Cataracts

What are cataracts

Cataracts are cloudy, opaque areas on the lens of the eye which interfere with proper vision, which eventually can cause blindness as they cover the lens. The lens of the eye needs to be clear to enable vision. The lens focuses light (or an image) onto the retina, when nerve signals are sent to the brain to receive a sharp image.

The lens of the eye consists of three layers:

• Outer layer (capsule) – this consists of a thin, clear membrane
• Middle layer (cortex) – this is the soft, middle layer
• Inner layer (nucleus) – this is the hard centre of the lens

3 types of cataracts

There are three types of cataracts depending on which part of the lens is affected:

• Subcapsular – affects the outer layer (capsule) and causes a small cloudy area just under the capsule of the lens preventing light from entering correctly and it causes problems with reading and vision at night
• Cortical – affects the middle layer (cortex) and causes cloudy streak formations on the outer edge of the cortex which then migrate to the centre of the lens and severely cloud vision so that both distant and near objects appear blurry or distorted
• Nuclear – affects the inner layer (nucleus) and causes a change in the way that light is focused, the lens eventually becoming more yellowed and cloudy affecting driving and inability to distinguish between certain colours (blue and purple)

Cataract formation can start as early as the 40’s, but it is people who are over 65 that have a higher risk of developing this condition, with more than half of all people in Australia estimated to have cataracts by age 80.

Facts about cataracts

• Cataracts are one of the leading causes of blindness in the world
• Most types of cataracts are due to ageing
• While symptoms of cataracts can start in the 40’s and 50’s, it is not until the 60’s that they cause vision loss
• The length of time it takes for cataracts to cause vision loss can take anywhere from many months to many years
• Cataract surgery is quite safe and very effective in removing cataracts and improving eyesight
• Cataracts can develop in one eye or in both eyes
• A diet high in fresh vegetables and fruits (rich in antioxidants) may help to prevent cataracts from developing in the first place

Symptoms of cataracts

General symptoms of cataracts:

• Cloudy or blurry vision
• Double vision
• Frequent prescriptions to change lens of glasses (as eyesight gets increasingly worse)
• Halo around lights
• Perception of colours looking faded
• Perception of looking through a veil or cloud
• Sensitivity to glare from lights, which may appear to be too bright

The development of cataracts is generally gradual and is not painful. Symptoms generally do not show up until the condition is very advanced. Anyone who experiences very rapid changes in their vision or any painful symptoms should see their doctor for evaluation and referral to an eye specialist.

Causes of cataracts

It is not yet known why cataracts develop, although scientists do have some theories about the causes:

• Being over 65 years – deterioration of eyesight is a normal part of aging and so are alterations to the structure of the eyes (especially the lens), which means people who are over 65 years are more at risk of developing cataracts basically due to their age
• Dehydration – some studies show that dehydration, especially if it is caused by excessive sodium intake can cause cataract formation
• Diabetes – secondary cataracts can occur due to the serious condition diabetes which may impair circulation in the body and especially circulation to the eyes and this may cause cataract formation
• Excessive alcohol intake – there have been many studies which have suggested that people who drink alcohol excessively have increased cataract formation than in people who have a low or no consumption of alcohol
• Excessive ultraviolet light exposure – many studies suggest that excessive exposure to ultraviolet light can cause cataract formation. Eye specialists recommend wearing sunglasses for people who are outside all day to prevent cataract formation from ultraviolet light damage to the eyes
• Genetics – some types of cataracts are congenital, so some babies are born with cataracts and other children develop cataracts in childhood. Some adults may develop cataracts later due to a family history of this eye condition
• Injury to the eye – traumatic cataracts are those which occur as a result of an injury to the eye
• Long term use of medications – certain medications are associated with cataract development, such as corticosteroids (oral, topical, or inhaled steroids) as well as statins (used in heart disease, especially to lower high LDL cholesterol) and phenothiazines (used for serious mental disorders such as schizophrenia)
• Malnutrition – some studies are starting to suggest that a diet deficient in the antioxidant vitamins, especially vitamin A, vitamin C and vitamin E may be more at risk of developing cataracts. People who are malnutritioned may not be getting adequate nutritional intake of any of the necessary vitamins and minerals
• Obesity – there some evidence about a link between obesity and cataract formation
• Unhealthy diet – people who have an unhealthy diet are unlikely to get adequate intake of of all the antioxidant vitamins and minerals that may prevent cataract formation

Prevention of cataracts

Non-preventable risk factors

Cataracts may be unpreventable in certain circumstances:

• Aged over 65 – it is difficult to prevent cataracts in people who are over 65 years old because as the eye ages, it is can be more susceptible to the oxidative damage that causes cataract formation. The only way to reduce the risk is to ensure the diet is rich in antioxidants, there is adequate physical activity each day and glasses are always worn when outside
• Diabetes – people who have diabetes may develop cataracts at a higher rate than people without diabetes due to the improper functioning of several systems in the body including blood circulation as well a probable deficiency in the various antioxidants through an extra requirement due to the diabetes, which can make cataracts more likely
• Genetics – cataract development appears to run in families, which scientists believe could be caused by defective genes
• Medications – people that are taking certain medications (such as corticosteroids) are known to have a higher risk for developing cataracts. If these medications have been prescribed for conditions that warrant their usage should talk to their doctor about alternative medication or try to increase the antioxidants in their diet to help boost their resistance to developing cataracts would be very useful
• Rubella in pregnancy – women who are pregnant and who develop a rubella infection (German measles) could possibly pass on cataract development to the baby. This is known as congenital cataracts and while it is very rare, it does occur

Preventable risk factors

There may be ways to prevent cataracts from occurring:

• Drinking less alcohol – people who drink a lot of alcohol may not be getting adequate levels of the antioxidants, as they may not be eating properly and so may develop cataracts as a result. Cataracts from this cause can be (almost) prevented if drinking amounts are reduced and nutritional intake and antioxidants are healthy. People whose alcohol intake is excessive over prolonged periods are the most at risk of cataracts
• Eye injuries – people who injury their eyes in any type of accidents are more prone to developing cataracts at a future point in their life. Studies have shown that people who have accidentally injured their eye in some way, have a higher risk of developing cataracts. This is because the eye injury could cause the eye to become less flexible, have scar tissue and not function properly. Protective eyewear should always be worn when doing any work that has the potential to damage the eyes to prevent possible cataract development in the future
• Reduce exposure to sunlight – it is well known that long term exposure to ultraviolet light is a cause of the development of cataracts. Sunglasses should always be worn when outside in sunlight, or even if it is a little cloudy, to prevent the ultraviolet light from damaging the eyes and possibly causing development of cataracts in the future. Foods rich in antioxidants should form part of the diet to further prevent the risk of development of cataracts
• Stop smoking – people who smoke should give up, because this is a well known risk factor for the development of cataracts, due to the complex way that smoking depletes the antioxidants from the body and further increases the risk of development of cataracts. Smoking causes many problems to blood circulation and in particular circulation to the eyes (as well as problems in many other systems in the body) and giving up smoking is one way to greatly reduce the risk of developing cataracts. People who do smoke cigarettes and cannot give up should be eating foods rich in the antioxidant nutrients rather than taking ay supplements. The diet of smokers should be rich in foods high in the following nutrients: vitamin A (or betacarotene), vitamin C, vitamin E, selenium, zinc

Complications of cataracts

There is one main complication of having cataracts:

• Blindness – once the cataract forms over the lens of the eye, clouding vision, then blindness will ensue. Cataracts are one of the leading causes of unnecessary blindness in the world, especially the developed world, where they do not have as much access to specialist eye treatment for the condition

The only way to remove the cataracts is generally through surgery (unless the doctor can effectively prescribe a non-surgical treatment solution). But as with all surgery, it comes with some complications too. Always discuss your treatment options with your ophthalmologist to make the best decision.

When to see a doctor about cataracts

People who have any of the symptoms of cataracts need to consult their doctor in order to get a referral to an eye specialist (an ophthalmologist) to perform the diagnosis to confirm cataracts and recommend a treatment plan. If caught early, cataracts can usually be treated non-surgically. Alternatively, most eye care providers (optometrists) have bulk billed eye tests, which can be the first step in diagnosing cataracts.

Cataracts are one of the main causes of blindness. They are one of the most preventable causes of lifelong visual impairment. Early detection can help to reduce risk of blindness.

Diagnosis of cataracts

Cataracts are diagnosed through complete eye exams including:

• Eye chart testing – to determine how well you can view the letters in the eye chart from each eye and at different distances; this test shows how clear vision is and at which distance vision becomes distorted
• Eye exam – special eye drops will be administered to each eye (which do not normally cause any pain) which widen the pupil to allow the eye specialist to view your eyes through a magnifying lens machine for signs of cataracts; vision may stay blurry after the eye exam, due to the effects of the eye drops, but this effect is temporary (it is recommended to have someone take you home after the test)

The eye examinations performed by the eye specialist are comprehensive examinations to determine exactly where the cataract is, how advanced it is and which part of the lens it affects.

The eye examinations will also determine if the patient is a good candidate for laser eye surgery to remove the cataract.

Conventional treatment of cataracts

The best way to treat cataracts is to have surgery to remove them and restore proper vision by replacing the damaged lens with a clear lens implant. Cataract surgery is simple and effective and is performed without the need for over-night stay in an eye hospital.

Sometimes the cataracts can be corrected through non-surgical means (if they are mild) to prevent further deterioration of eyesight. This is achieve through the use of special prescription glasses or contact lenses.

Surgical procedures to treat cataracts

There are 3 types of surgical procedures used to remove a complex cataract that is interfering with sight and insert an artificial lens in Australia, with the eye specialist (ophthalmologist) viewing the eye and operating through a special microscope device to enable precise surgery. Surgery usually involves anaesthetic only to the affected eye:

• Phacoemulsification – in this procedure, a small cut is made in the eye and a small probe is inserted into the cataract to break it up into small pieces and suction it up (the lens is also removed), after which the artificial lens is positioned; stitches are usually not required and this procedure usually last 1 hour
• Extracapsular Extraction – this procedure is not commonly used except on those patients whose lens is difficult to remove with the normal surgery (phacoemulsification), where the front of the capsule is cut to enable removal of the lens; this procedures requires stitches and post-operative care
• Intracapsular Extraction – this is a rare surgery, not normally performed, where the entire lens and capsule are removed and replaced with an artificial one; stitches and more post-operative care may be required

Alternative / complementary treatment of cataracts

There are a number of different alternative /complementary approaches for reducing the risk of cataract developing in the first place, but also to help reduce the symptoms and reduce deterioration of eyesight in people with existing cataracts.

Herbs

Certain herbs have known beneficial properties to help improve the health of the eye, to reduce cataract symptoms or prevent cataracts happening in the first place:

• Bilberry – British air force pilots who ate bilberry jam before night raids, found their night vision was better than if they didn’t eat it. Bilberries contain the antioxidant compound anthocyanidins which have known beneficial effects on eye health and cataracts prevention
• Ginkgo biloba – the herb ginkgo biloba increases vascular blood activity to the eye, ensuring there is a proper blood supply, plus it contains high levels of flavonoid and terpenoid compounds which are potent antioxidants that neutralise or prevent free radical damage that can potentially cause cataracts

Vitamins

Studies show that the antioxidant properties of many vitamins are responsible for reducing the severity of symptoms of cataracts (if the condition is already present) or preventing it from developing altogether:

• Betacarotene – the antioxidant betacarotene is the precursor to vitamin A and is often used instead of vitamin A, as it has less toxicity when used in higher doses. Betacarotene acts to prevent free radical damage to the eye and could reduce the risk of cataract formation. People who drink or smoke (or have done so in the past) should not take betacarotene supplements, but get their intake from the foods in their diet instead, due to a higher risk of cancer from this supplement (which a large study has recently found)
• Bioflavonoids – studies show the antioxidant activity of bioflavonoids (especially when combined with vitamin C) reduce the risk for developing cataracts or alleviating symptoms in people with existing cataracts
• Vitamin A – the antioxidant vitamin A is a potent antioxidant which acts to prevent free radical damage to the eye and lowers the risk of cataracts and reduces symptoms in people with existing cataracts
• Vitamin C – the antioxidant vitamin C (together with bioflavonoids) is a major antioxidant which acts to prevent free radical damage to the eye and lowers risk of cataracts and reduces symptoms in people with existing cataracts
• Vitamin E – the antioxidant vitamin E is a potent antioxidant which acts to prevent free radical damage to the eye and lowers the risk of cataracts developing, but also reduces symptoms in people with existing cataracts

Minerals

There are two main minerals which have potent antioxidant activity that may reduce risk of cataracts from developing in the first place or reducing symptoms in people with an existing condition:

• Selenium – studies have shown that the antioxidant mineral selenium works to prevent free radical damage which is thought to damage the eye cells and allow cataracts to develop in the first place
• Zinc – numerous studies show that the antioxidant mineral zinc is very important for eye health as it prevents free radical damage to the eyes which can enable cataracts to develop

Other nutrients

Various other nutrients have been shown to have a beneficial effect on cataracts by increasing antioxidant activity and reducing risk of damage to the delicate lens by free radicals

• Alpha-lipoic acid – the nutrient alpha-lipoic acid is a really potent antioxidant which greatly impedes the oxidation damage in the whole body, but especially to the cells of the eye. Alpha-lipoic acid also boost the antioxidant effect of the other antioxidants, so this further increases the reduction in oxidative damage to the eyes
• Glutathione – the amino acid glutathione is a really potent antioxidant which removes toxins and neutralises free radicals and prevents the damage that free radicals can cause to the eye that can lead to cataract formation
• Lutein – the antioxidant lutein is found in fruits and vegetables lowers the risk for cataracts and naturally exists in the retina. Lutein is one of the natural pigments that colours the eye and needs to be in adequate supply to ensure the eye is functioning properly
• N-acetyl-cysteine (NAC) – this amino acid cysteine, but more so in the form N-acetyl-cysteine is a powerful antioxidant which helps to removes toxin from the eye and neutralises free radical damages so that they cannot damage the eye and cause cataracts to form. Cysteine is the precursor to the antioxidant amino acid glutathione
• Zeaxanthin – the antioxidant zeaxanthin is found in fruits and vegetables lowers the risk for cataracts and naturally exists in the retina. Zeaxanthin is one of the natural pigments that colours the eye and needs to be in adequate supply to ensure the eye is functioning properly

Dietary modifications

There are a number of dietary modifications that can be utilised to help reduce severity and duration of symptoms and even to help reduce the risk of development of cataracts in the first place:

• Decrease cholesterol – some studies show that a diet high in cholesterol may cause an increased risk of cataract formation, so people with high blood cholesterol should endeavour to reduce their cholesterol levels by increasing legumes and wholegrains in their diet and reducing intake of red meat and animal products, but organic eggs can be eaten in moderation
• Eat more leafy green vegetables – these contain high levels of betacarotene and vitamin C, as well as other antioxidants and nutrients needed by the eyes to enable good health
• Eat more orange vegetables – these contain high levels of betacarotene and vitamin C, as well as other antioxidants and nutrients needed by the eyes to enable good health
• Reduce milk intake – this is because milk contains the simple sugar galactose which could increase the risk of cataract development and could make existing cataract symptoms worse. Another reason for milk’s adverse effects on the eyes could be due to an inability to metabolise calcium properly

Lifestyle modifications

Certain lifestyle factors are recommended to reduce risk of developing cataracts:

• Stop drinking – excessive alcohol intake is a well known risk factor for cataract development, so alcohol intake should be limited and dietary intake of antioxidant foods increased to help reduce risk of cataract development
• Stop smoking – people who smoke cigarettes are increasing their risk of developing cataracts, so they should give up. People who cannot give up smoking should at least try to increase their intake of foods rich in the antioxidant nutrients: vitamin A (betacarotene), vitamin C, vitamin E, selenium, zinc
• Wear a hat – whenever outside, always wear a hat, as that helps to reduce sun exposure to the eyes, especially ultraviolet light, which is another known risk factor for cataract development
• Wear sunglasses – whenever outside, always wear sunglasses, as they will help to reduce sun exposure to the eyes, especially ultraviolet light, which is another known risk factor for cataract development

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with cataracts

There are a number of strategies that are useful for people who have cataracts:

• Caution when driving – cataracts impair vision, so it may also impair your ability to drive, if your symptoms are severe. Check with your doctor if you can drive and ensure you don’t drive in poor weather, at night or when it is raining, because your vision will not be very good in these conditions. Ask your partner or other family member to drive you if you need to go anywhere in these conditions
• Eye specialist – ensure you see your eye specialist on a regular basis (as often as required). Your eye specialist can also advise if you are a suitable candidate for eye surgery to correct your vision problems or if you need special prescription glasses as a treatment option
• Glasses – since vision may be compromised, you will need to wear the glasses that the ophthalmologist or optometrist has prescribed. Vision will get worse with cataracts, so this is only a temporary solution until surgery (if that is the solution prescribed)
• Healthy diet – you must eat healthy food, such as fresh fruit (2-3 per day) and vegetables (5-7 portions a day), but especially leafy green, orange and red fruits and vegetables as they are full of the nutrients vital for eye health (lutein, zeaxanthin, betacarotene, vitamin A, vitamin C, vitamin E), nuts and seeds, oily fish about 2-3 times a week (mackerel, salmon, sardines, trout, tuna), legumes most days, wholegrains, some low fat dairy, poultry and some red meat 2-3 times a week. Always try to use fresh produce and organic is better as it has more of the nutrients available in the food than non-organic
• Help from family and friends – you may need help with shopping, with housework and paying bills (and other home maintenance), so if you have any family or close friends living near you, it would be very helpful for you if you could ask them for their help with these

Other strategies

Further strategies that are useful for people who have cataracts:

• Proper lighting – make sure you have proper lighting in your home so that you can see better
• Special large letter appliances – you may be able to purchase some special large lettering appliances (clocks, telephones, radios) which have extra large lettering to help you read them better
• Stop smoking – it is well known that cigarette smoking is implicated as a risk factor for cataract development. Smoking damages the fine blood vessels in the retina and macular and it also robs the body of a number of the antioxidant vitamins (such as vitamin C), which are vitally necessary for the health of the eye, so if you have been diagnosed with cataracts, you must stop smoking, to reduce any further damage to the eye and worsening of symptoms and disease progression
• Travel with other people – if your vision is no longer clear, try to get your friends and family to take you out when you need to do your errands, or use a bus (or other public transport), or even find a community bus which can take you from door to door and help you too
• Use a magnifying glass to read – a good magnifying glass can help to enlarge letters so that they do not appear fuzzy, which makes them easier to read

Strategies for people who’ve had cataract surgery

There are a number of strategies that are useful for people who have had surgery to remove their cataracts:

• Good hygiene – always practice good hygiene after the surgery, always wash your hands before touching your eye and keep your eye clean
• Use medications prescribed – the doctor may prescribe some painkilling (and other) medications after the surgery to prevent infection of the eye and reduce pain
• Wear glasses – after the surgery, the ophthalmologist will prescribe different prescription glasses (sometimes bifocals) than before the surgery to help with both near and distant vision

Caring for someone with cataracts

Partner

If you have a partner with cataracts, there are a number of useful strategies you can use to help them:

• Cleaning – your partner may not be able to perform much of the cleaning duties in the house, so either you will need to do most of them, you can try to enlist family and friends to help, you can employ a cleaner or a combination of all of these. Just make sure you and your partner are agreed about the way forward
• Depression – people with any type of vision loss condition can easily become depressed, due to the inability to be independent from loss of vision. If you notice your partner’s mood changes, you could suggest a visit to the doctor just as a precaution to make sure it is not depression, but if it is, your partner’s doctor can make some suggestions for treatment
• Healthy diet – some recent studies suggest that cataract formation may be linked to a diet deficient in certain antioxidant vitamins (vitamin A, vitamin C, vitamin E especially). A diet deficient in antioxidants enable free radical damage to the eyes, so it may be beneficial for your partner to include more foods rich in these vitamins
• Support – your partner needs your love and support and to know that you are there for them if they need you. Try to be there to listen to their concerns and worries and if you cannot manage everything, talk to your doctor about other support options (including from family and friends)

Friends and family members

If you have a friend or family member with cataracts, there are a number of useful strategies you can use to help them:

• Driving – your friend may not be able to drive themselves to visit you or go shopping, so you may be able to help them out when you can
• Support – your friend needs your love and support and to know that you are there for them if they need you. Try to be there to listen to their concerns and worries and let them know you are available for support

Parents

If you have a child with cataracts, there are a number of useful strategies you can use to help them:

• Eye specialist – ensure your child visits the eye specialist on a regular basis for all their appointments prior to, during and after surgery
• Healthy diet – some recent studies suggest that cataract formation may be linked to a diet deficient in certain antioxidant vitamins (vitamin A, vitamin C, vitamin E especially), so it may be beneficial for your child to include more foods rich in these vitamins
• Support – your child needs your love and support and to know that you are there for them if they need you. Try to be there to listen to their concerns and worries and let them know you are available for support

References

• Jacques PF, Chylack Jr LT . Epidemiologic evidence of a role for the antioxidant vitamins and carotenoids in cataract prevention. American Journal of Clinical Nutrition, 1991; Vol 53, 352S-355S
• Maitra I, Serbinova E, Trischler H, Packer L. Alpha-lipoic acid prevents buthionine sulfoximine-induced cataract formation in newborn rats. Free Radical Biology and Medicine, Volume 18(4), 1995:823-829(7)
• Mares, JA. High-dose Antioxidant Supplementation and Cataract Risk. Nutrition Reviews, Volume 62(1),2004:28-32(5)
• Moeller SM, JacquesPF, Blumberg JB. The Potential Role of Dietary Xanthophylls in Cataract and Age-Related Macular Degeneration. Journal of the American College of Nutrition, Vol. 19, No. 90005, 522S-527S (2000)
• Varma SD, Hegde KR, Kovtun S. Attenuation and Delay of Diabetic Cataracts by Antioxidants: Effectiveness of Pyruvate after Onset of Cataract. Ophthalmologica 2005;219:309-315
• Yeum K-J, Shang F, Schalch W, Russell RM, Taylor A. Fat-soluble nutrient concentrations in different layers of human cataractous lens. Current Eye Research, Volume 19(6), December 1999; 502-505

Last reviewed and updated: 6 May 2025