3 Tips for Caregivers Helping People With Low Vision

Receiving a diagnosis of age-related macular degeneration (AMD), diabetic retinopathy or glaucoma can be a shock. Loved ones naturally want to help, but they don’t always know what to do or how to do it. Here are 3 tips for caregivers helping people with low vision.

We asked vision-rehabilitation expert Maureen Duffy, CVRT, for advice. She suggests turning to local low-vision agencies, trained low-vision professionals and online resources, such as the Macular Degeneration Partnership and the VisionAware services guide. Perhaps most importantly, she says, look for a support group.
3 tips for caregivers
“I have found that most adults with whom I’ve worked turn to their peers, and they get the most guidance and help in vision-loss support groups,” says Duffy, an editor for Journal of Visual Impairment & Blindness, a writer and blog editor for VisionAware, and author of Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss.

Duffy shared the three most important things to ask a loved one after they find out they have AMD:

1. What do you understand about what the doctor said and about what’s going on with your vision? What don’t you understand? What do we need to clear up?
If they don’t understand completely, ask if you can go to doctor with them to be a note-taker and information-gatherer. Ask the doctor for explanations. Be clear and concrete about the information you need — and ask the doctor for next steps.

The Macular Degeneration Partnership website has a downloadable list of questions to take along, as well as suggestions on how to be an advocate during a visit to the doctor on its “Be an Advocate” page.

2. What is the one thing you are most afraid of RIGHT NOW?
At first, their biggest fear is of going totally blind: “I won’t be able to do anything; I’ll be all alone; I’ll be totally helpless.” With AMD, they won’t go totally blind, and they can learn to make the most of their peripheral vision. There are services that can help, but it’s tough in the beginning: Go slowly.

Vision-rehabilitation services can help teach them to function safely and independently in critical day-today activities, such as:

• Independent movement and travel:

  • getting around indoors
  • walking with a guide
  • using a long white cane
  • crossing streets
  • using public transportation
  • using electronic travel devices

• Independent living and personal management:

  • preparing meals
  • managing money
  • labeling medications
  • making home repairs
  • enjoying crafts and hobbies
  • shopping

• Communication and technology:

  • telling time with an adapted clock or watch
  • signing their name
  • using tablets and smartphones
  • using computers with speech or screen magnification
  • learning braille

3. What is the ONE thing you are most afraid you can’t do?
Don’t start talking about everything that may need to go on; it’s just too much and is overwhelming. Start with the one thing. “I can’t aim for the toilet”; “I can’t keep food on the fork”; “I can’t make my coffee in the morning.” Help them find solutions for simple things. Figure out alternatives. That little bit of accomplishment encourages self-analysis.

“Many people have difficulty telling currency bills apart,” Duffy says. She shares a simple, effective way to do this by folding each bill differently:

  • Keep the $1 bill flat and unfolded.
  • Fold the $5 bill in half crosswise (with the short ends together).
  • Fold the $10 bill in half lengthwise (with the long sides together).
  • Fold the $20 bill like a $10 bill lengthwise, and then in half again crosswise, like the $5 bill.

It’s important to remember that no matter how much you may want to help, your loved one may not be ready to accept assistance. Pushing too much too soon isn’t helpful. Once you ascertain that your loved one is ready to be receptive, offer your help gently, slowly and with empathy.

9/8/15


Maureen Duffy, CVRTMaureen A. Duffy, CVRT
Social Media Specialist, visionaware.org
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation

Print and Web Design for Older Adults

How to Design for Older Adults

Reading the small print can be very challenging as you age. Your eyes lose their elasticity due to a hardening of the lens inside your eye. This condition is called presbyopia and begins to affect many people after the age of 40, continuing to advance as you age. Readers glasses or a single prescription is no longer the best solution. You may find that you need one pair of eyeglasses for reading a book that you hold in your lap, while a different strength may be needed to use a computer at your desk, because it is further away. But it is not just the font size that can affect how easily you can read. Font shape, spacing and color all contribute to readability. Here are some helpful hints if you are producing printed materials for people over 40.
design for older adults
Print Size
Ideal size will vary depending on the font you choose as not all fonts are the same size. A 14 point type size in New Times Roman is smaller than a 14 point Verdana font. Therefore smaller fonts should not be less than 14 points and you may find they are easier to read at 16 points.

Font Type
Decorative fonts are difficult to read and should be used sparingly. For the body of text stick to a regular font that is bolder, with thick lines that are more legible.

Some people prefer a serif font, such as Times New Roman, as they say it is easier to read because of the “tails” at the end of the letters that create an illusionary line, helping to guide the eye along the line. However, others prefer a sans serif font, such as Ariel. It can be easier to read because of the simplicity of the lines. It is a personal choice.

Regardless of the font you select, use both upper and lower case letters in your body text. All capitals letters can be difficult to read. Save them for headlines or to emphasize a word or two.

Avoid using italicized text as the letters appear squeezed together, increasing the reading difficulty.

Presentation Style
Allow for white space as it provides natural places for the eyes to relax and can help you focus on what you are reading.

Align text to the left, as it is easier to read. And don’t wrap text around graphics.

Keep normal spacing between letters, neither expanding nor condensing them which make it more difficult to read the words. Space lines of text at 1.5 instead of single space, to make the lines of text much easier to follow.

Contrast & Color
As you get older, yellow, blue and green become increasing difficult to differentiate from each other if they are used in close proximity to each other, especially if you have cataracts. Yellow can almost disappear.

To make it easier for reading, stick with very dark type on a white background. Avoid patterned backgrounds.

Avoid using very glossy paper as it creates glare that can make reading hard. Also make sure your paper is thick enough so print form the other side of the page cannot be seen.
design for older adults
Websites & Blogs
Most of the rules listed above for printed materials also apply to websites and blogs (expect the glossy paper rule). But here are a few additional suggestions for online communications.

Use design templates that are one column (or one and a sidebar) to make it easier read. This is especially true for viewing on mobile devices, even if your web design is mobile responsive.

Allow enough space around clickable items, such as word links and buttons, so they are easy to target and click separately. Make sure the linked text is clearly defined with a color that is easy to differentiate for the surrounding text. Bright royal blue is the most common color used.

Provide a space between paragraphs.

Online a sans serif font is much easier to read, but keep the size at 12 -14 points. Ariel is common font, but Tahoma and Verdana are often used and were specifically designed for online usage. Verdana is a naturally large font, so a 12 point can work well.

Offer a feature where you can easily change the size of the font directly from the screen. An example is the Discovery Eye Foundation site where the control is located at the top right of the page. You can even offer on-screen contrast settings like on the Macular Degeneration Partnership page, at the top center of the page.

Avoid layering shades of the same color, such as dark blue type on a light blue background. Also avoid layering colors that clash such as red type in a purple block. These make reading the text more difficult.

These are just a few of the ways to make text easier to read, both in print and online. Do you have any other tips to share below in the comments?

7/28/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Toric Intraocular Lenses after Cataract Surgery

Toric Intraocular Lenses for Post-Transplant Astigmatism

Corneal transplants can be very successful at replacing diseased or damaged corneas. However, vision after a corneal transplant is often limited by high amounts of astigmatism. Treating this astigmatism is often difficult. Typically the amount of astigmatism is higher than can be corrected with glasses. Rigid contact lenses are often required. LASIK, PRK and astigmatic incisions in the cornea (astigmatic keratotomy) have all been tried with varying success.

This month, doctors at the Gavin Herbert Eye Institute at the University of California, Irvine, published a paper describing the use of commercially available, FDA approved toric (astigmatism correcting) intraocular lenses (IOL) during cataract surgery in patients with previous corneal transplant surgery.

Good candidates for this procedure are those who have had all transplant sutures removed and had corneal astigmatism that was stable, and for the most part symmetric and regular. (Image 1A shows topography that is both regular and symmetric. Image 1B is regular but not symmetric and image 1C is irregular.)

toric intraocular lenses

The study showed improvement in uncorrected vision (post-treatment average 20/40) and vision corrected with glasses only (post-treatment average 20/25). The images below, 1D and 1F, illustrate how toric intraocular lenses are positioned along the axis of corneal astigmatism.

toric intraocular lenses

While any intraocular surgery after corneal transplant can decrease the life expectancy of the graft, no complications or graft failures were seen during the course of the study. Not all types of astigmatism can be treated with this procedure.

This study highlights an effective treatment for regular symmetric corneal astigmatism after corneal transplant in patients needing cataract surgery.

7/24/15

Matthew Wade, MD - toric intraocular lensesMatthew Wade, MD
Assistant Professor of Ophthalmology
Gavin Herbert Eye Institute
University of California, Irvine

Eye Issues For Every Age Recap

Vision is something we take for granted, but when we start to have trouble seeing it is easy to panic. This blog has covered a variety of eye issues for every age, from children through older adults. Here are a few articles from leading doctors and specialists that you may have missed and might be of interest.
Artistic eye 6
Bill Takeshita, OD, FAAO – Visual Aids and Techniques When Traveling

Michelle Moore, CHHC – The Best Nutrition for Older Adults

Arthur B. Epstein, OD, FAAO – Understanding and Treating Corneal Scratches and Abrasions

The National Eye Health Education Program (NEHEP) – Low Vision Awareness
Maintaining Healthy Vision

Sandra Young, OD – GMO and the Nutritional Content of Food

S. Barry Eiden, OD, FAAO – Selecting Your Best Vision Correction Options

Suber S. Huang, MD, MBA – It’s All About ME – What to Know About Macular Edema

Jun Lin, MD, PhD and James Tsai, MD, MBA – The Optic Nerve And Its Visual Link To The Brain

Ronald N. Gaster, MD FACS – Do You Have a Pterygium?

Anthony B. Nesburn, MD, FACS – Three Generations of Saving Vision

Chantal Boisvert, OD, MD – Vision and Special Needs Children

Judith Delgado – Driving and Age-Related Macular Degeneration

David L. Kading OD, FAAO and Charissa Young – Itchy Eyes? It Must Be Allergy Season

Lauren Hauptman – Traveling With Low Or No Vision  /  Must Love Dogs, Traveling with Guide Dogs  /  Coping With Retinitis Pigmentosa

Kate Steit – Living Well With Low Vision Online Courses

Bezalel Schendowich, OD – What Are Scleral Contact Lenses?

In addition here are few other topics you might find of interest, including some infographics and delicious recipes.

Pupils Respond to More Than Light

Watery, Red, Itchy Eyes

10 Tips for Healthy Eyes (infographic)

The Need For Medical Research Funding

Protective Eyewear for Home, Garden & Sports

7 Spring Fruits and Vegetables (with some great recipes)

6 Ways Women Can Stop Vision Loss

6 Signs of Eye Disease (infographic)

Do I Need Vision Insurance?

How to Help a Blind or Visually Impaired Person with Mobility

Your Comprehensive Eye Exam (infographic)

Famous People with Vision Loss – Part I

Famous People with Vision Loss – Part II

Development of Eyeglasses Timeline (infographic)

What eye topics do you want to learn about? Please let us know in the comments section below.

7/21/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Driving With Vision Loss

Challenges Faced by Individuals Driving With Vision Loss

Overview
People of all ages often view driving as the key to independence. Individuals with vision loss are no exception. Three groups of people with vision loss who wish to acquire or maintain the privilege of driving include teenagers with a congenital or acquired visual impairment who have never driven, adults with the same who have never driven, and adults with an acquired visual impairment who have driven in the past but may lose their license because of their vision loss. driving with vision lossHowever, vision standards for driving vary from state to state, and this variation persists despite decades of research demonstrating that there is no absolute cutoff criteria in visual acuity or peripheral vision for safe versus unsafe driving. The fact that states have variable standards results in people with visual impairments not being able to be licensed in some states, including perhaps their own, while being able to be licensed in a neighboring state. Clearly, the ability of these individuals to safely operate a motor vehicle does not change when they cross a state line. Yet, to maintain at least some driving privileges, they may find themselves having to move to a different state.

It is well known that many older drivers modify their driving norms to help keep themselves and others safe. For example, many older drivers voluntarily reduce or stop driving at night, in hazardous weather conditions, or on super highways. By limiting their driving, older drivers, particularly those with visual impairments, are able to continue operating their automobiles safely and efficiently in spite of reduced vision. This is important, considering the vast majority of older adults live in the suburbs or in rural areas where automobiles are required for transportation.

Maximizing Visual Capabilities
It is important for all individuals, but particularly for drivers who are visually impaired, to make sure their spectacle correction is up-to-date. Contrast enhancement and glare control with filtering lenses can also be of great benefit. Most drivers have experienced driving into the glare of the sun, while looking through a dirty windshield. Although wearing sunglasses and keeping windshields clean is not mandatory, they certainly help drivers see more easily and feel more comfortable when driving.

Maximizing Visual Attention
Human factors research has found that inattention blindness and the cost of switching contribute to or directly cause automobile mishaps. Inattention blindness refers to when a person’s attention to one activity undermines his or her attention to other activities. For example, when drivers focus on directional signs, their attention is not on what is happening on the road in front of them. The cost of switching refers to the time it takes a person to switch attention between different activities. A common example that causes driving mishaps is when drivers text while driving. When people focus on texting while driving, their response to the traffic around them is delayed.

Useful Field of View testing research has shown that the time it takes a person to process visual information, especially the complicated visual environment experienced each time a person drives, increases with age. With this in mind, decreasing or eliminating the time it takes older drivers or drivers with visual impairments to look for and visually process signage should help them maintain their concentration on the road ahead and the traffic around them.

A simple way to reduce or eliminate the need to look for directional signage is with the use of a Global Positioning System (GPS) device that uses spoken directions. Older drivers and drivers with visual impairments in particular should consider using a GPS device with spoken directions so that they are freed from the distraction of looking for/at road signs and can keep their attention on the traffic around them.

Finally, with the technology, such as adaptive cruise control and lane alert warnings, currently available in cars, it is expected that all drivers will be safer behind the wheel.

Final Considerations
A good driver is someone who has the ability to perceive change in a rapidly changing environment; the mental ability to judge and react to this information quickly and appropriately; and the motor ability to execute these decisions, along with the compensatory skills to compensate for some loss of ability in the other areas. Additionally, a driver’s familiarity with the driving environment and his or her past driving record should be taken into account when considering limiting driving activities or retiring from driving altogether.

For many drivers with vision loss, a limited driver’s license that allows them to drive during daylight hours, within a restricted radius of their home, and at lower rates of speed may be all they desire. However, there are times when an individual will need to retire from driving altogether because of vision loss or a combination of vision and cognitive changes. When this time comes, the individual needs to understand that retiring from driving is for his or her safety and the safety of others.

Finally, it is well known that vision loss in general, as well as the loss of driving privileges, can lead to feelings of hopelessness and depression. Fortunately, there are many things that can enhance the functional abilities of individuals with vision loss. To learn about available resources for individuals with vision loss, visit the National Eye Health Education Program low vision program page at www.nei.nih.gov/nehep/programs/lowvision.

7/9/15

Dr. Wilkinson - driving with vision lossMark Wilkinson, OD
University of Iowa Carver College of Medicine
Chair of the National Eye Health Education Program Low Vision Subcommittee

LA Story – A Life of Vision and AMD

Growing up in Los Angeles, Leah Bernstein always loved movies and made it her goal to work in the entertainment industry. She took typing, shorthand and bookkeeping in school, and when she was turned 16, her sister’s friend got her a job working from 5 pm to midnight at MGM Studios.

vision and amd
Helga Esteb / Shutterstock.com
“I remember Judy Garland and Mickey Rooney playing outside the window, and Katharine Hepburn was always trying to get me to play tennis,” recalls Bernstein, now 93 years old.

“I made enough money at MGM to go to Woodbury’s Business College and become an executive secretary,” she says. She spent the rest of her career working with entertainment-industry executives, including Irving Fein, who managed Jack Benny; renowned animator Ralph Bakshi; and producer/director Stanley Kramer, who was best known for The Defiant Ones, Judgment at Nuremberg, Guess Who’s Coming to Dinner and It’s a Mad, Mad, Mad, Mad World. She worked with Kramer on 28 films, counting luminaries such as Sidney Poitier, Bobby Darin and Vivien Leigh among her friends, before she retired at age 69.

Vision and AMD

Since then, Bernstein spends time with her eight great-great nieces and nephews and has been a dedicated volunteer for organizations such as Cedars-Sinai Medical Center, the Los Angeles County Museum of Art and the Beverly Hills Public Library, where she regularly attends the Macular Degeneration Partnership’s monthly support group.

“I go to the meetings every month; I like to hear what other people are going through,” she says. “Mostly, though, I love hearing about the latest research. I would like to improve my eyesight, and I’m hoping they will come up with eye drops for my dry eyes.”

Bernstein started wearing glasses in her early 40s, and since being diagnosed with age-related macular degeneration, she’s had cataract surgery in both eyes. “That didn’t help, but I do take the vitamins given to me by my retina doctor twice a day. I’m hoping those might be keeping my macular degeneration from getting worse,” she says.

She’s given up driving and now lives in an assisted-living facility, where she really hates the food. She has a little computer “for looking things up,” and she gets by with two pairs of glasses and a magnifier for reading.

“I wish I could read better. I really wish my eyes were better,” Bernstein says. “I do watch television. I see it — not as you see it — but I can see it with my distance glasses. And of course, I watch movies on my DVD player.”

7/7/15

Lauren HauptmanLauren Hauptman
Lauren Hauptman INK

Vision Recap Of Previous Articles of Interest

Besides the comments that we get, one of the best parts of putting together this blog is the wonderful group of guests who share their expertise and personal stories. I want to thank all of the eye care professionals and friends that have contributed to make this blog a success.
Vision Recap
Here is a quick vision recap of some of the articles we had in the past that you may have missed.

Jullia A. Rosdahl, MD, PhD – Coffee and Glaucoma and Taking Control of Glaucoma

David Liao, MD, PhD – What Are A Macular Pucker and Macular Hole?

Kooshay Malek – Being A Blind Artist

Dan Roberts – 15 Things Doctors Might Like Us To Know

Jennifer Villeneuve – Living With KC Isn’t Easy

Daniel D. Esmaili, MD – Posterior Vitreous Detachment

Donna Cole – Living With Dry Age-Related Macular Degeneration

Pouya N. Dayani, MD – Diabetes And The Potential For Diabetic Retinopathy

Robin Heinz Bratslavsky – Adjustments Can Help With Depression

Judith Delgado – Drugs to Treat Dry AMD and Inflammation

Kate Streit – Hadley’s Online Education for the Blind and Visually Impaired

Catherine Warren, RN – Can Keratoconus Progression Be Predicted?

Richard H. Roe, MD, MHS – Uveitis Explained

Sumit (Sam) Garg, MD – Cataract Surgery and Keratoconus

Howard J. Kaplan, MD – Spotlight Text – A New Way to Read

Gerry Trickle – Imagination and KC

In addition to the topics above, here are few more articles that cover a variety of vision issues:

If you have any topics that you would like to read about, please let us know in the comments section below.

6/23/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

When Is The Best Time For Cataract Surgery?

As you age, cataracts become a concern prompting the question – when is the best time for cataract surgery?

There are decades worth of old wives tales floating around regarding cataracts that often lead to unnecessary fear and apprehension for many patients. These myths involve concepts such as “ripeness”, having to wear eye patches afterwards, danger in “waiting too long, etc. Just as the techniques of cataract extraction have changed over the decades, so have the indications to proceed to surgery.
best time for cataract surgery - people
Firstly, cataracts are a normal part of the aging process. Patients should not be alarmed if they are told that they are developing cataracts, even as early as their fifties. As we age, the natural clear lens inside the eye becomes progressively harder, darker, and cloudier. This dark, cloudy lens is what is referred to as a cataract. Cataracts develop at different rates for different people, and even between the two eyes of the same person. It typically takes many years for the lens to become cloudy enough to impact the clarity of vision. There are many different types of cataracts depending of what area of the lens becomes cloudy, but the typical cataract related to normal aging results in a relatively uniform cloudiness with a denser central core, and is referred to as “Nuclear Sclerosis”. Other varieties of cataracts tend to grow more quickly, are relatively uncommon, and often result from certain conditions other than typical aging.
best time for cataract surgery
Regardless of what type of cataract the patient has, the treatment is the same: cataract extraction with an implant of an intraocular lens. There have been great advances in lens design over the years, and they now result in excellent, stable, predictable vision for the remainder of the patient’s lifetime and do not typically need to be changed once implanted.

Cataracts result in different symptoms that may be more of less relevant to a specific person’s needs, such as:

  • Glare with bright lights
  • Difficulty with fine print
  • Difficulty following the golf or tennis ball
  • Impairment in night driving
  • Difficulty with seeing street signs
  • Seeing the score or small print on the television
  • Fine visual tasks such as threading a needle, etc.

Although cataract surgery is an incredibly successful procedure with only about a 1-2% risk of complications, it still DOES have some risk. Therefore, cataract surgery should only be undertaken when there is something to gain. In other words, the BENEFITS MUST OUTWEIGH THE RISKS. This means that if your symptoms are mild and are not interfering with your activities of daily living, it is not time to accept the risks of surgery. Once your visual impairment progresses to the point that YOU feel your activities of daily living and enjoyment are impaired, this is the time to proceed to surgery. This threshold is very different between people. Some people feel impaired with vision of 20/25, and others still function within their scope of usual activities until they are 20/100! The best first-step in determining if it is time for your surgery is to get an up-to date refraction. This means a detailed check for new glasses. Often, cataract development will change a person’s glasses prescription, and updating this can improve the visual symptoms for months to years. When a new glasses prescription no longer improves the sight adequately, this is when surgery is indicated.

For the most part, putting off cataract surgery does not impact the final outcome. It will not harm you or your eye to leave the cataract alone until you are ready. There are of course certain exceptions to this rule, such as in Fuchs’ dystrophy, pseudoexfolation, untreated narrow-angle glaucoma, and some others. However, these are relatively rare conditions that your doctor will speak to you about if you have any of these diagnoses.

In summary, the time to proceed to cataract surgery is something that you as the patient determine. YOU assess your lifestyle needs and your vision performance within your scope of activities. When you feel you are impaired in these activities, the benefits will outweigh the risks, and it’s time to take them out. You should not feel any pressure to urgency in this process.

Once you have determined you are ready to have cataract surgery, your surgeon will discuss with you your options for intraocular lens implantation including astigmatism neutralizing lenses, standard distance or near-vision lenses, multiple focal distance lenses, accommodating lenses, and others. The current standard approach for cataract surgery is called “phacoemulsification” and uses ultrasound technology to remove the cataract. There are also laser devices that assist in making the incisions and breaking up the lens, which many surgeons now employ in addition to the phacoemulsification. In general cataract surgery only takes a few minutes, is performed with topical anesthesia, is pain-free, and has a very short recovery time. No pirate-patches are used these days! Most patients are very happy with the results, but this requires adequate discussion with the surgeon prior to the procedure to best assess the needs of the individual patient. A well- informed patient who participates in their care results in the best outcomes!

6/18/15

Sameh Mosaed, MD best time for cataract surgerySameh Mosaed, MD
Director of Glaucoma Services, Gavin Herbert Eye Institute, UC Irvine
Associate Professor, Cataract and Glaucoma Surgery, UC Irvine School of Medicine

Cataract Prevention

The more you know about cataracts, the easier it is to focus on cataract prevention.

What is a cataract?

At birth, with rare exceptions, most of us arrive in the world with a clear crystalline lens within each eye. The pathway of our visual images start with light passing through the cornea (the clear front window of the eye), through the pupil (the opening in the center of the iris, or colored portion of the eye) and through crystalline lens which functions to focus light onto the center of the retina (the film of the eye). cataract preventionThe retina, via the optic nerve, will then transmit visual images to the brain. When the crystalline lens becomes opacified (cloudy), this system becomes disrupted, and vision becomes impaired. Opacification of the crystalline lens is called “cataract”, and there are many variations in appearance and type and many causes and can present at any age. The word cataract originates from the Greek word “cataracta”, which means waterfall. The ancient Greeks used this term as they noticed a similarity in the appearance of the white opaque rushing water of a waterfall and the appearance of a white mature cataract.

To understand the different types of cataracts and causes, it is important to understand the anatomy of the lens. Using a metaphor, the lens anatomy can be compared to a Peanut M&M candy™. There is an outer candy coating (the lens capsule), a chocolate layer inside (the lens cortex), and a peanut in the center (the lens nucleus).

The most common cause of a cataract is an age related nuclear clouding which is due to long term accumulation of metabolic and oxidative waste products within the lens and possibly UV-B/Sunlight light exposure. Cortical clouding (within the cortex of the lens), due to similar causes, is also a common cause of an age related cataract.

Cataracts can occur earlier in life with poorly controlled diabetes resulting in cortical and nuclear cataract. Patients who are exposed to steroid medications in any form (orally, topically as eye drops, skin creams etc.) are at an increased risk to develop a posterior subcapsular (PSC) cataract which occurs on the posterior lens capsule. PSC cataracts can have a much more abrupt and earlier onset in life than nuclear or cortical cataract. Smoking has also been known to predispose patients to formation of a PSC cataract. Other less common varieties of cataract can occur with any trauma to the eye or even present at birth as a congenital cataract with a large variety of causes.

What can be done to prevent cataracts?

I often joke with patients that a cataract is such a common occurrence that just like birth, death, and taxes, it is an issue we must all face at some juncture in life (hopefully later than earlier). I am often asked if there are any dietary measures or vitamin supplementation to reduce the formation of a cataract, however this is not as well studied as the use of vitamins in the prevention of macular degeneration. Several scientific epidemiological studies following populations over many decades have shown some merit however that using multivitamins regularly (Vitamin B6 and B12, Vitamin C, beta carotene, antioxidants and possibly lutein and zeaxathin) can reduce the degree of lens opacification over time. As with all medications, you should consult with your physician before deciding to use any vitamin supplementation to clarify if you have any contraindication to using them.

There is conflicting evidence regarding the role of UV-B exposure in sunlight as a causative agent for cataracts. There is some support that using sunglasses on a regular basis to block UV-B light may help to reduce cortical cataract formation. Smoking cessation can also help to reduce the formation of cataract. If a patient is diabetic, strict blood sugar control is also an important measure to reduce the formation of a cataract. If possible, reducing or avoiding the use of steroid medication can reduce the formation of a PSC cataract.

What can be done if a cataract is worsenening and glasses cannot help improve vision significantly?

If you are experiencing gradual painless loss of vision, you should consult with your ophthalmologist as cataract can be a common cause. If you are found to have cataract formation, there is generally a shift in the glasses prescription in the early stage. Having your glasses prescription checked to see if your vision can be improved with glasses is the first step in determining how significant your cataract has become. If glasses are not able to sufficiently improve your vision and your daily activities are affected by the decrease in vision your experience, you may be a candidate to have cataract surgery.

Modern cataract surgery has improved a tremendous degree compared to decades earlier. It is the most common and successful surgery in the world, and is typically performed on an outpatient basis with topical anesthetic and often without any sutures or eye patch. Prior to surgery the pupil is dilated, and once in the operating room, a small self-sealing incision is made on the side of the cornea. The surgeon then makes a circular opening in the anterior lens capsule (the candy coating of the peanut M&M), and uses an ultrasound instrument to emulsify and vacuum out the nucleus (the central peanut), and remove the cortex (the chocolate layer). The inside of the lens capsule is polished and an intraocular lens is folded and introduced into the eye through the corneal incision and seated into the remaining lens capsule to conclude the surgery.

Prior to surgery, measurements are taken to determine the power of lens necessary to achieve the best vision after surgery based on the curvature of the cornea and anterior-posterior length of the eye. Intraocular lenses (IOLs) can potentially have several features depending on a patient’s needs. The most common IOL used is a monofocal lens, which does not typically require an additional out of pocket expense. This lens is chosen to have a point of focus either for distance vision (driving, TV) or near vision (reading), but not both. Typically patients who have the monofocal lens will choose to have distance focus and use reading glasses for near vision. There are multifocal/accommodating IOLs available for patients who are appropriate candidates, to allow the patient a larger range of vision at far, near and intermediate (computer) distance and may allow great independence from glasses. There are still other IOLs which can correct astigmatism (a special type of glasses prescription) at the time of cataract surgery. After discussion of the patient’s needs and preferences, the surgeon can best advise their patient regarding which type of IOL may best suit them.

6/11/15

Anand Bhatt, MD - cataract preventionAnand B. Bhatt, MD
Assistant Professor of Glaucoma and Cataract Surgery, Gavin Herbert Eye Institute
UC Irvine School of Medicine