Knowledge and perception of cataract treatment
Johnson & Johnson Vision’s survey shares that half with cataract symptoms have not had cataract surgery are afraid of undergoing surgery.
Earlier this year, Johnson & Johnson Vision initiated a survey with Censuswide to understand the knowledge and perception of cataract treatments in Singapore. It found that half of the respondents with cataract symptoms who have not had cataract surgery are afraid of undergoing surgery and are concerned about the potential complications.
On the flip side, those who had the surgery, shared the benefits, with nearly 80 percent reporting they are able to carry out daily activities seamlessly and 63 percent indicating they are travelling and engaging in social activities more independently.
In total, 500 respondents, aged 40 to 70 years old, participated in the online survey.
Other key takeaways from the survey:
- 64 percent or 101 of respondents who had experienced cataract symptoms indicated a high-quality continuous range of vision (CRV) as the most important feature when considering lens options for cataracts yet only 30 percent of all respondents know about CRV lenses.
- 57 percent or 283 of respondents indicated that their doctor’s recommendation is what would motivate them to seek out CRV lenses.
- Nearly half (240) of respondents experience presbyopia symptoms and a third (157) experience cataract symptoms.
- 80 percent or 126 of respondents who have experienced cataract symptoms have been diagnosed with cataracts.
- 38 percent or 10 of those with cataract symptoms have not undergone cataract surgery as their eye doctor has yet to recommend it to them.
- Although nearly half or 240 of respondents knew about bi-focal lenses, 30 percent or 152 did not know of any intraocular lenses available to aid their vision. Only 30 percent of all respondents know about CRV lenses.
Ageless Online talks to Dr Yuen Yew Sen, consultant in the Department of Ophthalmology at the National University Hospital and assistant professor in the Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore about the survey and cataracts:
Can you share your thoughts on the J&J survey and its findings? A concerning issue is finding that 38 percent who have cataract symptoms have not undergone surgery as their eye doctor has yet to recommend it.
Before deciding to proceed with cataract surgery, there are a few factors to consider. The mere presence of a cataract alone is not a reason to undergo cataract surgery. Indications for cataract surgery would consider not just the symptoms of blurred vision that patients have, but also whether the blurring is significant enough to affect their quality of life, daily activities and occupation. For example, commercial drivers (e.g. taxi/lorry drivers) may require cataract surgery earlier to retain good vision in both eyes to meet LTA’s visual requirements to drive.
Another factor that we consider is the patient’s best corrected visual acuity. Generally, if the patient still has reasonably good vision, e.g. 6/9, we tend to recommend holding off surgery if the patient is not very bothered by their vision. However, in such patients, if they have other significant visual symptoms such as significant glare symptoms in bright light or at night, early cataract surgery can be considered.
Ultimately, the management of a patient’s cataract must be individualised, and it is important for them to work with their ophthalmologist to customise the treatment plan for themselves.
I also see that half of the respondents are concerned with the surgery as they are afraid and concerned about the potential complications. What are some of the concerns that people usually express?
It is understandable that patients are concerned about potential complications of surgery. However, as mentioned previously, once the patient has a visually significant cataract affecting their quality of life, they should be encouraged to balance their fear of rare surgical complications versus the significant benefits of cataract surgery.
A common concern is whether they will feel pain during surgery. In general, cataract surgery is typically painless due to the anesthetic drops used for surgery. During surgery, our patients are usually awake and reasonably comfortable, albeit a little bit anxious which is to be expected. They do not usually see the instruments coming close to their eyes and most patients describe just seeing a bright light and some shadows during the surgery.
They are frequently surprised at how fast the surgery can be and how painless the experience is during surgery. In fact, it is not uncommon for a patient to feel anxious and scared before the surgery only to ask us immediately after the surgery is done when they can do the other eye as they find the experience not quite as unpleasant as they imagined.
Complications during surgery can be managed well and still give patients good vision after cataract surgery.
What are cataracts? What causes it? What are its symptoms? Is there a link between presbyopia and cataracts?
Cataracts manifests as a gradual clouding of the lens in your eye – it is most commonly caused by ageing, with those aged 40 and above at higher risk. Typical symptoms of cataracts include:
- Cloudy or blurry vision
- Colours looking faded
- Poor night vision
- Lamps, sunlight or headlights seem too bright
- Haloes or glares around lights
- Frequent change of prescription for glasses
While age-related cataracts are the most common, there are also atypical types of cataracts including traumatic, radiation, pediatric and secondary cataracts.
It is linked to presbyopia, the diminished ability to focus on near objects, with both conditions developing as the natural lens in our eyes deteriorate as we grow older. Cataract surgery has the potential to correct presbyopia as well.
Who is at risk?
The risk for cataracts increases as you get older, thus the elderly is at most risk. However, smoking, excessive UV radiation exposure, poorly controlled diabetes, taking certain steroids and a predisposition to cataracts can also increase your risk in developing cataracts.
Singapore faces a high prevalence of cataracts that is projected to increase with an ageing population. Managing eye health and age-related conditions such as cataracts is crucial, to ensure patients receive the best visual care possible to enjoy their golden years independently and carry out everyday tasks with confidence.
In Singapore, nearly one in five citizens is over 65 years old and the prevalence of cataracts in this age group is high, with 70 percent of those 60 years old and above suffering from the disease. Furthermore, cataract cases are projected to increase by 1.33 million by 2040.
How can one prevent it?
There is no absolute way to prevent cataracts, however, you can reduce your risk or delay the progression of the disease by the following means:
- Protect your eyes from excessive sunlight and injury,
- Quit smoking,
- Eat a balanced diet,
- Limit alcohol consumption,
- And most importantly, go for an eye check-up if you have any visual symptoms.
How can a doctor check for cataracts?
Cataract screening can be done by your general practitioner using an instrument called a direct ophthalmoscope. Subsequently, if significant, a formal complete assessment can be done at any eye clinic. At the eye clinic, an ophthalmological assessment is performed not just to assess for the presence of cataract, but also to determine if there are other ocular issues to be managed such as age-related macular degeneration or glaucoma.
Frequently, a dilated eye exam will be performed as part of your assessment. The procedure is straightforward and painless – you will be given eye drops to dilate your pupil for your doctor to examine your eye. However, the dilating drops will cause your vision to be slightly blur with greater light sensitivity for two to three hours and it might be helpful to bring along a pair of sunglasses when you visit your ophthalmologist.
What are the treatments?
Mild cataracts can sometimes be managed by changing one’s spectacle prescription. However, if the cataract is visually significant, surgery is the only way to permanently remove it. During cataract surgery, the doctor replaces the clouded lens with an intraocular lens (IOL), more commonly known as an artificial lens.
Let’s talk about intraocular lenses – what are they and what are the different types? Are there possible risks of IOLs? How long do these lenses last? Do you still need glasses after?
First, we must understand that patients have three working distances that they need – far/intermediate/near. In real-life, far vision will be used to watch the television, intermediate to view a computer screen and near to use their handphone.
In general, there are three categories of lenses with various requirements for spectacles after cataract surgery.
- Monofocal lenses allow you to see far clearly but you need spectacles for intermediate and near.
- Extended depth of focus or EDOF lenses allows clear vision for far and intermediate, but you need spectacles for near.
- Multifocal lenses are generally clear for far/intermediate/near.
However, there is no perfect lens. The nearer you want to see without spectacles, the more you must sacrifice a bit of distant vision contrast and brightness as well as experience more glares/haloes. This is due to the inherent design of the lenses where the EDOF or multifocals have rings on them to help focus the light nearer and these rings contribute to the glares/haloes/loss of contrast.
Another issue with multifocal lenses is that patients will need a period of adaptation because for intermediate and near reading, vision tends to be clear only at fixed points and the patient will need to get used to finding these points to utilise their intermediate or near vision.
In recent years, there have been some interesting developments where the EDOF lenses have few or no rings which could potentially reduce the glares, haloes and contrast issues theoretically. Newer developments in multifocal technology have also purportedly reduced the blur between the focal points to allow patients to have a continuous range of vision (CRV) from far to near.
Patients who have significant astigmatism can also have this corrected during cataract surgery using the intraocular lens (also known as a toric intraocular lens). Toric versions of lenses are available for monofocal, EDOF and multifocal lenses. As compared to spectacles which need changing every few years, IOLs do not need to be replaced.
Can you share what happens during a cataract surgery? Is it considered day surgery?
Cataract surgery is typically a day surgery procedure. The surgery is usually done with just anaesthetic drops instilled on the eye and patients are usually awake. However, as mentioned previously, surgery is usually painless and patients will usually see some bright lights and shadows during the surgery. After surgery, they will need to instil some antibiotic and anti-inflammatory eye drops into their eye and attend post-operative reviews in the eye clinic.
What happens after surgery? Will vision return to normal after the surgery?
Following cataract surgery, patients can expect improved vision and quality of life. Other eye problems such as presbyopia and astigmatism may also be corrected through cataract surgery using intraocular lenses as elaborated previously.
Patients may feel itchiness and sensitivity to light for a few days following surgery, however, they can typically go back to low-impact daily activities – with the exception of driving – after 24 hours. Most patients completely heal within a month.
How much does surgery cost?
Surgery cost varies between different institutions. Patients should speak to their doctors to find out more about cost.
Can you share any advances of technology in cataract surgery?
Surgical equipment technology continues to advance over time with the newer addition of options such as laser-assisted cataract surgery, computer-assisted cataract surgery, and newer cataract surgery machines offering improved efficiency and safety during surgery. These options would best be discussed with your ophthalmologist when planning your cataract surgery as each surgery is customised to your individual eye.
With regards to intraocular lenses, there are novel advancements in lens technology, including lenses that can provide improved clarity between far, intermediate and near distances (CRV lenses). Seeing seamlessly through near and far distances allows the benefit of carrying out daily activities comfortably, including driving or reading Asian scripts in low-light conditions. The survey commissioned by J&J Vision on 40- to 70-year-olds in Singapore found that more than 60 percent consider high-quality CRV as the most important feature when considering lens options for cataracts.