Vision Health Part 3: Cataracts


Hi, everyone.
I’m Dr. Keller Wortham and welcome back to part three
of our four-part series on vision and things that
cause vision loss. Thank you for coming back. If you’ll remember in
part one of these series, we talked about
the components of the eye, broke them down, so
that we had kind of a basic knowledge of
what we’re discussing. In part two, we talked about
the number one cause of irreversible blindness in the world,
a diabetic retinopathy. And that takes place
in the posterior segment of the eye. Well, today we’re going to talk
about the number one cause of reversible blindness in
the world that takes place in the anterior
segment of the eye. In a case you forgot or
miss the first video, the anterior segment of
the eye is basically– I got my little photo here, the front part of the eye
that has the cornea, it has the iris, and the pupil,
and the lens. So, does anyone out there have a guess
on what the number one cause of reversal blindness is in the world? The hint being that it takes place
in the anterior portion of the eye, in those areas we just mentioned
and if you need an extra hint, it gets its name from waterfalls. Anybody got any guesses? Anybody? Yes, cataracts. Yes, today we’re talking about cataracts. A very common, common cause
of reversible blindness. And if you’re someone out there
getting up in your years, you might already be
familiar with cataracts or you might have a family member
who’s had cataracts. This affects millions of people worldwide. And, luckily, like I said,
it is preventable. So today, I figured I would go into
a little bit of what is a cataract. Why is it named that? And what can you do to diagnose it
and then to do something about it. So, first off, cataract coming
from the term waterfall. Why do we call it that? Well, it’s thought
because basically, the clouding of the lens that
is a cataract creates this kind of white hazy
filter that you have to see through. And that can often kind of feel like
looking through that white water that you might see in an active waterfall. Or actually if someone’s
really looking into the eye
and someone has a bad cataract then it can also look like a
white cloudy waterfall within their eye. So, I just touched on a little bit
but the cause of a cataract is basically a clouding of the lens. Got my little eye drawing here,
the lens is right there and that lens much
like in a camera is the device that has to
take the light coming in and shift and bend it so
that we can focus that light on the back of our
eye on the retina. Well, over time, little proteins
can build up within the lens and these little
proteins become white and cloudy, and the lens
loses its clarity. And you can imagine
just like in a camera if you’re trying to get light through
to develop film on the other side and you’ve got a very
cloudy or dirty lens, pictures not going to be as good. And that is exactly
what happens in your eye. So, there are three
common categories of cataracts. The most common is definitely
age-related cataracts. I see cataracts in my office all the time
among people who are getting into their ’60s, ’70s, and ’80s. And it’s like I said, it’s
a very common ailment and it’s one that you can do something
about which we’re going to discuss. But a second category of cataracts
are congenital or childhood cataracts and these happen for different reasons. And we’re not going to go into those as
much today because they’re not as common, but they can be due to
metabolic disorders, or issues with the pregnancy in utero. And then a third category
are acquired or secondary cataracts. And these are cataracts
that don’t just happen because of age
but because of some other issues. And this can be to another
health condition like diabetes. It can be related to medications that
a patient is taking like steroids or other meds like chemotherapy meds. They might have a secondary effect that
damages the lens or trauma, you got something
basically into the lens that damaged it. So, those are the three
main categories of cataracts but like I said from the get-go, the main cataract category
are these kind of naturally occurring cataracts that
happen in people as they age. So, other than aging, what are
the major risks of developing a cataract? Well the major risk is–
in addition to just aging is UV light. It’s thought that light coming in— we know we need UV light for our skin,
it’s unavoidable in the environment but UV light can damage
the lens over time. And we see this especially with people
who either work outside all the time or who live near the equator where UV lights are–
where UV intensity is stronger, or who live at elevation where basically
they’re getting a lot more UV light because it’s not filtered out as much
by being you know lower in the atmosphere. I think statistically
people who live in the Himalayas, like up in Nepal, and Bhutan,
and those higher areas of India, they have a much
higher incidence of cataracts. And it’s a lot less likely in those areas
that people are using UV protection to block the UV lights from
getting into their eyes. Talk a little bit more about this
in a bit. Some other risks for cataracts
include smoking, alcohol use, being overweight,
and having high blood pressure. So, if you’ve got a
combination of these factors, you’re basically aging, maybe you’ve worked outside
for a lot of your life, or you’re at high elevation,
or you’re near the equator, and maybe you’ve got some of these other
lifestyle things that aren’t helping like you smoked, or you’re overweight,
or you’ve got blood pressure issues, then you are at risk of cataracts. So, how do you know
if you’re getting a cataract? Well, cataracts can
start very, very mildly and you might not notice
any symptoms at all in the beginning. But over time,
as these proteins build up in your lens, you’re going to start to notice kind of
the effects of not enough light getting through your lens
to the back of your eye where it needs to be kind
of translated into sight. So, that can include kind of like
clouding of your vision, maybe double vision
in a particular eye, or glare especially
because if a light comes through and it hits those proteins
you might have glare during the day if the light’s very bright. You might have glare at night,
it might be a lot harder to see at night especially if there’s
you know traffic lights or headlights from
different cars because it can hit those
proteins within the lens and just cause it–
make it a lot harder to see. You can also start to have
difficulty seeing colors because it’s less light gets
to the back of the lens. We need a more intense level of light
in the back of our eye to really register vibrant colors. And another thing you can start to
become quite nearsighted. Funny enough, I have an office
manager at my practice who– now has been operated
and on for her cataracts and so she can see great. But at the time
before her operation, she would just basically
be pulling up a paper and she look way, way down like that. I’d be like at first, I was like,
“You need glasses.” She’s like,
“No I have cataracts, I’m going to get them fixed
but you know, blah, blah, blah.” So, if you have cataracts,
it can really make you quite nearsighted. So, what to do? You’re a person who thinks you might be
developing these changes in vision and thinks they might be
related to a cataract, what do you do? Well, you go to your doctor,
that’s what we’re here for. So, you go see your doctor, you can see
your family physician just like me. I can basically start to
evaluate you for cataracts. I can often tell
when someone’s developing a cataract because when you go in
for your routine exam and I check people’s eyes
for their annual exam, you basically look into
the eye with a special– funduscope, it’s called, and look back through
the lens at the retina. And if you start to see
a reduced kind of clarity through the eye, or you see reduced reflection of the light
on the back of the retina, then you know that the lens, most likely,
is the culprit and it’s clouding, and you know causing
someone’s vision to be impaired. So, if that’s the case then we can
refer you to an ophthalmologist, they’ll do a dilated eye exam they really get a good
picture of your lens, and they’ll see if the cause
of your vision changes is this clouding of your lens
called a cataract. So, what happens then? Well, I do have some good news. A couple pieces of good news actually. Number one, cataracts aren’t
really damaging to the eye so you don’t have to
do anything about them. It’s not like some of the other conditions
that we discussed. In the last video,
we discussed diabetic retinopathy which is a serious condition
that’s going to lead to blindness and is irreversible. Well, cataract,
it’s certainly going to affect your vision and that can be a problem in and of itself
but it’s not going to damage your eye. So, putting off management
of your cataracts while it might be annoying
and reduce your vision, it’s not going to
basically damage your eye or make that vision
loss irreversible. Now, that being said, cataracts can be
dangerous for you in other ways. If you can’t see very well,
you might be at a higher risk of a traffic accident
if you’re driving, or falling,
or running into things at night, if you’re losing your basically
your night vision. So, keep those things in mind. The decision on what to do
about your cataract really comes down to talking with your doctor
about how it’s affecting your lifestyle and looking at the overall
picture of your health to find out if
you’re in good shape to undergo what is the
definitive treatment for helping reverse a cataract
and that is cataract-removal surgery. So, basically surgery on the eye and now this might sound
a little scary I mean, definitely thinking of anyone
cutting into my eye sounds scary. But I have to tell you, cataract
surgery is a surgery that’s done millions of times per year
just here in the United States. I think over three million times per year and 95% of the people
who get the surgery say they see so much
better afterwards, and they have very, very
few if any complications. So, keep in mind, it’s
also done outpatient which means you go
in that morning, you have the surgery done,
you get to go home that same day. So, just to maybe allay some of
the fears I’m going to go over what happens
in a cataract surgery. So, if you’re suffering from cataracts
or know someone who is, you can discuss it with your doctor
and maybe get surgery on your eye. So, a cataract surgery involves basically
removing the affected lens and that’s done by making
a very small incision in the anterior
portion of the eye. So, if I show this again, we’re basically
talking about the cornea here, the iris and pupil, they’re going to make an incision,
in the front of the eye to get to that white area here, the lens. And once they’ve made that little incision
they’re going to use a specialized little ultrasound that’s going to
send shockwaves to the old lens that has that cloudy protein in
it to break up the lens so that then the ophthalmologist
can suck out the old debride lens. I know it sounds
really kind of intense and gruesome, but basically, it’s just kind of like
losing a tiny, tiny little shockwave and a tiny, tiny little vacuum to
get rid of an old lens and suck it out. Often times, these days they can use a
laser to help make those small incisions or even a laser to help break up the lens
and these techniques have allowed us to make much, much smaller incisions to
get that old lens out. And that can reduce the risk of
some of the issues with cataract surgery which can include infection
and retinal detachment. And those are serious consequences
but again they’re very, very infrequent and cataract surgeries usually very safe. So, after they’ve broken up your lens
and sucked it out, then the doctor is
going to put in a new synthetic lens to
replace the old one. And that basically is kind of a
new little kind of crystal lens that’s going to be inserted right behind
the iris like where your old lens was, and it’s going to serve the function
of what your old lens did. And that basically, fixes the problem. They allow you to kind of–
they sew you back up or they leave it open and it will close. They put a patch on
your eye afterwards to help protect the eye
and allow it to heal. And then your vision will
improve dramatically over the next several weeks
and usually within eight weeks’ time, your vision will be
completely healed and you’ll be ready to see and drive
and have color vivid covers colors back in all of those things. Now, cataracts tend to
develop on both sides because what’s affecting one eye is
typically affecting the other eye, whether that’s in your
environment or within your body. So, you can develop bilateral cataracts. It might not happen
exactly at the same pace but often times you might need
to have surgery on both eyes. If this is the case, your doctor
will usually almost 100% of the time operate on one eye first,
allow it to heal, and then you can go in
for surgery on the other eye. And then you’ll have brand new lenses to
replace those cloudy ones. Incidentally, when a person comes in,
I can often tell if they’ve had a cataract replacement, a lens replacement
because if I shine through their eye– the lens that is put
in the artificial lens has a different kind
of refractory pattern. It almost looks like
a little crystal spark within there, just a little bit of trivia for you. So, anyway, so that
is cataract surgery and it is really the real
and only way to help you get rid of a cataract once you have it. But as I always bring up here, my main focus is on preventing
things before they happen. So, what are the best steps
you can do to prevent cataracts, to prevent this number one
worldwide cause of reversible blindness? Well, the first thing I already alluded to
but it is, wear UV eye protection. It’s so important to wear sunglasses
especially if you’re working outside, if you’re especially near the equator
or at elevation that’s going to block the UV light coming into your eyes. Make sure you get lenses
that are UV protective and that is basically
going to reduce that primary risk factor for most cataracts. Some other things that you can do
are just improving your lifestyle. You can basically exercise more
which can improve health and reduce inflammation. You can eat a diet
that’s high in fruits and vegetables and antioxidants which
are very important and helping reduce some
of the things that cause cataracts. If you’re like many of us
and you don’t get enough fruits and vegetables and antioxidants,
by all means think of a multivitamin. Smarter Nutrition has a great food-based
and mineral-based multivitamin that’s great for you. So, that’s something you could add to
your regimen if you don’t think that you’re getting enough from eating
your servings of fruits and vegetables. And then some other things that
you should really watch out to help reduce your risk, avoid smoking. Smoking definitely
increases your risk for cataracts, control blood pressure,
control blood sugar as well and basically, I think
those are the main things. Basically, kind of handle those
other conditions in your life that might be leading
to cataracts. Wear sunglasses to protect
you against the UV light and you will be in good shape. So, I think that’s a pretty good
summary of cataracts. I hope this was helpful. If you’re out there, you’re starting
to notice vision changes as you age, and you’re thinking you
might have a cataract don’t worry about it, go talk
to your doctor like I said it sounds like it’s a scary
and involved process but a cataract surgery among all
the surgeries that exist out there, it does have risks but it’s
really a very ,very safe and well-tolerated surgery. So, talk to your doctor,
get screened, take the steps you can to
prevent it from happening, and hopefully cataracts
will not be an issue for you. Again, I’m Dr. Keller Wortham,
thank you for hanging out. We’ve got one more video in our series
on sight and causes of vision loss. This is a very important
one often called– a disease called
the silent thief of sight. It may be happening to you, destroying your vision
without you even knowing it so come back for part four
and we’ll discuss it. All right, Dr. Keller Wortham,
thanks for hanging out, see you next time.

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