What is a cataract?
A cataract is a painless, cloudy area in the lens of the eye that blocks the passage of light to the retina. The retina is the nerve layer at the back of the eye. The nerve cells in the retina detect light entering the eye and send nerve signals to the brain about what the eye sees. Because cataracts block this light, they can cause vision problems.
What causes cataracts?
Aging and exposure to sunlight can cause cataracts. Changes in your eyes are often a normal part of aging. But the changes do not always lead to cataracts.
Cataracts can also happen after an eye injury, as a result of eye disease, after you use certain medicines, or as a result of health problems such as diabetes.
Sometimes children are born with cataracts.
What are the symptoms?
Cataracts can affect your vision.
- You may have cloudy, fuzzy, or foggy vision.
- You may see glare from lamps or the sun. You may have trouble driving at night because of glare from car headlights.
- You may need frequent changes to your eyeglasses prescription.
- You may get double vision in one eye.
- Your near vision may improve for a short time if you get a cataract. This temporary improvement is called second sight.
The vision loss from a cataract often happens slowly and may never become severe. Sometimes cataracts do not cause any vision problems.
How are cataracts diagnosed?
Your doctor can find out if you have cataracts by doing a physical exam and by asking questions about your symptoms and past health. You may need tests to make sure you have a cataract or to rule out other conditions that may be causing vision problems.
How are they treated?
Surgery can remove cataracts. For most adults, surgery is only needed when vision loss caused by a cataract affects their quality of life.
There are a number of things you can do that may help you manage your vision problems. Many people get along very well with the help of eyeglasses, contacts, or other vision aids. Keep your eyeglasses or contact lens prescription up to date. Also make sure you have plenty of lighting in your home. You may be able to avoid or delay surgery.
Whether you need cataract surgery depends on how much of a problem the cataract causes for daily activities like driving and reading. Surgery is almost always by your choice (elective) and can be scheduled when it is convenient. For people who decide to have surgery, the surgery usually works very well.
Some people have to have surgery. Children are sometimes born with cataracts that need to be removed. Other people may get cataracts after an eye injury or as a result of eye disease or other health problems. Cataracts from these causes may also need to be removed.
How can you prevent cataracts?
There is no proven way to prevent cataracts. But there are some things you can do that may help slow cataract growth. Don’t smoke. Wear a hat or sunglasses when you are in the sun. And avoid sunlamps and tanning booths. Eat healthy foods. And keep diabetes under control.
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A cataract occurs when the lens inside your eye becomes cloudy. Things linked to clouding include:
- Aging (age-related cataracts).
- Overexposure to ultraviolet (UV) radiation, such as from sunlight, tanning booths, or sunlamps.
- Diabetes. Diabetes, especially when the blood sugar levels are above the safe range, causes changes in the eye that can result in cataracts.
- Disease inside the eye, such as glaucoma, retinitis pigmentosa, retinal detachment, or long-term uveitis.
- Long-term use of steroid medicines.
- Frequent X-rays or radiation treatments to the head.
- Family history (genetics). A person may inherit the tendency to develop cataracts.
- Vitrectomy. People who have had the vitreous gel removed from their eye (vitrectomy) have an increased risk of cataracts.
- Eye injury. Even though injury-related cataracts are rare, injury is a leading cause of cataracts in children.
- Being born with cataracts (congenital). Some children are born with the condition.
Not all cataracts impair vision or affect daily living. For those that do, common symptoms include:
- Cloudy, fuzzy, foggy, or filmy vision.
- Glare from lamps or the sun, which may be severe.
- Difficulty driving at night due to glare from headlights.
- Frequent changes in eyeglass prescription.
- Double vision.
- Improvement of near vision (second sight) that then gets worse.
- Difficulty doing daily activities because of vision problems.
Parents need to watch for signs of cataracts in infants and children.
Cataracts may stay small and you may not notice them. They often do not seriously affect vision. And many cataracts do not need to be removed.
Some cataracts grow larger or denser over time, causing severe vision changes.
- Severe cataracts can cause loss of independence for older adults as decreased vision may affect driving, working, reading, or hobbies.
- While cataracts can cause blindness, this is rare. Surgery is usually done before a cataract progresses far enough to cause blindness.
- A rare type of cataract can lead to glaucoma.
As a cataract progresses, more of the lens becomes cloudy. When the entire lens is white, the cataract is called a “ripe” or “mature” cataract and causes severe vision problems. Delaying surgery until cataracts are ripe or mature is neither recommended nor needed.
Cataracts in children are rare but serious. If a cataract prevents light from entering a child’s eye and stimulating the retina, the area of the brain used for sight does not develop properly. Usually the child won’t see well with that eye (amblyopia), even if the cataract is later removed.
What Increases Your Risk
Things that increase your risk for cataracts include:
- Age. Getting older is a major risk factor for cataracts.
- Family history (genetics). People with a family history of cataracts are more likely to have cataracts. People with certain genetic disorders may also have an increased risk for cataracts.
Some chronic diseases increase the risk for cataracts. Keeping these diseases under control may help lower your risk for cataracts:
- Diabetes. People with diabetes are at increased risk for cataracts. Damage to the lens of the eye results from persistent high blood sugar (glucose) levels.
- Glaucoma. Surgery to treat glaucoma may raise the risk of cataracts.
Other things that may increase your risk include:
- Smoking. People who smoke are more likely to develop cataracts. Smoking may damage the lens of the eye by leading to the formation of chemicals called free radicals. High levels of free radicals can damage cells, including those in the lens of the eye.
- Infection during pregnancy. If a woman has certain infections during pregnancy, such as rubella or chickenpox, the baby may develop a cataract before birth.
- Ultraviolet (UV) light exposure. Ultraviolet B (UVB) is related to cataract development.
- Long-term use and higher doses of steroid medicines. Long-term use of high doses of steroid medicines for conditions such as asthma or emphysema increases a person’s risk for cataracts.
When should you call your doctor?
Call your doctor right away if you have:
- Severe eye pain.
- A sudden change in your vision, such as loss of vision or double vision.
Call your doctor to discuss your symptoms if you:
- Need frequent changes in your eyeglasses prescription.
- Have blurred or double vision that develops slowly.
- Are having a problem seeing during the daytime because of glare.
- Have difficulty driving at night because of glare from headlights.
- Have vision problems that are affecting your ability to do daily activities.
If you are an older adult, discuss with your doctor how often you need to have routine eye exams.
If a doctor has not determined that you have cataracts but you have symptoms that concern you, see the topic Eye Problems, Noninjuryto find more information on what to do about your symptoms.
Watchful waiting is a wait-and-see approach. Watchful waiting is safe and appropriate in most cases of adult cataracts. If you notice signs that your baby or child may not be seeing well, see your doctor. Cataracts in children should be treated right away.
Speak with an ophthalmologist about surgery to remove cataracts. In most cases, you can decide if you want or need surgery based on whether vision problems caused by the cataract are interfering with your daily activities.
Who to see
The following health professionals can evaluate vision problems that may be caused by a cataract:
- Nurse practitioner
- Physician assistant
- Family medicine doctor
While other doctors may be able to detect problems that may be caused by cataracts, only an ophthalmologist can treat cataracts.
Exams and Tests
Diagnosis of cataracts is based on a medical history and physical exam.
Often tests are used to:
- Confirm the presence of a cataract.
- Rule out other conditions that may be causing vision loss.
When you are deciding whether to have surgery, you may find it very helpful to evaluate the effect that vision loss from a cataract has on your life. Your doctor may ask you to complete a questionnaire regarding the effect of the cataract on your daily activities.
If you already have some vision loss that cannot be corrected by cataract surgery, your doctor may do a low-vision evaluation to help find ways for you to make the most of your remaining vision and to keep your quality of life.
During routine eye exams, your eye doctor will look for early signs of vision problems, including cataracts.
Testing your child for cataracts may be needed if you think your child is having a vision problem.
Surgery to remove a cataract is the only way to get rid of a cataract. This surgery works well and helps people see better. But surgery is often not needed or can be delayed for months or years. Many people with cataracts get along very well with the help of eyeglasses, contacts, and other vision aids.
Whether surgery is needed for an adult with cataracts depends on the degree of vision loss and whether it affects quality of life and ability to function.
The choices for treating cataracts in children depend on how likely the cataracts are to interfere with the development of normal vision.
What to think about
Sometimes a cataract needs to be removed because of another eye disease, such as diabetic retinopathy or macular degeneration. In some cases the cataract has to be removed so that the eye specialist can treat the retina, the nerve layer at the back of the eye.
Misconceptions about cataracts are common. More and more medical centers have been built specifically for cataract surgery. Marketing campaigns aimed at older adults may encourage some people to have surgery when they do not really need it. Because of fear of blindness or loss of independence, older adults may think they need to have surgery even when their cataracts do not affect their quality of life. In many cases, wearing eyeglasses or contacts and using other vision aids might be appropriate and just as effective without any of the risks of surgery.
Only you can decide whether a cataract is affecting your vision and your life enough to have surgery. If surgery is not going to improve your vision, you may decide that surgery is not for you.
There is no proven way to prevent cataracts. But certain lifestyle habits may help slow cataract development. These include:
- Not smoking.
- Wearing a hat or sunglasses when you are in the sun.
- Avoiding sunlamps and tanning booths.
- Eating healthy foods.
- Avoiding the use of steroid medicines when possible (some people need them).
- Keeping diabetes under control.
If you have cataracts, these tips and vision aids may help you manage your vision problems and avoid or delay surgery:
- Tips for improving vision include using a soft background light plus a light on your task, avoiding glare on TV and computer screens, and keeping your eyeglass or contact lens prescription up to date.
- Low-vision accommodations in your home, such as using adequate lighting and adjusting carpets and furniture to avoid potential hazards, can make living with low vision easier and safer. For more information, see the topic Preventing Falls in Older Adults.
- Low-vision aids and adaptive technologies such as video enlargement systems or speech software for computer systems can help people who have impaired vision make the best use of their remaining vision.
Evidence shows that making certain lifestyle changes such as not smoking and protecting your eyes from sunlight may help slow the development of cataracts.
After cataract surgery
Your doctor will give you instructions about what to do after cataract surgery. Eye care for adults after cataract surgery includes using prescribed eyedrops, protecting your eye, and watching for signs of infection.
Contact your doctor promptly if you notice any signs of complications, such as:
- Decreasing vision.
- Increasing pain.
- Increasing redness.
- Swelling around the eye.
- Any discharge from the eye.
- Any new floaters, flashes of light, or changes in your field of vision.
It is normal to have blurred vision and some swelling after surgery. It takes time for the swelling to go down. Your eyeglass prescription may change after surgery.
A small number of adults and children with cataracts may benefit for a short time from eyedrops that widen (dilate) the pupil. These eyedrops increase the amount of light getting into the eye. They are sometimes used to help prevent vision loss in very young children who need to wait for surgery to be done.
What to think about
There is currently no medicine that will cure cataracts.
Surgery for cataracts involves removing the clouded lens of the eye (the cataract). The lens can be replaced with an artificial lens called an intraocular lens implant (IOL). Or, if an IOL cannot be used for any reason, it will be left out and contact lenses or, in rare cases, eyeglasses can compensate for its absence. Most people will get an IOL during surgery.
Before surgery, ask your doctor about what types of IOLs can go in your eye. Or, if you will not be getting an IOL, find out why, and ask about the pros and cons of contact lenses or eyeglasses.
Options to help you see better after surgery
- Intraocular lens (IOL). A variety of IOL types are available. Work with your doctor to choose the best one for you.
- Contact lens. You will need to insert, remove, and clean the lenses on a regular basis. A contact lens may not be a good choice for young children or older adults who have a hard time properly placing the lens on the eye.
- Cataract glasses. Cataract glasses were used for decades when there were no other options for lens replacement. Because they are thick and heavy, they are rarely used now.
For most adults, surgery is only needed when vision loss caused by a cataract affects your quality of life. The goals of surgery in adults who have cataracts include:
- Improving vision.
- Helping you return to work, leisure, and other daily activities.
The choices for treating cataracts in children depend on how likely the cataracts are to interfere with the development of normal vision. Surgery for cataracts in children may be needed.
For adults who have cataracts in both eyes, surgery is not normally done on both eyes at the same time. The first eye needs to heal. Then your doctor will determine how much eyesight has improved before surgery is done on the second eye.
There are two main types of cataract surgery. They are both done in an outpatient center. The decision about which one to use depends on what kind of cataract you have and how much experience the surgeon has with each type of surgery.
- Phacoemulsification (small-incision surgery). In this type of surgery, the incisions are small, and sound waves (ultrasound) are used to break up the lens into small pieces. This is the most common method of doing cataract surgery. Your doctor may use a laser to help with part of this surgery.
- Standard extracapsular cataract extraction (ECCE). In this type of surgery, the lens and the front portion of the lens capsule wrapped around the lens is opened. The lens is then carefully removed in one piece.
The most common problem after cataract surgery is clouding of the posterior lens capsule (called aftercataract) within 5 years after surgery. This clouding is usually not a serious problem. And it is easy to treat with a laser surgery (Nd:YAG laser posterior capsulotomy) if it occurs.
What to think about
Just because you have a cataract doesn’t mean you need to have it removed. Only you can decide whether cataracts are affecting your vision and your life enough for you to have surgery. Learn what to ask about cataract surgerybefore deciding whether to have the surgery.
For adults, cataract surgery is almost always elective and can be done at your convenience. The surgeon, or someone familiar with routine surgical practices, will usually be available for any follow-up exams and treatment.
Surgery may be advisable if you want to continue to drive a car. If you live in a retirement home or assisted-living facility, you may decide to use vision aids and avoid surgery.
If you do not have another eye condition, such as glaucoma or problems with your retina, your chances of seeing better after cataract surgery are very good. But you may still need reading glasses or glasses for near vision.
Other Works Consulted
- Awasthi N, et al. (2009). Posterior capsular opacification. Archives of Ophthalmology, 127(4): 555–562.
- Harper RA, Shock JP (2011). Lens. In P Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury’s General Ophthalmology, 18th ed., pp. 174–182. New York: McGraw-Hill.
- Long V, et al. (2007). Surgical interventions for bilateral congenital cataract. Cochrane Database of Systematic Reviews (1).
- Mathew MC, et al. (2012). Antioxidant vitamin supplementation for preventing and slowing the progression of age-related cataract. Cochrane Database of Systematic Reviews (6).
- Wright KW (2008). Leukocoria: Cataracts, retinal tumors, and Coats disease. In Pediatric Ophthalmology for Primary Care, 3rd ed., pp. 285–310. Elk Grove Village, IL: American Academy of Pediatrics.