticated eye care.  Third world countries though have little access to expert surgical techniques and being able to eliminate cataracts in such a society would have huge health benefits.

In the near future we might be brushing and flossing our teeth to prevent tooth decay and gum disease, while instilling eye drops in our eyes to prevent cataracts from developing later in life.  These same eye drops could be used in third world countries to dramatically reduce the incidence of cataracts, without having to train their doctors in expensive surgical techniques.

Unfortunately just like brushing ones teeth, prevention of cataracts with eye drops will depend on compliance.  Compliance with any medication at best tends to be 50% effective, even when a huge education education process is put in place.  People just forget to do it.

Then again 50 percent is better than no percent!

Cataracts some might say start from the day we are born.  If we live long enough they will eventually impede vision enough to significantly affect our vision and thus our lifestyle.

If you would like to find out more about what cataracts are CLICK HERE.

At The Eye Practice, a day does not go by that we do not have to advise a patient about cataracts. 

A very common question is: "When will I know that I need to have cataract surgery?"

Even though cataract surgery is very sophisticated and very successful, most Eye Doctors will tell you that you should wait until you are having some form of trouble.  This could be any of the following symptoms:

• Blurry Vision
• Frequent changes in spectacle prescriptions
• Ghosted vision out of one eye
• Colour perception difference between eyes
• Glare sensitivity and vision disturbance

Even though cataracts are more common as we get older, occasionally even someone in their 30's can develop cataracts to the point that surgery is required, as their vision deteriorates to a point that it affects their occupation or hobbies.

 There is no correct best time to do cataract surgery but at The Eye Practice, Dr Jim Kokkinakis tends to follow these principles:

• On average when cataract is developing, one eye is usually more  advanced than the other.
• When the more advanced eye has deteriorated to not passing a driver's license it is time to consider fixing this eye.
• This is even though with the better eye it is still possible to pass the license test.
• The logic here is that the worse eye will be rehabilitated by the time the second eye finally fails a drivers license.

Sometimes visual demand is very high and cataract surgery will be performed early.  The perfect example is a pilot.  In these circumstances a pilot might be referred for cataract surgery even though the vision is still 20/20.  This is because that glare can often cause significant vision issues and a pilot cannot take the risk.

On the other hand a person might be incapacitated and does not perceive that there vision is compromised to the point of interfering with whatever reading or TV they need to watch.  In this case it is reasonable to wait until the patient perceives a need.

Is there a time that it is too late to do cataract surgery?

Yes there is. There are a few circumstances:

• If a patient has an retina disease like Macular Degeneration or Diabetic Retinopathy (these have been described in previous posts)
• Retinal disease needs to be monitored carefully so that timely treatment can be offered.
• If the cataracts are interfering with the view of the retina, in these circumstances doing cataract surgery later can prove to be too late.
• If the cataract is allowed to progress too far, the lens in the eye tends to become hard. In these circumstances it is important to remove the cataract as if it is allowed to progress too far, it becomes very difficult to remove the lens and the procedure risks causing complications.
• In some cases as cataracts progress, the lens in the eye swells and it can raise the pressure in the eye.  In severe cases this can even block the drainage system totally and cause angle closure glaucoma, which is a medical emergency.

In most cases cataract monitoring and referral is quite simple.  It is important though that careful monitoring still occurs as concurrent eye disease needs to be looked for. Dr Jim Kokkinakis follows all cataracts closely and makes timely referrals to expert and experienced cataract surgeons.

Once the procedure has been performed he will do the after care and prescribe new glasses as required.  Remember everyone will develop cataract at some point, so start getting your eyes checked for cataracts from now.  Call 9290 1899 or make an appointment ONLINE now.

Cataracts  will affect everyone at some point in their life.  The older one is, the more likely you will develop them. The eye has a lens in it, which when we are born is perfectly clear, through which images are focused on the back of our eye called the retina.  As we age the lens tends to lose its transparency and as this occurs our vision slowly becomes blurry.  At some point changing glasses no longer helps the vision.

We have previously described what causes cataracts but if you want to find out what they are in detail go to our cataract page for a more in depth explanation:  CLICK HERE.

Once you know what cataract is, the next common question we get is how will know if I have it in one eye or both?

Common symptoms of cataract include:
•    progressive blurring of vision
•    blurry vision may be likened to looking through a dirty window
•    light sensitivity or glare
•    frequent spectacle prescription changes
•    double vision in one eye (known as ‘monocular’ double vision)
•    poor night vision that may be noticed when driving
•    halos around lights
•    the need for brighter light to read
•    reduced contrast or yellowing of colours

Cataracts usually develop slowly and at a different rate in each eye, therefore you may notice that the vision in one of your eyes is more blurry than the other with cataract.

If you are experiencing any symptoms of cataract call us at The Eye Practice on 92901899 for an eye exam or book online by CLICKING HERE. 

Dr Jim Kokkinakis will assess what stage the cataract is at. Just as importantly it is imperative to check the rest of the eyes to make sure there is no other eye disease that is developing concurrently.  There is no urgency in treating cataract but if the blurry vision is caused for example by macular degeneration or glaucoma, it is critical to not only get an accurate diagnosis, but also have these diseases treated immediately!

Often your spectacle prescription needs altering but once a cataract reaches a certain level (typically not passing a drivers license test) he will recommend surgical intervention by a cataract specialist.

What is amazing is that once a cataract has progressed to the surgery stage and the procedure is performed, the patient is delighted with the visual result.  Remember cataract surgery is one of the most common procedures performed on the human body and it is reassuring to know that the success rate is superior to nearly all other procedures.  It truly is a modern day wonder.

Cataracts have many causes.  It has always been an issue throughout history.  In a later post we will go through the history of cataract surgery - it is fascinating.

The most common causes of cataract are:

• Age
• Trauma/injury to the eye
• Congenital cataracts that develop in infants
• Developmental cataracts that occur in children
• Other eye diseases or eye surgery
• Diabetes and diabetic related eye disease
• Medications such as steroids
• Prolonged exposure to ultraviolet light
• Smoking or previous smoking

Age is the predominant risk factor for cataracts.  At The Eye Practice we are advising about cataracts every day of the week, as ultimately everyone will develop one.  That's as long as you live long enough.  So here is the moral to the story; make sure you develop cataract otherwise you have not lived long enough!

These days the technology to operate on cataracts and rehabilitate vision is so advanced that it is probably one of the most successful procedures done on the human body.