Are my cataracts and my glaucoma related?

Sometimes.   There are eye conditions (e.g. pseudoexfoliation syndrome) in which these typically unrelated ocular pathologies are very much related.  These conditions must be identified early and treated accordingly by your eye care professional team.

The typical form of glaucoma is unrelated to cataract.  Although not a treatment for glaucoma, removing the natural lens of the eye can increase intraocular fluid outflow and lower pressure.

Can my health influence my cataracts?

Yes - There are many systemic conditions that can directly cause early-onset cataracts (e.g. diabetes). 

Some systemic conditions (e.g. autoimmune conditions) can cause eye inflammations that can lead to cataract.  Also, some medications used to treat systemic health conditions can themselves cause cataracts (e.g. prednisone).

Systemic illness and ocular health issues including cataract are important connections not be ignored.  Your eyes can reflect your general health in many ways.   Speak to your eye care provider about the connection.  If you are developing premature cataracts there are many tests that should be performed to rule out specific conditions.

How is cataract diagnosed?

A cataract is diagnosed by a regulated health professional.   It can be observed in the lens of the eye with a hand-held ophthalmoscope or biomicroscope.

Cataracts are usually graded (0-4) on their density and the type is noted.  Sometimes dilating eye drops are required to better assess the type of cataract.

There is a danger in attributing vision loss solely to cataract without a full eye exam.   The eye is complex and often has concurrent issues (e.g. macular degeneration + cataract).  Only a full exam can sort out if vision loss is 100% attributable to cataract development.

When should I do cataract surgery?

There is no exact answer here.   The factors that are typically considered are :

1] Visual Acuity.  
Albeit low risk, there are risks involved with cataract surgery.  The benefit of the surgery has to exceed the risk.  A decision to proceed with cataract removal is based on many factors but in general terms, most surgeons in this area will discourage a patient from proceeding until visual acuity falls below 20/50-ish.

2] Visual Demands and motivation
If you are a retiree and spend a limited amount of time at a computer, your visual demands may make it acceptable for you to tolerate less-than-perfect best vision.   If you are working as e.g. a full-time accountant or transport truck driver, your high visual demands would require you get cataract surgery sooner.
Some folks are just simply queasy about eyes and have low motivation to proceed.  You can procrastinate with cataract surgery (most) without worry however there will likely be a point where the procedure simply needs to be done (e.g. failed driving requirements)

3] Status of other eye
If you see well from your other (no or low cataract) eye.   There may be less rush to a surgical solution.

4] Driving status / Caregiver status
If you have a standard driver’s license or a special license or if you are caregiver to others… these things should be taken into consideration for when to do cataract surgery.

5] Symptomology
Years of looking in eyes has taught me that you cannot always predict someone’s symptoms based on the objective look of the cataract.   Some folks have minor cataract changes but are devastated by the blurry vision.  Others have what objectively appears as a advanced cataract, but are getting along fine with their day-to-day lives.    With low symptomology, a surgeon is much less like to proceed.

6] Interest in enhanced refractive improvement
For a patient to consider the increased expenses of enhanced cataract procedures, they are generally going to be highly motivated and anxious to proceed as soon as possible.

7] Secondary ocular health factors
There are some eye conditions where removing cataract early is important.  If the surgery is left too long, there is greater risk for a poorly placed or dislodged implant.  Your doctor will tell you if you have a condition that requires early cataract surgery.

8] Payor
Albeit a controversial topic, payors can influence decisions when cataract surgery is done: Personally funded vs. co-funded vs. government-funded vs. third-party funded
Payors also ultimately influence the type of cataract surgery: Basic vs. enhanced (premium or astigmatic or multifocal implants)

9] Large prescription swing of one eye
As a cataract develops it can cause a large shift in a prescription.  E.g. If one eye experiences a dramatic nearsighted shift the imbalance will not likely be tolerable and cause issues that are hard to fix with glasses.   The recommended solution is to restore the right/left balance through surgery to one or both eyes).

What kind of cataract do I have?

I find it most useful for patients to explain that there are cataracts that are age-related and there are cataracts that are related to other things (e.g. trauma, inflammation, diabetes, medications).   These types progress at very different rates with age-related generally slower.

It is probably of little relevance to most, but you can certainly ask your doctor exactly what type of cataract that you have (e.g. cortical, posterior sub-capsular).  Cataracts are typically graded on a 0-4 scale (4 being the most advanced).

Sometimes the type of cataract can guide eye care professionals to investigate systemic health conditions like diabetes or autoimmune conditions.

Your doctor won’t likely commit to a definite answer, but you can ask them what to expect as far as the speed of progression.

This brief post is not meant to be a clinical list of cataract types - just take away that [1] different types advance at different rates and [2] have different underlying causes and can be clues to a puzzle.

A commonly Google searched phrase is

   "What does a cataract look like?"

Because cataracts occur inside of the eye (not on the surface) - It is difficult to see a cataract with the naked eye unless it is very advanced.    In late stages, you may be able to see a whitish haze within the pupil of the eye.   (She the What is a cataract post).    Two conditions commonly confused as cataract because they are visible on the surface of the eye are: Pterygium (more information here) and Arcus Senilis (cholesterol deposits in the cornea).

What are the common symptoms of cataract?

Folks experience different symptoms of cataract depending on the degree, location, one-side/both sides.  Your visual demands and other ocular issues also play a major role in visual symptoms.

The most common cataract-related symptoms that patients report are slowly increased glare and blurry vision.    There is not pain or irritation associated with cataract folks often report awareness like a film over the eye.

Constant cleaning of your glasses does not help!

What is a cataract?  A simple, non clinical description.

There are a million medical, wordy descriptions of cataract and highly graphic surgical videos online but I try very hard in clinic to keep things SIMPLE!

Albeit casual, this is verbatim what I tell patients - as I doodle on my whiteboard many times per day - to explain what a cataract is…

Please view the video and then the transcript will make more sense.

Approximate Transcript “This is the side of your eye.  If you had your glasses on, your glasses would be out front here….   When you look at anything… like the ‘E’ on my chart… the light from the chart will first pass through your glasses and then hit the cornea… the front surface of the eye.   Inside your eye, there is the iris (the coloured part the you see in the mirror) and the pupil (the black hole in the middle).  Behind where you can see there is a lens.   The lens is responsible to focus this beam of light to the retina at the back of the eye.   So, if everything goes according to plan… the light from the ‘E’ should pass through your glasses, the cornea, the pupil, the lens and form a nice sharp image of a letter ‘E’ at the back of the eye.   However, when you have cataract, the light scatters as it passes through the lens.  The scattered light degrades the image and things are unclear.     The only way to get you to see better is to remove this cloudy natural lens and replace it with a clear artificial lens… then the light will again pass cleanly through and you will see a clear letter ‘E’."

Additional points:   
1] When you have cataract, it does not matter what we do with glasses out front because the light still gets mucked up when it hits the cloudy lens.
2] The new lens will have a different power than your old lens.   The surgeon’s goal will be to choose a new power which will have you seeing well in the distance without glasses. 

How thoughts around cataract surgery have changed over my 25 years

When I graduated Optometry school many years ago, the main focus of cataract surgery and surgeons was simply to remove the natural cloudy lens in the eye.

Lens implants were commonplace. Procedures were safe with good success outcomes.  However, post-surgery refractive (glasses/no glasses) accuracy was hard to predict.

Safety and clarity was the measure of success.  The refractive result was of less concern to patients/surgeons.

With now over 4 million cataract proceedures performed annually in North America, the speed and efficiency of surgery has improved greatly over 25 years but these days, cataract surgery success is viewed as

[1] surgery to remove the natural lens and restore clear vision AND
[2] a refractive surgery opportunity when the end refractive (glasses/no glasses) result is highly tuned with many enhanced options.