Uveitis itself and the use of steroid in treating inflammation mean that the development of cataracts in uveitis patients is common. In addition, if you are using glaucoma drops to control your intraocular pressure, some of these drops will accelerate the growth of cataracts.
Your doctor should tell you when the first signs of cataract are present, often referred to as early formation. This is not the time to panic because cataracts can develop slowly in many uveitis patients, and at first, you may not notice any difference at all in your sight.
When you do notice a difference, it is worth asking your doctor if glasses, or a change in your current prescription, will be helpful. As the cataract continues to develop, changing a prescription becomes less helpful.
Visual effects of Cataracts
As a cataract develops, sight is affected and you may experience some of the following:
- Visual acuity reduces and text begins to blur.
- Colours start to fade and you may not be able to see light green and blue.
- Halos appear around lights.
- You are troubled by glare and have trouble seeing into a low sun.
- Double vision may occur.
- A yellowish/brown tint may be seen on light colours, especially white.
This simulation shows how a cataract patient sees the world.
If your cataract surgery is delayed, there are some techniques which will help you make the most of the vision you have. For close work, try using an angle poise lamp to direct light onto whatever you are looking at. This should make it easier to read and work. Drawing curtains to block out other sources of light also helps. Grey Polaroid lenses help reduce the glare from artificial light in offices, shopping centres and supermarkets, but check that this will help you before you buy. (High Street opticians will often let you try these free). Changing the contrast settings of a computer and enlarging text will also help. Many find black on yellow provides the best contrast.
During the time the cataract is growing, your doctor will be keeping a check on your visual acuity and when the cataract is about to, or has started to affect your lifestyle, for example, school work or driving, cataract surgery will be discussed. Your doctor will tell you how the cataract will be removed and how the new lens will be put in. A model eye may be produced.
Artificial lenses for uveitis cataract patients tend to be fixed focus lenses, which means you will need glasses afterwards, either for reading or for distance, depending on which fixed focus you chose. Most patients choose to have their fixed focus lens a distance lens. Multi focal artificial lenses are available to cataract patients, but there are certain conditions including if there are retinal problems, when such lenses are unlikely to be considered.
For surgery to have the best chance of a successful outcome, the eye should have been free of inflammation for at least three months. Surgery is done as an outpatient procedure and for adults, most operations are performed under local anaesthetic; children will be given a general anaesthetic.
Before surgery, you will have measurements taken of your eye and it is common to use eye drops, take oral steroid, or receive a pulse of steroid immediately before the surgery. The steroid is needed to reduce the chance of the eye reacting badly to surgery and flaring post operatively. After surgery, the eye is protected with a dressing, and you are given an eye guard to wear when you sleep. This is designed to protect the eye from being touched, or knocked, whilst tossing and turning when asleep.
The next day, the eye guard will be removed and most will have the pleasure of a world back in focus and vibrant colours. Eye drops will be given and it is very important that they are used as instructed to prevent infection, control eye pressure and prevent inflammation.
There will be regular check-ups in the weeks to follow and you should be given a number to ring if there is a change in visual acuity, you think your eye is flaring, or you think infection is present. It takes a few weeks for the lens and eye to settle and while it is not worth getting new distance glasses during this time, it may be helpful to buy some cheap, over the counter reading glasses, if your IOL is for distance.
Some patients will have post-operative complications such as inflammation, the development of cystoid macular oedema and problems with intraocular pressure.
Younger patients (includes those in their fifties!) have an increased chance of their artificial lens becoming clouded (opacification). This is sometimes called a secondary cataract. It may begin developing from about six months after surgery, or may take years to happen.
It is treated by YAG laser in an outpatient setting. The doctor fires the laser into your eye, and all you have to do is sit still. It’s entirely painless and is over in minutes. Afterwards, you may find your vision is filled with the debris that has been lasered off the lens, but in a few days’ time, this settles and you enjoy clear vision again.
These links take you to more detailed information:
- Of interest to parents – Outcomes of cataract surgery in children with chronic uveitis (Quiñones K et al, 2009)
- See the reference made to JIA uveitis made in the article Cataracts and Uveitis (Jancevski & Foster, in Discovery Medicine, 2010)
- JIA uveitis article with a section on cataracts (Sampson, Juvenile Rheumatoid Arthritis associated uveitis, from The Ocular Immunology and Uveitis Foundation website)
- Fuchs Heterochromic Uveitis: Treatment & Medication (Mansoor, 2010 from ‘Emedicine from WebMD’)
- Article on Cataracts and uveitis from Bright Sight website
- A clear explanation of Cataracts and Cataract Surgery from Patient UK
Search the archives at OSN SuperSite, a resource for ophthalmology professionals, if you wish to see videos and learn everything there is to know about cataract surgery (registration required)