October 12, 2015

New treatments for cataracts

By Anna Sharratt

For a lot of patients suffering with impaired vision due to cataracts, new treatment options can be a real life-changer.

First diagnosed with cataracts when she was 45, June Campbell had 20 years to think about how to deal with her degenerative eye condition. Then one day, the North Vancouver resident realized she needed to take action: “Suddenly you realize that you can’t thread a needle.”

Campbell, now 70, realized that the film developing over the lenses in her eyes was causing other symptoms as well. “Car headlight reflections in rain would just about blind me,” she said.

Campbell consulted her ophthalmologist, who recommended phacoemulsification, a procedure that breaks up the cataract with ultrasound waves. The lens of the eye is then replaced with a synthetic one, restoring the patient’s sight. Campbell had some pain and trouble seeing in one eye immediately following the procedure, but now her vision is back to normal. She can thread needles again and car light reflections don’t blind her as they did pre-surgery. “My eyes are considerably better than they were before,” she says.

“We’re seeing cataract patients at younger ages.”

Cataracts are common: More than 2.5 million Canadians have them, according to the Canadian National Institute for the Blind (CNIB).  “We have seen over the last decade more patients going for cataract surgeries,” says Dr. Ike Ahmed, Chief of Ophthalmology at the Trillium Health Partners hospitals and an eye surgeon at Credit Valley Eye Care in Mississauga, Ont. “We’re also seeing cataract patients at younger ages.”

What are cataracts?

Usually developing gradually, cataracts become increasingly visible as a painless film forms within the lens of the eye.  Because a cataract scatters light as it passes through the lens, it prevents a sharp image from reaching the retina, leading to blurry vision. Over time, the lens thickens and eyesight gets worse. Eventually, blindness can result.

What are the symptoms of cataracts?

Symptoms of cataracts include:

  • Blurry vision
  • Trouble seeing at night
  • Being very sensitive to light
  • Seeing halos around lights
  • Frequent changes in prescriptions for glasses and contacts
  • Seeing colours as less intense
  • Double vision in one eye

Cataracts affect people starting around age 40 and peaking at over 80. The average age for cataract surgery in Canada, according to a report by the CNIB and the Canadian Ophthalmological Society, is 74.

You’re at increased risk of a cataract if you smoke, you have diabetes or you’ve had lots of sun exposure without proper eye protection. Some babies have congenital conditions that predispose them to cataracts, or acquire them due to an illness the mother had in pregnancy. Other causes of cataracts include having had an eye injury that affects the lens, such as a chemical burn, and using certain medications such as steroid creams or drops, particularly around the eyes.

Cataract treatment options

Many cataracts are discovered during routine eye exams by an optometrist or ophthalmologist. “Cataracts are quite variable – some progress very quickly and some quite slowly,” says Ahmed. Although a mild cataract can be treated with a change in your glasses prescription, “there’s no real treatment for cataracts” that doesn’t involve surgery. Here are the options:

1. Phacoemulsification

Ahmed says he uses phacoemulsification, the industry standard, which involves replacing lenses with a polished, plastic polymer lens. “It’s a foldable lens that goes inside the middle part of the eye,” he explains.

The procedure, a day surgery in which the patient is awake but sedated, is “one of the most commonly performed surgeries in Canada and around the world,” he says. One-and-a-half million people have this procedure every year in North America, and 95% have a successful result, according to the Canadian Ophthalmological Society.

The procedure has few complications and side effects, according to Ahmed. He says patients most commonly experience dry eyes and some discomfort, which usually resolve in the month after the procedure.

If you have trouble with near- or far-sightedness as well as cataracts, multifocal lens implants, which are performed during the phacoemulsification procedure, may help. These lenses can act like permanent contact lenses. But they’re not for everyone, as they cause some patients to see halos around lights and decrease some people’s ability to perceive contrasts in colour or light.

If vision is blurred after cataract surgery because a haze has formed on the membrane behind the intra-ocular lens, a laser procedure called Yag Laser Capsulotomy can make a small opening in the capsule behind the implanted lens in the eye to allow for clearer vision.

2. Catalys precision laser system

This is a new form of cataract surgery that uses a femtosecond (one quadrillionth of a second) laser rather than a blade to make incisions in the cornea, correct nearsightedness and break up the cataract. In this procedure, the laser is guided via imaging that takes very precise pictures of the retina. The imaging allows for a customized approach to each eye being treated. If you are considering precision laser surgery, check whether it is covered under your provincial or private health plan.

3. N-acetylcarnosine eye drops

If your case is mild, you could try N-acetylcarnosine eye drops, which have been shown in some studies to slow or at least delay vision loss due to cataracts.

If you opt for surgery, Ahmed suggests you get measurements of your eyes before proceeding with the procedure, and advises that you’ll take about four to six weeks to heal after the surgery. During that time, you may experience light sensitivity, some eye soreness, a feeling of something gritty in the eye and temporarily blurred vision.

But the payoff is normal vision. “For a lot of patients, it’s a real life-changer,” Ahmed says.

To help prevent cataracts:

  • Have regular eye exams to identify problems such as cataracts early on.
  • Remember to wear your sunglasses even on cloudy days. UVA and UVB light can damage the lens of the eye and lead to cataracts, says Ahmed.
  • Quit smoking and cut back on drinking – both habits may heighten your risk.

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