Don’t Underestimate Your Cataract
Cataract is not merely an inevitable sign of ageing — it is a progressive, sight-impairing condition that can quietly erode vision and quality of life. Modern surgical technology has made its treatment almost risk-free, yet millions delay intervention until the damage becomes irreversible.
By Dr Anant Vir Jain
If you are experiencing symptoms such as blurry vision, difficulty seeing at night, fading of colours, increased sensitivity to glare, halos around lights, or double vision, you must not dismiss them as simple eye strain. These are unmistakable signs of cataract, a condition that can develop in one or both eyes, though it cannot spread from one to the other. If neglected, cataracts can progressively interfere with routine activities, and in advanced cases, lead to blindness. While a cataract may occasionally stabilise, it never disappears or shrinks naturally.
In simple terms, a cataract is the clouding of the eye’s natural lens, which normally remains clear. Those with cataracts describe it as if looking through a fogged-up or frosted window. Initially, the changes may be mild and go unnoticed. Over time, as proteins in the lens clump together, light entering the eye scatters instead of focusing cleanly on the retina, resulting in hazy or blurred vision. Most cataracts develop due to natural ageing processes, but several factors accelerate this change — including smoking, diabetes, prolonged exposure to sunlight or radiation, steroid medications, and chronic eye inflammation.
Although cataracts are more common in people over 60, they can appear at any age, sometimes even congenitally. As the inner lens grows progressively opaque, vision becomes increasingly hazy, colours lose vibrancy, and glare intensifies. Fortunately, cataract surgery is a highly standardised and successful medical procedure. The cloudy lens is removed and replaced with a transparent artificial lens, allowing light to once again focus sharply on the retina.
What Causes Cataracts and Who Is at Risk
There are multiple pathways to cataract formation. The main culprit is oxidative stress — an imbalance between harmful oxidants and the eye’s antioxidant defences. Smoking, pollution, and ultraviolet exposure increase these oxidative changes. Long-term steroid use, certain medications, trauma, diabetes, and even hereditary factors add to the risk. In rare cases, cataracts may develop after eye surgery, severe inflammation, or radiation therapy.
Cataracts are classified by where and how they develop within the lens. Nuclear cataracts form in the centre and cause the nucleus to harden and yellow with age. Cortical cataracts appear at the edges in a wedge-like pattern, advancing inward. Posterior subcapsular cataracts form quickly at the back of the lens and often cause the most glare. Less common are congenital cataracts, which appear at or soon after birth, and secondary cataracts arising from diseases like glaucoma or from medications such as corticosteroids.
Risk factors include older age, diabetes, obesity, hypertension, smoking, heavy alcohol use, prolonged sun exposure, and prior eye injuries. Those with a family history of cataracts or occupations involving outdoor work under bright sunlight are particularly vulnerable.
How Cataract Affects Vision
In age-related cataracts, clumps of protein scatter light and reduce image sharpness on the retina. The result is a slow, insidious decline in clarity. Initially, only a small area of the lens is affected, and one may not notice much difference. But with time, the cloudy area expands, and the lens may acquire a yellowish-brown tint, subtly dulling everything you see.
This discolouration alters colour perception — whites may appear beige, blues may fade, and purples may be mistaken for black. As the clouding worsens, everyday activities like reading, driving, or distinguishing traffic lights become challenging. Cataracts typically progress slowly, giving patients time to adapt to poorer vision — a dangerous illusion that often delays treatment.
Modern Treatment — Safe, Precise and Restorative
Cataract removal is one of the safest and most frequently performed surgeries in the world. The modern method, phacoemulsification with intraocular lens (IOL) implantation, involves making a tiny incision (2–3 mm), breaking the clouded lens using ultrasonic energy, and replacing it with a foldable artificial lens. The procedure is stitch-free, quick, and usually performed under topical anaesthesia.
The new IOL unfolds inside the eye and stays permanently in place. Most patients can return home the same day and resume light activity within 24 hours. The success rate exceeds 97 per cent in India and 99 per cent globally, making it one of the safest surgical procedures known. In select cases, femtosecond laser-assisted cataract surgery (FLACS) offers even greater precision by automating critical steps, reducing ultrasound energy use, and ensuring faster recovery.
In some instances, early cataracts can be managed temporarily with stronger spectacles, brighter lighting, or anti-glare sunglasses, but these are merely interim measures. Once vision begins to interfere with daily life, surgery is the only definitive treatment. The longer one delays, the denser and harder the lens becomes, increasing the complexity and risk of complications during surgery.
Possible Complications and Long-Term Outlook
Though rare, complications can occur. These include infection, bleeding, swelling, or fluctuations in eye pressure, all of which are treatable if addressed promptly. A common late effect is posterior capsule opacification (PCO) — sometimes called an “after-cataract” — which occurs when the thin membrane holding the lens becomes cloudy months or years after surgery. This is easily corrected with a painless outpatient laser procedure known as YAG capsulotomy, which restores clear vision within minutes.
Serious complications such as cystoid macular oedema or retinal detachment are uncommon, affecting less than two per cent of cases. With regular postoperative care and follow-up, most patients enjoy decades of clear sight after cataract removal.
Global and Indian Context
According to the World Health Organization (WHO), cataract remains the leading cause of preventable blindness worldwide. More than 94 million people over the age of 50 suffer from cataract-related visual impairment. In India, cataract accounts for nearly two-thirds of blindness cases, but the situation is improving rapidly with expanded access to free or subsidised eye-care programmes.
Public awareness, rural screening camps, and mobile surgical units have significantly increased surgical coverage. Yet, experts caution that awareness alone is not enough — timely action is critical. Many patients delay surgery because they assume their cataracts are “not ripe enough,” an outdated notion in the age of modern microsurgery. Today, cataracts can be safely removed at any stage once they affect daily life.
Why You Shouldn’t Wait
Early detection is key. If you notice even subtle blurring, night-time glare, or faded colours, consult your ophthalmologist. Waiting for the cataract to “mature” is unnecessary and potentially harmful. Mature cataracts are denser, harder to remove, and more likely to cause complications. Prompt treatment not only restores sight but also reduces dependency, improves mental health, and enhances overall quality of life.
Bottom Line
Cataract is both one of the most common and one of the most curable causes of blindness. Modern medicine offers an almost foolproof solution — yet its success depends on public awareness, timely intervention, and access to skilled surgeons. So, if your world looks dimmer, if faces appear hazy or colours dull, don’t wait for tomorrow. Don’t underestimate your cataract — act today to reclaim the gift of clear vision.
(The author is Head and Chief Surgeon at Lions Eye Hospital, Ghaziabad, and a fellow of Aravind Eye Hospital, Madurai. A veteran ophthalmologist, he has performed over three lakh cataract surgeries and trained numerous young surgeons in advanced cataract techniques.)