Understanding
Eye Health

Overview

Cataracts is a clouding of the lens of the eye, resulting in a gradual loss of vision. The lens is the structure just right behind the iris (the colored part of the eye). Most cataract types are related to aging — by age 80 more than half of Americans either have a cataract or have had cataract surgery. Two other common non-age related types include traumatic cataracts and those related to long-term corticosteroid use (like prednisone and cortisone).

How Cataracts Develop

In the healthy state, the transparent lens allows the passage of light through to the retina. When a cataract forms, the cloudy lens does not allow as much light through and vision becomes dull or blurry, and colors lose their brightness. Lights at night may have halos around them.

The lens is made mostly of water and protein. As we age, the proteins clump together creating a loss of transparency. The doctor notices the color of the lens becoming a yellow-green. Generally, cataracts cannot be seen with the naked eye — external, surface ocular scars are not cataracts, though many people call them that. A slit-lamp microscope is used to determine the presence or absence of the problem.

Risk Factors

• Age (primarily)
• Certain diseases like diabetes
• Smoking and alcohol use
• Steroid use
• Prolonged exposure to UV radiation in sunlight — UV protection recommended in all eyewear including sunglasses

Treatment

In early stages, prescription changes may improve vision. Surgery is usually required as the condition escalates. Cataract surgery is the most common surgical procedure in the United States, with 90% of patients achieving better vision afterward. The procedure is performed on an outpatient basis — the cataract is removed and an artificial lens implant is inserted.

Post-Operative Care

Eye drops are prescribed for healing and infection prevention. Heavy exercise is discouraged for several weeks following the procedure.

Advanced Techniques

Modern surgeons can calculate implant power to leave patients requiring minimal distance correction. Insurance (usually Medicare) covers a large part of the fees. Patients may pay more for a multifocal implant that provides vision at all ranges.

After-Cataract

Some patients develop clouding of the tissue surrounding the implant months or years later. This is easily fixed by a quick, painless laser procedure.

Overview

Glaucoma is a group of diseases that damage the optic nerve resulting in loss of vision or even blindness, often accompanied by an increase in intra-ocular pressure. It is the second leading cause of blindness worldwide, affecting an estimated 65 million people. Glaucoma is usually painless and often very advanced before the patient notices any changes.

Risk Factors

• Race — up to 8× more common in African Americans
• Age — more common after 60, especially in the Hispanic population
• Family history — 7% more risk if a family member has the disease, ~15% if a sibling
• Steroid users
• History of ocular trauma
• History of hypertension and/or diabetes
• High myopia (nearsightedness)

Four Diagnostic Methods

1. Intra-ocular Pressure (IOP) — Not weighted as heavily as before; some patients have normal IOP yet still have glaucoma (normal tension glaucoma).
2. Optic Nerve Appearance — The optic nerve looks like a donut where it enters the back of the eye. Glaucoma causes enlarging of the "donut hole" (optic cup).
3. Visual Field — Maps each eye's field of view. Typical losses in early glaucoma usually progress from the outside inward.
4. The OCT — A laser scan analyzing nerve fiber layer thickness, compared to age- and sex-matched norms.

Types of Glaucoma

Primary Open Angle Glaucoma (POAG) — The most common form. Drainage canals become clogged. Progresses slowly and responds well to medication.

Angle Closure Glaucoma — A medical emergency. Pressure rises quickly, accompanied by ocular pain, nausea, halos, and blurred vision. Requires immediate treatment.

Secondary Glaucomas — Including traumatic, pigmentary, neovascular, and pseudoexfoliative types.

Treatment

Treatment focuses on eye drops and surgery aimed at lowering intra-ocular pressure. Surgery is considered when medication is no longer sufficient to control the disease.

Key Points to Remember

• The disease is painless with no early symptoms
• It is never cured — monitoring never stops
• Treatment is usually effective in halting further vision loss

When Should My Child Have Their First Eye Exam?

• Infants: 6–12 months old — first comprehensive exam
• Preschool: Age 3–4 years
• School age: Before starting first grade, then every 1–2 years
• Children with vision problems: More frequently as recommended by your eye doctor

Common Kids' Eye Conditions