Cataracts are extremely common. They are the leading cause of treatable vision loss worldwide and develop in most people as they get older. In Australia, cataract surgery is the most frequently performed surgical procedure.
At Pure Sight Eye Surgeons, Dr Alison Chiu specialises in custom cataract surgery, offering a personalised approach to lens selection and surgical planning.
What Causes Cataracts?
The most common cause is age. Over time, the proteins in the lens gradually break down and clump together, causing the lens to become less transparent. This process usually begins from around mid to late 50s, though it may not affect vision noticeably until years later. By age 70, most people have some degree of cataract formation.
Other factors that can contribute to or accelerate cataract development include:
- Diabetes — people with diabetes are more likely to develop cataracts at a younger age
- UV exposure — prolonged sun exposure over many years increases the risk
- Smoking — significantly increases the rate of cataract formation
- Medications — long-term use of corticosteroids (including eye drops and inhalers) is a well-known cause
- Eye injury or inflammation — trauma or uveitis can cause cataracts to develop earlier
- Previous eye surgery — some procedures increase the risk of cataract formation over time
- Family history — genetics play a role in when cataracts develop
Types of Cataracts
Nuclear cataracts
The most common type, developing in the centre (nucleus) of the lens. Nuclear cataracts are strongly associated with ageing and can temporarily improve near vision before progressively worsening distance vision.
Cortical cataracts
These begin as white, wedge-shaped opacities in the outer edge (cortex) of the lens and gradually extend inward. They can cause glare and difficulty with contrast.
Posterior subcapsular cataracts
These form at the back surface of the lens, directly in the path of light. They tend to progress faster than other types and can cause particular difficulty with reading and glare. They're more common in younger patients, people with diabetes, and those who use corticosteroids.
Symptoms
Cataracts usually develop gradually, so you may not notice the early changes. As the cataract progresses, common symptoms include:
- Blurred, cloudy, or hazy vision
- Increased sensitivity to glare from headlights, sunlight, or bright lights
- Difficulty driving at night
- Colours appearing faded or yellowish
- Needing brighter light for reading or close-up tasks
- Frequent changes to your glasses prescription that don’t seem to help
- Double vision in one eye (less common)
Diagnosis
Cataracts are diagnosed during a comprehensive eye examination. After dilating your pupils, the doctor can see the cataract directly using a slit lamp microscope. The degree of clouding and its effect on your vision will be assessed, along with the overall health of the rest of your eye.
Additional tests, including OCT imaging, corneal topography and biometry (measurements for intraocular lens calculation), are performed when surgery is being considered.
Treatment
The only treatment for a cataract is surgery. There are no eye drops, medications, or exercises that can reverse or prevent a cataract once it has started to form.
In the earliest stages, updated glasses may help manage the symptoms. Surgery is recommended when the cataract begins to interfere with your daily activities, your ability to drive safely, or your quality of life. Some patients choose to proceed with surgery earlier, particularly if they are interested in premium lens options that can reduce their dependence on glasses.
Modern cataract surgery is a highly refined procedure with an excellent safety record. It involves removing the cloudy lens and replacing it with a clear artificial intraocular lens (IOL). The type of IOL chosen determines what you can see clearly without glasses after surgery.
Can Cataracts Be Prevented?
You can’t prevent cataracts entirely, but you may be able to slow their progression by:
- Wearing UV-protective sunglasses when outdoors
- Not smoking, or quitting if you do
- Maintaining a healthy diet rich in fruits and vegetables
- Managing diabetes and blood sugar levels carefully
- Having regular eye examinations so changes can be monitored
Frequently Asked Questions
Can cataracts come back after surgery?
No. Once the natural lens is removed, a cataract can’t return. However, the capsule behind the artificial lens can become cloudy over time (posterior capsular opacification). This is easily treated with a safe and short laser procedure in the clinic.
At what age do cataracts usually develop?
Changes in the lens can begin from around age 40 with first hardening of the natural lens, and cataract developing from mid to later 50s, but many people don’t notice symptoms until their 60s or 70s. Some types of cataracts, particularly those linked to diabetes or corticosteroid use, can develop earlier.
Is cataract surgery urgent?
In most cases, no. Cataracts develop slowly, and surgery can usually be scheduled at a time that suits you. However, in some situations, such as when a cataract is interfering with the monitoring of other eye conditions or causing pressure problems, surgery may be recommended sooner.
Will I still need glasses after cataract surgery?
This depends on the type of intraocular lens (IOL) implanted. Standard monofocal lenses usually require reading glasses. Premium lenses (EDOF and multifocal IOLs) can significantly reduce or eliminate the need for glasses for most tasks. Dr Chiu will discuss realistic expectations for your specific situation.