Cataracts: symptoms, causes, surgery and recovery

The NHS says cataract symptoms usually develop slowly, and you will often have cataracts in both eyes, though the symptoms may differ between eyes. NICE CKS describes the main symptom in adults as a gradual and painless reduction in vision, which may show up as difficulty reading, recognising faces or watching television.

• Blurred vision.

• Difficulty seeing at night.

• Difficulty reading and watching television.

• Eyes uncomfortable in, or sensitive to, light and glare.

• Looking at one object but seeing two (double vision).

• Seeing glowing rings (halos) around lights.

• Colours looking faded, especially blue.

• Needing to change your glasses prescription more often than usual.

NICE CKS defines a cataract as an opacity, a cloudy area, that forms within the lens of the eye and can reduce the transparency of the lens. A cataract may form in one or both eyes, at any age, but most are due to ageing and are most common in people over 60.

The NHS says that cataracts affect your sight and, without treatment, will eventually cause sight loss.

Most cataracts are age-related. The NHS and NICE CKS list a range of things that make them more likely.

The NHS says cataracts do not usually need treatment straight away. Using stronger glasses and brighter light for reading may help for a while. Over time they get worse, and surgery is the only way to get rid of a cataract.

A GP or eye specialist will talk to you about whether you want surgery. According to the NHS this depends on how much the cataracts affect your daily life and whether they are in one eye or both. NICE CKS says the discussion should also cover what surgery involves, its risks and benefits, how your quality of life may be affected if you choose not to have it, and whether you want it.

Cataract surgery replaces the cloudy lens with a clear artificial lens. If you have cataracts in both eyes they are treated on separate days. Surgery for children is different; the NHS says it is usually done as soon as possible to help their vision develop properly.

The NHS says surgery is usually done in hospital under local anaesthetic, given as eye drops, an injection or both. You are awake but should feel no pain, and you will see movement and changes of light and shade, though unlikely any detail.

The surgeon makes a tiny hole through the front of the eye, may use ultrasound to break up the lens, removes it with suction and places a clear plastic lens inside the lens capsule to hold the new lens in place. The operation usually takes between 20 and 45 minutes.

Usually you do not need stitches. You should be able to go home the same day, but you should not drive yourself home. Before surgery the NHS says you will see a specialist who will examine and measure your eye, and that you can eat and drink as normal for a local anaesthetic.

The NHS says most people recover quickly. You will be given eye drops to help healing and prevent infection, usually for about 4 weeks. Your vision may be blurry for a few hours, your eye may hurt for a few days and it may take several days for your vision to improve. You may need glasses for reading or distance, and your prescription may be different to before.

• Do follow the instructions about changing your dressing, take painkillers such as paracetamol or ibuprofen if needed, and wear sunglasses if lights seem brighter.

• Do not rub your eye, drive until your vision is back to normal, do any heavy lifting or play sports, wear eye make-up, get water in your eye or go swimming, even with goggles.

• You may need a plastic shield at night while the eye heals.

The NHS says serious complications are rare. Possible problems include cloudiness, blurriness or dark shadows in vision, a detached retina, infection, bleeding or inflammation, or a problem with the position of the new lens. Sometimes vision becomes cloudy months or years later, which may be posterior capsule opacification (PCO).

Go to an optician if your vision gets cloudy or blurry, you find it hard to focus, your eye becomes red or painful, you see light or dark areas in your vision or bright light becomes uncomfortable.

Get help from NHS 111 if floaters suddenly appear or increase, you get flashes of light, a dark curtain or shadow moves across your vision, or your vision gets suddenly blurred. The NHS says these could be signs of a detached retina.

Cataracts can be present at birth or develop in childhood. NICE CKS lists signs including poor vision, a white or grey pupil, involuntary eye movements and squint, and advises urgent referral to an ophthalmologist for suspected cataract in a baby or child. The NHS has a separate page on childhood cataracts.

The NHS says you may still be able to drive with cataracts if your vision is good enough. You must tell the DVLA if your eyesight does not meet the minimum standards for driving, and an optician can advise if you are not sure.

The usual route starts with an optician, who refers you to an eye specialist if they think you have a cataract. The NHS says there may be a wait for surgery, and you can ask your eye specialist how long. Private eye hospitals also carry out cataract surgery; the lens options, tests and any extra charges differ, so ask what is included.