What to Know About Cataracts and Cataract Surgery

Learn about the causes, symptoms and treatments for this common eye condition

Linda Marsa and Kimberly Goad,

Updated December 18, 2024

AARP

Medically reviewed by

Merle Myerson, M.D.

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En español

Published January 07, 2019

/ Updated December 18, 2024

Animation: AARP; (Source: Getty Images)

If you live long enough, you’ll probably get cataracts, an inevitable consequence of getting older. Beginning around age 40, the eye lens can begin to cloud, but you typically don’t notice a change until after 60. By 80, more than half of all Americans will either have cataracts or have had cataract surgery.

“I liken cataracts to wrinkles and gray hair,” says Anupama Horne, M.D., an ophthalmologist and eye surgeon at Duke University in Durham, N.C. “In the end, nearly everyone will develop them.”

But the good news is that today’s high-tech procedures restore clear vision in about 97 percent of the close to 4 million Americans who undergo cataract surgery every year.

Sarah Peng/AARP

What happens in the eye when you have a cataract?

Imagine a broken lens on a camera. “No matter how much you try to focus the camera, if the lens is broken, you’ll get a blurry picture,” says John Bartlett, M.D., an ophthalmologist and eye surgeon at UCLA Stein Eye Institute in Los Angeles.

Cataracts occur when proteins in the lens of the eye break down, causing the normally clear lens to become cloudy.

Eyeglasses can greatly help improve your vision

Getty Images

The lens in your eye works like a camera lens, focusing light onto the retina at the back of the eye. The retina then sends nerve signals to the brain, allowing you to see clearly both up close and far away. Over time, as we age, proteins in the lens to clump together, clouding the lens. This cloudiness, known as a cataract, gradually makes it harder to see as it grows larger and thicker. Cataracts usually develop slowly and can affect one or both eyes. Unlike infections, they don’t spread from one eye to the other.

What causes cataracts?

Aging is the most common cause of cataracts, but other culprits can contribute, including certain medications, chronic illnesses such as diabetes and cardiovascular disease, and poor lifestyle habits, like smoking or exposure to too much ultraviolet light from the sun. Family history also plays a role.

Because age-related cataracts generally develop over time, worsening vision may not be noticeable in the very early stages. But as the clear lens of the eye slowly turns a yellowish/brownish color, the increased tinting may make it more difficult to read and colors seem faded. Other symptoms include blurry or double vision, glare — when headlights, lamps or sunlight appear blindingly bright — and poor night vision that can make driving hazardous.

“It’s like a piece of clear plastic becomes yellowed and discolored,” says Bartlett. “As new layers are added, it becomes denser and harder.”

Three types of cataracts

Like an onion, the lens is composed of multiple layers. The outermost is known as the capsule. The layer inside the capsule is called the cortex. And the innermost layer is the nucleus. The three types of cataracts are named for their location in the lens:

Posterior capsular: Unlike the other two, this type of cataract, found in the back outer layer of the lens, tends to develop rapidly.
Cortical: Located in the outer layer of the lens surrounding the nucleus. Picture a wedge or a spoke — that’s what a cortical cataract looks like to your eye doctor.
Nuclear: As the name suggests, this type of cataract is found in the innermost layer at the center of the lens. The nucleus tends to darken with age, changing from clear to yellow and sometimes brow

How are cataracts diagnosed?

If you’re keeping up with regular eye exams—for people 50 and older, that means a comprehensive exam every year or two, depending on your specific age, overall health and risk factors for eye disease—your doctor will be on the lookout for the symptoms above.

Cataracts are usually identified with the help of a visual acuity test, where you read letters of varying sizes off an eye chart. This measures the sharpness and clarity of your vision, and how well you can see at various distances.

You’ll also be given a dilated eye exam, in which drops are used to dilate and widen the pupils, offering your eye doctor a clearer view of the back of your eye. Your doctor will then use a specialized magnifying microscope known as a slit-lamp to examine your cornea, iris, and lens to look for signs of cataracts, as well as examine the retina and optic nerve for evidence of eye damage and other problems such as glaucoma. Other tests may include measuring the pressure within the eye as well as tests to check color vision and glare sensitivity.

Treatment of cataracts

When cataracts are in their early stages, you may be able to find relief with a new eyeglass prescription, brighter lighting, antiglare sunglasses or magnifying lenses. But once the cataract progresses and symptoms are interfering with your daily activities — reading, driving, watching TV — then surgery to remove the cataract is the only alternative.

“Don’t get fooled by scams,” says Bartlett. “I see ads for eye drops, usually homeopathic, that purport to get rid of cataracts. The only treatment to remove cataracts is surgical.”

Before you undergo the procedure, your surgeon may have you see your family doctor for a thorough medical exam to make sure you’re stable enough for surgery, says Ravi Goel, M.D., a New Jersey eye surgeon and clinical spokesperson for the American Academy of Ophthalmology.

Cataract surgery is considered low risk, even in patients who have certain heart and lung conditions. The procedure does not require major incisions or general anesthesia.

What to expect from surgery

Before: A week before surgery, your doctor will test your eyes to measure the curve of the cornea and the size and shape of your eye. The information will help determine which type of artificial lens — known as an intraocular lens (IOL) — is right for you. Your lifestyle will also play a role. For instance: When you think about how you like to spend your day, what vision needs are most important to you—reading, driving, or using a computer? The answer to that question will help guide the selection of an IOL, which includes:

The monofocal IOL, the most common type of lens, provides clear vision at one distance (usually a far-off distance) meaning you’d require glasses for near or intermediate tasks.
The toric IOL corrects astigmatism in addition to providing focusing power.
The multifocal IOL—as the name suggests—provides clear vision at multiple distances, potentially reducing the need for glasses.
The extended depth of focus IOL improves vision across a range of distances, often with fewer side effects than multifocal IOLs.

A week before surgery, you may also need to temporarily stop taking certain medications. If you have cataracts in both eyes, each eye will be treated at a separate time to allow for healing.

During: The surgery itself takes less than an hour and is generally an outpatient procedure, performed under local anesthesia to numb the nerves in and around the eye. The operation involves removing the cloudy lens and replacing it with a clear, artificial one (the IOL). Your surgeon will use tiny tools to cut into your eye, break up the lens, take it out, and place the new artificial lens in your eye. (See “Four types of cataract surgery,” below.)

After: With most people, vision improves quickly, and colors appear more vivid. Normal activities can be resumed, although an eyepatch over the eye may need to be worn for several nights while sleeping. Itching and mild discomfort are normal, and eyes may feel sensitive to light and touch. However, these unpleasant aftereffects should diminish within a day or two. Eye drops will need to be administered to help with healing and decrease the risk of infection; an eye shield or eyeglasses may be worn to protect the eyes.

An example of phacoemulsification cataract surgery, a widely used procedure for treating cataracts.

Jacopin / BSIP / Science Source (3)

Four types of cataract surgery

Phacoemulsification Cataract Surgery: As one of the most common types of cataract surgery, phacoemulsification involves creating a small incision approximately 2 to 3 millimeters across the eye. A probe is inserted and ultrasound is used to break up the damaged lens into tiny pieces. The lens is then suctioned out of the eye with a vacuum to make way for the IOL.
Femtosecond Laser-Assisted Surgery (FLACS): This procedure combines advanced laser technology with phacoemulsification and is now a widely used technique. A device placed over the eye transmits detailed information to the femtosecond laser, enabling precise programming of the incision's location and depth. The laser creates the incision and softens the cataract, making it easier to remove during phacoemulsification. This method reduces the amount of energy required during the procedure, minimizes inflammation, and promotes faster recovery.
Manual Small Incision Cataract Surgery (MSICS): This procedure involves removing the damaged lens through a small, tunnel-shaped incision in the eye. The self-sealing incision eliminates the need for sutures, lowering the risk of complications. However, it is rarely used in the United States.
Extracapsular Surger: An older technique that is now seldom used, this procedure involves making an incision in the cornea with a scalpel to remove the lens. It is typically reserved for dense cataracts that cannot be treated with phacoemulsification.

Complications

As with any surgery, there is a possibility of complications, such as infection, bleeding, inflammation, double vision and high or low eye pressure. In rare instances, retinas can become detached. However, these problems are rare and can usually be treated with prompt medical attention. Occasionally, the eye tissue that encapsulates the IOL can cloud the new lens — a condition that is known as “posterior capsular opacification” or “secondary cataract,” which can develop months or even years after the surgery. It happens when a membrane called the posterior capsule—a sort of transparent pocket that holds your IOL in place—becomes cloudy. This normally can be corrected with a laser procedure.

Can you prevent cataracts?

While not everyone will develop cataracts, many do. That said, there are steps you can take to delay their onset, slow down the progression or even avoid the need for treatment. One of the most important: Protecting your eyes from the sun’s ultraviolet rays. “Long-term exposure to UV light does increase risks,” says Shahzad Mian, M.D., an eye surgeon at the Kellogg Eye Center at the University of Michigan. “People who live in equatorial climates get more advanced cataracts and at a younger age because of the more intense sunlight.”

When you’re outside, wear a wide-brimmed hat and sunglasses with UV400 or 100 percent UV protection to block harmful ultraviolet sunlight. Additional lifestyle changes include: If you smoke, stop; if you drink alcohol, do so in moderation; when sitting at the computer take screen breaks every 20 minutes; and focus on consuming a mostly plant-based diet, especially dark green veggies. A review of studies published in 2023 in the journal Nutrients shows that increased consumption of plant-based foods—vegetables, fruits, legumes, and nuts—as well as low-fat yogurt, coffee, and fish is particularly beneficial in reducing the prevalence of age-related cataracts. However, further research is needed to confirm these findings.

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Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.