Signs and Symptoms
Indications
The most common indication for cataract surgery via phacoemulsification with intraocular lens implantation is the patient's desire to improve vision. If a patient's best corrected visual acuity does not meet government agencies and industries' minimum standards of visual function for tasks for driving, flying, or operating complex equipment, cataract surgery via phacoemulsification with intraocular lens implantation may need to be considered.
Symptoms of cataract
- Reduced visual acuity (distant and near objects)
- Daytime glare (sunshine)
- Nighttime glare (street lights or car headlights)
- Distortion of lines (wavy, fuzzy)
- Monocular diplopia
- Altered colors (white objects appear yellowish, bright colors appear bleached)
- If you have had a refractive error like myopia (nearsightedness), you may experience a sudden improvement in vision, followed by a worsening of vision.
- You may even be able to see the cataract in your eye, behind your pupil in certain lighting conditions. It may appear like a milky white or yellowish spot.
- Not associated with pain, discharge, or redness of the eye
Signs of Cataract
- Reduced visual acuity measured on a Snellen chart or LogMar and near-vision chart
- An abnormally irregular, dim, or absent red reflex is seen when the retina is viewed with an ophthalmoscope at arm's length. Nuclear and posterior capsular cataracts cause a central black shadow across the red reflex. Cortical cataracts cause black spoke-like shadows coming from the edge of the red reflex.
- Reduced contrast sensitivity can be measured by the ophthalmologist using contrast sensitivity charts.
- Very dense "mature" cataracts causing severely impaired vision cause a white pupil.
- Shallowing of the anterior chamber and angles with very dense cataracts seen with slit lamp examination
- After pupils have been dilated, slit lamp examination shows whether the cataract is cortical, nuclear, or posterior subcapsular and allows fundus examination.
- Cataract in children is unusual but may be associated with a white pupil, inability to fix on a target (eg, a light) and the development of a squint.
When do I know my cataracts are ready for surgery?
Most cataracts are age-related, so it may be difficult to tell if you are developing a cataract or if your vision is changing in other ways due to age. Even after you have received a cataract diagnosis, your doctor may simply strengthen the prescription for your glasses or have you wear different kinds of corrective wear until other symptoms of the cataract become too difficult to manage. Your doctor may recommend wearing glasses with an antiglare coating, especially for night vision, or even a yellow pair of glasses to cut down glare.
When should somebody consider cataract surgery? Well, in general we recommend that you consider it when what you call your activities of daily living are being impacted by the cataract.
Now fortunate thing is that neither the doctor nor insurance companies can define activities of daily living. You get to define that. So what are the things that you need to do, want to do, enjoy doing that you’re no longer able to do even with a new pair of spectacles? That could be reading, driving, computer work, but it could even be hobbies.
The degree to which you are having difficulties with daily life activities due to your vision will be the deciding factor to move forward with surgery.
The 3 Most Common Ways Cataracts Impact Daily Life
- Quickly changing refraction: A new glasses prescription will not improve your vision or they never "seem just right"
- Glare significantly impacts your vision, this may feel like it is unsafe to drive at night due to glare from oncoming headlights.
- You cannot do the things you used to enjoy due to changing vision, such as sewing, reading, golfing, or hiking.
Common descriptions by patients are:
- “Everything is blurry”
- “Glare is really bothering me at night”
- "I can't see against oncoming headlights"
- "I can’t read the ticker on the TV”
- “I don't feel safe to drive at night anymore”
- “I need to be right up to the road sign to see it”
- “I just got new glasses but I still can’t see well”.
In addition to describing how your vision is affecting daily life, our clinical staff will take measurements at your exam to determine if your cataracts are visually significant.