Causes of early onset cataracts ?

Hello Vicky

Sorry I did not check this thread for so long !

Metabolic sister ... ? 

I'm not aware of any other particular symtoms. Not diabetic, I get bloodwork done often. Nothing showing up concerning my liver either.

I do get random joint pain, sometimes even seems like bone pain. It comes and goes. My mother has recently diagnosed with fibro, I don't know if I may be experiencing early signs of that... It's still very unkown as an illness.

What exactéy do you mean by neuro signs ? 

Your answer has sparked my attention, I hope you're still around to answer me !

 

My mistake about post being dormant - just saw reply by Dennis.  I DO need my eyes taken care of!

My left eye was done in september 2014 so a while ago now ! 

The surgery was a success, my eyesight is considered very good. I chose a farsighted lens implant to match my right eye. I am now quite handicapped when it comes to near sight, I have prescription glasses which are focused exactly at computer / desk distance for my studies but anything closer I'm pretty much blind. Which is very frustrating.

I also need a lot of light to see properly.

My astigmatism has gotten worse and so I can't recognise faces from a distance anymore, they have to be within 5m of myself.

I used to enjoy photography but I don't so much anymore. Being unable to ajust any one of your eyes' focus puts a damper on things ^^

But I should look on the bright side, my Dr. said he rarely sees such good results in his patients and that's down to my young age.

Being at Uni all day gives me horrible headaches from looking over my nose at the prof.'s powerpoint presentation to my notes with my glasses. 

But I've always had sight-related headaches so nothing new :P

I'm assuming both your lenses are monofocals. I don't know if you've ever tried contact lenses, but they make multifocal contact lenses that are mostly intended for people with presbyopia but presumably should work for people with monofocal IOLs as well, including toric multifocals that correct for astigmatism. Unfortunately multifocals split the light between focal points so they do reduce vision in dim light a bit, which may be a problem if you already have complaints about needing a lot of light. I wore them for presbyopia before I had cataracts and was happy with them, but I didn't have IOLs. You could also try regular single focus contact lenses that set your eyes for monovision, one eye adjusted closer in to improve near vision. 

If you like monovision, they can also use laser surgery to adjust your eye's permantly that way. Laser refractive surgery, or a surgical incision (blade or laser), can also correct your astigmatism.  I don't know which country you are in (many products aren't yet approved in the US but are elsewhere) but there are also new products called corneal inlays, lenses inserted just under the surface of your eye, that are meant to provide more near vision, like the Kamra (US approved, but might reduce low light vision) or Raindrop (not yet US approved, but less change of reducing low ligh vision). They were designed for people with presbyopia, but have also been studied for people with monofocal IOLs. 

I'm wondering if from your description if you just have single focus glasses, you've likely already heard about this since they are far more common than multifocal contact lenses, but just in case you hadn't heard of them,  you could get progressive glasses to see at different distances. There are a variety of designs that provide a different amount of space for far and near distances depending on what your daily tasks are like. 

In terms of the original topic of this page, unfortunately usually they can't determine the cause of a cataract. I'm guessing they ruled out the most common and easily checked possibility of diabetes, and often they can tell if a cataract is due to trauma.  In my case I had a problem cataract diagnosed at age 49, far older than you, but still far younger than typical, and I haven't a clue why. My vision degraded to best corrected 20/60 within a few months, though I put off surgery for 2.5 years since my other eye still had good vision. It only had a trace of cataract but I decided to get both eyes done at the same time. (Symfony extended depth of focus IOLs  so I can see far, but also  read my smartphone without glasses).

Symfony, but not here in the US of course since the FDA has not yet approved . Are you happy with your choice ? Anything lacking ? 

I think the Symfony was the best choice for my needs, but of course people's needs vary.  I traveled from the US to Europe to get the Symfony in December 2014 (its since become available in Canada and Mexico, including a clinic walking distance from the San Diego border, a bit more convenient for those in the US). There are guesses it might be approved by the FDA within the next year, but no one knows for sure.  I figured since I may live with the results for another few decades that it was worth some hassle to get a better lens.  I'd postponed surgery before that in hopes the US would approve a better lens, and had initially planned to travel to get a trifocal if they didn't, and then when the Symfony came out just before I finally decided I had to bite the bullet and get surgery, so I decided to go for that. As my usedname implies, I'm a software developer and so I use intermediate distance many hours a day at a desktop computer.

At the time the only multifocals in the US were high add bifocals which weren't as good for intermediate, and the Crystalens which risks not accommodating and doesn't provide as good near as the trifocals. I decided on the Symfony since its a better bet for good intermediate than the trifocals, and intermediate is useful for social distance, household tasks, finding footing when running/hiking on trails, etc. It also has a low risk of side effects like halos comparable to a good monofocal, and so I figured that also made it a better bet than a trifocal.

Sometimes I am curious how a trifocal might have worked since they might provide a bit better near vision, but I can read my smartphone without correction so pragmatically I don't really need better  near most of the time for anything. I've needed reading glasses to thread a needle, but I suspect that would have been the case with trifocals as well, and I figure any tasks where I do need readers are most likely just going to be at home or office where I can keep some. (though I've noticed some foldup readers that will fit in a pocket, but I haven't felt a need to bother). Of course results do vary, a small percentage of people with the Symfony do need readers, but fewer if you use a little bit of monovision, like -0.5D, which isn't enough to have much impact on stereopsis. Since I was highly myopic, the lens power formulas are more prone to error and I wound up +0.5D in one eye (plano, 0D, in the other), and might consider a laser tweak to -0.5D instead someday, but hadn't bothered exploring the option yet.

The low add bifocals now available in the US likely provide fairly decent intermediate, and a bit lower risk of problematic halos than the high add ones, but  not as low as the Symfony. I am in the small minority that see halos with the Symfony, but they aren't problematic since they are so mild that they are translucent, I see through/past them, and because my night vision overall is better than I can remember it being in the past even before my cataract (I always tended to feel my night vision left something to be desired). 

Hi! Stephanie. My daughter diagnosed also with cataracts and she's 23 years old. How your doctor advise you about this? We went to 2 different doctors and they have the same test result. Now we are referred to another specialist which is a private hospital. Where do you live though? The doctor said that in a private hospital, they have the latest equipment to deal with this case. For young people like you and my daughter, the cataract is not solid. Its liquidy and when they will open the eyes it can cause to spread all over the place and the governemnt funded hospital here don't have the latest equipment for that. We live here in Canada.

Hi Carmen, unfortunately I wasn't given any advice. I was told this by my eye doctor when I went for an eye check, who said that there is nothing that can be done for me at my age as they are not severe yet and no doctor would touch someone of such young age. I live in England, and I may try to get referred to a specialist as I wasn't told very much about them, they were sort of brushed under the rug!

re: "no doctor would touch someone of such a young age"

That is a bit misleading, they do cataract surgery even on infants with congenital cataracts. The issue I suspect is likely really that you say "they are not severe yet" since in most places governments and insurers don't cover cataract surgery until the eye's best corrected vision impairs driving ability, e.g. in the US that is worse than 20/40 best corrected vision. Some places are becoming more flexible so they will cover sugery if the cataract is interfering with everyday activities even if best corrected vision is still 20/40, for instance if the cataracts are causing night vision problems that make night driving unsafe. 

Often cataracts take several years, even a decade or more, before they impair vision enough that people decide to get surgery. However that varies quite a bit, and I think some young people may be more likely to have rapidly developing cataracts. (as I noted in a post above, my vision in one eye at age 49, which is still decades early for a problem cataract, went from best corrected 20/25 to 20/60 within 3.5 months or so).

The prior post saying "young people like you and my daughter, the cataract is not solid. ... it can cause to spread all over the place" is also off track, I don't know who would have told someone that.  There is no such difference between cataracts when old or young.  A cataract is a flaw in the natural lens, and all cataract surgery is doing is removing the natural lens (which includes the cataract) and replacing it with an artificial lens. 

 As a cataract becomes worse (at any age) it causes the lens to harden. A few decades ago they needed to wait for cataracts to become come very mature (and vision very bad) and hard before they would remove them. These days with modern surgical techniques it is actually easier to remove the lens before the cataract becomes mature and hard. If they wait until it becomes too hard (which almost never happens in a developed country because people's get the surgery before their vision gets that bad), it can stick to the capsular bag that contains the lens, and removing it is more likely to risk tearing the bag. They prefer to leave the bag intact and place the artificial lens inside the bag for the best results. 

The major concern with cataract surgery for a young adult is the loss of near vision. At your age, your eye can change focus from distance to very near when muscles inside the eye change the shape of the natural lens in a process called "accommodation". As people get older, their lens isn't able to change its shape as much. Somewhere around early to mid forties people discover that if their eye is corrected to see well at distance, that their eye can't change focus to see well enough at near to read. That is why older people start needing reading glasses, or bifocals or progressive/varifocal glasses (which have different strengths depending on where you look through the lens).  

The usual artificial lens used for cataract surgery is a monofocal lens, and  unlike a natural lens it won't change shape to change focus. If your eyes are set to see well at distance with a monofocal lens, then I'd heard a typical expectation is that things will start to get blurry from 6 feet (~2 meters) or so and closer in without added correction. The range of distance you can see without your eye changing focus is the "depth of focus", which does vary with the person. A tiny minority of lucky people have  eyes with a larger depth of focus and can even do some reading with monfocals set for distance, but people shouldn't expect that. 

There are a variety of premium lenses (paid for out of pocket) that will provide a larger range of vision and can often let people see well both near and far so they don't need glasses for most tasks, but not as close in as someone in their 20s (e.g. they might still need readers for threading needles or other really close up tasks), and there are some tradeoffs (e.g. some have a small risk of halos&glare at night), no replacement lens is perfect yet. In my case I went with the Symfony lens for both eyes,  which left me with 20/25 vision at  my best near distance. e.g. I can read my smartphone, the fine print on eye drop bottles, etc., but I couldn't thread a needle without reading glasses. They are inventing better lenses all the time, so the longer you hold off on surgery, the better lens you can get.

They can also use what is called monovision with a monofocal lens, setting one eye to focus well at distance and the other to focus well a bit further in to provide some reading vision. With only one eye doing the work at each distance, there is some loss of stereopsis, 3D perception, but most people don't notice it or get used to it, and the amount lost depends on how close in the near eye is set. 

Most people with cataracts are old enough that they already have needed to deal with reading correction. I suspect surgeons don't like dealing with younger patients since they are less likely to be happy with the results since they aren't used to having concerns about near vision.  When you need to get cataract surgery, the intent is to pick lenses that you may need to live with the rest of your life. However it should be possible in the future to replace the artificial lens with a newer model. Any surgery like that caries some risk, but overall its a safe surgery and getting safer all the time. I'm hoping in a decade or two I can upgrade the lenses for newer ones that'll leave my visual range   more like it was when I was 20.. and perhaps eventually one with a computer(/phone/TV) display built in :-)

 

I'm in England and was diagnosed with a cataract on my right eye three years ago, at the age of 48, and just a blurring at the top of the lens of my left eye.

Nothing could be done as they weren't severe enough to be operated on.

Now both my eyes are much blurrier, i'm terrified of having the operation, and in the UK on the NHS they only issue basic IOLs, i'm really concerned i won't be able to see my Smartphone or computer !

I'm particularly gutted as i had extremely excellent all round vision before this, now the cataracts have made me myopic !

Unfortunately I think pretty much all government health plans and insurers only cover monofocal IOLs currently (or at least almost all, I haven't heard of an exception but perhaps one exists). 

I'm guessing you must have been wearing correction for reading by your age: readers or bifocals or progressives/varifocals? You have that option after cataract surgery with monofocals. Or you can try multifocal contact lenses which give you a wider range of vision.

If you don't wish to pay extra out of pocket to consider a premium lens, then the thing to consider is monovision, having one eye adjusted for distance and the other for a bit nearer in. Your brain then chooses the best image. If your vision isn't too degraded from the cataracts you might do a contact lens trial to see if you can adapt to monovision, and how much. It won't be completely accurate since you have more near vision at that age than you'd have with a monofocal IOL, but it will give you an idea of if you can adapt to monovision. Those who adapt to it don't realize they are using one eye more for some distances. There can be a reduction in stereopsis, depth perception, but most people adapt to it and don't notice (even if I preferred to get premium IOLs to avoid that). . Some people don't adapt, which would require you to then wear correction to even out the eyes, or pay for a laser correction to even out the eyes.

You can increase the font size on a smartphone or computer if needed. 

Depending on your budget, there are some folks in the UK that get a premium IOL more cheaply via medical tourism to the UK. I hadn't done the currency conversion, but I think its typically anywhere from $1200-$2000/eye to get surgery in the Czech Republic with a premium lens (depending on whether you opt for things like laser cataract surgery, which many don't think is any better, I didn't). I don't know if there is any reciprocal arrangemnet within the EU (while the UK is in it) that covers any part of the treatment in the Czech Republic. 

In my case I was always a high myope, but my problem cataract made me even more myopic in that eye before surgery, it went from about -9 to about -19, i.e. best focal distance about 2 inches from the eye. 

Thank you for being so informative.

Really dreading how to decide what to do about replacement lenses as not something you want to get wrong !

Like you i work on a computer all day, i'm wondering if i might be better having my eyes operated on privately and being able to choose a better lens implant.

Very interesting what you said about the testing with the contact lenses.

Really i'm terrified of the op incase something goes wrong, really devastated to have cataracts so young, before this thought they only affected people in their 70's and 80's !

At least in the US, the last I checked the average age for cataract surgery is in the mid 70s, so of course I was also shocked to have a cataract at age 49. I'd heard of cataracts from eye trauma or steroid use, but I didn't have any risk factors like those, but unfortunately here are even people with cataracts much younger without obvious risk factors. However now, especially outside the US where you have more IOL options, there are growing numbers of people in their late 40s and older who hit presbyopia and are getting lens exchange surgery even without a cataract to deal with the loss of near vision. So although its frustrating to be forced to go throug it, its useful to look on the potential bright side, if you decide to go for monovision or a premium IOL.

I should have perhaps added before in terms of being "terrified" of the operation, that obviously its natural to worry about risking eyesight, but its very safe, almost everyone has good results with > 20 million cataract surgeries a year globally, > 480,000 with premium IOLs. A tiny percentage have some initial issues, which are resolved.  Most people who post online do so when they have a problem, so its easy to get a skewed view of the risks, since those without problems aren't likely to post (aside from some who researched things beforehand and come back afterwards to return the favor and provide balance).

Once you get rid of the cataract the odds are that at least if you wear correction you'll have much better vision than you are dealing with now with cataracts, especially if its gotten to the point where they will cover surgery.

 

One issue is whether you mind wearing glasses (or contacts), since if you don't there is less reason to consider a premium IOL or monovision. Have you been using progressive (also called varifocal) glasses or bifocals or something comfortably to deal with presbyopia, or just dedicated readers? In my case I disliked progressive glasses, and although I liked multifocal contacts I figured that as you age there is increased risk dry eyes will be a problem and so contacts might be a problem in the future, and vision with a premium IOL seems to be better quality than with contacts. I also figured in the unlikely chance I'd ever have say an accident and problems with vision in one eye, a premium IOL providing a larger range in the other eye made more sense than monovision where losing an eye would leave me with a smaller range of vision. I'd figured in terms of planning for the long term, that the elderly are more at risk of falls and at any age increased risk of  car accidents when wearing progressive glassses or bifocals (due to the narrower range of view), and that monovision (or at least a high level of it) increases the risk of falls in the elderly due to reduced depth perception. In my case at a younger age I'm jogging/hiking on trails that are rocky and with back ice patches, so I also like having a good range of vision to reduce the risk of falls (even if a fall isn't as bad as with someone elderly).

In the US, private pilots aren't supposed to fly with monovision, they need to wear glasses/contacts to even it out if they normall have monovision. Most people aren't private pilots, thats merely an indication that there are concerns over things like depth perception and other issues with monovision. I'd checked on it since I'd started to work on a pilot's license years ago, then got distracted, but may get back to it someday. Admittedly however while in the US we are allowed to have any IOL like a multifocal or the Symfony, in some countries they are still   cautious and haven't updated standards  and pilots can only have monofocals.  

 

In my case I needed correction for decades to see, so I figured if I had to have surgery, it was worth it to shoot for a premium lens so perhaps I'd be free of it the rest of my life. I always worried before this about the thought of ever losing correction in an emergency, say a fire in the middle of the night.  I was also still young enough to not have resigned myself to presbyopia, already disliking the loss of near and really disliking the idea of losing the remainder of my near vision, so a premium IOL seemed the best bet for me.

 

It may be your eyes are too blurry to get a good contact lens trial. Ideally even people who usually wear glasses would be encouraged when they get presbyopia to do a contact lens trial with monovision, and multifocal contacts, so they know what they'd want before they get cataracts that make it hard to do an accurate test.

i had a typo in that "medical tourism to the UK", obviously from the rest I meant "medical tourism to the Czech Republic" from the UK. Even with travel it can be cheaper than the out of pocket expense for private treatment with  a premium lens.   Its a better bet if you don't have much astigmatism, since with astigmatism correction there may be a chance you'd need to go back for followups (or get them locally) to adjust a toric IOL or get a laser touchup, etc. Since you report having had good vision before, I assume that means you didn't need to wear correction, which suggests your vision is in the range where usually they can accurately determine the right IOL power and there is no need for astigmatism correction, so it should just be one trip with followups with a local doctor (just checking to be sure there were no problems afterwards with infection, IOL being decentered, etc, which are rare).

I had a cataract in my left eye first so matched it to my right eye, which was good distance and close vision, but neededing mild reading glasses. This has worked very well. The right eye now has to be done so I will match to the left eye now! In my case my complication has been Negative Dysphotopsia but I know that this only affects about 1.5% of people. The next eye will have a different size lens, after much investigation! 

Thanks for you detailed comments!

 

I have for a decade partial seizures since an ice head and neck accident on ice at 25, Mystopia  and stigmatism at 8, and side Cataracts at 31. I have had insurance since my late 20's.Now I'm almost 33, my vision hasn't changed since 23, but now I am developing Cataracts and bone fractures from gum disease and really bad open skin sores. The dentists, doctors, neurologists, psychiatrists, psychologists, and eye doctors say that surgery for all removal of the brain cyst would be deadly after I argued saying it could be my last resort since they won't try me on seizure medication for partial seizures, they won't do anything about my protruding sore bleeding gums, and my side cataracts because they aren't too bad. I hate going to these places because they say I'm just a schizophrenic health nut whose worried about everything.