What is the primary treatment for cataracts?

Primary Treatment for Cataracts

Surgery is the only effective treatment for cataracts—specifically, small-incision phacoemulsification with intraocular lens (IOL) implantation performed on an outpatient basis. 1

Definitive Treatment Approach

Cataract surgery is the sole curative intervention, as no pharmacological treatments exist to eliminate cataracts or retard their progression. 2 The evidence is unequivocal: dietary intake and nutritional supplements have demonstrated minimal effect on prevention or treatment of cataracts. 1

Surgical Technique

• Phacoemulsification with foldable IOL implantation is the gold standard, producing superior uncorrected distance visual acuity and lower complication rates compared to other techniques. 2, 3
• The procedure is sutureless, uses small incisions, and is performed as outpatient surgery in the vast majority of cases in the United States. 1
• Femtosecond laser-assisted cataract surgery (FLACS) increases capsulorrhexis precision but is not cost-effective and has not demonstrated superior refractive outcomes or risk profiles compared to standard phacoemulsification. 1

Indications for Surgery

Surgery should be performed when visual function decline no longer meets the patient's needs and surgery provides reasonable likelihood of improvement. 2, 3 The American Academy of Ophthalmology establishes this as the primary indication. 2, 3

Specific Criteria for Intervention

• Cataracts affecting daily living activities constitute the fundamental criterion for surgical intervention. 2
• Surgery is indicated when tolerable refractive correction cannot provide vision that meets patient needs. 2
• Surgery may be performed for improved visualization and management of coexisting ocular disease (glaucoma, macular degeneration, diabetic retinopathy). 1
• Timing should be mutually agreeable between patient and surgeon, but waiting more than 4 months after clear indication can result in vision-related complications including falls and accidents. 3

Expected Outcomes

Up to 90% of patients undergoing first-eye cataract surgery report improvement in functional status and satisfaction with vision. 2, 3

Quality of Life Benefits

• Improved distance-corrected visual acuity, near work ability, depth perception, binocular vision, color vision, and peripheral vision. 3
• Reduced risk of traffic accidents, falls, and fractures. 1
• Substantial positive impact on vision-dependent functioning consistently demonstrated across well-designed studies. 2, 3

Contraindications to Surgery

Do not operate if:

• Tolerable refractive correction provides vision meeting patient needs and desires. 2
• Surgery is not expected to improve visual function and no other indication for lens removal exists. 2
• Patient cannot safely undergo surgery due to coexisting medical or ocular conditions. 2

Perioperative Management

• Intracameral antibiotic administration substantially reduces postoperative bacterial endophthalmitis risk, with increasing evidence that topical antibiotics provide no additional benefit. 1
• Topical NSAIDs reduce early postoperative cystoid macular edema incidence, though long-term benefit is not demonstrated. 1
• Standard postoperative regimen consists of topical antibiotic and corticosteroid, with preservative-free formulations preferred. 4

Common Pitfalls to Avoid

• Do not delay surgery beyond 4 months once clearly indicated, as this increases risk of vision-related accidents. 3
• Do not rely on nutritional supplements or dietary modifications as treatment, as these have minimal effect. 1
• Distinguish between patient-centered functional impairment versus arbitrary visual acuity thresholds when determining surgical timing. 2, 3