Cataracts: Symptoms, Causes & When to Consider Surgery

Vision has an expiration date.

The lens inside the eye, responsible for focusing and clear vision – medically known as the crystalline lens – inevitably deteriorates with age. This decline often becomes noticeable through blurred vision, increased sensitivity to glare, or the appearance of floaters. Sometimes, however, the condition develops without any obvious symptoms, only being discovered during a routine eye exam.

In fact, between the ages of 55 and 75, most people will develop cataracts. “As the global population continues to age, we are seeing a corresponding increase in the number of people with cataracts,” explains Manuel Nicoli, an ophthalmologist and president of the Argentine Society of Ophthalmology (SAO). “Today, cataract surgery – which involves replacing the clouded crystalline lens with an artificial intraocular lens – is the most frequently performed surgical procedure worldwide. However, mild cataracts can often be corrected with eyeglasses.”

Early detection is key to preventing becoming one of the 26 million people who undergo cataract surgery annually worldwide and it’s surprisingly simple: an annual check-up with an ophthalmologist. Nicoli recommends starting these check-ups around age 40, but emphasizes their importance after age 60, when the eye is more prone to age-related conditions that, if caught early, may not require surgery.

“There’s a growing trend towards earlier surgery,” Nicoli notes. “Previously, people waited until cataracts significantly impacted their vision. Now, many seek consultation simply because they want to reduce their reliance on glasses.” He acknowledges that advancements in technology, particularly in bifocal and multifocal intraocular lenses, have greatly improved visual outcomes. “However, I don’t recommend surgery at a young age to my patients. The eye is a unique organ, and while artificial lenses mimic the original, they are still prosthetics.”

Nicoli is cautious about surgery because, while effective long-term, it carries inherent risks. “The eye contains a gel-like substance called the vitreous humor, which is attached to the retina at certain points. With age, these attachments naturally break down,” he explains. “However, surgery carries the risk of retinal tearing and fluid leakage, potentially leading to retinal detachment. I advise postponing surgery with intraocular lenses until at least age 60, when these attachments are less likely to cause complications.”

—When is surgery recommended?

—Each patient needs individual evaluation. We consider age, eye characteristics – as eyes vary in size – and conduct thorough studies, imaging, and measurements. It’s also important to discuss the patient’s lifestyle, occupation, driving habits, hobbies, and activity level. For less active patients, glasses may be sufficient. However, for those with very active lifestyles – driving at night, playing sports, working extensively with computers, and needing clear vision at various distances – surgery can be justified, although I always explain that complete independence from glasses is difficult to achieve; most will still need some visual support.”

—What are the best types of eyeglasses?

—Eyeglasses correct all refractive errors: nearsightedness, farsightedness, and astigmatism. Today, we have single-vision lenses for distance or near vision, bifocals for both, and multifocals for patients needing correction at all distances. Technology has advanced significantly, offering options for everyone. Multifocal contact lenses are also available, as are monovision lenses, where one eye is corrected for distance and the other for near vision. Monovision lenses are more affordable, but require neuroadaptation as the brain processes two different images simultaneously. They are worth trying, and most patients adapt well.

—What about the eye drops recently released to correct presbyopia?

—Presbyopia, like cataracts, is an age-related condition that typically develops after age 40, causing difficulty focusing on close objects. While glasses are often needed, eye drops are now available in the country to aid with near focus. However, these drops aren’t for everyone. A retinal examination is necessary to determine candidacy. The drops work by constricting the pupil to create a focal point, which can sometimes reduce distance vision or limit peripheral vision, potentially causing problems with driving. It’s also important to rule out the possibility of retinal damage.

—What impact does screen time have on children’s vision as they become older adults?

—The primary risk associated with screens is reduced blinking. Blinking lubricates the eye. Less blinking can lead to conditions like dry eye, a common ailment causing irritation, burning, itching, a gritty sensation, and blurred vision. Dry eye is generally treated with lubricating eye drops.

—Beyond age, what other factors influence vision?

—Environmental pollution can sometimes damage the ocular surface, causing irritation and discomfort, especially during seasonal changes and allergy flare-ups. Family history of eye diseases also increases risk. Diet and smoking can contribute to conditions like glaucoma, which involves increased pressure within the eye. In my practice, I often recommend supplements containing vitamins, minerals, and Omega-3 fatty acids to support retinal health. I haven’t found evidence to support the effectiveness of eye exercises, which are sometimes recommended for presbyopia to stimulate near focus, but after age 40, the eye is genetically programmed to lose vision regardless of exercise.

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