CLEARING UP THE FOG PAINLESS HALF-HOUR SURGERY BRINGS BACK EYESIGHT TO PEOPLE WITH CATARACTS.

Byline: Phillip Zonkel Staff Writer

FOR THE PAST six months, Claudia Ramm's cloudy vision made her feel like she was living in a fog.

``It was impairing my life,'' says the 52-year-old registered nurse. ``I had to limit my driving. I couldn't see on the freeway. It wasn't safe.

``At my gym, I would walk up to total strangers thinking they were friends of mine,'' says the Long Beach resident. ``It was very embarrassing. The guys were going, 'Hmmm, sure you thought I was your friend?' It was very frustrating.''

Her ophthalmologist, Leif Hertzog, told her she had cataracts, which was good news.

``If your vision is going to be down due to something, you want it to be a cataract,'' Hertzog says. ``It's curable.''

Approximately 20.5 million Americans age 40 and older have cataracts, which is a clouding of the lens - like a window that is fogged up. The lens sits in a sealed bag or capsule, and as old cells die, they become trapped in the capsule. Over time, more cells die and accumulate, causing the lens to harden and cloud. And when the lens, which focuses light and produces clear images, becomes cloudy, light is scattered (rather than properly focused onto the retina at the back of the eye) and vision becomes blurry.

There are three types of cataracts - nuclear, cortical and subcapsular. Each affects a different part of the lens, has different symptoms and causes different vision problems.

A nuclear cataract is the most common type and is related to the aging process. The nucleus gradually hardens and becomes opaque, causing difficulty identifying colors and seeing at a distance.

Cortical cataract is the next most common type, often affecting people who have diabetes. Wedge-shaped opacities develop in the cortex, interfering with the passage of light. This blocking can cause problems with glare and loss of contrast as well as difficulty with distance and near vision.

A subcapsular cataract develops under the back of the capsule or elastic covering of the lens and is common in people with diabetes or high myopia, adults with retinitis pigmentosa and people taking cortisone. This type of cataract can cause glare sensitivity and blurred vision.

Heredity also may play a role in cataract development.

Cataracts are not a growth or a film over the eye, nor are they caused by overusing the eye. They do not spread from one eye to the other or cause irreversible blindness. A cataract doesn't have to be surgically treated if vision is only slightly blurry. Simply changing an eyeglass prescription may help to improve vision. But medications, eye drops, exercises and/or glasses won't cure cataracts. Only surgery removes a cataract. Surgery should be considered when cataracts interfere with daily life.

When Hertzog told Ramm surgery would correct her vision, she was ecstatic.

``I was excited and looking forward to it. I was thrilled. I was counting the hours,'' Ramm says. ``I knew I wouldn't have to wear glasses again - and I could see.''

Ramm also convinced her father, Richard Lawrence, 76, who also had cataracts, to undergo the procedure. He had his first eye operation two years ago. For that surgery, his wife, Patricia, 73, accompanied him; however, shortly thereafter, she died from lung cancer. Feeling despondent, Lawrence had indefinitely put off the second surgery until Ramm persuaded him.

He says he also heeded Hertzog's advice.

``The doctor said the longer I wait, the worse it will become,'' Lawrence says. ``So I decided I'd better get it done.''

In the United States, cataract operations are the most frequently performed surgery - more than 1.4 million people undergo it every year.

The most common cataract surgery is phacoemulsification. In this outpatient procedure, the eye is numbed with eye drops, a 2.75-millimeter surgical incision is made in the corner of the eye, and a tiny instrument is inserted. Ultrasound is used to break apart, liquefy and aspirate the nucleus of the lens. The cortex also is removed.

Then, a replacement lens is implanted into the capsule, and clearer vision is restored.

If a patient is nearsighted or farsighted, the replacement lens will correct most, if not all, of the vision impairment, which reduces the dependence on glasses or contacts.

The surgery takes from 20 to 30 minutes and causes virtually no discomfort.

``It's certainly revolutionized eye care throughout the world,'' says Dr. Bob Allen, an adviser with the American Academy of Ophthalmology.

Twenty to 30 years ago, cataract surgery patients suffered through a painful operation that involved a 180-degree incision and eight to 10 stitches. They also spent up to 10 days in the hospital. Afterward, patients needed thick glasses and weeks of recuperation at home.

With phacoemulsification, patients are out of the office the same day. But they do need to take prescribed eye drops (one an antibiotic and the other an anti-inflammatory) for a month. And for the first 24 hours, they have to wear glasses or a protective eye patch and avoid driving and strenuous activities.

After that, most people resume their daily life.

Ramm, who had cataracts in both eyes, had her first surgery July 6, and the second surgery two weeks later. Following both procedures, Ramm says neither she nor her dad experienced any discomfort.

Ramm's also thrilled that she can see clearly.

``I was so excited. I've worn glasses since I was 16,'' Ramm says. ``I could see my neighbors across the street. I was reading street signs while driving home. I was like, `Wow.' ''

WARNING SIGNS

Cataracts start out small and have little effect on vision at first. But as the cataract grows, vision worsens. See an eye doctor if these symptoms occur:

--Painless blurring of vision.

--Change in color of pupil.

--Sensitivity to light and glare, especially while driving at night.

--Cloudy, filmy or fuzzy vision.

--Double vision in one eye.

--Poor night vision.

--Fading or yellowing of colors.

--Frequent changes in glasses or contact lens prescriptions.

SENIOR PROGRAM

The American Academy of Ophthalmology's EyeCare America offers a program for seniors to receive a medical eye exam and up to one year of eye care with no out-of-pocket expense. The program is designed for people who are U.S. citizens or legal residents, are 65 and older, have not seen an eye doctor in three or more years, and who do not belong to an HMO or VA. For more information, call [phone] or visit www.eyecareamerica.org.

CAPTION(S):

10 photos, 5 boxes

Photo:

(1 -- cover -- color) Dr. Leif Hertzog performs cataract surgery on Claudia Ramm.

(2 -- color) A monitor helps track the progress of Claudia Ramm's cataract surgery.

Stephen Carr/Staff Photographer

(3 -- color) Richard Lawrence's eye is numbed with drops prior to surgery.

(4 -- color) Claudia Ramm has words of encouragement for her father, Richard Lawrence, before his cataract surgery.

(5 -- color) Normal vision

(6 -- color) Vision through a cataract

Photos from stlukeseye.com

(7 -- 9 -- color) no caption (cataract surgery)

(10 -- color) no caption (cataract) Box:

(1) WARNING SIGNS (see text)

(2) SENIOR PROGRAM (see text)

(3) What is a cataract?

(4) Cataract surgery

(5) Recovery