Cataracts

Antioxidant-rich diet (most important for prevention): colorful vegetables and fruits (vitamins C, E, carotenoids), dark leafy greens (lutein, zeaxanthin—spinach, kale), citrus fruits (vitamin C), nuts and seeds (vitamin E), carrots, sweet potato (vitamin A), berries (anthocyanins), Omega-3 foods: fatty fish 2-3x/week (anti-inflammatory), walnuts, flax, Avoid: high-glycemic foods (sugar, refined carbs—especially if diabetic, high glucose accelerates cataract formation), trans fats, processed foods, excessive alcohol (oxidative stress), Adequate hydration (lens requires proper hydration), Green tea (EGCG antioxidant), Dark chocolate (flavonoids), Mediterranean diet pattern (linked to lower cataract risk).

Smoking cessation (smoking doubles cataract risk, accelerates progression—MUST QUIT), UV protection (MOST IMPORTANT): sunglasses 100% UV-A and UV-B protection (wear outdoors year-round, even cloudy days—cumulative UV exposure damages lens over lifetime), wide-brimmed hat (additional protection), avoid midday sun (10am-4pm strongest UV), UV protection starting in childhood (lifetime exposure matters), Diabetes control: strict blood sugar management (HbA1c <6.5-7%—high glucose damages lens proteins, accelerates cataracts, diabetics develop cataracts 10-20 years earlier than non-diabetics), Avoid chronic corticosteroids if possible: oral, inhaled, nasal, topical steroids cause posterior subcapsular cataracts (discuss alternatives with doctor, if necessary use lowest effective dose, monitor eyes), Regular eye exams: baseline at age 40, every 2-4 years ages 40-54, every 1-3 years ages 55-64, every 1-2 years 65+ (earlier if diabetes, family history, risk factors), Cataract surgery (only proven treatment for visually significant cataracts): Timing: when vision impairment affects daily activities (driving, reading, hobbies—patient and ophthalmologist decide together, not based on arbitrary visual acuity cutoff), most ophthalmologists recommend surgery when vision 20/40 to 20/50 (legal driving limit 20/40 in most states), earlier if functional impairment despite better acuity, Procedure: outpatient, local anesthesia, 15-30 minutes, Phacoemulsification (ultrasound breaks up cloudy lens, aspirated out, replaced with intraocular lens IOL—foldable lens inserted through small incision), 95%+ success rate, complications rare (<1-2%: infection—endophthalmitis, retinal detachment, posterior capsule rupture, dislocated IOL, corneal edema—most resolve), recovery 1-4 weeks (vision improves within days, full healing 4-6 weeks), IOL options: Monofocal (single focus—near or far, most need reading glasses after, covered by insurance), Multifocal or Accommodating (near and far vision—reduces glasses dependence, more halos/glare, expensive $1,500-2,500 out-of-pocket per eye, not covered), Toric (corrects astigmatism—$500-1,000 extra per eye), Second eye: usually operated weeks-months after first (90% have bilateral cataracts, second eye done after first eye heals), Posterior Capsule Opacification (PCO—'secondary cataract'): occurs in 20-40% within 2-5 years after surgery (capsule that holds IOL becomes cloudy, vision blurs again), treated with YAG laser capsulotomy (quick outpatient laser, creates opening in capsule, restores vision immediately, 98% success, rare complications—retinal detachment <1%, cystoid macular edema), Cataract surgery improves quality of life dramatically: better vision (95% achieve 20/40 or better—legal driving), reduced falls (vision impairment increases fall risk 2-3x—hip fractures, disability, surgery reduces falls 25-30%), improved mood and cognition (vision loss linked to depression, cognitive decline—restoring vision improves both), longer independent living.