The cost of removing a cataract - between $2,000-$4000 dollars - is prohibitive for many, leaving them to struggle with a completely curable form of blindness. The Moran Eye Center has started a Charitable Surgery Day, to help restore sight to some Utahns.
According to the World Health Organization, in 2010, there were 20 million people who had become blind because of cataracts; that's half of the world's blind population.
Jeff Pettey, an Ophthalmologist at the University of Utah Moran Eye Center, says that many kinds of blindness, including that caused by cataracts, can be fixed. "Eighty percent of blindness in the world is either curable or preventable", he says. "And ninety percent of the blindness is in developing nations, but we have a lot here, I mean among us. This is a place where there's no reason anyone should be walking around with preventable or curable blindness."
But they are. Barbara Simons' vision has been impaired by cataracts for around 7 or 8 years.
"It's hard to see and read and I haven't driven a car for a while, and I trip a lot," say Simons.
Barbara doesn't have insurance nor the money to pay for cataract surgery on her own. Until recently, she was homeless. She receives health and eye care at the Fourth Street Clinic in downtown Salt Lake City.
"What we do with people whose care goes beyond the primary care setting is we will do case management around finding specialty care for patients," explains Kathy Chambers, CEO of the clinic. "That's a tricky thing, case management is always difficult because you're never sure if you can find it. But we do our best to try to match up the medical needs with people in the community and agencies within the community that are willing to participate in that."
That's how Barbara found herself at the Moran Eye Center last weekend, waiting with 18 other patients for cataract surgery provided by volunteers. There were dozens of volunteers from surgeons and anesthesiologists, to nurses and admitting staff that took part in what the center calls Charitable Surgery Day. Pettey started Surgery Day two years ago with a fourth year medical student after they realized how many people at the Fourth Street Clinic, and other clinics where they volunteer, needed help.
"We just had a big backlog of patients we were seeing who needed surgery," says Pettey. "They either had low vision or were blind and all they needed was surgery. But we were just having trouble figuring out a way to give everyone the care they needed."
Cataracts form in the lens of the eye and can lead to total blindness. "When we're born, the lens inside of our eye is crystal clear," explains Pettey. "And as we age, the lens becomes progressively cloudier. Each year it will become cloudier and cloudier. In it's most advanced form a cataract will completely block light entering the eye. So someone won't be able to see you moving your hand in front of their face."
The lens is an incredible work of nature. The organization of cells and crystallin proteins within the cells of the lens are critical for the transparency of the tissue. When this structure becomes disorganized, the lens becomes opaque and can no longer efficiently transmit and focus light on the retina.
"As we age with sun damage and other things, diabetes can also accelerate cataracts, ...the protein structure inside can change," says Pettey. "So as more and more proteins are created and connections are disrupted, you have a crystal structure that breaks down and no longer transmits light clearly."
Surgery is the only remedy for cataracts. Pettey says advances in the procedure have made it quick and painless because they only make two small incisions in the eye.
"Through the 2mm incision we'll enter in, we'll take the roof off of the lens, and then enter into the lens with an ultrasound machine that breaks up the lens, which at this point is fairly dense and hard," says Pettey. "The ultrasound breaks it up and there's also an aspiration pore, which will vacuum what you've broken up."
Before the lens is broken up, it is about the size of an M&M. After removal, they put in an artificial lens made out of acrylic or sometimes a plexiglass type material.
"We'll essentially put their glasses prescription in a lens inside of their eye and then we vacuum out anything we've left behind," says Petty. "At this point the incisions are so small there's no sutures at all. The wounds will seal on their own and the patient goes home the same day."
Once the affected lens has been removed and replaced, the patient will never get a cataract in the same eye again.
Old age is the primary risk factor for cataracts, but smoking, diabetes, UV radiation, and certain medications such as corticosteroids also increase the risk of developing cataracts.
It's rare for young people to get them, but 22-year-old Jose Alamos has had them in both eyes, which in the past has impaired his ability to get a job. He already had surgery on one eye, and was at Surgery Day to remove his second cataract. He says vision comes back fast, even overnight.
"It was awesome being able to see," says Alamos. "Actually being able to reach far away and see everything and see the clear faces on people now. It was great."
Pettey says for him, there's nothing better than seeing the look on a patient's face after taking the bandage off the next day.
"In the case of some of these advanced cataracts today, we're taking someone who can't read anything. Someone who hasn't seen the face of her grandchild for two years and at the end of the day she'll be able to read, she'll be able to see her grandkid's face. There's nothing I think I've ever done or could do that could give me that sort of reward."