Factsheets Cataracts and Eye Surgery

What is a cataract ?

A cataract is the clouding of the part of the eye called the lens. Vision becomes blurred because the cataract is like frosted glass, interfering with your sight and preventing light reaching the back of the eye.

There are two types of cataracts that affect vision –

• Congenital cataracts (also known as ‘infantile cataract) 

  • These are cataracts that people are born with, or acquire in early in life.  They prevent light reaching the back of the eye and stimulating the nerve endings in the part of the eye called the retina, and parts of the brain which help us to see.
  • Most children will have had this problem identified when post-natal health checks are carried out and if needed surgical treatment will be considered.
  • Before people were routinely considered for cataract surgery the cataract would not always have been removed, and resulting problems could occur as vision develops.

• Senile cataracts

  • These can occur at any time in life and to most people in the population.  However, commonly in the population this will be after the age of sixty, and associated with conditions of ageing.  It is important to recognise that people with learning disabilities and especially people with Down’s Syndrome can and do experience these conditions much earlier in life (typically late thirties onwards).

What are the signs to look for?

The appearance of eye:

• In the most advanced cases of cataracts the centre of the eye (the pupil), will be appear to be coloured white.
• In a health eye when pen torch light is shone at eye, the pupil will get smaller to stop light entering the eye.  If the eye is healthy, this reaction will only take a few seconds.  If a person has a cataract or other eye disease the pupil may stay the same. 

Behavioural changes:

• People with cataracts often dislike bright light.  They may:  
  • Shield their eyes in bright sunlight.
  • Be reluctant to go out when it is sunny.
  • Hold on tightly to supporter when previously able to walk unaided.
  • Draw curtains when indoors.
  • Turn off lights when indoors.

•  People with cataracts may display confused behaviours.  They may: 
  • Regularly put things down and not be able to find them.
  • Regularly rub or wipe their eye.  This has been described as trying to wipe the mist away.
  • Inability to recognise familiar faces. 

It is important to recognise that some behaviour associated with the onset of dementia could also be attributed to developing sight loss.  People with Down’s syndrome are more prone to dementia and certain eye conditions such as cataracts, earlier than the general population.  If it is suspected that a person may have a dementia related condition, it is important that they get their eyes tested.

• People with cataracts may display withdrawn behaviours.  They may:
  • Be reluctant to engage in activities they previously enjoyed.
  • Be reluctant to engage in activities that requires good sight.
  • May withdraw to a quiet area in the day centre or at home, when previously very sociable.
  • May withdraw or refuse to take part in familiar journeys.

Even if person is waiting for corrective surgery there is a lot supporters can do help in the meantime.

• Problems with bright light
  • Wear a hat or sunglasses
  • Use blinds indoors to reduce bright sunlight
  • Use paper globe lamp shades and dimmer switches, so individual can control artificial light in home 

What happens next?

• Make sure the person concerned receives an up to date eye test at the optometrist. 
• When an optometrist has been diagnosed with cataracts, the person will be referred to their local eye hospital to see an ophthalmologist.  The referral is usually made via their GP, following recommendation from the optometrist.  In some cases an optometrists may refer you directly to the eye hospital.  It usually takes about 3 months to get an appointment at the eye hospital.   
• Some people will be told that they have only early signs of cataracts and do not need to go to the hospital yet.
• This is usually because the optometrist does not think the cataract is causing significant problems to vision that cannot be corrected with glasses. It is important that this information is still
  •  Highlighted in their Health Action Plan
  • That they continue with regular eye tests.
  • That if behaviour changes this may be sign that vision has deteriorated, and would be a good idea to ask Optometrist or GP to now refer to local eye hospital.

June 2009 

Related information:

Adapting Accomodation for people with Learning Disabilities

Consent to Medical Treatments

The Need for an Eye Examination

Eye Poking and Touching in People with Learning Disabilities

Eye Poking and Touching - Strategies and Supporting People 

Glaucoma

Keratoconus

Recognising Eye Problems in People with Learning Disabilities 1

Recognising Eye Problems in People with Learning Disabilities 2

Supporting People to use their Sight Effectively

Taking Action on Eye Problems

Treatments and Interventions for Keratoconus Part 2

Treatments and Interventions for Keratoconus Part 3