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Melanie Cole (Host): Cataracts are the most common cause of vision loss in people over the age of 40 and the principal cause of blindness in the world. In fact, there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration, and diabetic retinopathy combined, according to Prevent Blindness America. My guest today is Dr. Alan Leahey. He's an ophthalmologist with Greenville Health System. Welcome to the show, Dr. Leahey. Those are some interesting statistics. What is a cataract?

Dr. Alan Leahey (Guest): Well, Melanie thanks for having me. A cataract is a clouding of the natural lens of the eye. We all get them as we age, most of us in our late 40s, early 50s, start to get them. Even folks that never have had any vision problems and are going in for a routine examination, may be told they have a little bit of cataract. No reason to panic. We don't worry about cataracts until they start to cause problems with your vision and usually what most folks notice when that starts to happen is cloudy vision when they're reading, when they're looking at things in the distance. Colors may not seem as sharp. Headlights at night; they all seem that they're the brightest halogen lights and they're getting halos or glare around lights. Sometimes bright sunlight can cause those glare symptoms, also. That’s usually, the first sign that cataracts are becoming an issue for the individual where they may start to interfere with activities of daily living such as driving, reading, watching TV, seeing street signs. But, just because you have a cataract, you don't have to worry about it if changing glasses can help, then that's sort of the first step. But often, if that does not help, that's when you have to think about surgical options.

Melanie: If we notice some of those symptoms that you've discussed today, then how do you detect them? When do you go to see an ophthalmologist? What do you do?

Dr. Leahey: Well, usually what's happened is, you have a dilated examination. It is important when you go in to see the ophthalmologist and before you see him or one of his assistants, make sure you're specific in what your complaints are. If it's problems with night time driving, or if it's problems from the glare from headlights or something like that, make sure you tell that to the staff and to the physician so that they can do the appropriate tests before they put drops in your eyes and dilate. Then, what will happen is they'll get certain measurements in the office and then you'll see the technician first and then the ophthalmologist. What the ophthalmologist will do is, he'll take a look with that slit lamp device. It's the device where, if you've been to the ophthalmologist before, where you put your chin in and they're looking with a microscope and they're looking at your natural lens which is shaped kind of like a lima bean and normally it is crystal clear. Looking through that is kind of looking through the lens of a camera and when things start to get cloudy from a cataract, that natural lens can become a little yellow or brown in color and it distorts your vision and when the ophthalmologist is examining you, he can actually see the cloudiness of the lens and what areas of the lens it's in. So, he will look at that lens, he or she will look at that lens and then also look at the rest of the eye to make sure there are no other problems such as glaucoma or some type of retinal disease, or something going on in the cornea that could be contributing to your vision. You want to make sure that the cataract is indeed what is causing the problem. Once that's determined, then that ophthalmologist will have a discussion with you about your options to correct your vision.

Melanie: Before we get into correcting the vision and working on a cataract with medical intervention, is there anything you can do to prevent it if it's already started down this course? Are there any foods? Are there any nutritional supplements or behavior modifications people can do that might help?

Dr. Leahey: Well, the biggest thing is ultraviolet light and most of the damage is already done from our early years, but wearing sunglasses, especially around reflected light. If you're out on the water, if you're out near where there is snow--things that where the light is going to be extra bright, it is smart. It's great to have sunglasses on all of the time on a bright, sunny day because it will help lessen the chance of a quickening of the cloudiness of the lens and may also help with slowing down the process of aging in the back of the eye for conditions such as macular degeneration. Just a well-balanced diet is going to be fine. There are no certain foods you're going to eat that are going to prevent you from developing cataracts. Unfortunately, it's one of those conditions that its management is really a surgical treatment. There is research being done for other methods of treating them such as possibly certain drops in the future but for right now, it's a condition that can only really be treated with surgical options.

Melanie: So, then, let's discuss that. What's involved? People think eye surgery and they get pretty nervous. Tell us about cataract surgery.

Dr. Leahey: Sure. Cataract surgery has had some major advances over the last 10 years. It is quite an efficient and safe procedure nowadays, but it is still surgery and that's one thing I try to tell my patients that even though it's a quick, safe, effective procedure where you're back to your normal activities often the next day with limited restrictions, you still have to remember this is surgery. Risks are minimal but they do exist. The chance of infection with cataract surgery is pretty rare--less than 1 in a 1,000, the chance of glaucoma, retinal detachment, conditions that could cause you to need additional surgery--less than 1%. That's one of the reasons when you're moving ahead with surgery; you want to always make sure that the benefits outweigh the risks. So, that's why the vision usually is at a certain level, worse than 20/40, or having glare problems from lights at night time or sunlight, so that we know that the benefits outweigh the risks of surgery. The surgery itself is about a 7-10 minute procedure in the operating room. It often takes more time getting you ready in the operating room, getting the drops in the eye, getting in an intravenous in so that the anesthesiologist or nurse anesthetist can give you a little bit of sedation to relax you, but nowadays, because the procedure is so quick and efficient, most patients will just have a little bit of sedation, the physician can talk to them during the surgery, tell them to look left, right, up, and down. A lot of people get nervous about this and what I usually tell my patients is that if we find that you're a little too nervous and not really able to do what we need you to do, we can give you a little bit more sedation to relax you a little bit more. By the time the surgery is done, often people think we're just getting started. The procedure involves, basically, making a very small incision about the size of a tip of a pen, into the cornea--the clear part of the eye that's dome-shaped. It covers the colored part of the eye. Through that small incision, we can vacuum that lens that's shaped like a lima bean out and then an intraocular lens that's going to replace the cataract. We roll it up like a taco, insert it through a straw-like device, and then can unfold it in the eye. Kind of like an idea of the ship in the bottle. We can do all this without having to put any stitches in the eye so your recovery is much quicker. Most individuals go home just with a clear shield over the eye and start using some eye drops later that day. Most individuals will notice a difference in their vision immediately, but the healing process takes several weeks for any inflammation to settle down. So, that's why your doctor will have you using drops over two to four weeks depending on how much inflammation you have. Surgery also, gives many individuals the option to get best corrected vision back, but also the option of trying to get vision corrected without having to use any glasses for distance or near. The majority of folks that have cataract surgery will have a standard intraocular lens placed and it's covered by insurance and that's kind of a gold standard. Insurances will cover cataract surgery that's medically necessary. However, often folks, when they're having the medically-necessary cataract removed, would like to limit their dependence on glasses for near or distance. So, that's when your ophthalmologist may discuss with you the options of a standard intraocular lens, or an intraocular lens that may be able to correct your distance at near and distance without needing glasses, or if you're an individual that has a fair amount of astigmatism, you might be given the option of what's called a toric intraocular lens that corrects your astigmatism so that you won't need glasses in the distance, but you may need them at near. These are all conversations you really have to have with your ophthalmologist surgeon that will be doing the procedure, so that you are aware of what your different options are and if there are additional costs not covered by insurance, that should be discussed with you, also.

Melanie: Wow. Such great information, Dr. Leahey. Just wrap it up for us in the last few minutes; what you really want the listeners to know about cataracts, about protecting their eyes from the sun, and really why they should come to Greenville Health for their care.

Dr. Leahey: So, cataracts are a problem that we all develop as we age. It is not a medical emergency where you have to have it taken care of right away. The patient--so you, the individual—is going to be the best judge of when the cataract needs to come out. How much is it affecting your activities and everyday life? It's not a type of condition where you don't know you have it and you go in to see an ophthalmologist and say, “Oh, you have a cataract. We need to have that taken out.” You're going to go in telling the ophthalmologist, “Hey, my vision's pretty bad,” or “I'm having problems doing these activities,” and that's going to be the best thing. So, number one is the individual patient is going to know when it's time to do something. And, the second thing is, it is a safe, effective procedure that will allow you to get your vision back to where it should be so you can function the way you need to, and risks are minimal nowadays with cataract surgery. Whether the surgery is done with ultrasound, which is called “phacoemulsification”, or by a laser-a femtosecond laser-to help make the incisions smaller, you're going to get an excellent result however it's done. You just need to discuss all those options with your surgeon.

Melanie: Thank you so much for being with us today, Dr. Leahey. You're listening to Inside Health with Greenville Health System. For more information, you can go to www.ghs.org. That's www.ghs.org. This is Melanie Cole. Thanks so much for listening.