What is the primary treatment for cataracts that significantly impair vision?

Primary Treatment for Cataracts That Significantly Impair Vision

Surgery is the primary and only effective treatment for cataracts that significantly impair vision, specifically phacoemulsification with intraocular lens implantation. 1

Understanding Cataracts

Cataracts involve the clouding of the lens in the eye, causing a decline in visual function that affects quality of life. They are the leading cause of blindness worldwide and one of the most common causes of visual impairment in the United States. 1, 2

The three main types of cataracts include:

• Nuclear cataract - affects the central lens, progresses slowly, and impacts distance vision more than near vision 1
• Cortical cataract - can be central or peripheral, often causing glare complaints 1
• Posterior subcapsular cataract (PSC) - located just inside the posterior lens capsule, causes substantial visual impairment with glare and poor vision in bright light 1

Non-Surgical Management Options (Temporary Measures)

Before surgery becomes necessary, temporary measures may help manage symptoms:

• Prescription changes - updating glasses or contact lens prescriptions to account for refractive shifts in early cataract development 1
• Low-vision devices - can maximize remaining vision pending surgery or allow deferral in high-risk patients 1
• Pupil dilation - in limited circumstances as a temporizing measure for small central cataracts, though this may worsen glare 1

Important Note on Pharmacological Treatments:

• Currently, no pharmacological treatments are proven to eliminate existing cataracts or retard their progression 1
• Patients should be advised that there is insufficient evidence to support the use of pharmacological treatments such as N-acetylcarnosine drops 1

Surgical Management - The Definitive Treatment

Primary Surgical Approach:

• Sutureless, small-incision phacoemulsification with foldable intraocular lens (IOL) implantation performed on an outpatient basis 1
• This technique produces better uncorrected distance visual acuity and has a lower rate of surgical complications compared to other extraction methods 1
• Phacoemulsification limits astigmatic changes that occur with larger incisions and enables both astigmatism management and specialty IOL implantation 1

Indications for Surgery:

1. Decline in visual function that no longer meets the patient's visual needs and for which surgery provides a reasonable likelihood of improvement 1
2. Clinically significant anisometropia in the presence of a cataract 1
3. Lens opacity interfering with optimal diagnosis or management of posterior segment pathology 1
4. Lens-induced inflammation and secondary glaucoma 1
5. Lens-induced primary angle closure or other forms of lens-related glaucoma 1

Contraindications to Surgery:

• When tolerable refractive correction provides adequate vision 1
• When surgery is not expected to improve visual function 1
• When the patient cannot safely undergo surgery due to coexisting medical or ocular conditions 1
• When appropriate postoperative care cannot be arranged 1
• When informed consent cannot be obtained 1

Benefits of Cataract Surgery

Cataract surgery significantly improves:

• Visual function - up to 90% of patients undergoing first-eye cataract surgery note improvement in functional status and satisfaction with vision 1
• Quality of life - several studies report an association between improved visual function and improved health-related quality of life 1
• Physical performance and well-being - particularly regarding mobility 1
• Mental health - patients who underwent cataract surgery experienced significant improvement in mental health domain scores 1
• Safety - reduces the rate of falls and fractures by approximately 34% over a 12-month period 1

Surgical Outcomes and Considerations

Cataract surgery is a low-risk procedure with high success rates. The procedure has evolved from being solely vision-restoring to becoming refractive in nature, with options for premium intraocular lenses to meet individual patient needs. 2, 3

Despite being highly effective, access to quality cataract surgery remains a global challenge, with inequities in surgical service quality limiting access in many regions. 4