A round the world, cataract is the leading cause of blindness, according to the Geneva-based World Health Organization. An estimated 42 million people are affected by severe loss of vision, and cataract causes 17 million of these losses. In the Philippines, 400,000 Filipinos get blind because of cataract.
Cloudy or blurry vision is the first symptom. The person will also have some problems with light, including headlights that seem too bright at night; glare from lamps or very bright sunlight; or a halo around lights. At night, poor vision is more likely. As cataract becomes worse, double or multiple visions may be experienced. To keep up, the person has to keep on changing the eyeglasses.
Cataract—whose global cost of blindness is approximately $25 billion annually in lost productivity—may also cause change in color vision. “Vision can be yellow-tinged,” informed Dr. Victor L. Caparas, founding partner of the Associated Eye Specialists.
Medical experts say that cataract, once it begins to develop, passes through three stages. The first stage shows small opacities that may pass undetected for many months or years. “There is no need for immediate consultation unless the visual loss is acute, severe or associated with other symptoms, such as pain,” said Dr. Tien Yin Wong, of the Department of Ophthalmology at the National University of Singapore.
The second stage enters when vision starts to decrease, and the individual may complain of fogginess and haloes around lights. “I cannot see clearly,” said Mariano, who has a cataract in both of his eyes. His grandson has to lead him around; otherwise, he wouldn’t be able to go anywhere.
It is during this stage that removal of the “milky substance” that fastens itself to the eye lens is most often recommended. If the removal is delayed until the final stage, the lens contents may become liquefied, vision entirely obscured, and the success of any subsequent operation is jeopardized.
“When a cataract happens, the amount of light that can enter the eye is reduced and the patient complains of blurring of vision especially in bright sunlight when the pupil gets constricted and also glare at night when driving,” said Dr. Manuel Agulto, chairman of the Department of Ophthalmology at the University of the Philippines College of Medicine. “These complaints are progressive, and by the time the cataract has become matured [noticeable by its white color] the patient is already blind.”
Medical scientists claim cataracts are most common among the elderly (called senile cataract). “The older a person is, the more likely he or she has cataract,” explained Tien.
Generally, senile cataract occurs in people over 50 years of age and generally involves both eyes. In the Philippines, about 80 percent of the 400,000 people who are blind due to cataract are age-related.
Generally, adults are its most common victims. My father is one example. When he was still in his 40s, he never had any vision problem. But as he grew older, he noticed that he had trouble seeing things. Finally, when he was in his 50s, he started complaining about having some clouds in his eyes. When he finally couldn’t stand it, he asked my mother to accompany him to an ophthalmologist based in Digos City. “Your husband,” the doctor told my mother, “has a cataract.”
Among younger generations, cataract may occur with those with diabetes. Studies have shown that cataracts associated with diabetes can be more rapid to develop and can have more severe glare symptoms. Such was the case of 38-year-old Nelly. The mother of two kept nursing two 25-cent-size brownish-black sores on her left thigh. The sores refused to heal or banish, despite applications of ointments, crushed herbs, and other medications for skin diseases. She didn’t bother to tell her husband; she also didn’t see a doctor.
Later on, Nelly found herself always drowsy and feeling hungry even between meals. Her eyesight was also turning blurry. Finally, she consulted a town doctor. “The reason why you have an off-and-on vision lately is due to the high levels of blood sugar in your body,” the attending doctor told her. “You have diabetes.”
“Persons with diabetes are at higher risk of developing cataract, and also develop cataract at any earlier age than similar people without diabetes,” Tien said. “Diabetes is associated with development of early cataract because of biochemical changes to the lens caused by the abnormal level of blood glucose,” added Caparas. “It does not cause cataract per se, and its effect is not fully determined.”
It has long been known that smoking can be irritating to the eyes of smokers and non-smokers alike. The 1972 landmark Surgeon General’s report in the United States indicated that 70 percent of those people queried concerning their antismoking complaints listed ordinary eye redness and the tear inducing menace of smoke as two of the most aggravating factors.
But there’s more to smoke than just eye irritation. In India, a study conducted by the Center for Cellular and Molecular Biology (CCMB) at Hyderabad showed that inhalation of the smoke coming from cigarettes and cooking fuels (wood, charcoal and dung) can accelerate cataract formation.
“We were initially uncertain whether smoke acted by penetrating the lens or after inhalation and absorption by body fluids,” reported Dr. D Balasubramanium, CCMB director. “But now we are fairly certain the latter is true.”
He explains that the eye lens, made up of proteins known as crystalline, is well protected from outside influences by the cornea, the circular window in front of the eyes and the lens capsule that holds the lens in place.
“When cigarette or fuelwood smoke is inhaled, the aromatic hydrocarbon compounds in it get metabolized and release oxidizing agents, which are activated by light and cause the crystalline to precipitate,” the CCMB study pointed out. In another study conducted at the Johns Hopkins University in Baltimore, researchers report that cigarette smokers are more likely than nonsmokers to develop cataract.
Strong sunlight is also suspected to cause cataract. Dr. Eric Domingo, a Filipino ophthalmologist, said chronic exposure of the eyes to the sun’s ultraviolet rays is one of the risk factors for developing cataract.
As such, avoiding excessive sunlight by wearing hats and sunglasses may protect you from having a cataract. “The most credible evidence shows that the best way to prevent cataracts is to protect your eyes from the sun’s ultraviolet rays,” Caparas said. So, don’t forget to bring your sunglasses or hat when you’re outdoors.
The depletion of the ozone layer also plays a big role. A report from the United Nations Environment Program says a 10-percent ozone decrease will bring up to 1.75 million cases of cataracts every year throughout the world.
Other causes of cataracts, although inconclusive yet, include too much exposure to x-rays (such as high-dose of radiotherapy to the eye), inflammatory eye disorders, and certain drugs (such as steroids). While it oftentimes strikes older people, babies can also be born with cataracts (called congenital cataracts), especially if during their conception they are affected by viral diseases like German measles or rubella.
In some instances, cataract may be hereditary in nature, particularly those children born with the defect. “If a person’s parents had cataract, he or she is more likely to develop the problem than is a person who has no history of the disease in his or her family,” Tien said.
“There are various procedures that can be done to remove cataracts and prevent blindness,” pointed out Dr. Carmen Abesamis-Dichoso of the Optometric Association of the Philippines. She encouraged people who have started to notice changes in their vision to see an ophthalmologist or eye doctor as soon as possible so that cataract can be detected at its earliest stage.
The only solution to the problem is surgery. “When a cataract becomes severe enough to interfere with a person’s job or normal activity, surgery is the only effective treatment for cataract,” Agulto said.
There are two basic types of cataract surgery: extracapsular cataract extraction (ECCE), and phacoemulsification (phaco). In ECCE, the doctor makes a slightly longer incision on the side of the cornea and removes the hard center of the lens. The remainder of the lens is then removed by suction. The removed lens is replaced by an intraocular lens (IOL), a clear, artificial lens that requires no care and becomes a permanent part of a person’s eye. For people with some problems during surgery or may have another eye disease, a soft contact lens is resorted to.
Phaco is even much better than ECCE. Here, the doctor makes a small incision on the side of the cornea. Then, the doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the cloudy center of the lens so it can be removed by suction. “Most cataract surgery today is done by phaco, which is also called small incision cataract surgery,” Tien said.
According to Caparas, cataract is one of the safest surgical procedures known to man. But still there are some risks of complications (less than 1 percent) like glaucoma, infection, severe inflammation and hemorrhage. “But these are quite uncommon,” assures Caparas.