A Practical Guide for Patients

Being told you have cataracts does not automatically mean surgery is required. Cataracts are

extremely common, and many people live comfortably with early lens changes for years. The

recommendation to proceed with cataract surgery is based not on diagnosis alone, but on how

vision changes affect daily life, safety, and independence.

Understanding when surgery is recommended—and why—can help patients feel confident

about timing rather than uncertain or rushed.

Cataracts Are a Spectrum, Not a Switch

A cataract forms gradually as the eye’s natural lens becomes less transparent. Early cataracts

may cause subtle changes such as increased sensitivity to light or a need for stronger reading

illumination. As cataracts progress, symptoms may become more intrusive, but progression

rates vary widely between individuals.

Because of this gradual development, there is no single moment when cataract surgery

suddenly becomes “necessary.” Instead, clinicians assess a combination of factors to

determine when surgery is likely to offer meaningful benefit.

Symptoms That Commonly Trigger Recommendation

The most important driver of cataract surgery recommendation is symptom burden. Surgery

is commonly advised when symptoms interfere with everyday activities that matter to the

individual. These may include:

.Difficulty driving, especially at night

.Persistent glare or halos around lights

.Reduced contrast, making steps or kerbs harder to see

.Fading of colours or a yellowish visual tint

.Visual fatigue during reading or screen use

When such symptoms are consistent and progressive, and when they are primarily caused by

cataracts rather than another eye condition, surgery is often recommended.

Functional Vision Over Visual Acuity

While visual acuity tests provide useful data, they do not fully capture functional vision. A

person may read an eye chart well but struggle significantly with real-world tasks involving

low light, glare, or rapid changes in visual demand.

For this reason, modern cataract assessment focuses less on reaching a particular acuity

threshold and more on how vision performs in day-to-day contexts. If cataracts reduce

comfort, confidence, or safety, surgery may be appropriate even if measured vision appears

“good.”

Lifestyle and Individual Needs

Lifestyle plays a major role in determining when surgery is recommended. Someone who

drives frequently, works in visually demanding environments, or lives independently may

experience greater impact from cataracts than someone with fewer visual demands.

For example, mild vision impairment may be tolerable for one person but problematic for

another whose work or daily responsibilities rely heavily on visual precision. Cataract

surgery recommendations account for these differences.

Safety Considerations

Beyond convenience, safety is a key reason cataract surgery may be advised. Visual

impairment from cataracts can increase the risk of falls, particularly in older adults. Difficulty

judging distance, reduced contrast, and glare can also affect driving safety.

When cataracts begin to pose a safety concern—either directly or through loss of visual

confidence—surgery is often recommended to reduce risk and preserve independence.

When Surgery May Be Deferred

Equally important is recognising when cataract surgery may not yet be recommended. If

symptoms are mild, stable, and well-managed with glasses or environmental adjustments,

observation may be entirely appropriate.

Cataracts themselves do not damage the eye, and there is rarely urgency to operate unless

symptoms or safety concerns dictate otherwise. Regular monitoring ensures that changes are

identified promptly should circumstances evolve.

Shared Decision-Making Matters

Cataract surgery decisions work best as a collaborative process. Patients benefit from

understanding the reasons for recommendation as well as the reasons to wait. This shared

approach leads to better satisfaction, clearer expectations, and outcomes that align with

individual goals.

Resources explaining when cataract surgery is recommended can help patients engage

more actively in discussions and make decisions based on understanding rather than

assumption.

A Recommendation Rooted in Function

Ultimately, cataract surgery is recommended when it offers a meaningful improvement in

daily life. It is not about treating an image or a number, but about restoring reliable,

comfortable vision that supports how someone lives.

Mr Mfazo Hove is a ZEISS Faculty Speaker and Key Opinion Leader, and a world-renowned ophthalmologist specialising in cataract, lens replacement, and refractive surgery.