How long is it possible to delay cataract surgery?

Cataracts occur when the natural lens of the eye becomes cloudy over time – once the lens is cloudy we call it a cataract. Generally this is a slow process with age, but once it occurs, it can only be corrected by surgical removal of the lens and insertion of a clear artificial lens.

While most cataracts are associated with age, sometimes they occur in younger people – associated with unusual genes, past eye trauma, diabetes, excessive smoking or drinking.

For the vast majority, cataract surgery is not urgent, and can be safely delayed until the person wishes to pursue surgery. Delaying surgery does not cause harm to the eye, however the vision just gets worse over time until the cataract is removed. When I counsel patients over the timing of cataract surgery, I generally reassure them that they will know when the time is right – they will begin to notice the deterioration in vision, and when it affects their quality of life, that is the time to pursue the surgery.

On the flip side, there is no major benefit in delaying cataract surgery. There has been considerable research into this, as to whether cataract surgery might hasten other eye problems, and this has not been found to be true. However, given all surgery has risks (albeit small), it is not wise to proceed with cataract surgery unless the individual truly needs it, and will truly benefit from the surgery.

There are some form of cataracts that need to be removed promptly – although these are rare. As the lens changes into a cataract, it swells in size as well as becoming cloudy. This swelling can push on the eye’s drainage area and close the drain. This can result in aqueous fluid building up in the eye, eye pressure problems and glaucoma. This only occurs in eyes with a predisposition to narrow drainage areas, such as individuals with a family history of angle closure glaucoma, or very long-sighted individuals. However, in such individuals, often cataract surgery is required to open the drain, even if the cataract is not obscuring the vision.

If the cataract is left untreated until it is very advanced or very dense, this can make surgery more difficult and increase the risk of complications. Generally the outcomes remain very good, but these cataracts ideally should be treated before they become so advanced that the risks of problems in surgery rises.