The Truth About Cataracts and Surgery

James E. Croley III, M.D.

James E. Croley III, M.D.

Author and Ophthalmologist

My Eye Doctor Said My Cataract is Going to Explode in My Eye! Really!!!

Unfortunately, cataract surgery has become one of the most unnecessary surgeries in the United States. Patients are told all kinds of crazy stories about why their cataracts need to be removed. Many are told that if the cataract remains in their eye any longer, it will damage their eyes. If the cataract isn’t removed now, it will be much more difficult later, with many more complications.

Patients have been told on rare occasions that the cataract is going to explode inside their eyes and ruin their eyes. What an outrageous statement by a supposedly caring eye physician that took the Hippocratic oath to help people and to do no harm. There are other stories that the cataract isn’t that bad now but should be removed immediately, as it is easier to perform the surgery now, or that their cataracts are going to go from a level 1 cataract to a level 4 cataract within 6 months and the surgery will be very difficult with more complications.

Unfortunately, too many doctors are more interested in making money than providing proper and compassionate care to their patients.

What is the Truth About Cataracts and Surgery?

What is a Cataract?

Nearly 100 percent of people believe that a cataract is a film or growth that grows over the eye. A cataract is actually not a film or piece of tissue that grows over the eye that blurs people’s vision. There is a lens inside of the eye that is positioned behind the pupil and the colored portion of the eye (iris) that focuses light as it passes through the pupil to be focused onto the retina (the retina is similar to the film of a camera as it receives the object you are looking at). The lens becomes hazy or cloudy from aging and various other reasons, and this cloudiness blurs the vision.

The term cataract comes from the description of rapids or a waterfall in a river. The water is clear until it reaches the rapids or waterfall and then the water turns white. Before there was cataract surgery, the pupil would turn white when the cataract became very advanced.

Light passes through the lens and the cataract scatters the light
Light passes through the lens and the cataract scatters the light

This image that the retina sees is transmitted from the retina through the optic nerve. The optic nerve transmits the image to the back portion of the brain called the occipital lobe. The occipital lobe is the vision center inside the brain.

As the human body ages, this lens behind the pupil loses its clarity over time. The lens becomes hazy or cloudy. As the lens becomes progressively hazy or cloudy, it causes the vision to blur. It is similar to the windshield of your car fogging and diminishing your ability to see through the windshield as the fogging progresses.

So now you know the truth about what a cataract is. Let’s take a look at why people get cataracts.

Example of Cloudy Vision cause by Cataract
Cloudy vision from a cataract

What Causes Cataracts to Develop in the Eye?

In nearly all cases, a cataract develops in the lens over time, secondary to just simple aging. Many genetic factors related to cataracts can lead to the development of different types of cataracts. In some families, cataracts develop at a younger age due to these genetic factors. On rare occasions, a child will be born with cataracts.

What other risks or factors contribute to the development of cataracts? There is very good scientific evidence that ultraviolet light or sun exposure can increase the risk of developing cataracts at a faster rate. Also, smoking leads to the development of cataracts at a younger age. People with diabetes can develop a diabetic cataract and usually develop cataracts at a younger age.

Cataracts develop slowly over the years and people develop bilateral cataracts in most cases. Many times, a person with cataracts needs to get a new prescription for glasses to clear their vision. Cataracts can cause the eye to become more nearsighted from the eye’s original state as the lens becomes denser.

The human lens is comprised of several different structures which can become cloudy, which are the causes of blurred vision. Having different structures in the lens means there can be different types of cataracts.

There are two major types of cataracts, which are immature cataracts and mature cataracts. Another subcategory is an incipient cataract. Incipient cataracts or early cataracts are cataracts early in development and do not affect a person’s vision.

Here is a list of some of the different types of cataracts:

Cloudy Lens cause by Nuclear Cataract
Bottom lens brown and cloudy (nuclear sclerosis)
Nuclear Cataracts

Nuclear sclerosis, senile cataract, nuclear cataract, nuclear sclerotic cataract, senile nuclear sclerosis, or aging cataract are some of the terms for the nucleus of the lens becoming hazy, brownish, and cloudy. A cataract lens where the nucleus becomes brownish and cloudy is the most common type of cataract. This type of cataract usually changes slowly over the years.

Nuclear sclerotic cataracts can cause a change in the glass prescription. As the lens becomes denser, it makes the eye more nearsighted. You may only need a new glass prescription change for several years.

Cortical Cataracts

The cortex is the portion of the lens located between the central nucleus and the outer capsule that surrounds the lens. A cortical cataract occurs when the tissue around the nucleus turns white when it develops a cataract. This whitening may have a variety of shapes, or the whole cortex may turn white. The shape may look like a snowflake cataract, a sunflower cataract, the spokes of a wheel, or a general haze of the lens.

Posterior Subcapsular Cataracts or PSC Cataracts
Eyes with Blurred Vision
Central blurred vision from posterior subcapsular cataract

The space between the cortex and the capsule surrounding the lens is where a subcapsular cataract develops. The most common is a posterior subcapsular cataract. This type of cataract occurs in younger people as well as older adults. This cataract may progress very rapidly and blur vision in only a few months.

Corticosteroid use can cause this type of cataract. An anterior subcapsular cataract occurs under the anterior capsule. This is not a very common type of cataract. It may occur with the use of certain drugs.

Traumatic Cataracts

A cataract can develop after a significant injury to the eye. A traumatic cataract may develop in a few days to a few weeks after the injury. If there is a penetrating injury and the lens is damaged, surgery would need to be done immediately and the lens removed.

Lamellar Cataract

A lamellar cataract or a zonular cataract is a cataract caused by a hereditary autosomal dominant gene. The opacity or clouding is located at the level of the embryonic nucleus. This a type of congenital cataract and there are other types of congenital cataracts.

Example of Eyes with Vision Color Change
Color changes that commonly occur with cataracts

A ripe cataract is a term used to describe a white, mature, or hypermature cataract. The term cataract comes from the word originally used for describing the appearance of rapids or waterfalls where the water turns from clear to white, which are also cataracts in the river.

A ripe cataract occurs when the lens in the eye becomes white. Also, the tissues of the lens start to degenerate, liquefy, or melt. The lens melts in a way like when a fruit becomes overripe and begins to soften. You can see a ripe cataract without any special equipment, as the pupil of the eye is white.

Vision with a ripe or hypermature cataract is horrible. The person can only see light out of the eye. They are only able to see light when a bright light is shown into the eye.

The term ripe cataract was used years ago by eye surgeons or rarely today when the cataract had advanced to a stage when cataract surgery would be indicated. It is very rare in the United States to see a mature cataract. Ripe or hypermature cataracts are very common in third-world countries due to limited access to health care.

Eye surgeons used this term in the past as it was an easy way to tell someone that their cataracts had advanced to a stage where cataract surgery would be indicated. You waited until the cataract had advanced to a significant stage. This was due to the fact the patient had to be admitted to the hospital for up to 2 weeks following cataract surgery, with sandbags by their heads to keep them from moving.

Before today’s modern techniques, there were many more complications related to cataract surgery as well. Since the patient is bedridden for two weeks, infections, pulmonary embolus, vein occlusions, and other diseases could occur. In the United States today, very few people let their vision or cataract advance to a ripe stage. Hypermature or ripe cataracts are a leading cause of blindness in third-world countries.

If you can see out of your eyes and your eye doctor is telling you that you have a ripe cataract, ask them to explain what they mean.

Posterior Polar Cataract

A posterior polar cataract is a rare cataract involving the area of the posterior capsule. The cataract formation can be attached to the posterior capsule. Cataract surgery needs to be done in a very careful manner to protect the posterior capsule from rupturing.

What Symptoms Do Cataracts Cause?

Common Complaints of Cataracts in the Doctor’s Office

Do You Need to Have Cataract Surgery?

This is absolutely one of the most important things you need to know about cataracts: There is almost never a medical reason or emergency for cataract surgery.

In very rare circumstances, there are medical indications for you to have your cataract removed. Cataract surgery is an elective eye operation, not a requirement. Unfortunately, many people are being told that they must have cataract surgery or need cataract surgery. Many are told they need to have the cataract surgery right away, as there will be more complications that can harm their eye.

Many people complain that they don’t see any better after the surgery. The surgery may have been performed well and their vision may be good, but these people probably had minimal cataracts or none before the surgery. Many people are being told to have cataract surgery with only a minimal cataract or no cataract present in their eyes.

Why or When Should You Consider Cataract Eye Surgery?

The first thing that you need is a thorough eye exam. You may need only a new eyeglass prescription to see better. Only after evaluating your best-corrected vision with glasses or contacts should you consider having a cataract operation if the vision with that correction is not sufficient.

The only reason for cataract removal surgery is if your blurred vision is interfering with your lifestyle, that is, if you are having trouble reading books which is your passion, the distance vision is blurred to the point that you are not happy with what you can see, you are having trouble driving at night, or you are having difficulty seeing well enough at work. The only real reason to have cataract extraction surgery is that you are unhappy with your vision, not that the eye doctor tells you it is time.

Also, the eye doctor tells you that your eye is healthy and it is their opinion that cataract surgery should make a significant difference in your vision. The role of the eye surgeon is to assist you in making the decision that is right for you.

People with eye diseases, such as macular degeneration, present more of a dilemma as it may be difficult to determine the amount of improved vision after cataract surgery. Sometimes, it can be a challenge to determine if a person’s blurred vision is related to macular degeneration or a cataract. This is when your eye surgeon can be of help in making the best decision. Otherwise, the decision of the most appropriate time for cataract surgery is yours.

You know better than anyone else how your blurred vision is affecting your daily life. Choosing to have cataract treatment surgeries are elective operations. It is your choice of the right time for you to decide that you need better vision, and not when an eye doctor wants to perform more surgery, period.

Dr. James E. Croley III is a respected eye surgeon and a Christian. He is the author of two books, Believing is Seeing and The Blinding of America. Order copies for your family and friends today.

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