Cataract: symptoms, surgery and recovery

What is a cataract?

Behind the iris – the coloured part of the eye – sits a clear lens that focuses light onto the retina. With age, the proteins in the lens change and it gradually loses its clarity. This is a cataract. Light is scattered, the image becomes misty and colours look faded, rather like looking through a frosted window.

According to the World Health Organization, cataract remains one of the leading causes of blindness and severe sight loss worldwide, mainly where surgery is hard to access. It is not a film over the surface of the eye and is not “scraped off” with a laser from outside – the change is inside the lens itself.

Cataracts are described by where the clouding sits: nuclear (in the centre, most common with age), cortical and posterior subcapsular. The last type tends to affect vision earlier, particularly reading and in bright light.

Causes and risk factors

• Age – the main factor; most people over 60–70 have some degree of cataract.
• Diabetes – cataracts appear earlier and progress faster.
• Smoking and heavy drinking.
• Long-term steroid use – tablets, inhalers or eye drops.
• Ultraviolet light – years of sun exposure without protection.
• Eye injury or previous eye surgery, inflammation (uveitis) and high short-sightedness.
• Congenital cataract – present in babies and children, needing prompt assessment by a paediatric ophthalmologist.

UV-protective sunglasses, stopping smoking and good control of diabetes and blood pressure are sensible for eye health, but they cannot fully prevent age-related cataract.

Symptoms

Cataracts usually develop over years and often affect both eyes, though not equally. Common symptoms are:

• blurred, cloudy or misty vision that glasses do not correct;
• glare from headlights, sunlight or bright lamps, and halos around lights;
• difficulty driving or seeing in dim light;
• faded or yellowish colours;
• double vision in one eye;
• frequent changes in glasses prescription; with nuclear cataract, near vision may briefly improve (“second sight”).

Cataracts do not cause pain or redness. Pain, sudden loss of vision, flashing lights or a “curtain” across your sight point to another problem that needs urgent assessment.

Diagnosis

An ophthalmologist (eye doctor) or optometrist checks your vision, measures eye pressure and examines the lens with a slit lamp microscope. After dilating drops, the retina is examined too – it is important to rule out other conditions such as glaucoma, macular degeneration or diabetic eye disease, which also reduce vision.

If surgery is planned, biometry measures the length of the eye and the curvature of the cornea to calculate the power of the lens implant. An optical coherence tomography (OCT) scan of the macula or corneal mapping may also be done. In Bulgaria you see an ophthalmologist with a referral from your GP or privately.

Treatment: when is it time for surgery?

Early on, a stronger glasses prescription, brighter lighting and magnifiers can help. No drops or tablets clear a cloudy lens – the only effective treatment is surgery.

A cataract does not need to be “ripe”, as people used to think. NICE guideline NG77 recommends basing the decision on how much the sight loss affects your life – driving, reading, work, risk of falls – rather than on visual acuity alone. Surgery may be advised sooner if the cataract interferes with treating another eye condition.

Phacoemulsification is the standard technique: through a tiny incision the cloudy lens is broken up with ultrasound and removed, and a foldable artificial lens is placed in the lens capsule. The operation is usually:

• a day case, with no overnight stay;
• done under local anaesthetic drops, sometimes with light sedation;
• about 15–30 minutes long;
• performed on one eye at a time, with the second eye typically a few weeks later.

Femtosecond laser-assisted cataract surgery uses a laser for some steps. Studies have not shown a clear advantage over standard phacoemulsification for most patients; the choice is the surgeon’s.

Lens implant options

Discuss the choice with your surgeon in light of your eyes, lifestyle and expectations. If you have had laser eye surgery, say so – the lens calculation needs special formulas.

Risks and recovery

Cataract surgery is among the safest operations, but it is not risk-free:

• Posterior capsule opacification – the commonest later problem, months or years afterwards, treated quickly with a YAG laser in clinic.
• Inflammation and raised eye pressure – usually temporary and controlled with drops.
• Swelling of the macula – may blur vision for a while.
• Serious but rare complications – infection inside the eye (endophthalmitis), retinal detachment, or lens fragments left in the eye.

Afterwards you use antibiotic and anti-inflammatory drops for several weeks. Avoid rubbing the eye, wear the shield at night as advised, and avoid swimming and dusty places for the first weeks. Most people see better within days. You can drive again once your eye doctor confirms you meet the legal standard, and new glasses are usually prescribed about a month after surgery.

Some patients from Bulgaria choose surgery at a large hospital in Istanbul – read about organisation, choosing a surgeon and follow-up in eye surgery in Turkey. New City Clinic coordinates such operations with partner hospitals; whatever you decide, ask for a written plan, the lens type and model, and arrangements for check-ups at home.

When to see a doctor

Book an eye examination if your sight is slowly getting worse, headlights dazzle you when driving or your glasses no longer help. People with diabetes need regular eye checks even without symptoms, and a routine health check-up is a good reminder to have your eyes tested.

Seek urgent eye care if, after cataract surgery, you develop increasing pain, redness, a sudden drop in vision, a shower of new floaters, flashing lights or a dark shadow. Sudden loss of vision together with weakness in an arm or leg or slurred speech may be a stroke – call 112.