The most common symptoms of a cataract are:

• Cloudy or blurry vision.
• Problems with light. These can include headlights that seem too bright at night; glare from lamps or very bright sunlight; or a halo around lights.
• Colors that seem faded.
• Poor night vision.
• Double or multiple vision (this symptom often goes away as the cataract grows).
• Frequent changes in your eyeglasses or contact lenses.

• Age-related cataract: Most cataracts are related to aging.
• Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.
• Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems, such as diabetes. Also, cataracts are sometimes linked to steroid use.
• Traumatic cataract: Cataracts can develop soon after an eye injury, or years later.

To detect a cataract, an eye care professional examines the lens. A comprehensive eye examination usually includes:

• Visual acuity test: This eye chart test measures how well you see at various distances.
• Pupil dilation: The pupil is widened with eyedrops to allow your eye care professional to see more of the lens and retina and look for other eye problems.
• Tonometry: This is a standard test to measure fluid pressure inside the eye. Increased pressure may be a sign of glaucoma.

For an early cataract, vision may improve by using different eyeglasses, magnifying lenses, or stronger lighting. If these measures don't help, surgery is the only effective treatment. This treatment involves removing the cloudy lens and replacing it with a substitute lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you decide on surgery, your eye care professional may refer you to a specialist to remove the cataract. If you have cataracts in both eyes, the doctor will not remove them both at the same time. You will need to have each done separately.

Sometimes, a cataract should be removed even if it doesn't cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.

There are two primary ways to remove a cataract. Your doctor can explain the differences and help determine which is best for you:

• Phacoemulsification, or phaco. Your doctor makes a small incision on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The doctor then inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the cloudy center of the lens so it can be removed by suction. Most cataract surgery today is done by phaco, which is also called small incision cataract surgery.

• Extracapsular surgery. Your doctor makes a slightly longer incision on the side of the cornea and removes the hard center of the lens. The remainder of the lens is then removed by suction.

A week or two before surgery, your eye care professional will do some tests. These may include tests to measure the curve of the cornea and the size and shape of the eye. For patients who will receive an IOL, this information helps your doctor choose the right type of IOL. Also, doctors may ask you not to eat or drink anything after midnight the morning of your surgery.

When you enter the hospital or clinic, you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed.

The operation usually lasts less than 1 hour and is almost painless. Many people choose to stay awake during surgery, while others may need to be put to sleep for a short time. If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After the operation, a patch will be placed over your eye and you will rest for a while. You will be watched by your medical team to see if there are any problems, such as bleeding. Most people who have cataract surgery can go home the same day. Since you will not be able to drive, make sure you make arrangements for a ride.

It's normal to feel itching and mild discomfort for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch. If you have discomfort, your eye care professional may suggest a pain reliever every 4-6 hours. After 1-2 days, even moderate discomfort should disappear. In most cases, healing will take about 6 weeks.

After surgery, your doctor will schedule exams to check on your progress. For a few days after surgery, you may take eyedrops or pills to help healing and control the pressure inside your eye. Ask your doctor how to use your medications, when to take them, and what effects they can have. You will also need to wear an eye shield or eyeglasses to help protect the eye. Avoid rubbing or pressing on your eye.

Problems after surgery are rare, but they can occur. These can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, or light flashes. With prompt medical attention, these problems usually can be treated successfully.

When you are home, try not to bend or lift heavy objects. Bending increases pressure in the eye. You can walk, climb stairs, and do light household chores.

You can quickly return to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.

If you just received an IOL, you may notice that colors are very bright or have a blue tinge. Also, if you've been in bright sunlight, everything may be reddish for a few hours. If you see these color tinges, it is because your lens is clear and no longer cloudy. Within a few months after receiving an IOL, these colors should go away. And when you have healed, you will probably need new glasses.

Sometimes a part of the natural lens that is not removed during cataract surgery becomes cloudy and may blur your vision. This is called an after-cataract. An after-cataract can develop months or years later.

Unlike a cataract, an after-cataract is treated with a laser. In a technique called YAG laser capsulotomy, your doctor uses a laser beam to make a tiny hole in the lens to let light pass through. This is a painless outpatient procedure.

The NEI is conducting and supporting a number of studies, such as the Age-Related Eye Disease Study (AREDS). In this nationwide clinical study, scientists are examining how cataracts develop and what factors put people at risk for developing them. Also, they are looking at whether certain vitamation
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April 2000