Cataracts: Symptoms, Types and When to Have Surgery

Not all cataracts are the same. The type you develop affects which symptoms appear first, how quickly the cataract progresses, and how our cataract surgeons approach treatment.

Nuclear sclerotic cataracts are the most common age-related type, forming in the center (nucleus) of the lens. They develop slowly over years and initially cause a yellowing of the lens that can shift color perception. As the cataract matures, it hardens and turns brown, progressively reducing clarity at all distances.

Cortical cataracts begin as white, wedge-shaped opacities along the outer edge (cortex) of the lens. These spoke-like formations gradually extend inward toward the center and scatter incoming light, creating significant glare problems. People with diabetes are at higher risk for this type of cataract.

Posterior subcapsular cataracts (PSCs) develop on the back surface of the lens, directly in the path of light entering the eye. They tend to progress faster than other types and are particularly disruptive to reading and close-up tasks. PSCs are more common in younger patients, people who take corticosteroid medications, and those with diabetes.

Some cataracts are present at birth (congenital) or develop in childhood, often due to genetic factors, infections during pregnancy, or metabolic disorders. Traumatic cataracts result from a direct injury to the eye, such as a blunt blow, penetrating wound, or exposure to radiation. These cataracts can develop rapidly and may require a more individualized surgical approach, including careful selection of the intraocular lens implant to suit the unique anatomy of the injured or developing eye.

Below are answers to common questions patients ask about cataracts and the decision-making process around treatment.

There is currently no medication, eye drop, or supplement that can reverse or dissolve a cataract once it has formed. In the early stages, updated glasses, brighter lighting, anti-glare coatings, and magnifying tools can help manage symptoms. However, when these strategies no longer provide adequate relief, surgery to remove the clouded lens and replace it with an artificial intraocular lens is the only proven treatment.

The natural lens of your eye is made primarily of water and precisely arranged proteins. Over time, these proteins break down and clump together, creating cloudy areas that block or scatter light. Aging is the most significant cause, but oxidative damage from UV light, metabolic changes from conditions like diabetes, certain medications, eye injuries, and genetic predisposition can all contribute to earlier or faster cataract formation.

Cataracts make the pupil's natural dilation in low light work against you. When your pupil opens wider at night, more light passes through the clouded portions of the lens, amplifying glare and halos around headlights and streetlights. Reduced contrast sensitivity also makes it harder to detect pedestrians, road markings, and obstacles in the dark. Many patients find that difficulty with night driving is the symptom that ultimately prompts them to explore their surgical options and post-operative care.

Age is the primary risk factor, with most people developing some degree of lens clouding by their mid-60s. Additional risk factors include a family history of early cataracts, diabetes, prolonged corticosteroid use, heavy alcohol consumption, smoking, significant UV exposure, previous eye injuries, and prior intraocular surgery. Some of these factors are modifiable, so protective measures like wearing UV-blocking sunglasses and managing blood sugar can help slow the process.

Once a cataract is surgically removed, it cannot grow back because the natural lens has been permanently replaced with an artificial one. However, some patients develop posterior capsule opacification (PCO), sometimes called a 'secondary cataract,' where the thin membrane behind the implanted lens becomes hazy. PCO is treated quickly and painlessly with a YAG laser capsulotomy, a brief in-office procedure that restores clear vision within days. If you want to learn more about wearing contact lenses after cataract surgery, our specialists can advise you on your options.

The concept of waiting until a cataract is 'ripe' is outdated. Modern cataract surgery can be performed safely at virtually any stage of development. The best time for surgery is when your vision loss begins to limit activities you value, whether that is reading, driving, working, or enjoying time outdoors. During your evaluation, your doctor will review your visual acuity, measure the cataract's density, and discuss your lifestyle needs to help you decide on the right timing.