Patient guide
Cataracts: what they are, when to act, and what surgery involves
Cataracts change slowly, over months to years. Call the same day for anything sudden: sudden blur or loss of vision, new flashes or floaters, a shadow or curtain across your vision, pain, or a red eye. Call (609) 246-0236. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call.
The lens inside the eye is clear at birth and slowly becomes less so. By 80, more than half of Americans have a cataract or have had one removed. It is not a growth or a film over the eye; it is the lens itself turning cloudy, the way an egg white turns opaque when cooked, and it happens to nearly everyone who lives long enough.
This guide covers how a cataract changes vision, how to decide when it is time, and what surgery involves, including the parts that happen in this office before and after.
How a cataract changes vision
- Glare and halos, especially around headlights at night. Often the first thing people notice, and the reason many stop driving after dark before they realize why.
- A general dimming, as though the lights are lower than they used to be, and a need for more light to read.
- Faded or yellowed colors. Whites look cream. Most people only notice how much after surgery.
- Blur that new glasses no longer fully fix, and a prescription that changes more often than it used to.
- Suddenly reading better without glasses. Some cataracts shift the eye toward nearsightedness for a while. It feels like improvement and is worth mentioning rather than celebrating.
- Double or ghosted images in one eye.
Cataracts do not hurt, do not make the eye red, and do not come on suddenly. Anything that does is something else.
Why they happen, and what speeds them up
Age is the main cause: the proteins of the lens gradually clump and discolor. Some things bring that forward. Years of sunlight without UV protection. Smoking. Diabetes, which also produces a particular kind of cataract at the back of the lens that affects reading and glare early. Long-term steroid use, in any form. An eye injury, even decades earlier. A family tendency.
Nothing reverses a cataract once it has formed. No drop, supplement or diet has been shown to dissolve one, whatever the label says. Sunglasses that block UV and not smoking slow them down; surgery is the only treatment.
When it is time
Surgery is decided by how much the cataract interferes with what you do, not by how cloudy it looks. The idea that a cataract must be ripe comes from a time when surgery was a different operation. Today it is timed around your life: night driving that has become hard, reading that is a struggle with up-to-date glasses, faces and steps that are harder to make out, a hobby or a job you are doing less well.
Waiting rarely makes the operation harder, with one exception: a cataract left until it is very dense is more difficult to remove. That is why a cataract that is not yet ready is still followed at regular visits rather than forgotten about. Until then, up-to-date glasses, more light for reading, sunglasses and a brimmed hat outdoors, and good lighting on the stairs make a real difference.
What surgery involves
It is one of the most common operations performed anywhere, done as an outpatient under local anesthetic drops with light sedation, and it takes around fifteen to twenty minutes. The surgeon makes a tiny opening, breaks the cloudy lens up with ultrasound, removes it, and places a clear artificial lens in the same position. The opening usually seals itself. One eye is done at a time, typically a week or more apart.
Choosing the lens
- A standard lens gives sharp vision at one distance, usually far, and is covered by insurance. Most people then use reading glasses.
- A toric lens corrects astigmatism as well, reducing the need for distance glasses.
- Multifocal and extended-range lenses aim to reduce dependence on glasses at more than one distance. They trade a little contrast and some halos at night for that convenience, and they suit some eyes and some people better than others.
- Monovision, one eye set for distance and the other for near, suits people who have already tried it in contact lenses.
The upgraded lenses are usually an out-of-pocket cost. Which is right depends on your eyes, your habits and your tolerance for compromise, and it is a conversation worth having here before the surgeon's consultation as well as with the surgeon.
The risks, plainly
Serious complications are uncommon. The ones worth knowing: an infection inside the eye, which is rare and is the reason the drops afterwards matter; a higher risk of retinal detachment that lasts for years, so the warning signs are worth learning; and swelling of the retina or cornea that usually settles. Months or years later, a harmless haze often forms behind the new lens and blurs vision again; a quick, painless laser in the surgeon's office clears it in minutes.
What happens in this office
- Diagnosis and follow-up. The cataract is graded, your vision is measured against what it should be, and the retina behind it is examined, because a cataract can hide other problems. Visits continue at the interval set until it is time.
- Referral. When you decide to go ahead, you are referred to a cataract surgeon with your records and imaging sent ahead, including the shape of your cornea and the health of your retina, which affect the lens calculation.
- Care after surgery. The early visits are with the surgeon. When the surgeon agrees, the later follow-up can be done here instead of driving back.
- New glasses. About three to six weeks after each eye, once it has settled, your prescription is checked here and updated.
If you have ever taken tamsulosin (Flomax) or a similar prostate or kidney-stone medicine, even briefly, tell the surgeon: it changes how the pupil behaves during surgery, and the surgeon plans for it.
Common questions
Can a cataract come back?
No. The cloudy lens is gone. What can happen is a haze on the thin capsule that holds the new lens, months or years later. It feels like the cataract returning and is cleared with a two-minute laser in the surgeon's office.
Will I still need glasses after surgery?
It depends on the lens chosen. With a standard lens set for distance, most people need reading glasses and some need a light distance pair. The multifocal and extended-range lenses reduce that, at a cost and with some compromises. No lens guarantees freedom from glasses.
Is the surgery painful?
No. The eye is numbed with drops and you are lightly sedated. Most people describe pressure and bright lights. The eye can feel gritty for a day or two afterwards.
Can both eyes be done at once?
Some centers now offer both eyes on the same day for suitable patients. Most surgeons in this area still do one at a time, a week or more apart, so the first eye's result can guide the second. Ask your surgeon which they offer and why.
Does a cataract visit go through my vision plan or my medical insurance?
Diagnosing and following a cataract is a medical visit and goes through your medical insurance, even though you are seeing an optometrist. Medicare covers standard cataract surgery and one pair of glasses afterwards. Vision plans cover routine eye exams and eyewear; medical plans cover conditions. Many patients carry both and are not sure which applies. Vision plan or medical insurance explains the difference, and a call with your plan details before you book sorts it out beforehand rather than afterwards.
Book an exam
If night driving has become hard, or new glasses no longer help the way they used to, an exam will show whether a cataract is the reason and how far along it is.
Book an exam Call (609) 246-0236
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing.
Sources
The figures and recommendations on this page come from the following. Ask at your visit if you would like a copy of any of them.
- American Academy of Ophthalmology. Cataract in the Adult Eye Preferred Practice Pattern. 2021.
- National Eye Institute. Cataracts: facts and statistics. nei.nih.gov.
- Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA. 2012;308(5):493-501.
- Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. Journal of Cataract and Refractive Surgery. 2005;31(4):664-673.