Cataracts and Clear Vision for Longer Life
Today’s seniors are living healthier, longer lives than ever before, but there’s one condition nearly all of us will develop as we age: cataracts. Roughly 9 in 10 people have at least one cataract by the time they turn 65, according to the Kellogg Eye Center at the University of Michigan, and half of people age 75-85 have cataract-related vision loss.
The good news is that new thinking about when to remove cataracts and new technology have made restoring clear vision safe and simple for most patients. The even better news is that cataract removal seems to be related to a dramatic reduction in premature death, according to an analysis of a very large, long-term health study. What does that mean for seniors with cataracts?
It may be better to have cloudy lenses replaced sooner rather than later.
Cataracts in Seniors
Cataracts are cloudy layers of broken-down proteins in the lens of the eye. Because of their location, cataracts that grow large enough can cause problems driving at night due to glare and halos around oncoming lights, seeing colors clearly and seeing well in low light.
The most common reason cataracts happen is the combination of time and UV exposure from the sun. Age-related cataracts can develop as early as your 40s or 50s, although you may not realize it until your eye doctor diagnoses them.
Birth defects, eye injuries and other medical conditions like diabetes can also lead to cataracts.
Treatment Options for Cataracts
Researchers have been trying to develop eye drops that will dissolve or shrink cataracts, but that work is in its early stages and won’t be ready for human use for years. As of now, surgery is the only way to eliminate cataracts, but not all cataracts need to be removed right away. If your parents’ cataracts aren’t severe enough to impair their vision, they can manage them by protecting their eyes from the sun and wearing glasses if they need them. You parents and their eye doctor will decide if and when it’s time to have cataracts removed.
A generation ago, the standard recommendation was to let cataracts “ripen” before surgery, which meant letting the cataract get very large and opaque, impairing vision in the meantime. But people with cataracts no longer have to wait until they can’t see properly, and in fact, it may be better if they don’t. Douglas Melzer, OD, a member of the American Optometric Association’s Content Review Board, answered our questions about cataracts via email.
“Rarely anymore does anyone reference a need for a ‘ripening’ of the lens, as that was most often regarding a much earlier surgery where the entire lens was removed,” Melzer wrote. “More modern procedures of the last 20 to 30 years involve a process that retains a large amount of the lens capsule and removes the clouded internal part of the lens only. As such there is actually some benefit if the lens is not fully hardened.”
So if your parents (or you) don’t need to wait to have cataracts taken out and if most of us will have at least one cataract by age 65, what’s the best time to have surgery? It varies by person, but in general, it’s time when cataracts are keeping your folks from living their normal lives.
“Often the need for surgery is based on adverse visual impact and what I describe to my patients as adverse effect on their quality of life,” Melzer wrote. “When the impact is enough to reduce [the] best-corrected vision to 20/40 in normal or glare-induced situations like night-time driving and it has made it difficult for patients to do the things they need (or want) to do, then consultation is indicated.”
Besides letting your folks keep doing the things they want and need to do, a new analysis drawn from a 20-year study shows that cataract removal may reduce the risk of early death. Researchers looked at data on more than 74,000 women who were part of the massive Women’s Health Initiative and found that those who had cataract surgery were a surprising 60% less likely to die prematurely than women who didn’t have the surgery.
The Benefits and Risks of Cataract Surgery
Dr. Anne Coleman, the senior author of the UCLA study based on the Women’s Health Initiative, told Reuters there could have been other factors that affected the overall death rate of the women who didn’t have cataract surgery. But she also pointed out that vision problems can affect quality of life in all kinds of ways, like “daily activities such as exercising, taking medicine and going to doctor appointments, all of which may be related to overall lifespan.” Although the study only included women, other research has shown improved longevity for men who have cataract surgery, too. Coleman told Reuters that the big takeaways from the study are that older women should have access to cataract surgery when they need it, and that all older adults should have regular eye exams.
In addition to clearer vision that leads to more mobility and better overall health, cataract surgery can have some unexpected benefits. Most people experience a dulling of their color vision over the years as the lens of the eye becomes clouded due to sun exposure and the passage of time. With a new, clear lens implant, you may find that colors seem brighter. Your eyes may look shinier to other people, too.
That’s not to say that cataract surgery is free of risks, but Dr.Melzer of the American Optometric Association said those risks should be weighed against the downsides of living with cataracts. “Obviously there are no surgical procedures that are 100% safe, but the decreased vision and personal safety associated with advancing cataracts are also a risk,” Melzer wrote. “A small percentage of patients are at risk for postoperative macular edema,” swelling in the center of the retina that can impair vision. Patients who have a cataract in their only functional eye should consider the potential for complications carefully, Melzer wrote, “although most of mine do pursue cataract surgery when the adverse impact of the clouding is particularly problematic.”
If your parent has other eye problems in addition to cataracts, they will need to talk with their doctor about how much improvement they can realistically expect from cataract surgery. “Those with some eye disease, such as age-related macular degeneration, may have reduced vision from multiple causes,” Melzer wrote, “and will need to weigh the advantages with the potential for less-than-expected improvement” if other eye problems are the major cause of their vision loss.
Other potential complications of cataract surgery, according to the American Academy of Ophthalmology, include:
- Bleeding inside the eye
- Detached retina
- Eye swelling
- Ongoing pain
- Posterior capsular opacification (PCO): A clouding of the membrane that holds the new lens implant in place
Ultimately, your parents and their eye doctor will need to talk about the particular risks cataract surgery might hold for them, based on their own health, and the potential benefits to their daily lives and overall health.
Safety Tips for People With Cataracts
Once your parents have been diagnosed with cataracts, there are some steps they can take to improve their safety, whether their cataracts are mild or severe enough to need surgery. The AOA recommends that people who have cataracts:
- Add anti-glare coatings to eyeglasses for safer driving, especially at night.
- Get their corrective glasses and contacts updated whenever their prescription changes.
- Have regular eye exams.
- Use brighter lights for reading.
Your parents may also need brighter overhead lights in their home, especially in bathrooms, the kitchen and stairwells, to reduce their risk of falls. If brighter reading lights don’t give your parents enough of an assist on their own, the Mayo Clinic recommends using a magnifier for reading printed material. You can also help your parents enlarge the fonts on their computer and smartphone screens; look in the Accessibility settings under “Vision.”
One standard safety tip for older adults is even more important for seniors with cataracts: Keep the floors of their home free of electrical cords, piles of books, throw rugs and similar items. “The reduced vision from the cataract can make seeing some potential trip hazards difficult,” Melzer wrote. You and your parents can use this fall safety checklist to make sure they’re able to get around the house safely.
Finally, if cataracts are affecting your parents’ night vision, they need to reduce or stop driving after dark until their cataracts are removed. The combination of blurred vision and glare or halos around oncoming vehicle lights can make night driving too risky.
What to Ask Your Doctor
The thought of surgery on the eye makes some people anxious, but “cataract surgery is a very common procedure. There is little or no discomfort,” Melzer wrote. According to the AOA, “approximately 90% of cataract surgery patients report better vision following the surgery.”
If your parents will let you attend a pre-surgery appointment with them, take notes on the pre and post-surgery instructions their doctor gives so you can help your folks have the best possible experience.
Among the questions you or your parents may want to ask are:
- Are there any medications they need to start taking before surgery, and if so, how long should they continue them after the procedure?
- How long should you expect the recovery to take?
- Once your parent is healed from the surgery, will they need new contacts or glasses?
- Should your parent stop taking any medications before the surgery? If so, when should they resume taking them?
- What are normal signs of recovery?
- What are signs that your mom or dad should call the doctor or go to the ER?
- When can your parent resume normal activity?
There’s one other thing you might want to ask about, and that’s the fact that older adults’ fall risk may not decline much after cataract surgery, especially if they are prescribed bifocal or progressive glasses after they recover. Your parents may be better off with two different pairs of glasses, one for reading and one for distance vision, according to researchers. They should also still keep their floors and yard at home clear of tripping hazards, no matter how clear their post-surgical vision.
Ways to Delay the Onset of Cataracts
Because environment and lifestyle choices can contribute to cataracts, health experts say you may be able to delay the onset of cataracts or slow their development by taking a few precautions that will help your overall health, too.
- Eat an antioxidant-rich diet that includes fruit and leafy greens.
- Follow your eye doctor’s recommendations for follow-up exams and prescription eyewear.
- Get a full eye exam (including dilation of the eyes) at least every two years once you reach age 60.
- If you have diabetes, follow your doctor’s recommendations for diet and medication consistently.
- If you smoke, quit.
- Protect your eyes from UV rays with sunglasses and a wide-brimmed hat when you’re outside in the sun.
- Reduce your alcohol intake.
Cataract surgery may help your parents live longer, and it will very likely improve their quality of life. The first step in protecting their vision and wellbeing is setting up a complete eye exam to see if they have cataracts and, if so, what needs to be done next, whether that’s new glasses and better lighting or surgery.
You can use the American Optometric Association’s “Find a Doctor” tool to locate optometrists near you and your parents.