In all likelihood, you’ve heard of cataracts before. Depending on how well-versed you are in the field of ophthalmology, the mention of cataracts may elicit no reaction or may trigger a fear of impending blindness. The good news is that cataracts are not usually associated with permanent blindness. The bad news is that cataracts are a normal part of aging, so if you live long enough, you can probably expect to develop them at some point.

What are Cataracts?

Cataracts are any opacity of the crystalline lens inside the eye. You may see cataracts described as haziness or clouding of the lens but whatever the terminology, it basically means that your eye’s lens is not as transparent as it used to/is supposed to be.

Cataracts can be due to a number of causes, the main one being older age. In a healthy, normal eye, the lens is clear at birth. However, as you get older, because of all the fun things happen to an aging human body, the lens slowly and gradually loses its transparency as its fibers break down. Eventually, this is called a cataract.

Other causes of cataract can include:

• Eye injury, such as electric shocks, and blunt or sharp trauma
• Certain medications, including steroids
• As side effect of other eye procedures, such as retinal detachment treatment
• In association with certain genetic disorders or medical conditions, including diabetes

It is also possible to be born with cataract or develop one shortly after birth. These are known as congenital cataracts and are often due to maternal infection during pregnancy, such as rubella or chickenpox, or genetic abnormalities meaning the lens doesn’t develop properly.

Symptoms of a Cataract

In the early to even moderate stages of a cataract, you may not be aware that you have one at all. Of course, if you get electrocuted and then realize soon after that your vision is not what it once was, you may suspect there’s something going on in the eyeball. Otherwise, as age-related cataracts tend to be quite slowly progressive over time, most cataracts are first pointed out during a routine eye exam, much to the patient’s surprise.

Typical symptoms of cataracts include:

Hazy or cloudy vision

Not everyone necessarily identifies their vision as taking on a blurry or hazy quality. You may be more likely to notice that certain activities are harder to perform.

Difficulties discerning fine detail in poor lighting

Where you may have once prided yourself on excellent night vision, you may now find yourself bringing out the torch on your smartphone to read the menu in a dimly lit restaurant.

The reason for this is that the haze of the cataracts decreases your contrast sensitivity. This makes it more difficult to pick out details (such as writing) against the background (the page). It can be especially difficult if you’re trying to read colored text against a colored background.

Similarly, navigating an uneven sidewalk at dusk can be more challenging as it becomes increasingly difficult to find the cracks and edge of the curb.

Feeling less comfortable driving in certain conditions

Similar to the issue with reading in low lighting, the impact of cataracts on your contrast sensitivity can make it more challenging on the road. This can be apparent when driving in heavy rain, at certain times of the day (often dusk or dawn), or if there’s low-lying fog across the road.

Another effect of many cataracts is an increase in glare sensitivity. Though glare sensitivity can be due to various factors (such as just being a glare sensitive person), discomfort in bright lighting can be exacerbated as your cataracts progress. On the road, this can manifest as feeling increasingly blinded when faced with oncoming car headlights or street lamps.

Alterations to your color perception

Some people may become aware of changes to their color vision as their cataracts develop. This is typically associated with a specific form of cataract known as nuclear sclerosis, which appears as a yellowish-brown clouding of the center of the lens (the nucleus). The discoloration of the lens causes certain wavelengths of light to be filtered out as it enters the eye, which changes the color spectrum that you’re able to see.

Unless you have particularly fine color discrimination, such as you’re a painter or colorist, you’re less likely to notice this as a symptom of cataract. However, many people comment on the sudden increased vibrancy of colors once their cataracts have been removed.

Frequent changes to your glasses or contact lens prescription

Cataracts are known for causing a shift in prescription. This can mean your prescription becomes more long-sighted, more short-sighted, or even changes in astigmatism. Depending on where your prescription started and the direction it shifts, you may actually find an improvement in your sight for certain activities (at least for a short while). For example, if you used to wear reading glasses, a short-sighted shift in your prescription from progressing cataracts may find you suddenly being able to read more clearly without your glasses as your natural near vision improves.

It’s important to note that while cataracts are associated with several symptoms, they are not typically associated with pain or redness of the eye. The caveat to this is cataracts that have been left unattended for too long (hypermature cataracts), resulting in them liquifying and sparking an inflammatory reaction in the eye. In developed countries such as the US, this scenario is extremely rare.

Do Cataract Symptoms Mean I Need Surgery Immediately?

In the majority of cases, cataract surgery is only necessary when you decide it’s necessary. As everyone’s visual demands are different (think someone whose job requires them to read tiny writing all day versus a professional swimmer) and everyone’s tolerance for blurry vision is different, the best guidance for the timing of cataract surgery is basically “get surgery when your cataracts annoy you enough”.

When first diagnosed with a cataract, have a chat with your eye doctor about the impact the cataracts are having on your vision and your daily tasks. If the final conclusion is that you’re still quite content with what you can see, then the best course of action would simply be to monitor your cataracts and your vision over time until they develop to the stage where they’re starting to cause a bother. For some people, they may reach the end of their very long and happy life without ever feeling like they needed to have their cataracts removed.

In some cases, your eye doctor may gently suggest that you consider cataract surgery before you personally feel like you need it. This is usually when your deteriorating eyesight is beginning to approach the limits required for holding a driver’s license, even if you subjectively feel that your vision is reasonable.

Cataract surgery is straightforward and relatively painless. Nine out of 10 people regain excellent vision between 20/20 and 20/40. If you believe you have a cataract, please contact us so that we can schedule a consultation with Dr. Michel.