Treatment for Vision Changes from Cataract
Surgical removal of the cataract through phacoemulsification with intraocular lens implantation is the definitive treatment for vision changes caused by cataracts. 1
Understanding Cataracts
Cataracts are a clouding of the lens of the eye that leads to:
- Impaired visual acuity
- Increased sensitivity to glare
- Loss of sensitivity to differences in contrast 1
They typically progress over time and are the leading cause of reversible blindness worldwide, affecting approximately 50% of US adults 75 years or older 1, 2.
Treatment Options
Non-Surgical Management
Non-surgical options are limited and only temporary:
- Prescription changes: In early stages, updating glasses or contact lens prescriptions may help manage refractive shifts 1
- Low-vision devices: Can maximize remaining vision pending surgery 1
- Pupil dilation: In limited circumstances, dilating the pupil may temporarily improve vision around a small central cataract, though this may worsen glare disability 1
Important: Currently, there is insufficient evidence to support any pharmacological treatments for cataracts. Patients should be advised that no medications can eliminate existing cataracts or retard their progression, as confirmed by a 2017 Cochrane Systematic Review of N-acetylcarnosine drops 1.
Surgical Management
Surgery is the only definitive treatment for cataracts 3, 4. The primary indication is a decline in visual function that no longer meets the patient's needs and for which surgery provides a reasonable likelihood of improvement 1.
Surgical Approaches:
Phacoemulsification (gold standard):
Femtosecond laser-assisted cataract surgery:
- Advanced technology that automates several surgical steps
- Note: RCTs have not shown superiority over standard phacoemulsification 6
Manual extracapsular cataract extraction (ECCE) or manual small-incision cataract extraction (MSICS):
Intraocular Lens Options:
After cataract removal, various types of IOLs can be implanted:
- Monofocal IOLs (standard)
- Multifocal/presbyopia-correcting IOLs
- Toric IOLs (for astigmatism correction)
- Extended depth of focus (EDOF) IOLs 5, 2
Contraindications to Surgery
Surgery should not be performed when:
- Current vision correction meets the patient's needs
- Surgery is not expected to improve visual function
- Patient cannot safely undergo surgery due to medical or ocular conditions
- Appropriate postoperative care cannot be arranged
- Informed consent cannot be obtained 1
Benefits of Cataract Surgery
Beyond vision improvement, cataract surgery is associated with:
- Lower rates of falls (>30% reduction)
- Reduced risk of dementia (20%-30% reduction)
- Potential reduced dependence on eyeglasses with advanced technology IOLs 2
Surgical Considerations
- Most procedures are performed with topical anesthesia
- Patients typically do not require preoperative general medical testing
- Anticoagulants usually do not need to be discontinued
- Intraocular antibiotics have reduced rates of post-surgical endophthalmitis from 0.07% to 0.02% 2
Caution: Patients taking systemic α1-adrenergic antagonists (e.g., tamsulosin) for benign prostatic hyperplasia have an increased risk of surgical complications; some ophthalmologists temporarily discontinue these medications preoperatively 2.
Cataract surgery remains one of the most commonly performed and effective surgical procedures in medicine, with generally good outcomes when performed by qualified ophthalmologists 4, 7.