Cataracts and ageing: What to expect

If you live long enough, you will almost certainly develop a cataract. That sounds alarming, but it is one of the most reassuring facts in eye care. A cataract is a normal part of ageing and, when the time comes, one of the most treatable conditions in medicine. Around a third of people over sixty-five in the UK already have one.

What a cataract is

Just behind the coloured iris sits a small clear lens. It works like the lens of a camera, focusing light to give a sharp picture at the back of the eye. That lens is made from special proteins arranged so precisely that it stays perfectly see-through. Here is the key point: those proteins are made before you are born and are never replaced. Over many decades they slowly gather damage, from natural wear and from a lifetime of sunlight.

Eventually, the damaged proteins clump together. When the clumps grow large enough they scatter light rather than letting it pass cleanly through, and the lens turns cloudy. A useful way to picture it is a clear window that very gradually frosts over.

What makes it appear sooner

Age is by far the biggest factor. Changes often begin quietly in your forties, long before you notice anything, and most cataracts that affect vision appear from the sixties onwards.

Some things speed it up. Diabetes is an important one, as higher blood sugar changes the lens faster. Smoking, heavy alcohol use, years of strong sunlight without eye protection, long-term steroid medicines, and previous eye injury or surgery all raise the risk.

Not all of these can be changed, but stopping smoking, wearing good sunglasses and managing diabetes are sensible steps for your whole body, not just your eyes.

What you might notice

Cataracts develop slowly, so the changes are easy to miss. Vision may become misty, as though you are looking through a smeared window. Colours can seem faded or yellowed. Headlights may dazzle or create haloes. You may need more light to read, or find your glasses prescription keeps changing.

Because both eyes are usually affected, though rarely to the same degree, the world can simply seem gradually dimmer than it once was.

How it is treated

It is worth being clear about this, because there is a lot of misinformation. No eye drop, tablet, diet or exercise has been proven to clear a cataract once it has formed. The only effective treatment is cataract surgery.

The good news is that this is among the most common and successful operations performed anywhere. In England alone, around 330,000 cataract operations are carried out each year, making it the most frequently performed planned operation in the NHS.

The procedure usually takes around twenty minutes under local anaesthetic. The cloudy lens is removed and replaced with a clear artificial one, and most people go home the same day.

Importantly, surgery is not decided by reaching a particular number on a vision chart. It is offered when the cataract interferes enough with the things you need and want to do, such as driving or reading, to make the small risks worthwhile for you. That decision is shared with your surgeon, and there is rarely any need to rush.

When to seek advice

If your vision is gradually becoming cloudy or harder to manage, arrange an eye examination. For most adults that is sensible every couple of years anyway, and there is no need to wait until your sight is poor.

Seek prompt attention for any sudden change in vision, new pain, or flashes and floaters. These point to other problems rather than a simple cataract. For gradual, painless blurring, an unhurried assessment is the right next step.

Ophthalmology in Central London