How Cataracts Can Impact Dental Visits
Hygienists who understand the condition are better prepared to assist their patients
Ann-Marie C. DePalma, CDA, RDH, MEd
Patients exhibit with many medical conditions that can affect how dental professionals provide care. Hypertension, heart disease, cancer, diabetes, pregnancy and many other factors can bring challenges to both patients and hygienists.
In addition, there are many mobility, hearing, and vision changes that can occur at any stage of a person's life. Multiple sclerosis (MS) is an auto-immune disease affecting the brain and spinal cord (central nervous system) and can appear at any age but most commonly manifests itself between the ages of 20 and 40.1 MS can cause many different symptoms, including vision loss, pain, fatigue, and impaired coordination, which can result in mobility issues for the patient.1 Hearing loss can be precipitated by loud noises, genetic defects, ear infections (otis media with or without effusion), or by age. It is estimated that by age 75, more than half of Americans have some type of hearing loss.2 In fact, the US Food and Drug Administration (FDA) has recently allowed over-the-counter hearing aids to be sold because many Americans suffer from some form of hearing loss. Vision changes such as cloudy or blurry vision, floaters, flashes, or sudden eye pain can be signs of minor or more serious vision disturbances ranging from presbyopia (inability to focus on close objects), to cataracts, retinal tears, and macular degeneration. Although cataracts are most common among the older population, anyone can experience a cataract. But what is a cataract and how is it treated?
A cataract is a clouding of the natural lens within the eye that can progressively affect one's vision. As a person ages, the proteins in the eye begin to deteriorate and cause the eyesight to become blurry. Cataracts develop slowly over many years, and many people do not realize they have them until late in life when their vision becomes increasingly affected. Most patients are affected between the ages of 60 and 80; however, many are affected as young as 40 years of age as well. Cataracts can even be seen in newborns and children. Cataracts can develop in both eyes or in just one eye and can be partial (affecting only part of the lens) or full (affecting the total lens). For babies and young children, a cataract diagnosis can be determined by the child not tracking appropriately by 3 to 4 months of age or showing jiggling eye movements. For adults, cataracts can cause the following:3,4
• Cloudy or blurry vision
• Decreased vision
• Double vision
• Light sensitivity
• Halos or glare around lights (especially during nighttime driving or the person having difficulty with night driving)
• Faded colors
• Frequent eye glass prescription changes
If you notice a patient is experiencing any of these vision symptoms, suggest they get checked for cataracts. When a patient has cataracts, the lens of the eye is positioned behind the iris and focuses light as the light passes through the eye to the retina. With a cataract, whether through age or genetics, the lens becoåmes less flexible, less transparent, and thicker where the proteins and fibers within the lens begin to break down and clump together, causing clouding of the lens. As the clumping becomes denser the cataract is formed, which then scatters and blocks the light as it passes through the lens. This clumping prevents a sharp, clearly defined image from reaching the retina and results in blurring of the vision. One eye may develop a cataract at a faster rate than the other, which can then cause a difference in vision between both eyes.3,4
There are several types of cataracts: nuclear, cortical, posterior subcapsular, and congenital.3
Nuclear cataracts initially may cause more nearsightedness (far away objects appearing blurry) or temporary improvement in presbyopia. However, over time, the lens begins to gradually become more dense and yellow or brown, thus clouding vision and causing an inability to distinguish colors.
Cortical cataracts begin as white, wedge-shaped opacities or streaks on the outer edge of the lens. As the cataract progresses, the streaks extend more toward the center, interfering with light entering into the center of the lens.
Posterior subcapsular cataracts, the fastest developing type, begin as small, opaque areas in the back of the lens directly in the path of the light to the retina. A posterior subcapsular cataract will interfere with a patient's reading vision, reducing vision in bright light, and causing glare or halos around lights at night.
Congenital cataracts are cataracts that a child is born with or that develop during childhood as a result of genetic issues, intrauterine infection, trauma, or rubella.
Anyone is suspectable to cataracts, however there are a number of risk factors:3,4
• Increasing age
• Diabetes
• Excessive exposure to sunlight
• Smoking
• Obesity
• Hypertension
• Previous eye surgery, inflammation or injury
• Prolonged use of corticosteroid medications
• Alcoholism
• Genetics
There are four predominant stages of cataract formation: early, immature, mature, and hyper-mature.5
The early cataract is the beginning stage of cataract formation with the lens remaining clear and the vision beginning to have an inability to focus between near and far, with slight eye strain and early light sensitivity. An immature cataract is when the proteins within the lens begin to cloud the lens making it more opaque, requiring anti-glare glasses and needing brighter lights to see clearly. A mature cataract is when the vision has significantly decreased where prescription lenses may not improve the vision and the eyes may appear milky. This is the optimum point of cataract surgery. A hyper-mature cataract is when the cataract almost completely obscures vision, resulting in a hardened lens. This hardening may make it more difficult to remove during surgery but yet without treatment can cause inflammation, increased eye pressure and resulting glaucoma.5
Cataract removal surgery is the best way to treat cataracts and is highly successful in restoring full and improved sight. The procedure is performed in an out-patient setting under local anesthesia with a mild sedative, and can take less than an hour.5,6 Cataract surgery can be minimal using laser assisted technology rather than surgical knives, although the incisional surgery is still used in some cases. As with any surgical procedure, cataract surgery does have its risks. The patient may be placed on a regimen of antibiotic and/or corticosteroid eye drops pre- and postoperatively, and an eye shield will also be given to the patient to wear during the first week postoperatively to protect the eye during sleep. The patient undergoing laser surgery is advised to rest the day of surgery and can resume normal activities within 2 to 3 days with some minor exceptions such as no swimming in order to prevent infection. Sunglasses are required when outdoors to protect the eye. Driving may be limited due to discrepancies in vision between the operated eye and the non-operated eye. Cataract surgery is only performed on one eye at a time with a several-week interval required between surgeries. Follow up appointments are as needed, and if prescription eyewear is needed additional appointments will be required approximately one month after the final surgery to allow the eyes to properly heal before making any necessary prescription adjustments. Insurance and Medicare usually cover one pair of new prescription lenses following cataract surgery.
Despite all of this, the gift of sight is irreplaceable, and patients will experience better quality of life following cataract surgery. As health professionals, dental hygienists can help educate patients about the alternatives available to improve their vision and quality of life. Patients will thank you for it.
References
1. Penn Medicine. About multiple sclerosis (MS). Penn Medicine website. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/multiple-sclerosis-ms. Accessed October 4, 2023.
2. National Institute on Deafness and Other Communication Disorders. Age-related hearing loss (presbycusis). U.S. Department of Health & Human Services, National Institutes of Health website. https://www.nidcd.nih.gov/health/age-related-hearing-loss. Updated March 17, 2023. Accessed October 4, 2023.
3. Cataracts. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/cataracts/symptoms-causes/syc-20353790. Updated Sept. 28, 2023. Accessed October 4, 2023.
4. Cataracts (age-related). Cleveland Clinic website. https://my.clevelandclinic.org/health/diseases/8589-cataracts-age-related. Updated March 7, 2023. Accessed October 4, 2023.
5. Stages of cataract symptoms - cataract progression. Progressive Ophthalmology website. https://www.thenewyorkeyedoctor.com/post/stages-of-cataract-symptoms.html. Accessed October 4, 2023.
6. Cataracts. Progressive Ophthalmology website. https://www.thenewyorkeyedoctor.com/cataracts-faqs.html. Accessed October 6, 2023.
