Signs and Symptoms of Cataracts

If your knowledge of cataracts begins and ends with “I know I don’t want them,” this guide is for you.

Cataracts. We’ve all heard of them (and maybe even joked about them being an “old-age thing”), but do you really know what they are? Simply put, cataracts are cloudy areas on the normally crystal-clear lens of your eye. Not surprisingly, these cloudy areas interfere with your vision.

All jokes aside, cataracts usually are an old-age thing — by age 80, more than half of Americans have them or have already had surgery to remove them. But cataracts typically start to form in your 40s or 50s. (They can also occur in children; more about that later.)

If you have cataracts, addressing them is crucial. Imagine if you were on a long car trip, and with every mile your windshield gradually became cloudier and harder to see through. Eventually, you’d need to pull over and do something. It would no longer be safe to drive.

It’s a similar story with cataracts: The loss of clear vision may be gradual — but at some point, you’ll have to take care of it.

What are the symptoms of cataracts?

At first, you may not be aware of the subtle changes to your eyesight caused by cataracts. But as the cataracts grow, you’ll probably begin to notice changes. For instance:

Your vision is becoming blurry or hazy.
Colors don’t seem as bright as they did in the past.
Activities that require seeing small, close-up details clearly, such as reading, sewing, or following sheet music, become more difficult, and you may feel you need brighter lights in your home.
Your night vision becomes less sharp, and you may see “halos” or experience severe glare from headlights and streetlights, making it difficult to drive at night.
Even in the daytime, bright lights, such as lamps or sunlight, may cause glare or seem too bright.
You may need frequent changes to your eyeglass or contact lens prescription as you try to compensate for your less-sharp vision. (Unfortunately, that will only help for a while.)
You develop double vision in one or both eyes.

These effects may creep up on you almost before you know they’re happening. “You may not realize on your own that small vision changes are a sign that cataracts are beginning to develop,” says Kristina Buster, O.D. She’s an optometrist with Doctor’s Exchange of Idaho, P.C., located inside America’s Best Contacts & Eyeglasses in Twin Falls, Idaho. “It’s important to get recommended eye exams so that cataracts can be found, and so that your eye doctor can help you assess when it’s time to consider cataract surgery.”

What causes cataracts?

A cataract is caused by a clump of protein on the lens of your eye. The lens is normally clear, but as its natural proteins break down, they start to stick together, which clouds your vision.

Aging is a major cause: Cataracts tend to grow larger and thicker over the years. But there are other factors that can increase your risk of cataracts:

Smoking
Excessive exposure to sunlight
Drinking a lot of alcohol
Having diabetes
Serious eye injuries
Long-term use of steroids (such as for arthritis or allergies), as well as some diuretics and major tranquilizers
Radiation treatment

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What are the different kinds of cataracts?

Cataracts are classified by where they first occur in your eye. In adults, there are three types:

1. Cataracts that form in the center of your lens. These are known as nuclear cataracts, and they can cause nearsightedness — in fact, your close-up vision might actually improve at first. But that won’t last. Over time, the cloudiness will worsen and start to spread out from the center.

2. Cataracts that form at the edges of your lens. Called cortical cataracts, these look to your eye doctor like streaks along the sides of the lens. As the cataracts progress, the streaks start to extend toward the center of your lens and interfere with light passing through.

Both nuclear and cortical cataracts are typically slow-growing.

3. Cataracts that form at the back of your lens. This third type, called posterior subcapsular cataracts, usually starts in a small area at the rear of your lens, right where the light passes through. These cataracts are often responsible for problems with reading, and they contribute to nighttime glare and halos around lights. They can grow very quickly.

Can cataracts be prevented?

No, but you may be able to slow down their growth by protecting your eyes from ultraviolet (UV) rays. Wear sunglasses that offer 100 percent UV protection whenever you’re outdoors, and if you wear eyeglasses, consider getting anti-UV coating on the lenses.

For more on what to look for when buying sunglasses, read “Sunglasses for Eye Health: The Definitive Buyer’s Guide” here.

And to learn about UV lens coatings, read “Which Lens Coatings Are Right for You?” here.

How will my eye doctor diagnose cataracts?

Your doctor can look for signs of cataracts during a comprehensive eye exam. This is an all-around check of your eye health and vision, where an optometrist:

Asks you about your vision and overall health
Checks your vision
Looks at the lens of your eyes with a strong light and a microscope to find any signs of cataracts
May dilate your eyes to evaluate the retina
Measures your eye pressure
Conducts extra tests for color vision and glare sensitivity

In addition to being on the lookout for cataracts, your doctor will look for signs of other vision problems, such as glaucoma, macular degeneration, and diabetic retinopathy.

Mature woman getting her eyes checked for cataracts

How are cataracts in adults treated?

Lifestyle fixes: You may not need any treatment in the early stages. “Some cataracts grow so slowly that it will be years before you need treatment,” says Dr. Buster. Vision problems caused by early-stage cataracts can often be handled by getting a new eyeglass or contact lens prescription.

For a while, you’ll probably be able to get away with simple adjustments to your daily routine, such as:

Using a magnifying glass while reading or pursuing hobbies
Adjusting the lighting in your home so that the rooms are brighter
Avoiding night driving, to minimize discomfort from the glare of streetlights and oncoming headlights

Surgery: Eventually, though, as the cataracts progress, new glasses won’t do enough to correct your vision. At that point, the only way to treat cataracts is to remove them with surgery.

“A major question people ask when they hear that they have cataracts is ‘When will I need surgery?’” Dr. Buster says. “It depends on how poor your eyesight currently is, how fast the cataract is growing, and how it affects your daily life.”

Though eye surgery may sound scary, it’s a relatively simple procedure that will help you see better. Your optometrist will need to refer you to an ophthalmologist for this outpatient procedure.

You’re usually awake during the surgery, and you should feel little or no discomfort. You’ll receive numbing eye drops beforehand. Once those take effect, the doctor uses small surgical tools to make an incision in your eye and remove the clouded lens. Then they’ll replace it with a clear artificial lens called an intraocular lens — IOL for short. After the procedure, you’ll rest for a little while and get checked before heading home.

Why do I need to have surgery on only one eye at a time?

While cataracts typically develop in both eyes, surgery is done on just one of your eyes at a time, with a wait of about four weeks as the eye heals before you have the other eye done. The reason: While cataract surgery is extremely safe and effective, there is a potential risk of infection or inflammation during recovery.

Although it is unlikely, you could develop an infection called endophthalmitis or an inflammatory condition known as toxic anterior segment syndrome — and it would be far better for that to occur in only one of your eyes, in case it threatens your vision. Ophthalmologists say that the one-eye-at-a-time approach also lets them make adjustments to the second surgery based on what they observed during the first one.

That said, cataract surgery in both eyes on the same day is a growing — though controversial —trend. It’s called SBCS: simultaneous (or sequential) bilateral cataract surgery, sometimes shortened to SB. At least one study has suggested that the risk of a serious infection in both eyes is minimal — in fact, far less risky than having to undergo anesthesia twice.

On the other hand, some research has shown that people who had same-day cataract surgery ended up with slightly worse vision than the one-at-a-time folks, according to a report in Review of Optometry.

Bottom line: More studies are needed before we can know if SBCS is definitely a good idea. Talk to your optometrist and ophthalmologist to make an informed choice about what is right for you.

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What are the risks of cataract surgery?

Complications after cataract surgery are not common. However, as with any surgery, there are some risks to be aware of, including:

Swelling
Bleeding
Infection
Vision loss or double vision
Changes in the pressure inside your eye
Detachment of the light-sensing retina at the back of your eye

While you’re recovering from cataract surgery, call your eye doctor immediately if you have any of these symptoms of a serious infection or complication:

Vision loss
Severe pain that doesn’t get better with pain relievers
Eyes that are extremely red
Seeing light flashes, dark spots, or squiggly lines in your field of vision

In the weeks, months, or years after cataract surgery, some people might also develop a “secondary cataract” in what’s called the posterior capsule. This is the eye tissue that holds the lens in place.

A secondary cataract, just like a primary one, can interfere with your vision. The treatment is a procedure called YAG laser capsulotomy, which creates a small opening in the posterior capsule so that light can pass through.

What will my recovery be like?

After cataract surgery, you’ll use special eye drops for about four weeks, and you may wear an eye shield or glasses to protect your eye. Avoid touching your eye, bending over, and lifting heavy objects. You should also skip eye makeup for about a week, avoid swimming for about two weeks, and avoid driving until your doctor says it’s all right.

At first, your eye may itch and feel sensitive to light. It may also be red or watery and feel gritty. But that will diminish. You can usually return to work in one to three days, and you can get back to most everyday activities within two days. Your vision may be blurry for a while, but it should reach its “new normal” state within three to six weeks — longer if you’ve opted for a monofocal IOL (more on that in a moment). According to the Cleveland Clinic, it takes about eight weeks for full recovery. During this time, your doctor will periodically check to make sure your eye is healing properly and that your new lens is working correctly.

If you wear eyeglasses, you’ll probably need a new prescription after cataract surgery. Most of the time, your eye doctor will wait about a month after your cataract surgery before assessing your vision for new glasses, Dr. Buster says.

Has it been a while since your last eye checkup? Now’s the time to book an appointment. Click here to find an appointment time that fits your schedule.

Does it matter what kind of IOL I get?

There are different types of intraocular lenses that can be implanted during cataract surgery, each with different focusing capabilities. Your IOL may allow you to stop wearing glasses, for example, or to wear them only for reading. Your eye doctor will discuss the various options with you. They generally include:

Monofocal IOLs: These can provide near, midrange, or distance vision. A common choice is to get monofocal IOLs for distance vision and to use reading glasses for close-up vision, although some people prefer the opposite arrangement, wearing glasses for distance vision and taking off their glasses for reading, working on a computer, and other close-up activities. “It’s important to talk about your lifestyle — when you wear glasses and when you’d prefer to not need glasses — with your doctor when making a decision about implants,” Dr. Buster says.

Multifocal IOLs: These work like bifocal or progressive eyeglass lenses, with different areas of focus for near and far vision built into the lens. Some also offer intermediate focus.

Accommodative IOLs: These use the natural movements of your eyes to change the focus of the lens, providing near, intermediate, and distance vision.

Extended depth-of-focus (EDOF) IOLs: These have a deeper field of vision that covers intermediate and distance vision.

Toric IOLs: These are designed to correct vision distortions caused by astigmatism. “There are a lot of specialty implants that can correct astigmatism and presbyopia,” Dr. Buster says. “Even if you need eyeglasses after cataract surgery, you won’t need a special correction for astigmatism with these IOLs.”

IOL lens treatment for cataracts

Be sure to talk with your doctor about the pros and cons of each IOL type and the best option for your situation. For example, multifocal and EDOF lenses aren’t recommended for people with glaucoma, macular degeneration, and some other eye conditions, because they let less light into the eyes, which may be a problem if you already have vision loss. Or maybe you drive at night frequently — in which case, monofocal IOLs may be a better choice than multifocal or EDOF IOLs, which can contribute to glare and cause diminished contrast vision in low light.

You’ll also want to think about affordability, of course. Check your insurance plan about coverage before you make a decision. Medicare and most private health insurance cover monofocal IOLs, but they may not cover (or may only partially cover) other more expensive types of IOLs.

Can children develop cataracts?

Although they’re most often associated with aging, cataracts can sometimes develop in childhood — or even, in rare cases, in newborns. The cause may be genetic, an infection or injury before birth, or a health condition such as myotonic dystrophy, galactosemia, neurofibromatosis type 2, or rubella. In children, untreated cataracts can interfere with the normal development of vision.

Usually, cataracts in young children are discovered by their pediatrician during routine eye screenings or during an eye check after an eye injury. But your child might also have symptoms that can tip you off, such as:

Reduced vision in one or both eyes
A cloudy or whitish look to the lens of your child’s eyes
Unusual light sensitivity
A “wandering” or crossed eye (called strabismus)
A need to hold objects close to their eyes in order to see

It’s important to remember, though, that a child with a cataract may have no symptoms at all, which is another reason to rely on regular eye exams.

How are cataracts in children treated?

Cataract surgery is recommended for babies born with severe cataracts, according to the American Academy of Pediatrics. Once the cloudy lens is removed, the baby may be fitted with a special contact lens or eyeglasses so that they can see clearly and their vision can develop normally. After about a year, an IOL may be implanted. Kids with cataracts may also need vision rehabilitation to make sure the affected eye functions normally. This may involve wearing an eye patch until their vision matures.

If a child is born with a small cataract that doesn’t interfere with vision, experts recommend careful monitoring to prevent vision problems.