The lens is a transparent disc that sits behind the coloured part of your eye (iris). It adjusts its shape to allow light entering your eye to be focused onto the back of your eye (retina). This results in clear, sharp vision.
The lens is usually clear but as you age it changes, becoming more opaque, rigid and thicker. It becomes less transparent as you get older because proteins inside the lens break down and clump together to form cloudy patches. These are called cataracts. Cataracts scatter light as it passes through your lens, which prevents the light from properly focusing on the back of your eye, causing misty, blurred vision.
At first, you may only notice small blurry areas in your vision. However, over time, less and less light will be able to reach the back of your eye. As your lens becomes more opaque, your vision will become increasingly blurred. You may struggle to read, drive a car or pick up the expressions on people’s faces. Eventually, if left untreated, cataracts cause vision loss.
Cataracts are most common in people over 65 but they can begin earlier than this.
There are three main types of cataracts:
Also known as nuclear sclerotic cataracts, these are the most common type of cataract. They occur in the centre of the lens, which is called the nucleus. As the lens hardens you may temporarily see an improvement in your near vision (eg when reading) — this is called second sight but is fleeting. As the centre of your lens continues to harden, it turns yellow and sometimes brown. Symptoms of nuclear sclerotic cataracts include:
These cataracts occur on the outer edge of your lens. They initially form white wedge shapes pointing towards the centre of your lens. As the white wedges grow, light passing through your eye scatters more, causing glare. Symptoms include:
Cortical cataracts are usually removed at an early stage of their development as they impair both near and distance vision.
Posterior subcapsular cataracts
These cataracts occur at the back of the lens, right next to the back of the lens capsule — a thin sac that holds the lens in place.
Other types of cataracts
There are several other types of cataracts, which are less common. These include:
Cataracts can also be caused by another medical condition or treatment — these are called secondary cataracts and include:
In young children, lamellar or zonular cataracts can occur in both eyes.
Cataracts develop slowly over many years so you may not notice them at first — if you wear glasses, you may just think your lenses are dirty. However, the first signs are:
As symptoms get worse over time, your impaired vision will eventually affect everyday activities. Even if you wear glasses, you may find that reading and driving become increasingly difficult — driving at night, in particular, may become challenging due to extra glare and halos around bright lights. Sometimes one eye is worse than the other and occasionally only one eye is affected. Other symptoms of worsening cataracts include:
Cataracts are usually painless and do not cause redness or irritation. However, if you have cataracts alongside another eye condition or have very advanced cataracts, you may experience some pain.
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If you think you have cataracts, go for an eye check-up with an optician who can refer you to an ophthalmologist (a doctor who specialises in treating the eyes) for treatment. Treatment is usually cataract surgery.
Cataracts are usually diagnosed with the following:
By far the most common cause of cataracts is ageing of the proteins in the lens of the eye. One in three people over 65 have cataracts or have had cataracts removed by surgery but sometimes people can get them in their 40s or 50s.
Lifestyle factors, such as smoking and alcohol, can contribute, as well as a family history of cataracts.
Some medical conditions can also mean you’re more likely to develop cataracts. These include:
Taking certain medications, such as long-term use of steroids, also increases your risk of cataracts, as does too much exposure to sunlight.
Cataracts can only be effectively treated with surgery.
In the early stages of cataracts, it may help to wear glasses and avoid bright lights, but eventually, surgery will be necessary to restore failing vision.
You don’t have to wait for your eyesight to become really bad before you have surgery. For most people, the sooner they have cataract surgery the better their quality of life and ability to continue everyday activities. Cataract surgery is generally considered a safe and effective procedure.
Cataracts may affect your ability to drive. If you still meet the visual standards set by the DVLA for driving, you do not need to tell them if you have cataracts or have had cataracts.
This is also true if you drive a bus, coach or lorry, but with the added requirement that you should not have any increased sensitivity to glare caused by your cataracts.
There are no guaranteed ways to prevent or slow down cataracts. However, doctors do recommend:
What does vision look like with cataracts?
Your vision may appear cloudy, misty or blurred, with colours looking faded and halos appearing around bright lights.
How quickly do cataracts progress?
Cataracts caused by getting older usually take many years to develop. However, cataracts caused by injury or by a medical condition, such as diabetes, can develop much faster.
Can you go blind from cataracts?
If cataracts are left untreated, you will go blind. However, this loss of vision is reversible with cataract surgery.
What are the three types of cataracts?
There are many different types of cataracts. However, the three main types of cataracts are nuclear sclerotic cataracts, which develop in the centre of your lens, cortical cataracts, which develop on the outer edge of your lens and posterior subcapsular cataracts, which develop at the back of your lens. Nuclear sclerotic cataracts are the most common type of cataract.
Does cataract surgery give you 20 20 vision?
Cataract surgery replaces your natural, cloudy lens with an artificial lens. Whether or not you achieve 20 20 vision will depend on how well-placed the artificial lens is and whether and by how much it shifts after surgery. Around 30-50% of people still need to wear prescription glasses after cataract surgery.
When should you have cataracts removed?
This will depend on how advanced your cataracts are and the impact they have on your quality of life. Your optician or ophthalmologist can advise you on when is an appropriate time for you to have them removed.
Can you get rid of cataracts without surgery?
No, cataracts can only be treated ie removed via surgery.
Can you see cataracts in the mirror?
In the early stages, you can’t see cataracts in the mirror. However, advanced cataracts can be seen; they appear as a milky white covering over the pupil of your eye (the opening in the middle of your iris that lets light in).
Is cataract surgery painful?
No, cataract surgery is not painful. You will be awake for your procedure but your eye will be numbed using a local anaesthetic so you won’t feel any pain.
Are floaters a sign of cataracts?
Floaters are not a sign of cataracts. However, they can occur after cataract surgery, either because they have always been there but you were unable to see them until your cataracts were removed, or as a complication of surgery.
When should I worry about eye floaters?
You should see your optician or GP urgently if you notice a sudden increase in the number of floaters in your vision or if your floaters are accompanied by other symptoms including flashes of light, blurred vision, eye pain, a curtain or shadow appearing to block part of your vision or sudden decreased vision.