Wondering why I’m writing about cataracts?  I just had cataract and lens replacement surgery in both eyes over that past 2 months.  I’m now living with extreme clarity, vivid colors and total relief that it is done and I am healing well. 

I’m 63 and I’ve had T1D for over 52 years. When I realized that I was headed for cataract surgery, these thoughts kept rolling around in my head:

• NO, I don’t want to deal with this!
• I’m TOO YOUNG for this!
• I’m scared … don’t mess with my eyes!
• What if something goes wrong?

The first cataract ophthalmologist told me I could wait and only do one eye at a time.  He said I’d know when it was time … when I couldn’t see well enough while driving and when I couldn’t keep up with eyeglass lens replacements every 3-6 months.  I hit that point 4 months ago.  My optometrist said they couldn’t correct my vision much further.  BINGO … time to find out more and identify my surgeon.

Let’s understand more about cataracts.

What is a cataract?

A cataract is a clouding and/or yellowing of the lens in the eye that affects vision. Most cataracts are related to aging. 

What is the lens?

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye.

In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain.

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.

What causes cataracts?

The lens lies behind the iris and the pupil. It works much like a camera lens. It focuses light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye’s focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years.

Who is at risk for cataract?

The risk of cataract increases as you get older. Other risk factors for cataract include:

• Certain diseases (for example, diabetes).
• Personal behavior (smoking, alcohol use).
• The environment (prolonged exposure to ultraviolet sunlight).
• 

(Source: National Eye Institute of the National Institutes of Health)

Did you see it?  Diabetes is a major risk factor for developing cataracts.  So is exposure to ultraviolet sunlight, so if you’re a T1 living in sunnier climes, that’s a double whammy.

Risk factors for cataracts in diabetes

Cataracts are among the earliest complications of diabetes mellitus. Klein et al demonstrated that patients with diabetes mellitus are 2–5 times more likely to develop cataracts than their nondiabetic counterparts; this risk may reach 15–25 times in diabetics less than 40 years of age.

(Source: Bernth-Peterson P, Bach E. Epidemiologic aspects of cataract surgery. Frequencies of diabetes and glaucoma in a cataract population. Acta Ophthalmol. 1983;61:406–416. [PubMed])

It’s technical … so if you want the details, go to: Cataracts in Diabetic Patients: A Review Article

Cataract Surgery

Cataract surgery is more complicated in diabetic patients overall.  The surgeon’s skill affects surgical time, decreases the chance of intraoperative complications and is associated with less postoperative inflammation.

Intraocular Lens Choice

You have some options for intraocular lenses (IOLs).  All choices should be discussed with the surgeon you choose, paying particular attention to your age, lifestyle, level of diabetes control and other factors.

(Source: Journal of Ophthalmic & Vision Research, January 2008)

Choosing the Best Cataract Surgeon for You

Everything boiled down to this for me.  This was my criteria for settling in on my doctor (and of course, insurance coverage is always a factor).

• Experience
• Time allowed to understand all my options
• Manner of the doctor and his/her staff
• Access (was he reachable most days and after hours)
• Responsiveness to questions and phone calls

I think these factors are really critical.  We already have diabetes.  We already are in the higher risk category.  I’m sure many of you know folks who’ve had cataract surgery and say, “it’s so easy, no big deal!” 

I’d say something VERY different.  Yes, once you:

• choose your eye surgeon in whom you have TOTAL confidence and
• choose the lens replacement with your surgeon’s input

Then you may set up your surgery, being particularly diligent to manage your blood sugars prior and after surgery to allow of the best healing possible.  The surgery is mostly pain-free and fast (usually 15 minutes, out-patient).  Be sure to allow yourself time to let your eye heal

Then enjoy your new, clear, vibrant visual life! And remember to wear UV protected sun glasses!

(These are my blinged out granny shades for good sun protection!)

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