Living With Cataract: Daily Adjustments Before and After Surgery

What cataract is

The natural lens sits behind the pupil and focuses light onto the retina. With age, proteins in the lens clump and the lens turns cloudy or yellow-brown. The change is gradual, often over years, and may affect one or both eyes at different rates. Other causes and contributors include diabetes, long-term steroid use, eye injury or inflammation, smoking, heavy sunlight exposure and family tendency. No drops, tablets, exercises or foods dissolve a cataract; the treatment is surgery to replace the clouded lens. See cataract surgery: when you need it and get familiar with eye cataract.

Common symptoms

• Blurred, cloudy or misty vision, as if looking through a dirty window.
• Glare and halos around lights, especially at night, when driving or facing sunlight.
• Faded colours, with a yellow or brown tinge.
• Difficulty seeing in dim light, and needing more light to read.
• Double vision in one eye.
• Frequent changes in glasses, which help less and less.
• A temporary improvement in near vision ("second sight") in some people, as the lens swells, which is not a sign that the eye is getting better.
• Trouble recognising faces, reading signs, steps or kerbs.

These symptoms can also arise from other eye diseases, so an eye examination is essential. Sudden vision loss, flashes of light, a curtain or shadow, new floaters, eye pain with redness, halos with severe headache and vomiting, or distortion of straight lines are emergencies and need immediate care, not a routine cataract appointment.

When surgery is advised

The decision depends on how much the vision affects the person's life, safety and independence, not just on a number on a chart. Reasons to consider surgery:

• Difficulty with reading, watching television, cooking, recognising faces, managing medicines or walking safely.
• Glare that makes outdoor movement or night travel unsafe.
• Frequent falls or near-misses.
• A cataract that makes it hard to examine or treat the retina, for example in diabetes.
• A very swollen or dense cataract that may cause pressure problems in the eye.
• Reduced quality of life.

Delay does not usually harm the eye in the early stages, but very dense cataracts can be harder to remove and, in some cases, raise risks. Waiting too long can also cost safety and independence through falls and isolation. The surgeon will discuss timing, risks and benefits. See low vision home safety: contrast, labels and layout.

What surgery involves

In the most common operation, the surgeon makes a very small cut, breaks up the clouded lens with ultrasound or a similar technique, removes it and places a clear artificial lens, an intraocular lens (IOL), in the same position. The operation usually takes around 15 to 30 minutes, is done under local anaesthetic drops or an injection, is painless or nearly so, and the person goes home the same day. Different IOLs exist, including those that correct distance vision, and those that help with near and far; the surgeon advises on the type, taking account of the eye's health and the person's needs. People with other eye diseases, diabetes, previous eye surgery, or conditions such as glaucoma or macular degeneration may need special planning, and the expected benefit may be less. The surgeon will say so. Costs vary by hospital and lens type, and government and charitable programmes offer cataract surgery in many places; ask the hospital and see government schemes for senior citizens.

Living safely while waiting for surgery

Lighting and glare

• Increase light where tasks are done and reduce glare; see lighting for older eyes: brightness, colour and glare.
• Use a strong, adjustable reading lamp, and consider a magnifier lamp for close tasks; see magnifier lamps: reading and hobbies with low vision.
• Wear a hat or sunglasses outdoors in strong sun, as advised by the optometrist; see best sunglasses for seniors.
• Cover shiny surfaces and use matt finishes. Avoid facing bright windows.

Contrast and falls

• Put contrast tape on step edges, and use a dark rug mat at light doors or vice versa.
• Keep floors clear of clutter and cords; see flooring, rugs and trip hazards.
• Install handrails, night lights and good lighting on stairs; see stairs, steps and thresholds and motion night lights for seniors.
• Use a walking stick or frame if the doctor advises. See falls risk assessment at home.
• Take care at night and in dim places, and wait for the eyes to adjust when moving from bright to dark.

Reading and daily tasks

• Use large-print books, bold pens and high-contrast labels.
• Use a talking clock and clear labels on medicines; see talking clock guide and pill organiser guide. Ask the pharmacist to help with medicine labelling; do not guess.
• Keep items in fixed places, and tell the family when moving things.
• Use audio books, radio or phone features; see phone accessibility features for hearing and vision loss.

Kitchen and cooking

• Use good task lighting, contrasting chopping boards (dark on light foods and light on dark foods), and avoid hot-oil hazards by sitting while chopping. See kitchen setup for seniors.

Travel and driving

• Avoid driving at night or in glare if vision is impaired, and follow the doctor's advice and legal rules on fitness to drive. See safe driving tips for the elderly.
• Use assistance for outdoor trips, especially at dusk.

Diabetes and other conditions

• Keep blood sugar and blood pressure under control, as advised; see diabetic eye care for older adults.
• Tell the eye doctor about medicines, including blood thinners and medicines for the prostate, which may affect surgery planning. Do not stop any medicine without the doctor's advice.

Before surgery

Ask the hospital for written instructions. In general:

• Complete the pre-operative tests, which may include eye measurements, blood pressure and blood sugar checks.
• Tell the team about all medicines and conditions.
• Follow instructions about eating, drinking and medicines on the day.
• Arrange a family member to accompany and take your parent home.
• Prepare the home for recovery; see home care after cataract surgery.
• Ask what to expect, including the possibility of needing glasses afterwards.

After surgery in brief

Most people notice improved vision within a day or two, though it can be blurry at first. The surgeon prescribes eye drops, protects the eye with a shield, and gives instructions on activity. Detailed guidance is in home care after cataract surgery. Glasses are usually updated a few weeks later. If the second eye also has a cataract, surgery may be planned after a gap. Sometimes the thin membrane behind the new lens clouds over months or years (posterior capsule opacification), which is treated with a quick laser procedure; this is not a new cataract.

Warning signs: urgent

After surgery or at any time, go to an eye doctor or emergency the same day for:

• Increasing eye pain, redness or swelling.
• Sudden drop in vision or new blurring.
• Flashes of light, a shower of floaters or a curtain or shadow.
• Discharge or a very sticky, red eye, or fever.
• Severe headache with nausea or vomiting and halos around lights.
• Sensitivity to light that is getting worse.
• A feeling that something is in the eye that does not go away, after surgery.

Call 112 if vision loss comes with weakness, facial droop, speech difficulty or confusion.

Common myths

• "Cataract needs to be ripe before surgery." Modern techniques do not require waiting for a cataract to ripen, though the timing is for the surgeon.
• "Drops or eye exercises can dissolve cataract." No such treatment has been proven. Do not use unproven drops; see eye drops made easy: tips for older hands.
• "Surgery with a laser burns it off." Most cataract surgery uses ultrasound or a femtosecond laser for some steps; the lens is replaced.
• "If it is not hurting, it is not serious." Cataract is painless, but it affects safety.
• "Older people cannot have surgery." Age alone is rarely a barrier; the eye and general health matter.

Emotional side

Vision loss can be frightening and isolating. Some people fear surgery or blame themselves. Acknowledge fears, provide information, accompany them to appointments, and encourage them to ask questions. See anxiety in older adults.

When to ask a professional

See an ophthalmologist for diagnosis and advice on timing, lens choice and risks. See an optometrist for glasses and vision checks. Ask the doctor about diabetes and blood pressure control, and for medicine review. Ask an occupational therapist for a home safety assessment if vision is affecting daily life. Go urgently for sudden vision changes, pain, flashes or a curtain. Call 112 for signs of stroke.