Cataract

Inside your eye, behind the coloured part (iris), there is a clear lens. It works like the lens of a camera, focusing light onto the back of the eye so you see a sharp picture. A cataract is when this lens becomes cloudy. Looking through a cataract is like looking through a dirty or frosted window.

Cataracts usually develop slowly over years. They often affect both eyes, but one eye may be worse than the other. Cataract is the leading cause of blindness in the world, even though it can be treated with a simple operation [1].

Image to add

Side-by-side drawing of a clear lens and a cloudy lens inside the eye, with light passing through each. Alt text: "Diagram comparing a clear lens that focuses light sharply with a cloudy cataract lens that scatters light."

What causes it?

As we get older, the proteins in the lens slowly clump together and the lens becomes cloudy and yellow. This is part of normal ageing. Diabetes, smoking, steroids, injury and UV light can make it happen earlier or faster [2].

Most people will get some cataract as they get older. Your risk is higher if you [2]:

• are over 60 (age is the biggest risk)
• have diabetes
• smoke
• have used steroid medicines for a long time (tablets, eye drops or inhalers)
• have had an eye injury, eye surgery or radiation treatment to the head or upper body
• spend a lot of time in strong sunlight without eye protection (UV light)
• drink a lot of alcohol
• have a family history of cataracts

Babies and children can get cataracts too. Some babies are born with a cataract (congenital cataract). This needs to be found and treated early, because a child's vision is still developing [6]. If your baby's pupil looks white or grey instead of black, or your child does not seem to follow faces or toys, see a doctor soon.

Cataracts are not painful and usually do not make the eye red. Common signs are [3]:

• Cloudy, blurred or misty vision
• Glare: car headlights or street lights seem too bright, or have halos around them, making night driving difficult
• Colours look faded or yellowish
• Needing brighter light to read
• Frequent changes to your glasses, which do not seem to help for long
• Sometimes double vision in one eye

An eye doctor or optometrist can see a cataract easily during a painless eye check, usually after putting in drops to widen your pupil.

What can happen?

A cataract does not damage the eye permanently, but as it gets worse it can:

• make it hard to read, drive, cook or recognise faces
• make you unsafe to drive, especially at night
• increase the risk of falls and accidents
• make you lose confidence and independence
• in very advanced cases, cause blindness until the cataract is removed

A cataract on its own is not an emergency. But if you have had cataract surgery recently, a serious infection or other problem can rarely happen and needs treatment the same day.

If you have sudden loss of vision, or a painful red eye, this is not caused by cataract. Get checked urgently.

In the early stages, new glasses, brighter lighting and anti-glare sunglasses may help. But surgery is the only way to remove a cataract [2].

When should I have surgery? You do not need to wait for the cataract to be "ripe" (very thick). This is an old belief. Surgery is offered when the cataract affects your daily life, such as reading, driving, working or looking after yourself [3][7]. In fact, very advanced cataracts can make surgery harder.

The operation

• The most common method is phacoemulsification (phaco for short). The surgeon makes a tiny cut in the eye, uses sound waves to break up the cloudy lens, and removes it.
• A clear artificial lens (intraocular lens, or IOL) is put in its place. It stays in the eye for life.
• It is usually done under local anaesthetic (eye drops or an injection to numb the eye). You are awake but should not feel pain.
• It usually takes less than an hour, and most people go home the same day (day case) [4].
• If both eyes need surgery, they are usually done on different days.

Cloudy again after months or years? Some people find their vision slowly becomes cloudy again. This is usually posterior capsule opacification (PCO), sometimes called a "secondary cataract". The thin bag that holds the new lens becomes cloudy. It is not the cataract coming back, and it is fixed with a quick, painless YAG laser treatment in the clinic [4][5].

Most people recover quickly, and many notice brighter, clearer vision within a few days. Good care in the first month helps your eye heal well and lowers the risk of infection [4][5].

Your check-up appointments

In Brunei, you will usually be seen three times after surgery. Your clinic may give you slightly different dates, so always follow the appointment card you are given.

1. Day 1

   The day after surgery. The doctor checks your vision, the eye pressure and the wound, and makes sure there is no early infection. You start or continue your eye drops.

2. Day 7

   About one week later. The doctor checks that the eye is healing, the inflammation is settling and there is no infection. Your drops may be changed.

3. Day 30

   About one month later. The doctor checks your final vision. Your drops are usually stopped, and you are told when to get new glasses, and plans are made for your other eye if needed.

Your eye drops

• You will usually be given antibiotic drops (to prevent infection) and anti-inflammatory drops (steroid drops, to calm the swelling). Most people use them for about 4 weeks, often reducing them step by step.
• Wash your hands before putting in drops. Do not let the bottle tip touch your eye.
• If you use more than one type of drop, wait about 5 minutes between them.
• Do not stop early, even if your eye feels fine. Bring all your drops to every check-up.

Protecting your eye

• Wear the eye shield at night for the first week, or as your doctor advises, so you do not rub your eye in your sleep.
• Do not rub or press on your eye.
• Clean around the eye gently with cooled boiled water and clean cotton wool, wiping from the nose outwards. Do not wash inside the eye.

For the first 2 to 4 weeks

• Keep soap, shampoo and water out of the eye. You can shower or bathe, but keep your eye closed and avoid splashing your face.
• Taking wudhu? Wipe around the eye gently with a damp hand instead of splashing water into the operated eye. Ask your doctor or religious teacher if you are unsure.
• No swimming, and avoid dusty or smoky places, gardening and dirty water.
• Avoid heavy lifting and straining for the first week.
• Do not wear eye make-up.
• You can read, watch TV, use your phone and walk as normal.
• Drive only when your doctor says your vision is good enough.

What is normal?

For the first few days, it is normal for the eye to feel a little gritty, watery or sensitive to light, and for vision to be slightly blurred. Colours may look brighter or bluer than before. This settles as the eye heals.

What is not normal? Increasing pain, vision getting worse, a redder eye, or flashes, many new floaters or a dark curtain need checking the same day (see "When to get help urgently" above).

New glasses: you may need new glasses, especially for reading. Wait until your doctor says the eye has settled, usually after the Day 30 check, before you get an eye test for glasses.

There is no proven way to stop age-related cataract, but you may be able to slow it down:

• Stop smoking.
• Keep diabetes well controlled.
• Wear sunglasses and a hat in strong sun.
• Do not use steroid medicines or eye drops unless a doctor prescribed them.
• Wear eye protection for sports, DIY and work with tools.
• Have regular eye checks, especially if you are over 60 or have diabetes.

Where to get help in Brunei

If your vision is getting cloudy or blurred, you can walk in to a Community Eye Clinic at your health centre. No referral is needed. They can check your eyes and refer you for surgery if needed.

For emergencies after eye surgery, especially after clinic hours, go to the hospital Emergency Department.