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Cataract in adults

Deborah S Jacobs, MD
Section Editor
Jonathan Trobe, MD
Deputy Editor
Howard Libman, MD, FACP


Cataract is the leading cause of blindness in the world [1]. A cataract is an opacity of the lens of the eye that causes partial or total blindness. The word derives from the Latin "catarractes," which means "waterfall"; to the naked eye of an observer, the foamy white opacity of an advanced cataract, seen through the pupil, resembles the turbulent water of a waterfall.

Modern microsurgical technique allows intervention for cataract before it has resulted in blindness; normal vision typically is restored with intraocular lens implantation [2]. Except in certain very uncommon situations, delay in treatment does not result in an adverse outcome. The major advances in the surgical treatment of cataract in the last century have not been matched by advances in the understanding of cataract formation, in approaches to prevention, or in nonsurgical therapy.


Epidemiologic models estimate that there are approximately 30 million blind people in the world, 50 percent of whom are blind due to cataracts [3]. The pattern and rate of blinding disorders is different in developed and developing nations depending upon whether nutritional and infectious causes of blindness are eradicated and whether there are resources available for treatable disorders such as cataract.

The definition of blindness is different for international health purposes than it is for social and rehabilitative purposes in the United States. The least-developed nations are estimated to have a 1 percent rate of blindness using the international definition; developed nations are thought to have a 0.2 percent rate of blindness. Blindness by international health standards is defined as the inability to count fingers at 10 feet; this converts to 10/200 by Snellen notation, which means that a patient can see at 10 feet what a normal person would see at 200 feet. This level of vision allows ambulation but does not allow the reading of print of any size. The standard for legal blindness in the United States is 20/200. This standard is lower than the international standard, meaning it is easier to qualify as "blind." Individuals with 20/200 vision can ambulate, and some can read print with appropriate low-vision aids.

The Eye Diseases Prevalence Research Group (EDPRG) estimated causes of blindness and visual impairment in the United States by applying the results of population-based studies conducted in North America, Western Europe, and Australia between 1990 and 2001 to the population structure of the United States based on the year 2000 census [4]. The EDPRG estimated that 0.78 percent of people older than age 40 in the United States were blind by the US definition and an additional 1.98 percent had low vision, with a best corrected visual acuity between 20/40 and 20/200. Cataract was associated with approximately 50 percent of cases of low vision. Using a definition of cataract that did not require visual impairment, the EDPRG estimated that in 2000 there were 20.5 million people over 40 in the United States (17.2 percent) with cataract in either eye and projected that this number would rise to 30.1 million by 2020 [5].

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Literature review current through: Oct 2017. | This topic last updated: Aug 30, 2017.
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  1. Thylefors B, Négrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organ 1995; 73:115.
  2. Asbell PA, Dualan I, Mindel J, et al. Age-related cataract. Lancet 2005; 365:599.
  3. Thylefors B. The World Health Organization's programme for the prevention of blindness. Int Ophthalmol 1990; 14:211.
  4. Congdon N, O'Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004; 122:477.
  5. Congdon N, Vingerling JR, Klein BE, et al. Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Arch Ophthalmol 2004; 122:487.
  6. Kanthan GL, Wang JJ, Rochtchina E, et al. Ten-year incidence of age-related cataract and cataract surgery in an older Australian population. The Blue Mountains Eye Study. Ophthalmology 2008; 115:808.
  7. Klein BE, Klein R, Lee KE. Incidence of age-related cataract over a 10-year interval: the Beaver Dam Eye Study. Ophthalmology 2002; 109:2052.
  8. Kuszak JR, Deutsch TA, Brown HG. Anatomy of aged and senile cataractous lens. In: Principles and Practice of Ophthalmology, Albert DM, Jakobiec FA (Eds), WB Saunders Company, Philadelphia 1994. p.564.
  9. West SK, Valmadrid CT. Epidemiology of risk factors for age-related cataract. Surv Ophthalmol 1995; 39:323.
  10. Lindblad BE, Håkansson N, Philipson B, Wolk A. Metabolic syndrome components in relation to risk of cataract extraction: a prospective cohort study of women. Ophthalmology 2008; 115:1687.
  11. Zheng Selin J, Orsini N, Ejdervik Lindblad B, Wolk A. Long-term physical activity and risk of age-related cataract: a population-based prospective study of male and female cohorts. Ophthalmology 2015; 122:274.
  12. West SK, Duncan DD, Muñoz B, et al. Sunlight exposure and risk of lens opacities in a population-based study: the Salisbury Eye Evaluation project. JAMA 1998; 280:714.
  13. West S. Does smoke get in your eyes? JAMA 1992; 268:1025.
  14. Christen WG, Glynn RJ, Ajani UA, et al. Smoking cessation and risk of age-related cataract in men. JAMA 2000; 284:713.
  15. Schaumberg DA, Mendes F, Balaram M, et al. Accumulated lead exposure and risk of age-related cataract in men. JAMA 2004; 292:2750.
  16. Kempen JH, Sugar EA, Varma R, et al. Risk of cataract among subjects with acquired immune deficiency syndrome free of ocular opportunistic infections. Ophthalmology 2014; 121:2317.
  17. Rasmussen LD, Kessel L, Molander LD, et al. Risk of cataract surgery in HIV-infected individuals: a Danish Nationwide Population-based cohort study. Clin Infect Dis 2011; 53:1156.
  18. Mares JA, Voland R, Adler R, et al. Healthy diets and the subsequent prevalence of nuclear cataract in women. Arch Ophthalmol 2010; 128:738.
  19. Moeller SM, Voland R, Tinker L, et al. Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the Carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Women's Health Initiative. Arch Ophthalmol 2008; 126:354.
  20. Glaser TS, Doss LE, Shih G, et al. The Association of Dietary Lutein plus Zeaxanthin and B Vitamins with Cataracts in the Age-Related Eye Disease Study: AREDS Report No. 37. Ophthalmology 2015; 122:1471.
  21. Lindblad BE, Håkansson N, Wolk A. Smoking cessation and the risk of cataract: a prospective cohort study of cataract extraction among men. JAMA Ophthalmol 2014; 132:253.
  22. Schaumberg DA, Liu S, Seddon JM, et al. Dietary glycemic load and risk of age-related cataract. Am J Clin Nutr 2004; 80:489.
  23. Mathew MC, Ervin AM, Tao J, Davis RM. Antioxidant vitamin supplementation for preventing and slowing the progression of age-related cataract. Cochrane Database Syst Rev 2012; :CD004567.
  24. Christen WG, Glynn RJ, Gaziano JM, et al. Age-related cataract in men in the selenium and vitamin e cancer prevention trial eye endpoints study: a randomized clinical trial. JAMA Ophthalmol 2015; 133:17.
  25. Christen WG, Glynn RJ, Manson JE, et al. Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology 2014; 121:525.
  26. Greenberg PB, Liu J, Wu WC, et al. Predictors of mortality within 90 days of cataract surgery. Ophthalmology 2010; 117:1894.
  27. Keay L, Lindsley K, Tielsch J, et al. Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev 2012; :CD007293.
  28. Schein OD, Katz J, Bass EB, et al. The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery. N Engl J Med 2000; 342:168.
  29. Lai FH, Lok JY, Chow PP, Young AL. Clinical outcomes of cataract surgery in very elderly adults. J Am Geriatr Soc 2014; 62:165.
  30. Backer CL, Tinker JH, Robertson DM, Vlietstra RE. Myocardial reinfarction following local anesthesia for ophthalmic surgery. Anesth Analg 1980; 59:257.
  31. Kiire CA, Mukherjee R, Ruparelia N, et al. Managing antiplatelet and anticoagulant drugs in patients undergoing elective ophthalmic surgery. Br J Ophthalmol 2014; 98:1320.
  32. Kong KL, Khan J. Ophthalmic patients on antithrombotic drugs: a review and guide to perioperative management. Br J Ophthalmol 2015; 99:1025.
  33. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e326S.
  34. Katz J, Feldman MA, Bass EB, et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 2003; 110:1784.
  35. Lumme P, Laatikainen LT. Risk factors for intraoperative and early postoperative complications in extracapsular cataract surgery. Eur J Ophthalmol 1994; 4:151.
  36. Hall DL, Steen WH Jr, Drummond JW, Byrd WA. Anticoagulants and cataract surgery. Ophthalmic Surg 1988; 19:221.
  37. McMahan LB. Anticoagulants and cataract surgery. J Cataract Refract Surg 1988; 14:569.
  38. Gainey SP, Robertson DM, Fay W, Ilstrup D. Ocular surgery on patients receiving long-term warfarin therapy. Am J Ophthalmol 1989; 108:142.
  39. Barequet IS, Sachs D, Priel A, et al. Phacoemulsification of cataract in patients receiving Coumadin therapy: ocular and hematologic risk assessment. Am J Ophthalmol 2007; 144:719.
  40. Chang DF, Osher RH, Wang L, Koch DD. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmology 2007; 114:957.
  41. Yaycioglu O, Altan-Yaycioglu R. Intraoperative floppy iris syndrome: facts for the urologist. Urology 2010; 76:272.
  42. Neff KD, Sandoval HP, Fernández de Castro LE, et al. Factors associated with intraoperative floppy iris syndrome. Ophthalmology 2009; 116:658.
  43. Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA 2009; 301:1991.
  44. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005; 31:664.
  45. Schwinn DA, Afshari NA. Alpha1-adrenergic antagonists and floppy iris syndrome: tip of the iceberg? Ophthalmology 2005; 112:2059.
  46. Oshika T, Ohashi Y, Inamura M, et al. Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha(1)-adrenoceptor antagonist. Am J Ophthalmol 2007; 143:150.
  47. www.fda.gov/medwatch/safety/2005/safety05.htm#Flomax (Accessed on December 05, 2005).
  48. Vollman DE, Gonzalez-Gonzalez LA, Chomsky A, et al. Intraoperative floppy iris and prevalence of intraoperative complications: results from ophthalmic surgery outcomes database. Am J Ophthalmol 2014; 157:1130.
  49. Invega (paliperidone) [package insert]. Janssen Pharmaceuticals, Inc. 2014. Available online at http://www.invega.com/prescribing-information (Accessed on September 11, 2015).
  50. Risperdal (risperidone) [package insert]. Janssen Pharmaceuticals, Inc. 2014. Available online at http://www.janssenpharmaceuticalsinc.com/assets/risperdal.pdf (Accessed on September 11, 2015).
  51. Clark A, Morlet N, Ng JQ, et al. Whole population trends in complications of cataract surgery over 22 years in Western Australia. Ophthalmology 2011; 118:1055.
  52. Bass EB, Wills S, Scott IU, et al. Preference values for visual states in patients planning to undergo cataract surgery. Med Decis Making 1997; 17:324.
  53. Age-Related Eye Disease Study 2 Research Group, Huynh N, Nicholson BP, et al. Visual acuity after cataract surgery in patients with age-related macular degeneration: age-related eye disease study 2 report number 5. Ophthalmology 2014; 121:1229.
  54. Saraf SS, Ryu CL, Ober MD. The effects of cataract surgery on patients with wet macular degeneration. Am J Ophthalmol 2015; 160:487.
  55. Laidlaw DA, Harrad RA, Hopper CD, et al. Randomised trial of effectiveness of second eye cataract surgery. Lancet 1998; 352:925.
  56. Herrinton LJ, Liu L, Alexeeff S, et al. Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery: Retrospective Comparison of Postoperative Visual Outcomes. Ophthalmology 2017; 124:1126.
  57. Tan AC, Tay WT, Zheng YF, et al. The impact of bilateral or unilateral cataract surgery on visual functioning: when does second eye cataract surgery benefit patients? Br J Ophthalmol 2012; 96:846.
  58. Busbee BG, Brown MM, Brown GC, Sharma S. Cost-utility analysis of cataract surgery in the second eye. Ophthalmology 2003; 110:2310.
  59. Woodcock M, Shah S, Smith RJ. Recent advances in customising cataract surgery. BMJ 2004; 328:92.
  60. Hamed WW, Fedorowicz Z. Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 2004; :CD004242.
  61. Gower EW, Lindsley K, Tulenko SE, et al. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev 2017; 2:CD006364.
  62. Haripriya A, Chang DF, Ravindran RD. Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries. Ophthalmology 2017; 124:768.
  63. de Silva SR, Riaz Y, Evans JR. Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev 2014; :CD008812.
  64. Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev 2012; :CD003169.
  65. Wilkins MR, Allan BD, Rubin GS, et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology 2013; 120:2449.
  66. Ong HS, Evans JR, Allan BD. Accommodative intraocular lens versus standard monofocal intraocular lens implantation in cataract surgery. Cochrane Database Syst Rev 2014; :CD009667.
  67. Ang M, Evans JR, Mehta JS. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev 2014; :CD008811.
  68. Riaz Y, de Silva SR, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev 2013; :CD008813.
  69. Wittpenn JR, Silverstein S, Heier J, et al. A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients. Am J Ophthalmol 2008; 146:554.
  70. Kessel L, Tendal B, Jørgensen KJ, et al. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology 2014; 121:1915.
  71. Juthani VV, Clearfield E, Chuck RS. Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery. Cochrane Database Syst Rev 2017; 7:CD010516.
  72. Powe NR, Schein OD, Gieser SC, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994; 112:239.
  73. Mehta S, Linton MM, Kempen JH. Outcomes of cataract surgery in patients with uveitis: a systematic review and meta-analysis. Am J Ophthalmol 2014; 158:676.
  74. Erie JC, Raecker MA, Baratz KH, et al. Risk of retinal detachment after cataract extraction, 1980-2004: a population-based study. Ophthalmology 2006; 113:2026.
  75. Sheu SJ, Ger LP, Ho WL. Late increased risk of retinal detachment after cataract extraction. Am J Ophthalmol 2010; 149:113.
  76. Ripandelli G, Scassa C, Parisi V, et al. Cataract surgery as a risk factor for retinal detachment in very highly myopic eyes. Ophthalmology 2003; 110:2355.
  77. Kaiser RS, Fenton GL, Tasman W, Trese MT. Adult retinopathy of prematurity: retinal complications from cataract surgery. Am J Ophthalmol 2008; 145:729.
  78. Cheng JW, Wei RL, Cai JP, et al. Efficacy of different intraocular lens materials and optic edge designs in preventing posterior capsular opacification: a meta-analysis. Am J Ophthalmol 2007; 143:428.
  79. Centers for Disease Control and Prevention (CDC). Toxic anterior segment syndrome after cataract surgery--Maine, 2006. MMWR Morb Mortal Wkly Rep 2007; 56:629.
  80. Bell CM, Hatch WV, Cernat G, Urbach DR. Surgeon volumes and selected patient outcomes in cataract surgery: a population-based analysis. Ophthalmology 2007; 114:405.
  81. Schein OD, Steinberg EP, Cassard SD, et al. Predictors of outcome in patients who underwent cataract surgery. Ophthalmology 1995; 102:817.
  82. Quintana JM, Arostegui I, Alberdi T, et al. Decision trees for indication of cataract surgery based on changes in visual acuity. Ophthalmology 2010; 117:1471.
  83. Powe NR, Tielsch JM, Schein OD, et al. Rigor of research methods in studies of the effectiveness and safety of cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994; 112:228.
  84. Casparis H, Lindsley K, Kuo IC, et al. Surgery for cataracts in people with age-related macular degeneration. Cochrane Database Syst Rev 2017; 2:CD006757.
  85. Wang JJ, Klein R, Smith W, et al. Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains eye studies. Ophthalmology 2003; 110:1960.
  86. Dong LM, Stark WJ, Jefferys JL, et al. Progression of age-related macular degeneration after cataract surgery. Arch Ophthalmol 2009; 127:1412.
  87. Cataract Management Guideline Panel. Cataract in Adults: Management of Functional Impairment. Clinical Practice Guideline Number 4. AHCPR Pub No. 93-0542. Public Health Service, Agency for Health Care Policy and Research; US Department of Health and Human Services, Rockville, MD 1993.
  88. Steinberg EP, Javitt JC, Sharkey PD, et al. The content and cost of cataract surgery. Arch Ophthalmol 1993; 111:1041.
  89. Busbee BG, Brown MM, Brown GC, Sharma S. Incremental cost-effectiveness of initial cataract surgery. Ophthalmology 2002; 109:606.
  90. Agarwal A, Kumar DA. Cost-effectiveness of cataract surgery. Curr Opin Ophthalmol 2011; 22:15.
  91. Lansingh VC, Carter MJ, Martens M. Global cost-effectiveness of cataract surgery. Ophthalmology 2007; 114:1670.
  92. Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA 2012; 308:493.
  93. Owsley C, McGwin G Jr, Sloane M, et al. Impact of cataract surgery on motor vehicle crash involvement by older adults. JAMA 2002; 288:841.