Understanding cataracts and cataract surgery

Cataracts refer to clouding of the lenses in your eyes, which impairs your vision. They most often occur due to age-related changes in the proteins of these lenses as they absorb UV light over the years and are a natural part of ageing. However, when you develop cataracts depends on a variety of risk factors. 

Risk factors for age-related cataracts

Age-related cataracts occur sooner in people who smoke, drink excessive amounts of alcohol and lead a sedentary lifestyle.

Other risk factors include diabetes, obesity, high blood pressure and prolonged use of steroid tablets. 

Risk factors for other types of cataracts

In addition to age-related cataracts, which are by far the most common type of cataracts, there are also paediatric cataracts and traumatic cataracts.

Paediatric cataracts refer to cataracts that occur from birth or that develop in early childhood. These are usually due to genetic faults that cause the lenses to develop abnormally, genetic conditions and less commonly, infections in the mother during pregnancy (eg rubella and chickenpox).

Traumatic cataracts are caused by eye injuries or radiation therapy, which is often used to treat cancer.

Cataract symptoms

Cataracts are not painful but cause your lenses to become cloudy, which results in blurry images and has a dimming effect on your vision. You may notice that colours appear faded and/or tinged yellow or brown, and that haloes appear around bright lights.

Cataracts also make your eyes more sensitive to light due to the way light bends through the cloudy lenses. This makes driving at night difficult due to the glare of lights from oncoming traffic. This same effect can occur at night with streetlights or other bright lighting against a dark background.

You may also notice that you need to change your glasses prescription much more often as cataracts can worsen shortsightedness.

Delaying the onset of cataracts

Leading a healthier lifestyle can delay the onset of cataracts. This includes cutting back on smoking and drinking alcohol, eating a healthy, well-balanced diet and exercising regularly. This will help prevent diabetes, which is a major risk factor for developing cataracts earlier on in life. 

Cataract surgery

Currently, the only effective treatment for cataracts is surgery to remove the cloudy lenses and replace them with artificial lenses. The artificial lenses allow for clear distance vision. After cataract surgery, you will therefore need to wear glasses to have clear near vision. 

Cataract surgery is one of the most common surgeries performed in the UK, with over 450,000 carried out each year and with a very high success rate. 

What does cataract surgery involve?

Each lens in your eyes is held within a thin film of tissue called the lens capsule. During cataract surgery, the cloudy lens inside the capsule is removed using a technique called phacoemulsification. This uses ultrasonic energy to break up the cloudy lens, after which it is vacuumed out of the lens capsule. Phacoemulsification can be laser-assisted or performed manually, where a blade is used to cut into the eye to reach the lenses instead of a laser.

When is the right time for cataract surgery?

The right time for cataract surgery depends on your particular needs and lifestyle. If you drive, you will need regular check-ups with your optician to make sure that your cataracts aren’t impairing your ability to drive safely. If your profession or hobbies involve a lot of near-vision work (eg needlework, painting, watch or jewellery making, reading, using a computer etc), the burden your cataracts place on your vision may become a problem sooner and, therefore, need surgery sooner. 

Is it ever too late to have cataract surgery?

Once your vision is impaired, it is important to seek treatment. If cataracts are left untreated, they can cause blindness as the lens clouds over completely, preventing any light from getting through. Cataracts can also become hypermature, which makes cataract surgery more challenging. 

In hypermature cataracts, the lens capsule becomes wrinkled and the lens inside either becomes solid and shrunken or softens and liquifies in parts. This makes surgery difficult but it is still necessary as left untreated, hypermature cataracts can trigger glaucoma, an eye condition that can cause permanent blindness. 

Risks of cataract surgery

Cataract surgery is a highly successful procedure, with complications being rare. However, as with any surgery, there are some risks, including infection and the need for further surgery due to bleeding, inflammation, retinal detachment, vision loss (which can be permanent) and secondary cataracts. 

Secondary cataracts occur when the lens capsule, which is left in place to hold the artificial lens, becomes cloudy in response to the introduction of the artificial lens and/or as part of your body’s natural healing process. This can be treated with a laser procedure called ​​YAG laser capsulotomy.  

Recovering from cataract surgery

It is normal to experience some discomfort and soreness after cataract surgery, which should resolve after a few days. You will likely need one to two weeks of rest before you can return to work. Complete recovery usually takes four to six weeks. Before you return to driving, see your optician to check that your vision meets the legal requirement.

Author biography

Miss Tina Khanam is a Consultant Ophthalmologist at Spire St Anthony’s Hospital, specialising in cataract surgery, lid lump surgery, blepharitis, blepharoplasties, dry eye treatment, red eye treatments, pterygium surgery, keratoconus, refractive surgery and corneal transplants. She has performed over 2,000 ocular surgeries with excellent reviews. She is a Founder and Trustee of The Mannan Foundation Trust, a UK charity supporting disadvantaged children and women. She has been voted the best surgical teacher with outstanding teaching resources. She is also the Co-chair of Homefield Association, a local school charity.