Cataract: when surgery is actually needed
Cataract is the most common correctable cause of vision loss in the world. It develops slowly, it is painless and it is not an emergency — so the practical question is almost never whether to operate, but when. Dr. Chassid performs cataract surgery at the clinic.
What a cataract is
Inside the eye, behind the pupil, sits a clear natural lens whose job is to focus light onto the retina. With age, the proteins in that lens change structure, and it gradually loses transparency and yellows. This clouding is called a cataract.
It is a natural process of ageing, not something you catch and not the result of "overusing" your eyes. In most people it becomes measurable after 60; in some it appears earlier — after trauma, after prolonged steroid treatment, in conditions such as diabetes, or as a congenital finding.
One point worth clearing up: a cataract is not "a film growing over the eye", and it is not removed by laser alone. It is a change within the lens itself, and the treatment is to replace that lens.
How it feels
- Gradual blurring that new glasses do not correct — the sensation of looking through a dirty windscreen.
- Glare and halos around lights, particularly driving at night against headlights.
- Faded or yellowed colours. Many people notice this only after surgery on one eye, when they compare the two.
- Frequent changes of spectacle prescription.
- A temporary improvement in reading without glasses in some people — a recognised effect caused by a shift in the lens's focusing power, and not a good sign.
- Needing more and more light to read.
A cataract almost always develops slowly and painlessly. It is not an emergency, and a delay of months causes no permanent harm — unlike the retinal conditions covered in the other articles on this site.
When to operate
The old rule about "waiting for the cataract to ripen" has been obsolete for years. The criterion today is simple and practical: you operate when the vision interferes with life.
Signs that justify considering surgery include difficulty driving — and certainly failing to meet the vision standard for a licence; difficulty reading or working despite an up-to-date prescription; giving up activities because of vision; or glare that makes night driving impossible.
There are also situations where surgery is advised for a medical reason rather than a functional one — for example when the clouding prevents monitoring or treatment of a retinal condition, or when an over-mature lens raises the risk of complications.
Conversely, while vision is still adequate and not limiting, waiting is a perfectly reasonable decision. There is no window of opportunity that closes.
What the operation involves
Dr. Chassid performs cataract surgery, alongside the retinal surgery that is his subspecialty.
Cataract surgery is one of the most commonly performed operations in the world. It is usually done under local anaesthetic drops, takes around fifteen minutes, and the patient goes home the same day.
The standard technique is called phacoemulsification: the clouded lens is broken up with ultrasound through a tiny incision in the cornea and removed, and a permanent artificial intraocular lens is implanted in its place. The incision usually seals itself without stitches.
Choosing the lens
The implant is selected in advance, based on measurements of the length of the eye and the curvature of the cornea:
- A monofocal lens — the standard choice. It gives sharp vision at one distance, usually far, and reading glasses are needed afterwards.
- A toric lens — also corrects astigmatism.
- Multifocal or extended-depth-of-focus lenses — reduce dependence on glasses, but are not suitable for everyone. Where retinal or macular disease is present, they are usually not the right choice.
There is no single "best lens" — there is a lens that suits a particular eye, its other conditions, and the person's expectations. That is a conversation to have before surgery, not after.
Recovery
Vision begins to clear within days, and full stabilisation takes several weeks. During that period antibiotic and anti-inflammatory drops are used as directed, and it is advisable to avoid rubbing the eye, heavy lifting and swimming until cleared.
New glasses are prescribed only once vision has settled.
Vision after cataract surgery is only as good as the health of the retina behind the lens. If macular degeneration, diabetic oedema or an epiretinal membrane is also present, the operation will remove the clouding, but the result will be limited by the state of the macula.
An examination of the fundus, and where needed an OCT scan of the macula, is therefore an essential part of the pre-operative assessment. It determines both what to expect and which lens is appropriate. A very dense cataract makes that examination harder — one more reason not to wait indefinitely.
This is the practical advantage of having cataract surgery done by a retina specialist: the surgeon is also the person who examined the retina, so what to expect is settled in advance rather than discovered afterwards.
Complications, and what comes later
Cataract surgery is considered safe, but like any operation it is not without risk. Significant complications are rare and include intraocular infection, macular swelling and retinal problems. The risk of retinal detachment after surgery rises slightly, and more noticeably in people with high myopia — another reason to know the warning signs of a detachment.
"Secondary cataract" is a common and untroubling phenomenon: the clear capsule holding the implanted lens can thicken months or years after surgery, and vision blurs again. The treatment is a YAG laser — an outpatient procedure lasting minutes, with no incision and no anaesthetic, done once and not repeated.
Severe or increasing pain, worsening redness, a sudden drop in vision, flashes of light, a sudden shower of floaters or a shadow in the visual field are not part of normal recovery. In these cases seek help immediately — from the clinic or an eye emergency room.
The information in this article is general information only. It does not constitute medical advice or a diagnosis, and it is not a substitute for examination by a doctor. Every case is different, and nothing here should be relied on for medical decisions. In the event of a sudden loss of vision, flashes of light, a sudden shower of floaters or a shadow falling across your vision, seek urgent medical care immediately.
