Management of cataracts

At present there is no pharmacological treatment to cure existing cataracts or to halt its progression (1).

Non surgical management that can be considered includes:

• counselling the patient about cataract symptoms and how it may affect daily activities
• advising the patients about minimizing their exposure to risk factors e.g. - cessation of smoking, control of diabetes, alternate medications for people on oral or inhaled corticosteroids.
• prescribing spectacles or contact lenses to improve vision (1)
• using brimmed hats or sunglasses to minimize glare
• dilating the pupil (if there is a small centrally located cataract) (2)

Surgery remains the only effective treatment method in cataract patients to restore or maintain vision. In UK over 90% of cataract surgeries are done in people who are 60 years or older (3). In one systematic review of systematic reviews, cataract surgery was consistently associated with improved vision-related quality of life, particularly if carried out immediately after diagnosis (5)

Ophthalmological referral for surgery should be based on factors such as:

• the level of visual impairment and how it affects the patient’s quality of life
• patient's willingness to have surgery
• co-morbidity which might benefit from surgery
• posterior segment condition where cataract surgery may help in managing and/or monitoring e.g. - diabetic retinopathy (1)
• when the lens threatens to cause a secondary glaucoma or uveitis

Surgery may be indicated despite there being good visual acuity, particularly if there are symptoms associated with the cataract such as glare. Other indications for referral include double vision (or ghosting) and change in colour perception.

The outcomes of modern surgical techniques are so good that a visual acuity of 6/9 and 'trouble with vision' due to cataract is often accepted as sufficient indication for surgery (4).

References:

1. American Academy of Ophthalmology. Preferred practice pattern: cataract in the adult eye. Nov 2021 [internet publication].
2. Allen D, Vasavada A. Cataract and surgery for cataract. BMJ. 2006 Jul 15;333(7559):128-32.
3. Cataracts in adults: management. NICE Guideline NG77 (Nov 2017)
4. Cataract. Adnan A. Nizami et al. In: StatPearls [Internet]. StatPearls Publishing; 2024 Jan. 2024
5. Assi L, Chamseddine F, Ibrahim P, et al. A global assessment of eye health and quality of life: a systematic review of systematic reviews. JAMA Ophthalmol. 2021 May 1;139(5):526-41.