Cataracts - What will happen?

Do I need an operation?

Not everyone with cataracts needs an operation to take them out. Some people get by with their cataracts for longer than others because their poorer sight doesn't bother them much. For example, a person who loves bird-watching might decide to have surgery sooner than a person whose hobby is listening to music. And older people sometimes put off having an operation or decide not to have it at all.

In the past, doctors told people that their cataracts had to be very bad before it was worth having an operation, for two reasons:

• One reason was that cataract surgery was a big operation, and it took a long time to get better
• Another reason was that doctors didn't have good artificial lenses yet, so people had to wear very thick glasses after surgery.

But now we have safer, quicker operations, so cataracts are generally taken out earlier, before they cause serious problems. Also, now we have good artificial lenses. These are put in place of your own cloudy lens and let you see better without thick glasses.

Your eye test can help tell if now is a good time to have surgery. Doctors use a score to talk about the results of this test. The score tells how good or bad your vision is. Most people with a score of 6/18 or worse in both eyes because of cataracts will see better if they have surgery to take them out.[3] For more, see Eye tests.

But your doctor will probably suggest the operation when your cataracts get in the way of your daily life rather than when you have a certain score on your eye test. With some cataracts, you might be able to read well on the eye chart indoors, but you get a lot of glare from light outside. Your cataracts may mean you can't see well enough to read, work, play sport, go shopping or drive a car.[1]

And your doctor might suggest taking out your cataracts even if you don't have trouble seeing. This could be because you have another eye problem that needs treating, and the cataracts are in the way.[4] For example, if you have diabetes, the other eye problem could be leaky blood vessels in the back of your eye. Doctors called this diabetic retinopathy. Or you could have damage to the back of your eye in its centre part. Doctors call this macular degeneration.

How can an operation help?

A cataract operation can:

• Help you see better
• Let you get on with the things you enjoy
• Give your eye doctor a chance to check for other eye problems.

And if you drive, this operation could make you safer on the road.[5] Research shows older drivers who have had surgery to take out their cataracts are half as likely to be in a car crash.

But an operation also has risks that you should talk about with your doctor. Your eyesight probably won't be perfect afterwards. And you might need to wear glasses some of the time.

What if I am older?

Cataract surgery can help even very old people.[6] A study of people over age 85 who had their cataracts taken out showed 9 in 10 could see better afterwards:

• More than half who couldn't read a newspaper before surgery were able to see well enough to read after
• Two-thirds were better able to watch television
• Most of the people needed less help to get on with their daily activities.

Another study of women over age 70 found that a year after cataract surgery, women were less likely to have falls, were more likely to be active and felt more confident than women who didn't have the operation.[7]

What if I have another eye condition?

Almost a third of people with cataracts have another eye problem at the same time.[2]

For example, you might have cataracts and also have:

• Macular degeneration (this is when the back of your eye is damaged in its centre part)
• Diabetic retinopathy (this is when blood vessels in the back of your eye leak because of diabetes)
• Glaucoma (this is when pressure builds up in your eye).

If you have cataracts plus another eye condition, you probably won't see as well after cataract surgery as someone who has only cataracts. But about 8 in 10 people, including those with other eye problems, can see well enough to drive after a cataract operation.[8]

What if I don't have an operation?

If you choose not to have an operation, your cataract will not get better on its own. In fact, it will keep growing until your whole lens is cloudy. Your sight will slowly get worse until you can't see anymore.

Also, cataracts can cause other problems that can badly harm your sight. And leaving them to grow can make surgery harder. If you wait, it's more likely that something will go wrong during the operation.