Cataracts

People who have cataracts tend to gradually lose their eyesight. That is the only symptom: Cataracts are not painful and do not cause burning or other similar symptoms. They cause your vision to become increasingly blurred and cloudy, as if you're looking through fog. You can no longer see fine details clearly. Over time, contrasts become weaker and colors look dull or faded.

Some people become very sensitive to the glare of the sun or other sources of light. Then they might see a ring of light ("halo") around them, for example. Driving becomes more difficult, particularly at night. Poor vision increases the risk of falling and getting hurt. Spatial vision is affected as well. This makes it harder to judge how far away things are, for instance.

Cataracts may have surprising effects too: Sometimes people who wear glasses can suddenly see better without them. This is because the refractive power of their eye changes, affecting their ability to focus on objects close up or in the distance. But this improvement doesn't last long.

About 90% of people who have a cataract have what is called a "senile" cataract. Here, the gradual clouding of the lens is caused by aging. Vision becomes cloudy and blurrier over time.

Cataracts develop earlier in some families than in others. It is very rare to have cataracts from birth on. A baby might be born with cataracts if the mother gets measles or rubella (German measles) during the pregnancy.

Some evidence suggests that, for example, smoking and exposure to UV light from the sun also increase the risk. Cataracts are more common in people who have diabetes too. In developing countries, cataracts are often caused by malnutrition and poor living conditions. Many people there already have them earlier in life.

Cataracts can also develop following an eye infection or eye injury. Other risk factors include eye surgery and the long-term use of steroid medication.

Cataracts cause your vision to gradually get worse over time. At first, you become more short-sighted. In other words, you can see close-up things better and faraway things worse. People who were previously farsighted can then see better without glasses for a short while. But their vision gradually becomes more cloudy and blurred. Left untreated, cataracts can lead to blindness.

People who have cataracts usually have them in both eyes. The condition might progress more quickly in one eye than in the other, though.

Its natural course can vary from person to person. Some people experience quite sudden loss of vision, while others have hardly any problems. The type and progression of symptoms depends on various things, including what part of the lens becomes cloudy. There are three main types of cataracts:

• Cortical cataracts: Here the cloudiness develops in the outer part (cortex) of the lens. People with this type of cataract have blurred vision and are easily dazzled by light – for example, when driving at night.
• Posterior subcapsular cataracts: Here the cloudiness starts to develop on the back (posterior part) of the lens. This type of cataract is more common in younger people and progresses relatively quickly. Their eyesight then gets a lot worse within weeks or months.
• Nuclear cataracts: Here the cloudiness affects the center (nucleus) of the lens. These cataracts affect your ability to see things in the distance more than your ability to see nearby objects. Sometimes they don't affect your eyesight very much. They generally develop quite slowly over several years.

There are many reasons why your vision may get worse as you grow older Because of this, other possible causes need to be ruled out before cataracts can be diagnosed. Your eye doctor (ophthalmologist) will first ask you about your symptoms and your general medical history. You will have a few eye tests done to find out how much your eyesight is affected and what might be causing the symptoms.

The lens of the eye is examined using a slit lamp (a microscope with a light). The doctor looks at the eye through the microscope with the help of a line – or slit – of light that shines onto your eye. This allows them to take a close look at the lens and other parts of the eye, like the vitreous body and the retina. The examination is not painful.

In order to look at the back of the eye, doctors usually use special eye drops to dilate (enlarge) your pupil. It remains dilated for a few hours. During that time, your vision is blurred and you are more sensitive to bright light and glare.

There is no scientific proof that particular preventive measures lower the risk of developing cataracts.

It is thought that smoking cigarettes increases the risk and that stopping smoking could therefore lower the risk. Stopping smoking has a lot of health benefits anyway.

If you spend a lot of time in the sun, you can protect your eyes from UV light – for example, by wearing sunglasses with a UV filter.

Long-term treatment with steroid medications can increase the risk of cataracts. It may be possible to switch to a different medication or reduce the dose.

Dietary supplements (e.g. containing vitamin C, vitamin E and beta-carotene) are often claimed to prevent eye diseases. But research has shown that they can't prevent cataracts.

Some people can continue to see well enough (temporarily, or even in the longer term) with the help of vision aids like eyeglasses, contact lenses or magnifying glasses. But they often have to replace the vision aids with stronger ones as the cataracts progress. There are no medications for the treatment of cataracts.

The only treatment that can really help is surgery. Cataract surgery involves removing the cloudy eye lens and replacing it with a new, artificial lens. The lens capsule – an elastic membrane surrounding the lens of the eye – is left in the eye during surgery. The inner core (nucleus) and outer cortex of the lens are broken up into small pieces using ultrasound. The pieces are then sucked out of the eye through a small cut. Once the lens has been removed, an artificial lens is implanted into the lens capsule. This procedure, called phacoemulsification, is the standard technique in Germany. Some doctors offer to do the operation using a laser to break up the lens. This laser-assisted cataract surgery doesn't have any advantages or disadvantages compared with the standard approach. But you have to pay for some (or all) of the costs of laser-assisted surgery yourself.

Cataract surgery takes about 20 to 30 minutes. You can usually go home on the same day, being picked up a few hours after the procedure is over.

The decision regarding whether or when to have cataract surgery is a personal one. It will greatly depend on how much the vision loss is affecting your life. The following questions may help you to decide: Are there certain things that you can no longer do, such as reading and sports? How good does your eyesight have to be for you to be able to do your job? Do you still feel safe in traffic? As long as your cataracts aren't greatly affecting your life, you don't necessarily have to have surgery.

The surgery usually doesn't lead to any complications. As with any surgical procedure, though, problems can occur. The outcome of the surgery can also be influenced by other eye conditions, such as glaucoma or age-related macular degeneration (AMD).

The good news is that cataracts usually only progress slowly. This means there's enough time to weigh up the pros and cons of the treatment options and talk to your eye doctor about whether or when to have surgery.

When people are ill or need medical advice, they usually go to see their family doctor first. If you have problems with your eyes, you can also contact an eye doctor's practice (ophthalmologist) directly.

Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.