Springtime brings its fabulously bright, crisp flora to the area, making up for winter’s dearth of color. But for people suffering from cataracts, the foliage isn’t so much sunny as it is blurry. What can be done to restore or prevent the loss of vision resulting from cataracts? We asked local experts about the latest advances in cataract treatment.
“A cataract is a blurring of your natural lens that most commonly occurs with age,” says Dr. Sean Breit of Eye Care Associates of St. Louis. “The lens is a part of the body that grows throughout life. But it’s in a confined space, so it can only grow so large before the new protein starts to compress the older protein cells in the middle of the lens. That hardening is part of the cataract,” explains Breit. “Once the lens hardens, there’s no way to soften it.”
Some studies have been carried out that suggest things people can do to delay the occurrence of cataracts. “There have been a lot of recent nutrition studies, and there’s some evidence that vitamin E, lutein and zeaxanthin may have some preventive effect on certain types of cataracts, and vitamin C might have a small effect,” Breit says.
Yet a national study of high levels of antioxidants and zinc found that they had no effect on the development or progression of cataracts. (Those vitamins are still important for the eye, however.) “Recently there has been a lot of research on a special eyedrop, called N-acetyl carnosine, that has been shown in small trials to prevent the worsening of cataracts and even in some cases to improve cataracts, but it’s not yet FDA-approved,” Breit notes.
Dr. Jay Pepose of Pepose Vision Institute says, “There are ways to try to prevent cataracts from forming early in life. If you have diabetes, have good diabetic control. Wear UV-blocking sunglasses outdoors, because UV light seems to precipitate cataracts in patients, maybe 20 percent of cataracts come from UV rays.” And Pepose mentions that some drugs can cause cataracts, including steroids such as prednisone and steroidal nasal sprays.
Correlations also have been found to exist between cataracts and smoking and drinking. “One study in 1992 showed that people who smoked a pack of cigarettes a day had twice the risk of developing cataracts as others; and there has been a study showing a slight association between cataracts and chronic drinking to excess,” Pepose says. “Also, people with autoimmune diseases like MS and lupus have a higher risk of cataracts because their tissues get inflamed.” It’s unknown, however, whether there is a genetic link in the development of cataracts.
Once someone has a cataract that interferes with activities of daily living, when vision worsens to 20/40 or 20/50, the consensus today is that it can’t be reversed, leaving surgery as the only option. Twenty years ago, that meant hospitalization and immobilization, with sandbags around the patient’s head to keep him from moving. Nowadays, surgery is just a half-hour outpatient procedure, with smaller incisions, as small as 1.8 millimeters in length.
Going in for surgery not only can correct the blurriness, it also can eliminate the patient’s need for glasses, thanks to new artificial lenses. “Before artificial lenses were available, patients would have to wear those big Coke-bottle glasses simply to focus light on the retina. Now with the advance of the artificial, implantable, intraocular lens, the lens can do that,” explains Dr. Anjali Pathak, medical director of refractive surgery at Washington University at Barnes-Jewish West County Hospital.
Three kinds of lenses are available for patients to choose from: traditional monofocal lenses, which correct for near and farsightedness; toric lenses, which also correct for astigmatism; and multifocal or accomodative lenses, which correct for presbyopia, the age, related loss of the ability to focus on a distant object and then on a near object, which usually comes on in the mid-40s. “Cataract surgery has been revolutionized by these lenses,” says Pathak. “Now it’s not just a matter of treating someone’s near or farsightedness. We can address their astigmatism and offer them a range of intermediate and near vision.”
Pathak points out that cataract surgery is the most common surgery done in the U.S. “Typically it is done under local anesthesia with mild sedation, and we can numb the eye with eyedrops. The patients tend to be very comfortable and have a quick recovery post-operatively,” Pathak says.