Claude Monet, one of the founders of the Impressionist style of art, was known for using a bright, light palette to portray his iconic water lilies and landscapes. But in 1912, his style began to change as his colors grew darker and his brushstrokes less detailed. His paintings became murky and barely recognizable. This wasn’t due to a dark night of the soul or an exploration of a new style: It was his vision. Monet’s worsening cataracts deprived him of the ability to discern colors or detail.
Over the years, his vision continued to deteriorate to near blindness until he underwent cataract-removal surgery in 1923. Not long after, he returned to his original painting style, though his postsurgical results were a far cry from what people can expect today.
For hundreds of years, cataract removal surgery was only that— removal of the clouded lens that impaired vision. In 1949, Sir Harold Ridley invented the first artificial lens to replace the one that was removed in surgery, but it wasn’t a widely accepted practice for decades.
Now, not only are lenses replaced, but patients aren’t limited to a basic, one-size-fits-all approach: Several lens choices offer the opportunity to improve vision. (You might even be able to ditch those reading glasses you’ve needed for years.)
About half of all people will develop cataracts by age 80, but the process starts sooner than you think. Proteins can begin to build up on the lens in your 40s, though they likely won’t cause any noticeable effects until your 60s or later. If you notice that colors seem faded, lights look too bright or have haloes, or your night vision is declining, make an appointment with an ophthalmologist. A comprehensive eye exam can identify cataracts as well as other dangerous eye conditions that become more common with age.
When it’s time for surgery
In the early stages of cataracts, you can try a variety of stopgap measures to improve your vision (see sidebar). When those measures are no longer sufficient, it’s time to have your cloudy lenses replaced with clear ones.
Cataract surgery is an outpatient procedure. Your eye will be numbed, so you won’t feel any discomfort, and you may also be given medication to help you relax. In the most common procedure, the surgeon will make a tiny incision and use ultrasound waves to break the cataract apart, remove it, and then replace it with an intraocular lens (IOL). There are several options:
Fixed-focus monofocal IOLs. These lenses will give you clear vision at a distance, but you’ll still need reading glasses to see up close. If you have cataract surgery in both eyes, you might choose a lens that provides near vision in one eye and a lens that provides far vision in the other, a combination called monovision.
Accommodating monofocal IOLs. Using the natural musculature around the eye, you can shift these lenses from near to far vision. Distance and middle-distance vision are typically excellent with this newer choice, but close-up vision may not improve.
Toric IOLs. These lenses are used for people with astigmatism, a flaw in the eye’s curvature that causes blurred distance and near vision. By bending light more efficiently, toric lenses provide focused vision at a single distance, correcting astigmatism so distance glasses are no longer needed.
Multifocal IOLs. These lenses work like progressive or bifocal glasses, with different sections geared for distance, middle, and near vision. Your brain and eyes work together to decide which part of the lens you need at any given time. Multifocal lenses are the most versatile.
What to expect
If you have cataracts in both eyes, expect to have two separate surgeries. Two procedures separated by mere weeks may seem inconvenient and even wasteful, but there are distinct advantages to this approach. By staging your second surgery once the first eye has healed and vision is stable, you can determine how the new lens behaves. If tweaking seems appropriate, the power of the second lens can then be fine-tuned. Most health insurers cover cataract surgery, though your out-ofpocket costs will vary.
Want to ensure you’re among the nine in 10 people for whom cataract surgery spells success? While the odds of complications such as infection, pain, or vision loss are low, your actions in the days and weeks after the procedure influence the outcome. The main goal is preventing infection. You’ll need to use antibiotic eye drops several times a day and keep water out of your eyes. You may also need to wear a bandage or shield to stop yourself from rubbing and keep specks of dust or debris from getting in your eye.
Light daily activities are fine as your eyes heal, but avoid bending over, jogging, or lifting heavy objects. You’ll schedule follow-up visits with your eye surgeon for the day after the procedure, as well as a week or two later and a month after that.