Cataracts, what they are and when to operate

A cataract is the loss of transparency of the crystalline lens, which is a natural lens immediately behind the pupil. In a young, healthy person, the lens is transparent and elastic, and this transparency allows light rays to pass through it, forming images on the retina. While elasticity turns the crystalline lens into a multifocal lens, capable of focusing according to the distance of the objects we are looking at, similar to the functioning of a camera lens.

Over the years, the crystalline lens loses elasticity and presbyopia appears or what is commonly called: tired eyesight, which is corrected with close-up glasses. When what is lost is transparency -of the crystalline lens- we call it cataract and it does not allow the clear passage of light to the retina, losing vision progressively. Cataracts cannot be corrected with glasses and eye drops, which are supposed to slow down the progression, have not proven to be effective.

The only treatment for cataracts is surgery, removing the opaque lens and replacing it with an artificial lens (intraocular lens).

The symptoms

When the cataract is forming, blurred vision and sometimes double vision appear. Some cataracts cause a paradoxical situation, you can see better on cloudy days than on sunny days, or you no longer need your glasses up close. It also becomes difficult to drive at night, in most cases, and repeated changes in the prescription of your glasses are often necessary.

As the cataract progresses, vision decreases and may even lead to blindness if not treated at the right time, and may even affect the contralateral eye if the cataract ruptures, releasing its contents intrasacularly. In these cases a very serious condition known as sympathetic ophthalmia appears.

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When to operate

If the decrease in vision interferes with the patient’s normal activities, it is time to operate. Another situation in which surgery may be indicated is when the ophthalmologist appreciates an increase in intraocular pressure or other complications related to the progression of cataracts, in these cases, although the patient has a certain degree of vision that allows him to perform his usual activity, the most advisable is the removal of the cataract.

In the past, cataracts were not operated on until the patient was practically blind, but this has changed and nowadays this attitude not only does not make sense, but can also entail risks since the intervention of a very advanced cataract is, in general, more complicated, increasing the risks of the surgery.

On some occasions, we recommend lens surgery with a mainly refractive objective: in presbyopic and high myopic or hyperopic patients, lens surgery with intraocular lens implantation not only allows them to improve their vision, but at the same time, allows them to dispense with their glasses or contact lenses.