The timing of a cataract operation should be tailored to the individual’s visual requirements. Some will need and want their cataract removed sooner than others. For example if the person wishes to continue to drive then a cataract will need to be removed when it is still relatively mild. Early surgery may also be appropriate if the cataract is affecting the individual’s ability to perform their job safely and effectively, or if it is spoiling the enjoyment of their hobbies and past times. However if the person has less demanding visual requirements then it may be appropriate to leave the cataract until it is more advanced. The decision to operate or not should be based on the particular circumstances and wishes of each patient. There are not fixed rules about the timing of surgery.
Each individual should consider how much difficulty their cataract is causing them. Their optometrist or doctor may have spotted some cataract but if the patient is having no vision problems then surgery is probably not needed. Cataract on it own is rarely harmful to the eye. Sometimes the patient may be aware of impaired sight but can cope safely with all their needs of daily living and may not wish to undergo surgery. This is quite acceptable. On the other hand if the individual is bothered by even mild cataract it may be entirely appropriate to remove it. In such circumstances there is no need to wait until it gets worse or becomes “ripe” or “mature”. The days of that approach are long gone.
There are though sometimes special factors that may influence the timing of cataract surgery. If there is some other disease or abnormality within the eye then surgery may need to be delayed, or performed as soon as possible, or may not be worthwhile at all. Which of these applies will depend on the exact nature of the other condition. If the cataract is in an only eye, then the small risks of surgery must be considered very carefully. The chance of an only eye suffering serious surgical complications is remote but the consequence could be devastating. Again each case must be considered on it own merits setting the risks of surgery against the likely benefits. Generally speaking though one would hesitate a little more before removing a cataract from an only eye, but if the visual impairement is significant then surgery may still be the right thing to do.
Very rarely a cataract may be directly harmful to the eye or vision. This can occur if the cataract is particularly advanced (“hyper-mature”), or physically large. In these circumstances it should usually be removed quickly.
Having been given the necessary information by their eye specialist in the end the decision to opt for surgery, or not, rests with the patient. It is often helpful and reassuring to discuss the issues with family and friends. No one should be arm twisted into having cataract surgery. Keep in mind though that most cataracts develop slowly and there is a creeping compromise to vision. If this occurs simultaneously in both eyes there is a faded memory of what vision used to be like. The affected individual may not fully appreciate what they are missing. It is often with amazement and surprise that they realize, after the cataract has been removed, how bright and colourful the world really still is. So if your vision isn’t what it used to be because of cataract and there is no particularly good reason not to have it fixed why go on waiting.