Cataracts and ageing: what is normal and what is not

As the years go by, it is common for vision to change. Many people notice that they need more help to read at close range, that they find it harder to adapt to certain situations or that their prescription is no longer as stable as it used to be. Among these age-related changes, cataracts are one of the most common causes of progressive vision loss.

A cataract develops when the crystalline lens, the eye’s natural lens, gradually oxidises and loses its transparency. This process usually progresses slowly and forms part of the ageing of the eye, although not everyone develops it at the same age or with the same severity.

Knowing which changes may be considered normal and which are not is important in order to seek advice in time and rule out other eye diseases.

Cataracts: a common consequence of eye ageing

The crystalline lens allows images to be focused correctly. At younger ages, it is usually transparent and flexible, but over the years it becomes more rigid and opaque. When this loss of transparency interferes with vision, we refer to it as a cataract.

Although age is the main risk factor, it is not the only one. Certain diseases, some treatments, trauma or family history may cause cataracts to appear earlier or progress more quickly.

For this reason, although cataracts are common, they should always be assessed on an individual basis.

What can be normal with age

Some visual changes develop gradually and may be related to the ageing of the eye. These include:

1. Needing a stronger or weaker glasses prescription
   It is common for the prescription to change over the years. In the early stages, updating the glasses may improve vision, although as the cataract progresses, this correction may no longer be sufficient.
2. Noticing a gradual loss of sharpness
   Vision may become progressively less clear. This change often affects activities such as reading, driving, watching television or working with screens.
3. Taking longer to adapt to certain visual situations
   Some people notice that they need more time to focus or to see clearly when moving from one environment to another.
4. Greater dependence on visual aids
   Wearing glasses more often, increasing the font size or moving closer to certain objects may form part of this process.

These changes may be consistent with cataracts, but they may also occur for other reasons. An ophthalmological examination is therefore needed to confirm whether the cause lies in the crystalline lens or whether there is another associated condition.

What should not be attributed solely to age

One of the most common mistakes is to assume that any loss of vision in an older person is “normal”. Some symptoms should not be left to wait and require an ophthalmological assessment.

It is advisable to seek medical advice if there is:

• sudden loss of vision;
• eye pain;
• persistent redness;
• recent-onset double vision;
• spots, shadows or dark areas in the visual field;
• flashes of light or a sudden increase in floaters;
• distortion of straight lines;
• rapid deterioration over a few days or weeks;
• a very marked difference between one eye and the other.

These signs are not typical of an age-related cataract following its usual course and may be associated with other eye diseases that require specific diagnosis and treatment.

When does a cataract become more than just “an age-related change”?

Having a cataract does not necessarily mean that surgery is required immediately. In many cases, it can be monitored for some time through regular check-ups, changes to the prescription and adaptation measures.

However, a cataract becomes more significant when it starts to limit the patient’s daily life. For example, if it makes it difficult to read, drive, work, cook, recognise faces or carry out everyday activities safely.

The decision to consider surgery depends not only on the degree of opacity of the crystalline lens, but also on how it affects quality of life and on each person’s visual needs.

The importance of a comprehensive examination

At older ages, cataracts may coexist with other conditions, such as glaucoma, age-related macular degeneration, diabetic retinopathy or dry eye. For this reason, a comprehensive ophthalmological examination does not simply assess whether a cataract is present, but also allows the retina, optic nerve, cornea and ocular surface to be examined.

This is particularly important because two patients with apparently similar cataracts may have a different visual prognosis if other associated eye diseases are present.

Cataract treatment

When a cataract significantly affects vision, treatment is surgical. Surgery involves replacing the cloudy crystalline lens with an intraocular lens.

It is a very common procedure, but the indication for surgery must be personalised. Before surgery, a comprehensive assessment is carried out to evaluate the eye, calculate the most appropriate lens and explain the expected visual outcome in each case.

In some patients, surgery can restore very satisfactory vision. When other eye diseases are also present, the degree of improvement will also depend on the condition of the other structures of the eye.

Ageing does not mean having to accept poorer vision

Cataracts are a common part of eye ageing, but not every visual change should be considered normal. The key is to identify those symptoms that may indicate another problem.

Seeking advice when visual changes appear, attending regular check-ups and receiving an individual assessment make it possible to act at the right time and preserve as much independence as possible.

At Barraquer, we recommend not waiting until vision prevents you from carrying out everyday tasks. An ophthalmological examination can help identify the cause of the symptoms and guide each patient towards the most appropriate treatment.

Dr Elena Barraquer, ophthalmologist at Barraquer Ophthalmology Centre