Cataracts: when the world grows hazy

A cataract is the clouding of the lens, the natural lens inside our eye. Once transparent, this lens gradually becomes more yellowish and opaque, and seeing through it is like looking through a very dirty window: outlines soften, colors fade, and light glares. It is not a disease in the fearsome sense of the word, but an unavoidable appointment for almost all of us, just like the arrival of gray hair.

Cataracts are typically age-related and begin to appear after the age of sixty, although earlier forms can occur due to trauma, diabetes, prolonged use of cortisone, or high myopia. As a rough estimate, around 600,000 cataract operations are performed each year in Italy: by far the most commonly performed surgical procedure in the country.

Historical depictions of “couching,” the ancient technique for displacing the clouded lens.

How cataracts are noticed

The patient reports progressively blurred vision that glasses can no longer correct, growing sensitivity to glare — car headlights at night, low sun — and sometimes a curious perception of duller, “washed out” colors. In some cases, a degree of nearsightedness appears that wasn’t there before, so much so that some people paradoxically find they can read again without glasses: this happens because the lens, as it hardens, changes its optical power. These are signs that call for an eye exam, not a new pair of glasses.

A history spanning millennia

Cataract surgery has a fascinating history. Even the ancients practiced “couching,” a maneuver that involved dislodging the clouded lens and letting it fall inside the eye — somewhat like removing a dirty lens and dropping it inside the camera. This was followed by extraction of the entire lens and, in the second half of the twentieth century, by Kelman’s use of ultrasound, which introduced phacoemulsification. Today we also have femtosecond laser technology, capable of performing certain steps of the procedure with extreme precision.

An intraocular lens (IOL): the artificial lens that replaces the clouded one.

The procedure today

The modern operation involves fragmenting and aspirating the clouded lens through a microincision and replacing it with an intraocular lens (IOL) — a small artificial lens that will remain in the eye permanently. The procedure lasts on average 15-20 minutes, is performed on an outpatient basis under topical anesthesia (using anesthetic eye drops), is completely painless, and the patient can return home within an hour. Visual recovery is generally quick, within a few days.

Not just removing the cataract: seeing better

Replacing the lens today offers a valuable opportunity: choosing the type of intraocular lens based on the patient’s needs. Toric IOLs are available, which also correct astigmatism, as well as multifocal or “premium” IOLs, which allow focusing at multiple distances, reducing dependence on glasses even for reading. The choice should be tailored case by case, evaluating lifestyle and expectations together with the eye doctor.

In conclusion

Among the conditions of the aging eye, cataracts have the happiest outcome: it is the only true cause of “blindness” that is completely and brilliantly reversible. The timing of surgery is not dictated by a rigid threshold, but by how much the cataract interferes with the patient’s daily activities. This is why a periodic eye exam after the age of sixty remains the simplest tool for deciding together, without haste or alarm, when the right moment has come to see the world clearly again.