When is the right time for cataract surgery? Do you really need to wait?

You may have heard that a cataract needs to be “mature” before it can be removed. This advice dates back to older surgical techniques, when cataracts were often left until they were very advanced. Today, there is no need to wait for this stage. What matters most is how the cataract affects your vision and everyday life. In fact, a very advanced white or brown cataract can be more challenging to remove. ESCRS guidelines identify these cataracts as a factor that can increase surgical risk. [1, 3, 5]

Ophthalmologists still use the term “mature cataract” to describe how cloudy the lens has become. But it is not a milestone you need to reach before having surgery. The decision is based on your vision, the difficulties you experience, and the likely benefits and risks of treatment. [1, 2]

How does a cataract affect your vision?

People often describe cataract vision as looking through mist or a dirty window. Things become less sharp, colours may look faded, and contrast can be reduced. Glare, difficulty seeing in dim light and problems driving at night are also common. [4]

A cataract can sometimes cause double vision in one eye. Some people, especially those with a nuclear cataract, find that they can temporarily read without glasses again. This does not mean the cataract is getting better. Changes in the natural lens can make the eye more short-sighted, briefly improving near vision. [4, 10]

A cataract does not have to be advanced to interfere with daily life. Even an early or moderate cataract can reduce contrast or make certain tasks difficult. Studies show that being able to read an eye chart well does not necessarily mean that everyday vision is comfortable or reliable. As vision deteriorates, it can also affect independence and may increase the risk of trips and falls. [6, 7, 9]

Does every cataract need surgery?

No. If the cataract is mild, you can still see well with the right glasses, and it is not causing significant problems, it can be monitored. [1, 2]

An eye chart result should not be the only factor in the decision. Two people with similar results may have very different needs. A small change in vision may barely affect one person, while making it difficult for another to drive safely or do detailed work. Both clinical guidelines and research emphasise the importance of considering the quality of vision and the difficulties a person reports. [1, 7, 8]

Your examination results matter, but so does how you use your vision every day. [1]

In Poland, cataract surgery funded by the National Health Fund (NFZ) is also subject to specific eligibility criteria. The main criterion is distance visual acuity of 0.6 or less on the decimal scale with the best possible glasses correction. Certain medical and occupational exceptions also apply. [2]

Could something else be affecting your vision?

A cataract may not be the only reason your vision has become worse. Other possible causes include an outdated or unsuitable glasses prescription, problems with the cornea or the surface of the eye, age-related macular degeneration, diabetic macular oedema, an epiretinal membrane, glaucoma or another eye condition. [1, 2]

If more than one condition is present, the assessment needs to establish how much each one is affecting your sight. Having another eye condition does not necessarily mean you cannot have cataract surgery, but it may limit how much your vision improves. It is important to discuss this before the operation. [1, 12]

A dense cataract can sometimes block the view of the retina and other structures at the back of the eye. Ultrasound can help assess these structures before surgery, although a more detailed examination may only be possible once the cataract has been removed. [1]

When is it worth considering surgery?

It is worth discussing surgery when your cataract starts to get in the way of everyday activities. You might stop driving after dark, struggle to read or recognise faces, or find it harder to use a computer or do your job. [1, 2]

There may also be medical reasons to recommend surgery. For example, a cataract may make it difficult to examine or treat the retina, or the lens may be affecting the internal anatomy of the eye. [1, 2]

When I assess someone for cataract surgery, I look beyond the eye chart. I consider the type and severity of the cataract, the health of the cornea, retina and optic nerve, and the vision in the other eye. Your lifestyle and expectations are just as much a part of that discussion. Together, these factors help me assess the likely benefits and risks and plan your treatment. [1]

What can cataract surgery improve?

Cataract surgery replaces the cloudy natural lens with a clear artificial lens, called an intraocular lens. It removes the cataract, but it cannot reverse damage caused by other eye conditions. If you also have macular disease, damage to the optic nerve from glaucoma, or a corneal condition, these may limit the improvement in your sight. [1, 4, 12]

The outcome depends on several factors: the health of your eye before surgery, the lens selected, the focus we aim for, how the operation and healing progress, and how closely you follow the aftercare instructions. The surface of the eye also plays a role. Dry eye disease can affect both the quality of your vision and the accuracy of the measurements taken before surgery, particularly measurements of the cornea’s curvature, known as keratometry. Studies included in a systematic review found that treating dry eye before repeating lens measurements reduced errors in the final focusing result. [1, 11]

For these reasons, it is not possible to promise everyone the same visual outcome or complete freedom from glasses. Your likely result needs to be assessed individually. [1]

What happens at a cataract assessment?

We start by talking about your vision. How much you can read on an eye chart is only part of the picture. I also want to understand which activities you find difficult and what you hope surgery will help you do. [1]

The examination usually includes checking your vision with the best possible glasses correction, measuring your prescription and eye pressure, and examining the front of the eye. The retina and the fundus of the eye are also examined whenever the cataract allows a clear enough view. Measurements of the eye and cornea are then used to calculate the power of the artificial lens. [1]

Additional tests depend on your individual needs. An OCT scan of the macula or optic nerve is particularly useful if you have macular disease, diabetic retinopathy or glaucoma, or if your vision is worse than the cataract alone would explain. OCT may also be used routinely, particularly when considering a lens designed to reduce the need for reading glasses. [1]

Detailed mapping of the cornea, known as corneal topography or tomography, is especially important if you have astigmatism, are considering a toric lens, or have previously had refractive surgery. It may also be needed for certain lens options or if a corneal condition is suspected. [1]

We also discuss the intended focus of your eye after surgery—the distance at which we aim to give you the clearest vision without glasses. This is called the target refraction. We talk through the lens options, their limitations and when you are likely to need glasses afterwards. Your preferences and expectations help guide that choice. [1, 4]

Questions to ask at your appointment

• Is the cataract the main reason I am having trouble with my vision?
• Do I have any other eye conditions that could limit the improvement?
• What is likely to improve after surgery, and what will it not change?
• At what distance should I expect to see best without glasses?
• Which types of lens would be suitable for my eyes?
• Am I likely to need glasses afterwards?
• What are the implications of waiting a little longer?

You do not need to wait for a cataract to become “mature” before considering surgery. Equally, finding a cataract during an examination does not automatically mean it needs to be removed. The right time to consider surgery is when it is affecting your life and the likely benefits outweigh the risks. [1, 2, 8]

This article is for educational purposes and does not replace an individual consultation with an ophthalmologist.

References

1. European Society of Cataract and Refractive Surgeons. ESCRS Recommendations for Cataract Surgery. Final extended document; current online version, accessed 30 July 2026. ESCRS guidelines

2. Polish Ophthalmological Society. Eligibility standards for cataract surgery—excluding children [in Polish]. Updated 7 February 2020; standards for procedures funded by Poland’s National Health Fund (NFZ), accessed 30 July 2026. Polish Ophthalmological Society standards

3. Allen D, Vasavada A. Cataract and surgery for cataract. BMJ. 2006;333(7559):128–132. DOI

4. Lapp T, Wacker K, Heinz C, Maier P, Eberwein P, Reinhard T. Cataract Surgery—Indications, Techniques, and Intraocular Lens Selection. Dtsch Arztebl Int. 2023;120(21–22):377–386. DOI

5. Ermiş SS, Oztürk F, Inan UU. Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts. Br J Ophthalmol. 2003;87(11):1356–1359. DOI

6. Adamsons IA, Vitale S, Stark WJ, Rubin GS. The association of postoperative subjective visual function with acuity, glare, and contrast sensitivity in patients with early cataract. Arch Ophthalmol. 1996;114(5):529–536. DOI

7. Charalampidou S, Nolan J, Loughman J, et al. Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract. Eye (Lond). 2011;25(9):1147–1154. DOI

8. Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis. Acta Ophthalmol. 2016;94(1):10–20. DOI

9. Hodge W, Horsley T, Albiani D, et al. The consequences of waiting for cataract surgery: a systematic review. CMAJ. 2007;176(9):1285–1290. DOI

10. Dinkin M. Diagnostic Approach to Diplopia. Continuum (Minneap Minn). 2014;20(4 Neuro-ophthalmology):942–965. DOI

11. Biela K, Winiarczyk M, Borowicz D, Mackiewicz J. Dry Eye Disease as a Cause of Refractive Errors After Cataract Surgery — A Systematic Review. Clin Ophthalmol. 2023;17:1629–1638. DOI

12. Armbrecht AM, Findlay C, Kaushal S, Aspinall P, Hill AR, Dhillon B. Is cataract surgery justified in patients with age related macular degeneration? A visual function and quality of life assessment. Br J Ophthalmol. 2000;84(12):1343–1348. DOI