Key Signs and Symptoms of Cataracts
Cataracts present with three cardinal symptoms: progressive blurring of vision, increased sensitivity to glare, and reduced contrast sensitivity. 1
Primary Visual Symptoms
- Decreased visual acuity that progressively worsens and may not improve with refraction, affecting both distance and near vision depending on cataract type 2, 3
- Visual glare is a hallmark symptom, particularly problematic in bright lighting conditions, with oncoming automobile headlamps at night, or in sunny daytime environments 1, 2, 3
- Reduced contrast sensitivity affecting the ability to detect subtle variations in shading, which impairs daily activities even when standard visual acuity appears relatively preserved 1, 2
Type-Specific Presentations
The visual symptoms vary significantly based on anatomical location of the opacity:
- Nuclear cataracts cause central lens opacification that primarily affects distance vision more than near vision, progressing slowly over time 2
- Cortical cataracts appear as opaque spokes or oil droplets and commonly produce prominent glare symptoms 2
- Posterior subcapsular cataracts (PSCs) located just inside the posterior lens capsule cause substantial visual impairment with glare and particularly poor vision in bright light, with near vision typically affected more than distance 2, 4
Additional Clinical Features
- Monocular diplopia may develop as the opacity increases and symptoms progressively worsen 2, 5
- Myopic shift can occur, temporarily improving near vision in some patients 5
- Changes in color vision may be reported by patients 5
- Photophobia is common, particularly with posterior subcapsular cataracts 5
Critical Diagnostic Considerations
Standard visual acuity testing alone significantly underestimates the functional impact of cataracts. 2 Patients may demonstrate normal or near-normal visual acuity when tested in a darkened examination room, but experience severe visual disability in real-world lighting conditions. 1
- Glare testing reveals functional disability greater than Snellen acuity alone suggests, with visual acuity or contrast sensitivity dropping significantly when retested in the presence of a glare source 1, 2
- Contrast sensitivity testing demonstrates loss of visual function not appreciated by Snellen testing alone, providing crucial information about real-world functional impairment 1, 2
- Clinically significant cataracts can be visualized on physical examination as change of color or opacities in the eye lens 1
Common Clinical Pitfall
Impaired visual acuity in older adults may not be recognized by the individual or may remain unreported because vision changes can be relatively subtle, occur in more advanced stages, progress slowly over time, or occur in persons with cognitive dysfunction or other comorbid conditions. 1 This underscores the importance of proactive screening rather than waiting for patient complaints.