Cataracts

A cataract is a clouding of the lens inside the eye. It develops slowly, usually over years, and because it is gradual and usually affects both eyes, people adapt without noticing: colours become less vivid, night driving becomes difficult, headlights and streetlights produce glare and haloes, and vision becomes progressively hazy — as though looking through a dirty window. Cataract is the leading cause of blindness worldwide, and it is almost entirely a solvable problem: cataract surgery is one of the most effective, safest and most commonly performed operations in all of medicine.

For two reasons that pull in opposite directions and both need saying. The first: NOTHING DISSOLVES A CATARACT. No eye drop, no supplement, no diet, no laser, and no herbal remedy has ever been shown to clear a clouded lens, and a substantial market exists selling exactly that to people who would rather not have surgery. The only treatment is to replace the lens. The second: the surgery is genuinely excellent — typically fifteen to twenty minutes, under local anaesthetic, with a very high success rate — and people delay it for years out of fear, losing vision, independence and, importantly, falling. Restoring vision reduces falls and fractures in older people, and vision loss is itself associated with cognitive decline.

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   FoundationHealthy AgingThe best place to understand what genuinely preserves healthspan.
2. 2

   BiomarkerHemoglobin A1cAverage blood sugar over ~3 months
3. 3

   Signal RecordVitamin CIt doesn't prevent colds — and it isn't useless either
4. 4

   Body SystemLongevityAging biology and the science of healthy lifespan.
5. 5

   ConditionType 2 DiabetesChronic high blood sugar from insulin resistance

1. Recognize risk factors
2. Get diagnosed
3. Track key biomarkers
4. Lifestyle first
5. Evidence-based treatment
6. Long-term monitoring

An orientation to how this topic is typically approached — not medical advice.

• Stop smoking — it is the largest modifiable risk factor
• Wear UV-blocking sunglasses. This is one of the few places where the advice is simple and it works
• Control diabetes
• Do not buy eye drops or supplements that claim to dissolve cataracts. They do not exist

Cataract is the leading cause of blindness worldwide and is caused by progressive opacification of the crystalline lens. No pharmacological, dietary or supplement intervention has been shown to reverse or dissolve an established cataract; surgical lens replacement is the only effective treatment. Phacoemulsification with intraocular lens implantation is among the most frequently performed and most successful surgical procedures in medicine, with high rates of visual improvement and a low rate of serious complication. The historical requirement for a cataract to be 'mature' before surgery is obsolete; the indication is functional impairment. Cataract surgery in older adults is associated with reduced rates of falls and fractures, and visual impairment is itself associated with cognitive decline. Smoking is the principal modifiable risk factor; ultraviolet exposure, diabetes and corticosteroid use also contribute. Posterior capsule opacification is a common late sequela and is treated definitively with YAG laser capsulotomy.

• NICE NG77 — Cataracts in adults: management
• Cochrane reviews of cataract surgery and of interventions claimed to prevent or treat cataract
• Studies of cataract surgery and subsequent fall and fracture rates in older adults
• WHO World Report on Vision