Cataracts

Causes

• Aging: This is the most common cause. As people age, the proteins in the lens can clump together, forming cloudy areas.
• Diabetes: People with diabetes are at a higher risk of developing cataracts, often at a younger age.
• Eye injury: Trauma to the eye can damage the lens and lead to cataract formation.
• Previous eye surgery: Surgery for other eye conditions (e.g., glaucoma) can sometimes increase the risk of cataracts.
• Long-term use of certain medications: Particularly corticosteroids (oral, inhaled, or topical eye drops).
• Excessive exposure to ultraviolet (UV) radiation: Prolonged, unprotected exposure to sunlight is a risk factor.
• Smoking: Tobacco use increases the risk of cataract development.
• Excessive alcohol consumption: High alcohol intake has been linked to an increased risk.
• Other eye conditions: Certain inflammatory eye conditions or genetic disorders can increase the risk.
• Family history: A genetic predisposition can make some individuals more susceptible.

Symptoms

• Cloudy, blurry, or dim vision: Vision may appear hazy or like looking through a foggy window.
• Difficulty with night vision: Reduced ability to see in low light, making driving at night challenging.
• Increased sensitivity to light and glare: Halos around lights, especially at night, or discomfort from bright lights.
• Fading or yellowing of colors: Colors may appear less vibrant or have a yellowish tint.
• Frequent changes in eyeglass or contact lens prescription: As the cataract progresses, vision changes rapidly.
• Double vision in one eye: Though less common, a cataract can sometimes cause double vision.
• "Second sight" phenomenon: In some cases, a nuclear cataract (affecting the center of the lens) may temporarily improve near vision, allowing older adults to read without glasses, before vision worsens again.

Diagnosis

• Visual acuity test: Measures how well you see at various distances.
• Slit-lamp examination: A special microscope allows the doctor to examine the lens and other structures at the front of the eye in detail.
• Retinal exam: The pupil is dilated with eye drops to allow the doctor to examine the back of the eye (retina and optic nerve) for other conditions.
• Tonometry: Measures fluid pressure inside the eye.

Treatment

• Cataract Surgery:
  • This is a very common and generally safe outpatient procedure.
  • The cloudy natural lens is removed and replaced with a clear artificial intraocular lens (IOL).
  • The procedure typically takes less than an hour.
  • Most people experience significant improvement in vision after surgery.

• Types of Intraocular Lenses (IOLs):
  • Monofocal IOLs: Provide clear vision at one distance (usually far), requiring glasses for near vision.
  • Multifocal IOLs: Designed to provide clear vision at multiple distances, potentially reducing the need for glasses.
  • Toric IOLs: Correct astigmatism.

• Post-Surgery Care:
  • Eye drops are prescribed to prevent infection and control inflammation.
  • Avoid strenuous activity and eye rubbing for a few weeks.
  • Follow-up appointments are scheduled to monitor healing.

Deciding on Cataract Surgery, and What Comes After

Cataract surgery is among the most common and most successful operations, so the decisions that matter are when to have it, which lens to choose, what to tell the surgeon beforehand, and what the years afterward look like.

When it is time

There is no measurement that decides it; the cataract is ready when it interferes with what you need to do. Night driving, glare on wet roads, reading, and recognizing faces are the usual breaking points, and a new glasses prescription that helps for only a few months is the signal that the next one will not. Waiting is usually safe, but a very dense cataract is harder to remove, and vision that affects driving matters more here, where most errands are by car; our driving safety for older adults article covers the vision standard.

Choosing the lens, and one medication to mention

A monofocal lens set for distance is the standard choice and the one insurance covers, with reading glasses afterward; multifocal and extended-depth lenses reduce dependence on glasses at extra cost and with more halos at night, and a toric lens corrects astigmatism. Tell the surgeon about every medication, especially tamsulosin, alfuzosin, or silodosin taken for an enlarged prostate, because they make the iris floppy during surgery. They are not stopped, but the surgeon plans for it. Blood thinners are usually continued.

The weeks after surgery

Vision is often clearer within a day and settles over a few weeks, while antibiotic and anti-inflammatory drops taper over about a month on a schedule worth writing down. The second eye usually follows within a few weeks, and the final glasses prescription is written a month or so after the last surgery. Dry eye is common for a few months and is treated as its own condition; the dry eye syndrome page covers it. Increasing pain, worsening rather than improving vision, or new flashes and floaters are reasons to call the surgeon the same day, as our floaters and flashes article explains.

The cloudiness that comes back

Months or years later, the membrane behind the new lens can cloud and vision dims again. This is not the cataract returning and is cleared in minutes with an in-office laser. Cataract surgery does not treat macular degeneration, glaucoma, or diabetic retinopathy, which is why the retina is examined before surgery and vision that stays poor afterward is investigated.

Slowing the other eye and protecting the result

Ultraviolet exposure, smoking, poorly controlled diabetes, and long courses of steroids such as prednisone each speed cataract formation. Wraparound sunglasses with full UV protection and a hat matter more here than in most of the country, as our sun safety for eyes and skin guide explains. Our ophthalmology team coordinates the referral and the medical checks before surgery. The National Eye Institute and the American Academy of Ophthalmology publish patient guidance on surgery and recovery.

If glare, night driving, or reading have become difficult and a new prescription no longer helps, schedule a visit to start the evaluation.