Cataract Surgery Co-Management

What Is a Cataract?

A cataract is a clouding or loss of transparency of the eye’s natural crystalline lens. The lens sits behind the iris and pupil and normally acts like a clear optical element that focuses light onto the retina.

As the lens becomes cloudy, light is scattered rather than cleanly focused on the retina. This can lead to:

• Blurred or hazy vision

• Glare

• Halos around lights

• Reduced contrast

• Difficulty seeing at night

• Changes in glasses prescription
  
  

Importantly, a cataract isn’t something that suddenly “appears” when someone becomes elderly. Lens changes begin gradually throughout life, and clinically significant cataracts develop when those changes become substantial enough to affect vision.

What Causes a Cataract?

The most common type is an age-related cataract, but aging isn’t the only cause.

As we age, several things happen within the lens:

• Lens proteins called crystallins undergo chemical and structural changes.

• These proteins can become damaged, aggregated, and lose their normal transparency.

• The lens gradually becomes more yellow and eventually brown.

• Lens fibers become increasingly compacted and less flexible.

• Changes in the lens’s water and electrolyte balance also contribute to loss of transparency.
  
  

Think of it somewhat like a clear window gradually becoming cloudy or yellowed. Instead of light passing cleanly through the lens, some of it becomes scattered.

Factors That Can Accelerate Cataract Formation

• Age

• Diabetes and chronically elevated blood glucose

• Long-term corticosteroid use

• Smoking

• Ultraviolet (UV) exposure

• Previous eye surgery

• Eye trauma

• Ocular inflammation, such as uveitis

• Radiation

• Certain genetic conditions

• Certain metabolic diseases
  
  

While cataracts are predominantly associated with aging, they aren’t exclusively an age-related disease.

When Do Cataracts Typically Start?

There isn’t a specific age when someone “gets” a cataract. Lens changes occur gradually throughout life, but clinically significant age-related cataracts become increasingly common with advancing age, particularly after age 60.

Some people may develop noticeable lens changes in their 40s or 50s, while others may not experience significant visual symptoms until much later.

​​​​​​​Cataracts can also develop earlier in life because of diabetes, medications, trauma, inflammation, genetics, or other conditions.

How Can a Child Have a Cataract?

Although cataracts are most commonly associated with aging, children can also be born with or develop cataracts during childhood.

A cataract may be present at birth, known as a congenital cataract, or develop later as a result of:

• Genetics

• Certain medical or metabolic conditions

• Eye trauma

• Inflammation

• Medications such as corticosteroids

• Other eye conditions
  
  

In some children, no specific cause can be identified.

Cataracts in children are particularly important because vision is still developing during childhood. The brain needs a clear image from each eye to develop the visual pathways responsible for normal vision.

If a cataract blocks or significantly blurs the image reaching the retina during this critical period, the affected eye may not develop normal vision. This can lead to deprivation amblyopia, sometimes referred to as a “lazy eye.”

For this reason, a cataract that might simply be monitored in an adult can require much more urgent evaluation in an infant or child.

​​​​​​​The size, location, density, age of the child, and whether one or both eyes are affected all influence management.

What Are the Symptoms of Cataracts?

Cataracts typically develop gradually. Symptoms may include:

• Blurred or hazy vision

• Increased sensitivity to light

• Glare or halos around lights

• Difficulty driving at night

• Faded or yellowed colors

• Reduced contrast

• Difficulty reading

• Frequent changes in glasses prescription

• Double vision in one eye

• Difficulty seeing in low-light conditions
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Some cataracts may be present for years before causing noticeable symptoms.

Treatment & Management

Monitoring

Not every cataract requires treatment immediately. Early or mild cataracts that aren’t significantly affecting vision can often be monitored during routine eye examinations.

Your eye doctor can monitor the cataract’s progression and determine whether it is beginning to interfere with your vision or daily activities.

Updating Your Prescription

In the early stages, changes in the lens can alter your prescription. Updated glasses or contact lenses may improve vision and allow you to continue your normal activities.

Other strategies, such as brighter lighting, anti-reflective lenses, and appropriate sunglasses, may also help manage symptoms.

These approaches, however, do not remove or reverse the cataract.

Can Eye Drops Treat Cataracts?

Currently, there are no FDA-approved eye drops or medications that can reverse an established cataract. Supplements have also not been proven to eliminate cataracts.

​​​​​​​Managing conditions such as diabetes, avoiding smoking, and protecting your eyes from excessive UV exposure can help address modifiable risk factors.

When Is Cataract Surgery Recommended?

Cataract surgery is generally considered when the cataract begins to interfere with a person’s daily activities, work, hobbies, or quality of life.

This might include difficulty:

• Driving, especially at night

• Reading

• Working on a computer

• Recognizing faces

• Watching television

• Playing sports

• Performing work-related activities
  
  

There isn’t one specific visual acuity number that automatically means someone needs cataract surgery.

​​​​​​​The decision is based on the patient’s symptoms, visual function, examination findings, lifestyle, and individual goals.

What Happens During Cataract Surgery?

Cataract surgery involves removing the cloudy natural lens and replacing it with an artificial intraocular lens (IOL).

The most common technique uses a small incision and ultrasound energy to break up and remove the cloudy lens. An artificial lens is then placed inside the eye.

Depending on the patient’s eye health, prescription, astigmatism, lifestyle, and visual goals, different IOL options may be considered, including:

• Monofocal lenses

• Toric lenses for astigmatism

• Multifocal lenses

• Extended-depth-of-focus (EDOF) lenses

The appropriate lens depends on each patient’s individual needs and should be discussed with their eye-care and surgical teams.

When Should You Have Your Eyes Examined?

Because cataracts can develop gradually, you may not recognize changes in your vision at first.

A comprehensive eye examination can identify cataracts and determine:

• Whether a cataract is present

• Its location and severity

• Whether your prescription can still adequately correct your vision

• Whether monitoring is appropriate

• Whether referral for cataract surgery should be considered
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If you’re experiencing increasing glare, difficulty driving at night, blurred vision, halos, faded colors, or frequent prescription changes, schedule a comprehensive eye examination.