I am asked this question on a regular basis, “are my cataracts ready for surgery?”  The answer to this question is not a “one size fits all.”  Since cataracts develop slowly in most cases, the change in vision is subtle.  Very often, the only way to know that you have developing cataracts is to be told by your ophthalmologist during a routine examination.  In any case, the earliest symptoms are often glare while driving at night, glare during the day, dim vision in low light or double vision.  In all cases this is a painless process.  The symptoms will be different depending on the location of the cataract change in the lens of the eye.

Cataracts which are found in young individuals are often associated with using steroids (cortisone) for extended periods or following eye trauma.  This type of cataract is located in the back of the lens (posterior subcapsular cataract).  Because it is closest to the retina, the impact on vision is most profound; a small cataract can cause substantial loss of vision.  These cataracts tend to develop quickly.  The more common type of cataract is called a nuclear cataract and is the typical age related lens change.  This cataract grows slowly sometimes taking ten or twenty years to become a problem.  There is also an anteriorly located cataract known as an anterior cortical cataract seen quite often in diabetics.  Because it is further forward in the eye and away from the retina, it has less of an impact on vision.

The over-riding factor that determines when it is appropriate to intervene with surgery is the lifestyle of the individual.  Depending upon your line of work or your recreational interests, you will have different visual needs.  I have performed cataract surgery on commercial airline pilots who had only a slight loss of vision with only a small amount of glare.  Their complaints would probably not bother most of us.  But when attempting a landing at night there is an exquisite need for sharp vision and these young pilots were in need of help.  I have operated a number of recreational fisherman whose complaints were not being able to see into the water or see the markers at night.  Golfers ofter complain that their friends can follow the ball and they can not.  At the other end of the spectrum is an elderly inactive person whose only interest is to sit in front of the T.V.  This individual can just move closer to the screen and defer surgery indefinitely.  I hasten to add that I have seen amazing changes come over debilitated folks (who might also have hearing problems and possibly Alzheimers Disease) following cataract surgery and the resumption of good vision.

Most of us are somewhere between the pilot and the elderly infirmed T.V. watcher.  It is for that reason that routine exams are recommended and once cataracts are diagnosed, continued followup is important.  Cataracts are not a disease, they are a normal part of having birthdays.  These days we are all hoping to live well as long as we can and often early intervention with cataract surgery can put spring back in your step.