Cataracts - Diagnosis and treatment (2023)

Diagnosis

To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:

Visual acuity test. A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment.
Slit-lamp examination. A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification. The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any tiny abnormalities.
Retinal exam. To prepare for a retinal exam, your eye doctor puts drops in your eyes to open your pupils wide (dilate). This makes it easier to examine the back of your eyes (retina). Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a cataract.
Applanation tonometry. This test measures fluid pressure in your eye. There are multiple different devices available to do this.

Treatment

When your prescription glasses can't clear your vision, the only effective treatment for cataracts is surgery.

When to consider cataract surgery

Talk with your eye doctor about whether surgery is right for you. Most eye doctors suggest considering cataract surgery when your cataracts begin to affect your quality of life or interfere with your ability to perform normal daily activities, such as reading or driving at night.

It's up to you and your doctor to decide when cataract surgery is right for you. For most people, there is no rush to remove cataracts because they usually don't harm the eyes. But cataracts can worsen faster in people with certain conditions, including diabetes, high blood pressure or obesity.

Delaying the procedure generally won't affect how well your vision recovers if you later decide to have cataract surgery. Take time to consider the benefits and risks of cataract surgery with your doctor.

If you choose not to undergo cataract surgery now, your eye doctor may recommend periodic follow-up exams to see if your cataracts are progressing. How often you'll see your eye doctor depends on your situation.

What happens during cataract surgery

Cataract surgery

During phacoemulsification — the most common type of cataract surgery — the rapidly vibrating tip of the ultrasound probe emulsifies and helps break up the cataract, which your surgeon then suctions out (top). An outer housing of the cataract (the lens capsule) is generally left in place. After removing the emulsified material, your surgeon inserts the lens implant into the empty space within the capsule where the natural lens used to be (bottom).

Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as your natural lens. It remains a permanent part of your eye.

For some people, other eye problems prohibit the use of an artificial lens. In these situations, once the cataract is removed, vision may be corrected with eyeglasses or contact lenses.

Cataract surgery is generally done on an outpatient basis, which means you won't need to stay in a hospital after the surgery. During cataract surgery, your eye doctor uses a local anesthetic to numb the area around your eye, but you usually stay awake during the procedure.

Intraocular lenses

Vivien Williams: There are some things about aging you just can't control. Take your eyesight, for example. You can fight it, but after age 40, the fine print on restaurant menus gets hard to read. And as you continue to mature, cataracts can form. But now, doctors are implanting lenses that can correct these things and even more. Here is the latest from Mayo Clinic.

Edyth Taylor is having cataract surgery. Her vision is such that it's hard for her to read the numbers on a clock.

Edyth Taylor, cataract surgery patient: I could guess. It's about five after 1:00.

Dharmendra Patel, M.D.—Mayo Clinic ophthalmology: But it's hazy?

Edyth Taylor: But it's hazy.

Dharmendra Patel, M.D.: And this is sharper?

Edyth Taylor: Oh yeah. That's as clear as can be.

Dharmendra Patel, M.D.: OK. Well, we're going to try to match it up so that your vision is equal in both eyes.

Vivien Williams: Edyth's already had one eye done. Now it's time for the other. Dr. Dharmendra Patel says the new lenses he's implanting will take care of the cloudiness caused by the cataract, plus they'll fix a whole lot more.

Dharmendra Patel, M.D.: The newer implants that are available, they do give you the multifocality. So, you will get correction for distance vision, which is similar to LASIK, but you also get the correction for near vision or reading vision, and that's something that's very unique to these implants.

Vivien Williams: Another patient, Joyce Wisby, got the new intraocular implants a few months ago.

Joyce Wisby: My coworker kept saying to me, 'You need to have this done, you can't see.'

Vivien Williams: Joyce says, after a lifetime of poor vision made worse by cataracts, she can finally see the fine print without glasses or contacts.

Joyce Wisby: If the numbers are real small, I'd have to go and ask for help or use a magnifying glass even with my glasses. Now I can read everything and everybody's coming to me and asking me to help them with the numbers.

Vivien Williams: During the procedure, Dr. Patel numbs the eye with drops. Then, through tiny incisions in the cornea, he removes the lens with the cataract. Next, he inserts the implant, which unfolds into position.

Edyth just got out of surgery.

Edyth Taylor: I can see the clock.

Vivien Williams: A 15-mininute operation for a lifetime of better vision. Dr. Patel says these lenses are most commonly used for people with cataracts, but younger people who want correction from nearsightedness could benefit too. For Medical Edge, I'm Vivien Williams.

Yes, Babies and Children Get Cataracts, Too

Hello. My name is Eric Bothun. I'm a pediatric eye surgeon at the Mayo Clinic in Rochester, Minnesota, caring for kids of all ages and eye diseases. Many times, kids simply need glasses to straighten their eyes, but others have crippling eye conditions. Some of my greatest professional joys and accomplishments have come in diagnosing, researching and treating pediatric cataracts.

Yes, babies and kids get cataracts, too — whether from complex genetic disease, a firecracker injury in an older child, or a birth defect in a newborn. Cataracts may severely cloud the vision of children. And since vision development in the brain takes years to refine, having a cataract even for a short time will have a lifelong implication.

Here at the Mayo Clinic, I seek to diagnose pediatric cataracts early — hopefully even in that newborn baby — and determine an appropriate workup and treatment plan. Caring for these kids typically involves complex cataract surgery, even for the smallest, and a team approach in rehabilitation with families for years as they grow. It all starts by first understanding and addressing a given child's unique systemic or ocular anomalies and related conditions like glaucoma. Many times, I enlist a team of specialists to aid in the various aspects of that care.

This is an example of a complex pediatric cataract surgery. The ocular features in this unilateral condition include the eye being abnormally small, having an irregular iris appearance and an often membranous-like cataract with a vessel stalk that connects that cataract to the back of the eye. One can see that stalk in this surgical video. Eyes like this often have a less favorable outcome because they hold a greater risk of glaucoma and retinal detachment. Standard intraocular lenses are typically not an option, and thus, contact lenses are often used to correct the vision postoperatively. But first and foremost is giving the child a clear view to the world.

I often compare the hazy lens to a chocolate M & M candy. And my cataract surgery involves opening that candy shell, carefully removing the chocolate and inserting a special new lens into the remaining candy shell. There, that artificial lens is meant to provide clarity for the eye and the child, lifelong.

There are unique challenges in some eyes and in some kids. I enjoy tailoring the known surgical and clinical treatment options for each kid, visit by visit, as they grow. And through research and teaching, I continue to find better ways to help these kids with cataracts.

This is an example of a fairly up-to-date approach for pediatric cataract surgery in a child between nine months and two years of age. Here, the cataract capsule is opened with a special vitrector instrument. There are a variety of techniques, depending on the anatomy and age of the child, to do this. The lens contents, which can vary in density and opacity, is completely removed. And this leaves that natural capsular bag in place behind the iris for the insertion of the artificial lens and long-term stabilization.

Some eyes simply cannot hold a standard lens in the typical location. I have been involved in studying a newer lens design that simply clips the artificial lens to the front side of the iris. This approach is only suitable for certain eyes but has become a valuable tool for visually rehabilitating special patients.

Through my service and the coordinated care at the Mayo Clinic, we deliver quality outcomes for pediatric cataracts. The before and after photos are dramatic. But the real positive emotion and the real blessing is in watching the eyes recover and the vision improve as kids grow up into fuller lives. If you know someone who has a pediatric cataract — or condition even that puts them at risk of one — please come to our team at the Mayo Clinic.

More Information

Cataract surgery

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

To deal with symptoms of cataracts until you decide to have surgery, try to:

Make sure your eyeglasses or contact lenses are the most accurate prescription possible
Use a magnifying glass to read if you need additional help reading
Improve the lighting in your home with more or brighter lamps
When you go outside during the day, wear sunglasses or a broad-brimmed hat to reduce glare
Limit your night driving

Self-care measures may help for a while, but as the cataract progresses, your vision may deteriorate further. When vision loss starts to interfere with your everyday activities, consider cataract surgery.

Preparing for your appointment

Make an appointment with your usual eye care provider if you notice changes in your vision. If your doctor determines that you have cataracts, then you may be referred to an eye specialist who can perform cataract surgery.

Because there's often a lot to talk about, it's a good idea to be well prepared for your appointment so that you can make the most of your time with your doctor. Here's some information to help you get ready.

What you can do

List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all medications, vitamins or supplements that you're taking.
Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
List questions to ask your doctor.

For cataracts, some basic questions to ask your doctor include:

Are cataracts causing my vision problems?
What kinds of tests do I need?
Will cataract surgery correct my vision problems?
What are the potential risks of cataract surgery? Are there risks in delaying surgery?
What will cataract surgery cost, and will my insurance cover it?
How much time will I need to recover from cataract surgery?
Will any usual activities be restricted after cataract surgery? For how long?
After cataract surgery, how long should I wait before getting new glasses?
If I use Medicare, will it cover the cost of cataract surgery? Does Medicare cover the cost of new glasses after surgery?
If I don't want surgery right now, what else can I do to cope with my vision changes?
How will I know if my cataracts are getting worse?
I have these other health conditions. How can I best manage these conditions together?
Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

When did you begin experiencing symptoms?
Do you have your symptoms all the time or do they come and go?
Do you experience vision problems in bright light?
Have your symptoms gotten worse?
Do your vision problems make it difficult for you to drive?
Do your vision problems make it difficult to read?
Do your vision problems make it difficult to do your job?
Have you ever had an eye injury or eye surgery?
Have you ever been diagnosed with an eye problem, such as inflammation of your iris (iritis)?
Have you ever received radiation therapy to your head or neck?

By Mayo Clinic Staff

Sept. 13, 2022

FAQs

What is the most common treatment for cataracts? ›

Cataract surgery is the only way to remove cataracts and restore your clear vision. During cataract surgery, an ophthalmologist removes your clouded natural lens and replaces it with an intraocular lens (IOL). An IOL is an artificial lens that permanently stays in your eye.

What happens when you get diagnosed with cataracts? ›

If your doctor determines that you have cataracts, then you may be referred to an eye specialist who can perform cataract surgery. Because there's often a lot to talk about, it's a good idea to be well prepared for your appointment so that you can make the most of your time with your doctor.

Tell Me More ›

What is the best way to correct cataracts? ›

Over time, cataracts can lead to vision loss. The good news is that surgery can get rid of cataracts. Cataract surgery is safe and corrects vision problems caused by cataracts.

How cataracts are diagnosed? ›

Using a slit lamp or ophthalmoscope, the physician inspects the retina for signs of cataracts. If, at the conclusion of this exam, your eye doctor diagnoses you with cataracts, you will move into a discussion of treatment options and timing.

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At what stage should cataracts be removed? ›

The operation can be performed at any stage of cataract development. There is no need to wait until your cataract is “ripe” before removing it. Most people choose to have their cataracts removed when the change in their vision starts to cause them difficulties in everyday life.

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What is average age for cataract surgery? ›

In most people, cataracts start developing around age 60, and the average age for cataract surgery in the United States is 73.

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Is there a downside to cataract surgery? ›

Some complications of cataract surgery may involve: Damage to the back part of the lens capsule – this can lead to a disturbance of the gel (Vitreous) that is inside. In turn, this can cause reduced vision. All or part of the cataract may be lost into the back of the eye, which may require further surgery.

How painful is cataract surgery? ›

How painful is cataract surgery? Most people feel little or no pain during or after cataract surgery. You'll receive a topical anesthetic (eye drops) to numb your eye during the surgery. Shortly after surgery, your eye may feel gritty or slightly tender, but over-the-counter pain medicine should improve this.

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What worsens cataracts? ›

UV light can cause cataracts to progress faster than they otherwise would. While it would not be healthy to avoid all exposure to the sun, it's best to avoid going out when the glare is brightest and the UV light is strongest—from 10 am to 4 pm most of the year, and from 11 am to 3 pm during daylight savings time.