Cataract very slowly deteriorate vision hence patient gradually acclimatize with the reduced visual acuity and the resultant vision keeps dropping further to a point where patient is legally blind. Classically in olden days there was the concept of cataract ripening before surgery. Back then the concept was very useful because the type of surgeries performed needed easy manipulation of cataract and hard cataracts are usually easy to manipulate though large incisions. With advancement in technology the incisions are limited to around 3mm. The technology used for removal of cataract there days is called phacoemulsification (basically an ultrasound). So now the tables have turned and soft cataract are easy to manipulate now with these sophisticated machines.

Hard cataract become difficult to manipulate and causes higher ultrasound energy to be used by phaco-probe leading to damage to other internal structures. More-over the chances of complications in such eye tend to be much higher than in early cataract.

Certain types of cataracts require early surgery even when they are not mature (posterior subcapsular cataract) because they affect the nodal point of vision and deteriorate vision much faster. They cause severe glare and reduce the quality of vision to a great extent. On the contrary many advanced nuclear cataracts may preserve near vision much better than far vision. Quantitatively vision may be corrected to 6/6 with spectacle but the quality of vision degrades.

So the dilemma is “to be or not to be?”

The answer is simple.

  1. Judge the quantity:  When the vision drops to more than 6/12 even with best corrected glasses.
  2. Judge the quality: If you have difficulty in night driving or bright sunlight due to cataract then its best to opt for surgery.
  3. Discuss with your doctor: Its always a good idea to discuss this with your doctor because he will not only assess the above-said points but will also assess the density of your cataract on slit lamp and then suggest the plan of action.