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Cataract is a condition where the natural lens in your eye becomes progressively cloudy, impacting your vision and making it difficult for you to go about performing your daily activities.
Most forms of cataract develop in adult life and cause the lens to harden and become cloudy as you age. Although most cataracts are age-related, there are other types, including congenital (present at birth), drug induced (steroids), and traumatic (injury to the eye).
Cataract is also more common in people who have certain diseases such as diabetes, which tend to occur at an earlier age than those without the disease.
While cataract cannot be prevented, it can be treated by a surgical procedure commonly known as phacoemulsification, where the cloudy cataract lens is removed and replaced with an artificial lens implant.
If the amount of cataract is little and does not disturb your vision or your daily activities (e.g. driving or reading), it can be left alone.
Eyeglasses may help at this stage to allow you to see better. If using eyeglasses does not help, and the cataract interferes with your vision, your eye doctor may suggest doing a cataract surgery.
In this 'Ask the Specialist' Q&A forum, Dr Melissa Wong, Senior Consultant from the Cataract & Comprehensive Ophthalmology Department at Singapore National Eye Centre (SNEC), a member of the SingHealth group, will answer your questions on the causes, symptoms and treatment for cataract. So don't miss this chance to get all your questions answered!
This forum is open from 15 May to 12 June 2022.
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If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
1. Will cataract return years later even when phacoemulsification has been done?
2. If eyesight deteriorates years later, can a new lens be inserted?
Thank you.
Answered by Dr Melissa Wong, Senior Consultant, Cataract & Comprehensive Ophthalmology Department, Singapore National Eye Centre (SNEC)
Thank you for your questions.
I am a 72 year with a history of Retina Detachment on my left eye. I was told by an eye doctor that I have cataract in my right eye. Is it safe to remove the cataract at my age. I have high blood pressure and high cholesterol but under control through medication. Thank you.
Thank you for your question. Most people who have cataract surgery are within the 60 to 90 year old age group. If your medical conditions are well controlled, they should not be a major concern. However, success of a cataract operation depends on other factors as well, and there will always be potential (but low rate of) complications in any operation.
Two months ago I had a surgery close up a macular hole and a rectinal tear on my left eye. Doctor also says I have some cateract as well on my right eye and recommended sugery. But I can see well with my right eye and dont see any urgency to do anything for now. My question is generally how long does it take for a cateract to get really bad before a surgery is absolutely necessary? I am age 63 and used to have perfect eye sight.
Thank you for your question. If you can cope well with your current vision, there is no urgency for operation unless the cataract is causing other eye problems such as high eye pressure. Most cataracts take years to become significant. However in certain types of cataracts as well as in certain people eg diabetics or patients on steroid medications, cataracts can develop more quickly.
Is there such a thing as too early to do a cataract surgery? I heard from a friend who did it, she now sees both far and near clearly!! So can I do it if I'm 55 years old but no 'serious' cataract yet? How long does the new lens last? A lifetime?
Thank you for your question. The timing of cataract surgery has to be balanced by a risk benefit ratio. Everyone above 50 years old will start to have some cataract developing but most people will be unaware of it as their vision is still good.
Since you do not have significant cataract yet, it is very reasonable to hold off surgery.
An intraocular lens usually "lasts a lifetime", but in rare occasions, you can have lens dislocation or opacification of the lens, requiring a lens exchange.
Following cataract removal, can the condition recur later in life? If the answer is yes, can a second cataract removal surgery be done? Will I have near perfect eyesight following cataract removal?
Thank you for your question. Cataracts once removed, will not recur. However there is a condition called posterior capsule opacification that can occur post cataract surgery. This condition can cause blurring of vision, somewhat like what a cataract does. Hence giving some people the wrong impression that their cataract has recurred.
Perfect eyesight following cataract removal depends as well on other eye conditions that you may have, eg glaucoma, age-related macular degeneration, retinal problems etc. If you have no other associated eye problems, and the cataract surgery went smoothly, you should be able to see well.
Near perfect eye sight can be achieved with reading glasses if you implant a monofocal lens. If you implant a multifocal lens, it can reduce your spectacle dependence on near, but some patients still rely on reading glasses when light conditions are dim or when the font size is small.
The choice of lens is best discussed with your ophthalmologist.
What is the difference between cataracts and pterygium? Is the treatment the same for both? Which specialist should I see if I have pterygium?
Thank you for your question.
Cataract comes about from the aging of our natural lens. Pterygium is a fleshy growth on the cornea. The treatment is different in both situations.
If your pterygium is uncomplicated, you can see a general Ophthalmologist. In certain situations when you have had recurrent pterygium from previous pterygium surgery, or a very large pterygium, we may refer you to the cornea team.
Hi Dr Melissa Wong,
I am wearing glasses and have both myopia & hypermetropia.
Recently, I have experienced slight blurr vision during night driving.
I am not sure if it is due to the potential cataract problem or my current astigmatism detoriation.
Please advise. Thanks.
Thank you for your question. You likely have myopia and presbyopia (lao hua). Hypermetropia is long sightedness, so it is unlikely to be both long and short sighted (myopic) at the same time.
It is difficult to ascertain if you have cataract or astigmatism that is causing your symptoms as both, as you rightly mentioned, can cause blurring of vision. May I suggest you make an appointment to see an Ophthalmologist?
Hi, my mother-in-law is 86 yo and she's afraid to go through the cataract surgery. Her friend told her that cataract can be "washed away" ... is there such treatment?
Dear Yen Ping, Thank you for your question.
Cataract surgery is relatively painless, and as the surgery is performed under local sedation, the patients are usually awake during the surgery. We use irrigation as well as aspiration to remove the fragments of the cataract. Hence throughout the surgery patients may feel the water from the irrigation and have the impression that the cataract is being "washed away". In actual fact, we use ultrasound energy to break up the cataract into pieces first and then aspirate them away.
My mother is required to go for cataract surgery. She has Parkinson's disease and has tremors in her lower jaw sometimes. Is it safe for her to go for the surgery? Would GA be able to stop her tremors should they happen? Thank you.
Thank you for your question. We have performed many cataract surgeries on patients with Parkinson’s disease. It would be advisable to optimize her medications first.
GA is usually not advisable as there are higher risks associated with GA.
Hi Dr, drug induced cataract anything we can do to slow down the progression besides tapering the dosage of drug?
Dear Chwan meei, Thank you for your question. Often, tapering the drug or stopping it can retard the progression. However, if you are above 50 years old, you may have age-related cataract forming as well.
I had sort of a sudden increased in my shortsighted degree - from sub 100 to 500+.
The specialist said I had cataract. Is this possible as my believe and understanding had all along been the vision will be blurred rather than having shortsightness and can be corrected with glasses.
Dear Lester,
Thank you for the question. Cataract itself can cause a jump in your myopia. Your vision need not be blur if it can be corrected with glasses. As the cataract progresses, blur vision may set in even with glasses.
I was diganosed with cataract recently. As I have a very high degree of astigmatism, my specialist recommended that implanting monofocal is more suitable than multifocal as there is less complexity. Also, for monofocal lens, is it recommended to correct for distance vison than near?
Usually if the patient has any ocular problems, we do not implant multifocal lenses. Your high degree of astigmatism may be due to an eye problem perhaps, hence your doctor did not recommend multifocal lenses. For monofocal lens, you can choose to either correct for distance or near, depending on your lifestyle requirements.
1. Will the artificial lens easily shift position if I rub my eye after cataract surgery?
2. If both byes need cataract surgery, is it better to have both eyes use the same degree of long distance artificial lens or one eye for long distance and the other one for short distance?
3. Is it necessary to wear sunglass for life after cataract surgery?
4. What are the major causes of the lens fragment be left behind in cataract surgery? Is it rare in happening?
Dear ELAM, Thank you for your question.
1. No, it should not change position after two weeks and with gentle occasional rubbing. However it may dislocate if you constantly rub your eyes a lot or encounter severe trauma to your eye.
2. This will depend on your visual requirements and occupation. Most people choose to correct for distance in both eyes. However some do choose monovision (one eye for distance, one eye for near), still.
3. No it is not necessary.
4. The main technique used to remove Cataract is phacoemulsification which uses ultrasound energy to break down the cataract into tiny pieces to be aspirated. However these tiny pieces can sometimes hide under the iris or parts of the eye during the entire operation. Some people with small pupils, high myopia may be at risk. It is not that uncommon, but can usually be easily dealt with by a shorter duration operation to aspirate the tiny fragment.
I'm only 45 but I have some cataract in my right eye and it does affect my vision. Currently relying more on my left eye vision. If I choose to do surgery now, is there a chance that the cataract will recur? And if it does, will another cataract procedure be possible? will it affect my eye in the long term?
Cataract will not recur, but a condition called posterior capsule opacification (PCO) can occur in 20 percent of the patients within 3 years. If you have significant PCO, we can do a YAG laser to improve your vision.
Dear Dr, when is the right time to go for opeation?
The right time varies between individuals. Your vision should be significantly affecting your lifestyle, quality of life and work before you consider surgery. You should also have exhausted wearing glasses as an option first before thinking of surgery.
We generally do not recommend surgery if you have mild cataracts.
Question posted by FelixDear Dr Wong, would appreciate if you could address my questions below:
Medical problem:
Tearing in the eyes regularly. Prescribed eye drop but did not improve my problem. Tends to have "misty" vision. With bright lighting vision is acceptable. When lighting is low/dim, hard to visualise wording like road signs even within 5-10m away.
In 2013, I was diagnosed with Cataract onset in my right eye. In a 2021 yearly review, the Medical Officer informed me my cataract had become "smaller" and do not need surgery.
I was then referred to see a Retina Specialist which later proof to be not the cause of my eyes problem in 2021 but was ask to replace my spectacles which I did in March 2021: R-14.25, Cyl-0.50, Axis 155, Progressive 125 and L-14.00, Cyl-1.75, Axis 145, Progressive 125.
Recently I again encounter "misty" vision, had apply "Refresh eye drops" but it does not help for night vision.
Questions:
Dear Felix, thank you for your question.
Question posted by shirleyHi doctor,
I have cataract for years. I consulted the ophthalmologist at SGH for many years. They discharged me but I still have my cataract. The question: Is there any risk of going blind or being unoperable with time? Thank you for your answer.
Dear Shirley,
Thank you for the question. Everyone above 50 years old may have a little cataract. If your vision is good, you do not need to have regular follow up as cataracts usually progress quite slowly. We usually advise glasses to cope with the poorer vision in the early stages of cataract. If you find that glasses do not improve your vision, please seek advice from an Ophthalmologist. If you are vigilant about your vision, you will unlikely reach a stage that the cataract develops until it is very dense. Cataract itself should not cause blindness unless there are complications associated with a very dense cataract, which can cause poor vision.
Question posted by MatthewHello,
I have been diagnosed with the cataracts due to my age (mid 50s) a few years ago. However the eye doctor discharged me saying it is slow growing and said I need only go back the hospital if it gets worse.
Currently my left eye has some cloudiness around the periphery but doesn’t interfere with my daily work when I read or use the computer nor if I drive.
Are there specific symptoms that might require me to see a doctor again? How might I know when a certain "threshold" is crossed that requires medical attention? Should I also do an eye check annually? Thank you.
Dear Matthew, Thank you for your question. Your doctor is correct. If you can cope with your vision, annual check-up is not necessary as cataracts are usually slow growing.
If you experience blurring of vision that affects your daily work; if you have any family member with a history of eye problems or are concerned about new issues with your eye, please see an eye doctor again.
Question posted by CalvinHi Dr Melissa, I have blurred vision on left eye and I suspect it is cataract.
Hi Calvin, Thank you for the question.
Question posted by tikenlimHi Dr,
