If I had known these were cataract symptoms - I would have pushed harder for them to diagnose and treat them. But, it took me nearly two years of rapidly declining vision, among all of the other anxiety-causing and terrible upheavals in my life, for them to finally 'see' that problem. And now, after all that time, I am reading my screen again without a magnifier - and with black text on white background.
The signs I missed (and they did, too)
Everything seems dark or dim - even when you have the lights on! You seem to need to a lot more light for everything, and especially direct or 'sweet spot' light on what you are doing. Going outside is amazing, things are sparkling beautiful colors, but as the months progress - it produces a 'London Fog' type effect that makes it very hard to see long distances.
Anxiety - You have a definite sense something is wrong, but you probably ascribe it to other things. You probably have been adapting to doing things differently, but your body knows something is up, even if you're ignoring it.
Small text was hard, and now is nearly impossible. Up until now, your closeup vision has been what is mostly affected, but you're getting older, right? It should be 'natural' in your thirties or forties to need stronger and stronger glasses to see small text. But, every three months or so your prescription isn't good enough, anymore. You need magnifiers over your glasses or small magnifying glasses to see phone numbers, mail and magazines. You didn't need these last year - and even bifocal glasses only help at some distances with 'most' type. You may feel depressed, or incompetent, or both. Everything has gotten harder, paying bills, reading recipes, checking receipts, cleaning up and sometimes when you set paperwork down on the desk or table you have trouble finding it later without looking closely at every item.
Clear shapes in your vision: The one that confused my ophthalmologist the most? I was complaining of these 'clear overlays' like patterned glass that would show up in my vision. Some people might call these artifacts - but they are not the typical type. They were not 'floaters' or strands of white blood cells like most people describe. These were bullseye patterns, small triangles, bumps and circles like pixels that would appear and then 'travel' with my gaze across my line of sight. They would be there worse in some lights, and disappear in others.
Polarized or Fishing sunglasses help some : I would put on polarized glasses towards the worst part here and the London Fog would diminish a lot. I couldn't see a person on the other side of the room before I put them on, if fluorescent lights were on overhead. The polarization stops certain wavelengths of light from getting to your eye, which cuts down on the interference overall. But, those clear overlay patterns were STILL there. That was because they were caused by light reflecting wrong inside the eye, through and bouncing between the separated layers.
You want Dark Mode for everything, even in the daytime. Dark mode on facebook and tablets and readers helps SO much - you can read small type in white on black background fine, but not the other way around.
Night Driving is difficult or impossible: Every car that drives by in the opposite lane fills your eyes up with the headlight glare, and it doesn't go away for several seconds. You find yourself having to slow down for every oncoming car, and/or weaving off the road and missing turns.
Streaming Eyes : Your eyes seem dry a lot, but then at other times they stream for no reason.
partial Double Vision : You may see 'double vision', partial double vision, or one and a half vision, especially when focusing at near distances but not far.
You keep getting a new prescription, but it only lasts a few months. It gets worse and worse as the months progress
I was diagnosed with posterior subcapsular cataracts (PSC) in January, after noticing changes for more than a year, and only getting new glasses which failed the solve the problems. I was told they are VERY hard to see, and if they aren't thinking that is the problem, they might not look for them in the right places under full dilation.
They can also progress VERY fast. At the beginning of the year it is just a magazine that is difficult but possible with a magnifying glass. By the end of the year you can't see yourself in the mirror (but can still see the road to drive, but not read the street signs or exit signs!) or read your own handwriting or phone screen.
They are becoming much more common in younger people, but the medical profession has not yet started looking for them as routine in these age groups.
What Causes This?
They can be caused by diabetes, genetic conditions (like collagen disorders, yay me), any condition that causes excess inflammation or has trouble with healing, those that have been regularly prescribed steroids for lungs or other conditions, or the result of head, eye or face trauma. They can also be caused by lots of UV exposure, stress or past alcohol abuse. Put any of those together and it increases the risk. It sounds like they're still sorting out what 'really' causes it, and how to identify it early - but a little knowledge to the public can only help.
The layers of the back of the lens get separated for some reason (you might not even register it as a real injury or think 'I'm fine' - because this takes months to years to develop the initial condition, and then it begins to grow & change exponentially after that like a nick in a windshield that one day begins to crack all the way across...), and the cataract forms as a 'bubble' in between these layers, in the back inside of the lens, where the problem can only be seen 'through the axial lens'.
But - won't I know? It's obvious, right?
It's invisible to the naked eye, and hard to find even under dilation by the eye doctor. So, no, you probably won't know, and their job is to get you glasses - so that is what they will try. One of your first signs in the office will be that the little floating balloons or Aladdin swirling lights machine - the spectroscope - will try and fail to get your prescription. Your ophthalmologist may or may not say anything at all about it, or may brush it off - 'that's weird, this never happens', 'you can't trust the machine, it's just there to get a basic reading', etc. That machine works by bouncing light into your eye and measuring how fast and at what angles it comes back to measure the shape of your lens. If your lens has bubbles or clouded areas in it that is not going to work as expected.
So, how does your Ophthalmologist recognize it early?
If you see these symptoms listed above, you need to tell them, or they'll just keep up with glasses until they can't match you up any more. Enough warning signs, we hope they will look, but nowadays everybody is in a rush and they have to have enough reasons to look and check everything. That is what finally alerted them that I had a 'real' problem. The vision machine - spectroscope - could not read the worst eye. The problem was already progressed quite a bit, but at that point they still hadn't identified it.
They failed me on the vision machine with the floating balloons twice. I failed the reading test in the chair as well. Then - they gave me another dilation and looked hard and detailed at my eye, and found the problem after looking back and forth through the lens across my optic nerve and cornea for several minutes checking and rechecking. This occurs on the inside back of the lens and can only be seen by looking at the 'axial' or side of the lens and realizing you are seeing the problem in the lens - like a spot on your glasses when you keep trying to wipe your computer screen.
After seeing this finally, the eye doctor referred me to the specialty clinic, which also had to go through all the same things, including the spectroscope confusion. But, the specialist doctor knew what he was looking for, any and all types of cataract. As a note, there is a cataract in my OTHER eye, as well, but not as large, and they were still able to get prescription on that one.
Why does cataract surgery fix it?
I was a bit pessimistic, after all this, that it wouldn't be entirely fixed. I thought the overlays would still be there, because they were there even with the polarized glasses. But they remove the entire lens, and replace it with an artificial one. This problem is in the bottom inside of the lens- if it was a plastic cereal bowl and you placed it upside down on your counter, it would be a separation in the layers on one side near the countertop, flaking upwards. They remove all of that - not just the top section of the lens, and put a new 'fake' lens in, that reflects light properly.
Will they come back?
Once upon a time, I've been told, they used biological lenses, donated from cadavers to replace the lens after cataract surgery. These lenses were susceptible to the same stresses, fractures and cloudings as the original lens you were born with. So yes, THEN they did come back. Now, with artificial lenses, they should not come back. But, you do have to protect your eye from UV much more with an artificial lens, to protect your retina from macular degeneration. The retina is in the back of the eye, and with improper diet, dry eye or blocked eye drainage or other genetic conditions, it can be damaged even more by UV exposure after cataract surgery. This is why most people after cataract surgery will continue to wear sunglasses outside whenever possible.
Will I still need glasses?
Maybe. But they won't be able to tell until a week to four weeks after your surgery, because the new lens has to settle and your focusing power (your eye bends the lens to see near or far) will be different for each person. Once your eye has settled, any prescription you get should be the one you will have the rest of your life.
The outcome for me:
With the cataract gone from the left eye - I am reading with no glasses at all, and I only did the basic replacement because of insurance, not the fancy ones. The ever-stronger prescription in my glasses was not because of 'age' only - as we often think of it - but because the specific cataract type disrupting the light reflecting in my lens. Cataracts can come with age, but this type specifically can hit anyone of any age, if the conditions are correct.
I've tried to hit as many of the keywords and search terms as I can in my text that I was looking for when I was going through this problem in the beginning. Maybe, it will help someone. If I could go back to the 'everything is dark - turn on the lights' stage and whisper into their ear - it might be a posterior subcapsular cataract.. I would. I would definitely tell myself it wasn't that I was suffering from depression and anxiety - my dad had just died, I had quit a soul-sucking job .. all of that -- But I wish I had known it was possible that it was a physical problem with my eye, and it needed to be taken care of.