#SeeTheMusic and More – Cataracts, are they clouding your performance?

Cataracts and the performing arts professional

Being the UK’s only performing arts eye care specialists and the only optician registered with the British Association For Performing Arts Medicine (BAPAM), we understand first-hand how eye disorders can negatively impact a career. 

Artists such as musicians, dancers, singers, presenters and technicians including camera operators, sound engineers and Audio-visual technicians, are just some of the performing arts professionals we have assisted to see the music.

At some point in our lives, most of us will have vision problems. The majority of these problems are caused by refractive errors, which means they’re problems with the way the eyes focus light, rather than an eye disease or disorder. However, there are some eye disorders and diseases that many of us could experience. This blog series highlights the common eye conditions that many performing arts professionals encounter. 

Here is our list of the 5 most common eye disorders and diseases:

  • Cataracts

    are a widely occurring eye problem and usually affect people over the age of 65. Most have a visually impairing cataract in one or both eyes. Cataracts are usually seen as the formation of a dense, cloudy area in the lens of the eye. When this happens, light is simply unable to pass through to the retina and the victim is unable to clearly see objects in front of them.

  • Dry eye disease

    is a common condition that occurs when your tears aren’t able to provide adequate lubrication for your eyes. Some people may experience subtle, but constant, eye irritation to significant inflammation and even scarring of the front surface of the eye. 

In different parts of the world, dry eye syndrome affects anywhere from 5% to 50% of the population. Contact lens wearers are particularly susceptible to the condition. The condition is also common in the elderly.

  • Glaucoma

    causes damage to the eye’s optic nerve.  In most cases, this is due to fluid buildup and increased internal pressure. This interferes with the transmission of images from the optic nerve to the brain. If the buildup of pressure continues without treatment, it may lead to permanent loss of vision. 

Glaucoma progresses relatively quickly and can cause blindness within a few years. The most common symptoms of glaucoma include tunnel vision, peripheral vision loss, blurry eyes, halos around the eyes, and redness of the eyes.

  • Macular degeneration (AMD)

    is a condition affecting the central part of your view. It typically affects people in their 50s and 60s. The condition does not cause total blindness. Nevertheless, it can make everyday tasks difficult, such as reading and recognising faces.

Your vision may deteriorate without treatment. AMD can develop slowly over several years (“dry AMD”) or rapidly over a few weeks or months (“wet AMD”).

The exact cause of AMD is unknown. The risk factors include smoking, high blood pressure, being overweight, and having a family history of AMD.

  • Retinal Detachment

    is precisely what it sounds like. It is the detachment of the retina from its place within the eye. There may be small tears in the retina before the whole retina is detached. If it is left untreated, complete vision loss can occur in the affected eye. It sounds painful, but people rarely feel any pain during retinal detachment.

There are various warning signs that a retinal detachment may occur. These include blurred vision, a sudden appearance of light flashes, and a curtain-like shadow in one’s field of vision.

Cataracts: An overview…

Cataracts are the result of the crystalline lens, developing cloudy patches. The crystalline lens is an important part of the eye’s anatomy that allows the eye to focus on objects at varying distances. It is located behind the iris and in front of the vitreous body.

These patches tend to grow larger over time, causing blurry, misty vision and eventually blindness.

Our lenses are generally clear when we’re young, allowing us to see through them. As we age they start to become frosted or yellow, like dirty bathroom windows, often severely limiting vision.

It is common for both eyes to be affected by cataracts. That said, they may not necessarily develop at the same time or be the same type of cataract in each eye. They’re more common in older adults and can impact daily activities such as driving. Cataracts can also affect young children and babies.

Seeking medical advice

Consult an optician if any of these symptoms occur:

  • Blurred or misty vision
  • Lights seem too bright or glaring 
  • You have trouble seeing in low light
  • Night driving is difficult
  • Colours appear faded
  • If you wear glasses, you may feel your lenses need constant cleaning, or that your lens coating isn’t working.

Although most cataracts aren’t painful and won’t irritate your eyes, if they’re in an advanced stage or you suffer from another eye disorder, they may cause discomfort.

Performing Arts Professionals and Cataracts

Q: Can Cataracts Affect My Performance?

A:  Cataracts can affect sight-reading and your ability to perform if your vision is affected as a result.  The crystalline lens is similar to the camera lens. Through it, light is focused on the retina for processing as vision. Cataracts form when Collagen, the most abundant protein in the body, builds up on the lens, clouding vision.

As cataracts progress, you may encounter issues with limited vision.  You may have difficulty seeing music on the stand, the accidentals, dynamics or even key signatures. For dancers, dance notation may appear blurred or for production staff problems viewing computer screens may become evident.  As cataracts progress, they can affect more aspects of your day-to-day and performing life if left unchecked.

We find that musicians tend to feel the effects of cataracts sooner than most general practice clients. This is because cataracts cause problems with sight-reading and depending on the type of cataract can appear as blurred patches or discoloured areas across the music manuscript. 

There are 31 types of cataracts, but the 3 main types of age-related cataracts are nuclear sclerotic, posterior subcapsular and cortical. Because they’re grouped by where they form, they present slightly different symptoms, develop at different speeds, and have different causes. They can all cause progressive vision loss, which means the vision gets worse over time.

Nuclear sclerotic cataract

Nuclear sclerosis is the most commonly occurring type of cataract. ‘Nuclear’ refers to it from the nucleus of the lens, while ‘sclerosis’ refers to hardened body tissue. 

Symptoms

It is difficult to focus when you have nuclear sclerosis. As your sight deteriorates, you might experience a temporary improvement in your close-up vision. As your cataract progresses, your vision will deteriorate again. Objects at a distance will appear blurry and colours will appear faded as the lens yellows further.

Cortical cataract

‘Cortical’ refers to the outer layer of something, which describes this cataract as being on the outer edge of the lens,– the opposite of a nuclear sclerotic cataract. A cortical cataract develops spoke-like lines that lead to the centre of the lens, scattering light as it enters the eye.

Symptoms

Your vision may be blurred or you may see blurry lines. You can also experience problems with glare from the sun and artificial lighting, as well as driving at night. Cortical cataracts may develop fairly quickly, with symptoms becoming more apparent within months rather than years.

Posterior subcapsular cataract

They form at the back of the lens – i.e., posterior – in the capsule where the lens sits (subcapsular). Cataracts in this area can produce more disproportionate symptoms for their size because the light is more focused towards the back of the lens. Diabetes or extreme short-sightedness place you at greater risk for a subcapsular cataract. Additionally, if you are exposed to radiation or use steroids, you may develop a cataract of this type.

Symptoms

Under certain conditions, a subcapsular cataract can cause difficulty seeing in bright light and can produce glare or halos around lights at night – so it can be particularly problematic when on stage or when dealing with stage lighting. You may have blurry vision and be unable to read.  Subcapsular cataracts tend to develop faster than both nuclear sclerotic and cortical cataracts.

Performers visual demands

Performers are required to use one or more of the following skills:

  • Rapid changes in focus. Changing focus between objects at different distances rapidly and accurately is vision focusing. A musician, for instance, needs to read the music on the stand, look at the conductor and other members of the ensemble all at different distances clearly and accurately. This can be affected by cataracts as they cause the lens to become stiff, affecting the lenses flexibility and the ability to change focus quickly.
  • Vision fixation: The ability to read sheet music, regardless of how fast its tempo. This also can be affected by cataracts as they cause blurring, glare and patchy vision.
  • Peripheral vision: The ability to see and observe out of the corner of your eye when looking at a fixed object such as sheet music on the stand. In an orchestra, a player must be able to see both their stand partner or another member of their section even when they may be unable to alter their head position due to their instrument.  This can be severely compromised by cortical cataracts that begin on the outside edge of the lens (the peripheral). Cortical spokes, or white streaks or wedge-shaped opacities, progress inward on the lens, impairing vision and obstructing light reflection. 
  • Focusing regulation: The ability to retain eye coordination during high-speed activities or while under high physiological pressure.

The above demands can place a lot of pressure on the performer, especially when their vision isn’t up to par. 

Effective treatment of age-related cataracts

For a while, new glasses and brighter reading lights can ease the symptoms of cataracts. 

However, cataracts do get worse over time, so you’ll eventually need surgery to remove and replace the affected lens.

The only proven treatment for cataracts is surgery. During cataract surgery, an artificial lens replaces the cloudy one inside the eye. The procedure is highly effective at improving vision, but it can take between two and six weeks for vision to be fully restored.

Generally, cataract surgery takes 30 to 45 minutes. It is usually done as a day surgery under local anaesthesia, and you can usually go home the same day. 

Monofocal lenses are offered by the NHS, which have a single point of focus. In other words, the lens will be fixed either for near vision or distance vision, but not both.

If you opt to have your surgery privately, both multifocal and accommodating lenses are available to you, which allow you to focus on both near and distant objects.

Unless you have opted for multifocal or accommodating lenses most people will need to wear glasses for some tasks, like reading, using computers or reading music.

If you have cataracts in both eyes, surgery is done 6 to 12 weeks apart to allow the recovery of one eye at a time.

In Summary

Cataract treatment is beneficial to both performers and amateurs. However, they do have limitations and will not stop the ageing process. We recommend that you continue with regular eye examinations after your surgery, Either every two years or 12 months, as recommended by your optometrists. As performers ourselves our unique perspective enables us to offer balanced, impartial advice on all aspects of cataract treatment.

Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them. 

With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians using cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve hyperopic performing arts practitioners’ vision problems.

Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/

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