Risks of Not Treating Cataracts and Benefits of Early Treatment

A cataract occurs when an opacity develops within the eye’s natural lens. When we are born, the lens is crystal clear, allowing crisp focusing light onto our retina for great vision. However, with age, exposure to sunlight and other oxidative damage over time, the lens can accumulate opacity (cloudiness) and a cataract develops.

The cloudiness of a cataract results in blurred or cloudy vision. Cataracts may also cause glare at dawn or dusk from oncoming headlights because the opacities within the lens cause scattering of light. These changes may interfere with many daily activities, such as driving, watching TV, playing sports, working on the computer, reading the newspaper, or walking down the street.

Some people are unaware of how much their vision is reduced by the cataracts because the cataracts have developed slowly over time. It is only after we perform cataract surgery that they realise how much they were limited by the cataract.

So – once cataracts develop, what is the risk of not treating them?

Fortunately, although cataracts cause a progressive loss of vision, this is generally reversible, so often there is no harm in delaying cataract surgery. As I often explain to my patients, there is no rush to attend their cataracts. They are often relieved to hear this, as many of my patients have other priorities or health concerns to address first – in these cases it is OK to defer the cataract surgery until the timing suits the individual.

However, cataract surgery should not be delayed for too long, for the following reasons:

• Maintaining independence and driving

If ignored for years, cataracts progressively cause a reduction in vision that interferes with a person’s lifestyle and independence, notably driving. There are specific vision requirements for a driving licence, and some people have cataracts so advanced they are no longer legally able to drive. 

• Reducing risk of falls

For some people, especially older patients with other health or mobility problems, untreated cataracts can increase their risk of falling and potentially breaking a bone (e.g. a hip). Hip fractures are serious causes of poor health in the elderly, and cataract surgery reduces the risk of this. 

• Improving memory problems and confusion

Memory problems and confusion are also issues for some elderly patients. By improving their vision, in many cases cataract surgery helps people with memory problems and/or early dementia be better orientated to their environment and hence their clarity of thinking improves.

• Reducing the risk of cataract surgery

If the cataract becomes so advanced, the surgery is more involved, requiring more energy to remove the cataract. Often removing the cataracts earlier reduces the risks of surgery and energy required to breakup and remove the cataracts. This is especially important for certain conditions of the eye, such as pseudoexfoliation syndrome (in which the bag that holds the lens in place becomes excessively loose over time) and Fuchs corneal endothelial dystrophy (in which the cornea becomes increasingly sensitive to ultrasound energy used in cataract surgery).

• Reducing the risk of angle closure glaucoma

Glaucoma is another common eye condition that occurs when the pressure of fluid within the eye builds up and damages the optic nerve connecting the eye to the brain. Without this nerve we cannot see. As cataracts progress, they not only accumulate opacity resulting in clouded vision, they also grow in bulk within the eye. In this way they take up space within the eye, pushing the iris forward and over the eye’s natural outflow drains. This can lead to closure of the drainage angle and the potential for raised pressure and glaucoma damage. In eyes with narrow drainage angles, cataract surgery involves replacing the bulky cataract with the slim intraocular lens, widening the drainage angle.

Bulky cataract pushing the iris forward, Drainage angle wide open following 

Drainage angle wide open following cataract surgery

As a cataract surgeon, I believe that it is not my role to rush people into surgery; they must feel comfortable and in control, making a fully informed decision to proceed at a timing that suits them. However, there is often nothing to be gained from delaying cataract surgery, and once performed, the process does not need to be repeated.