Cataracts don’t need to ‘ripen’ anymore

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Dr. Jeffrey S. Heier

Q. I think I may have cataracts. I heard somewhere that they need to be “ripe” before I get surgery. Is that true?

A. The lens of the eye is normally clear and has a consistency that is a bit stiffer than Jell-O.

A cataract is a clouding of the lens caused by degradation and clumping of various proteins in the tissue. When that happens, the lens also gets stiffer, and in extreme cases, a lens can get as hard as a rock.

It’s true that people used to have to wait until their cataracts hardened, or “ripened,” before they could get cataract surgery.

The operation involved removing the lens more or less intact through a fairly large incision in the eyeball. The results were better if the lens was solid, so it wouldn’t fall apart as the surgeon extracted it.

But since the early 1990s, most cataracts have been removed by breaking up the lens into small pieces and then suctioning them out.

Doing the surgery this way means that the lens doesn’t need to be hard to be removed. In fact, it’s more difficult to suction out the chunky pieces of a hardened lens.

So now cataract surgery can be based on how much the cataract is affecting a person’s vision, not on whether it is ripe.

There are other advantages to the phacoemulsification technique, as the suction procedure is called. The incision is much smaller, so stitches often are not needed and the eye heals faster.

The pocket-like lens capsule is left behind, and it helps hold in place the artificial lens that replaces the cataract. In about a third of patients, the back of the capsule clouds up, but that problem is easily treated by lasering a small hole in the capsule. The laser procedure is quick and painless.

Vision improvement for 98%

Cataract surgery isn’t risk-free. No surgery is. Infection, swelling and bleeding in various parts of the eye can occur. But in something like 98 percent of cases, the vision of people who have cataract surgery improves.

By the time we turn 60, most of us will have some clouding of the lens. A noticeable increase in the amount of glare you experience can be a sign of a cataract, as can an overall increase in blurriness, although many different kinds of eye problems can cause glare or blurriness.

There’s no objective test for when you need cataract surgery. It’s a question of how much the loss in vision is affecting you.

Can cataracts be prevented? Ultraviolet light is hard on the eyes, so wearing sunglasses may help some, but the data on that are pretty inconclusive.

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