Disclaimer: This article provides general health information for public awareness. It is not intended as medical advice, diagnosis, or treatment. Please consult a qualified healthcare professional for personalised guidance.
Understanding Cataract
Cataract is a leading cause of blindness and visual impairment worldwide, and one of the most common causes of reduced eyesight among older adults in Malaysia. If left untreated, cataract can progress from mild visual disturbance to significant vision loss and blindness. Cataract is a treatable condition, and with timely diagnosis and appropriate surgical intervention, vision loss caused by cataract can often be reversed, allowing individuals to regain visual function and maintain independence in daily life.
Table of Contents
- What Is Cataract?
- Common Symptoms of Cataract
- How Cataract Symptoms Differ From Common Vision Problems
- Causes and Risk Factors (Including Malaysia-Specific Factors)
- How Cataracts Affect Daily Life in Malaysia
- Myths vs Reality: Who Should Consider Cataract Surgery?
- When Is the Right Time for Cataract Surgery?
- Modern Cataract Treatment in Malaysia: Before, During and After Surgery
- Frequently Asked Questions (FAQ)
- When Should You See an Eye Specialist?
- Conclusion
What Is Cataract?
A cataract occurs when the eye’s natural crystalline lens becomes cloudy. Normally, this lens is clear and focuses light onto the retina, allowing us to see sharp images. When the proteins in the lens change and clump together, the lens becomes cloudy and vision turns blurry, hazy, or dim.
It is important to understand that:
- Cataract is not a film or growth on the surface of the eye.
- It develops inside the lens itself.
- Many people describe it as “looking through a foggy or frosted window.” Locally, some patients liken it to “seeing through a hazy or fogged-up plastic sheet.”
Cataracts can affect one or both eyes, but they often do not progress at the same speed. In Malaysia, cataract is a major reason older adults lose vision, and cataract surgery is one of the most frequently performed eye procedures nationwide.
Common Symptoms of Cataract
Cataracts usually develop slowly. Many people adapt to the changes without realising how much their vision has been affected. Common symptoms include:
- Blurry, cloudy or hazy vision
- Increased sensitivity to sunlight or bright headlights, especially at night
- Halos or glare around lights
- Difficulty reading small print, even with glasses
- Colours appearing dull, faded or yellowish
- Needing brighter light for near tasks (reading menus, sewing, using smartphones)
- Frequent changes in glasses or contact lens prescriptions
These changes are usually gradual and some people only realise how poor their vision has become when it interferes with safety or daily activities, such as driving, working, or moving around at home.
How Cataract Symptoms Differ From Common Vision Problems
Some symptoms of cataract may look similar to other common vision problems such as myopia (short-sightedness), hyperopia (long-sightedness), presbyopia (age-related near blur), astigmatism, or even dry eye. Having blurred vision does not always mean a cataract is present.
| When It’s Likely Not Cataract | When It May Be Cataract |
|---|---|
| Difficulty reading up close — often related to presbyopia after age 40. | Vision remains cloudy even after updating glasses. |
| Blurred distance vision — may be due to myopia or astigmatism. | Colours appear dull, faded, or yellowish. |
| Temporary blur after prolonged screen use — commonly linked to dry eye. | Glare or halos gradually worsen over months or years. |
| Glare from headlights — may happen with uncorrected refractive errors or dirty lenses. | You need increasingly brighter light for reading or near tasks. |
A comprehensive eye examination can determine whether symptoms are caused by cataract, refractive issues such as myopia, hyperopia or presbyopia, or other causes like dry eye. Many people with blurry vision only need updated glasses or basic treatment rather than cataract surgery.
Causes and Risk Factors (Including Malaysia-Specific Factors)
Ageing is the most common cause of cataract, but several other factors also play a role. Cataracts are usually due to a combination of lifestyle, health and environmental influences.
General Risk Factors
- Ageing – most people over 60 will have some degree of lens clouding.
- Family history – genetics can increase the likelihood of developing cataract.
- Medical conditions – such as diabetes or high blood pressure (hypertension).
- Certain medications – long-term use of steroids and some eye drops.
- Previous eye injury or surgery – trauma can speed up cataract formation.
- Smoking and alcohol – both are associated with faster lens damage.
Malaysia-Specific Factors
- High rates of diabetes – in Malaysia, many adults live with diabetes, and cataracts often develop earlier in people with poor blood sugar control.
- Strong tropical sunlight – long-term exposure to ultraviolet (UV) rays, especially among motorcyclists and outdoor workers, may contribute to earlier onset.
- Delayed eye checks – some patients only seek help when vision is very poor, which can make daily life and driving riskier.
Can Cataracts Be Prevented?
There is no guaranteed way to prevent cataracts completely, as ageing and genetics are beyond our control. However, certain habits may help slow down their development:
- Keeping blood sugar and blood pressure well controlled.
- Wearing sunglasses or hats with UV protection when outdoors.
- Not smoking and reducing alcohol intake.
- Eating a balanced diet with fruits and vegetables rich in antioxidants (leafy greens, citrus, colourful produce).
- Scheduling comprehensive eye exams every 1–2 years from around age 40 onwards.
How Cataracts Affect Daily Life in Malaysia
Cataracts are more than just a medical diagnosis. They can quietly affect many aspects of daily living, safety and confidence. In Malaysia, this often shows up in practical, everyday situations.
Driving and Transportation
- One of the earliest problems people often notice is difficulty driving at night. Bright headlights from oncoming vehicles — especially newer vehicles with intense white or xenon lights — can cause discomfort, glare, or halos around lights, making highway or kampung roads feel less comfortable to navigate.
- For motorcyclists, headlights from larger oncoming vehicles such as buses or lorries may feel particularly intense, which can momentarily reduce visual comfort and clarity.
- Strong tropical sunlight during the day can also worsen glare and reduce contrast, making road signs and lane markings harder to see.
Work and Household Tasks
- People who work with written materials or presentations may find it harder to see clearly from a distance.
- Those handling fine details, sharp tools or hot surfaces may experience safety concerns.
- Anyone who frequently shifts focus between screens, documents and meetings may feel more visual strain.
- Older adults may notice that hobbies such as sewing, games or gardening become less enjoyable due to reduced clarity.
Reading and Communication
For many Malaysians, WhatsApp and social media are part of daily life. Cataracts can make reading small text on smartphones, newspapers and price labels frustrating. Family members sometimes notice older relatives:
- Holding reading material very close to their faces.
- Asking for brighter lights to read messages or bills.
- Complaining that fonts are “too small” despite wearing glasses.
Falls, Accidents and Emotional Impact
Cataracts reduce contrast sensitivity, making it harder to distinguish steps, curbs and uneven flooring. This increases the risk of falls, especially among older adults, which can lead to fractures and hospitalisation.
Poor vision can also affect emotional wellbeing:
- Reduced confidence to go out alone.
- Fear of driving or travelling.
- Withdrawing from social events or activities.
- Feeling frustrated, irritable or low in mood.
In short, cataract does not only cloud the lens of the eye; it can cloud daily life and quality of living if left unaddressed.
Myths vs Reality: Who Should Consider Cataract Surgery?
There are several common beliefs about cataract surgery that may delay treatment. Understanding what is fact and what is myth helps patients make clearer decisions together with their eye specialists.
Myth 1: “Only old people need cataract surgery.”
Reality: Cataracts are more common with age, but younger adults can also be affected.
- People with diabetes may develop cataracts earlier in life.
- Eye injuries from sports or accidents can lead to “traumatic cataracts.”
- Long-term steroid use for conditions such as asthma or arthritis can contribute to cataract formation.
Cataract surgery is considered based on how much vision is affected, not only on age.
Myth 2: “You should wait until the cataract is ‘ripe’.”
Reality: The term “ripe” is sometimes used to describe a cataract that has become more visually significant. In practice, surgery is considered based on how the cataract affects vision and daily activities, rather than waiting for a specific stage.
Eye specialists can detect cataracts early through slit-lamp examination, sometimes before symptoms appear. However, only patients can describe how their vision feels in daily life, and these symptoms are an important part of the decision.
Surgery is usually considered when:
- Vision interferes with daily tasks (driving, reading, recognising faces, working, cooking).
- Glare or halos become troublesome, especially at night.
- Safety becomes a concern (falls, difficulty navigating steps, trouble with depth perception).
- The cataract limits monitoring of other eye diseases (e.g., glaucoma, diabetic retinopathy).
- Glasses no longer improve clarity, even after updates.
During follow-ups, it’s helpful to inform your doctor if you have:
- Diabetes.
- Long-term steroid use (oral, inhaled, or certain eye drops).
- Previous eye injuries or surgeries.
If you’re unsure about your medical history or medications:
Bring along any long-term medicines, recent prescriptions, or clinic records when seeing the eye specialist. This helps your doctor understand your overall health and plan the most suitable timing for treatment.
Regular eye exams plus open communication lead to clearer, more confident decisions together.
Myth 3: “Cataract surgery is very dangerous.”
Reality: Cataract surgery is one of the most commonly performed eye procedures worldwide and is generally considered safe when carried out by trained eye surgeons.
The procedure is usually quick, done under local anaesthetic, and many patients return home on the same day.
Myth 4: “After surgery, you will never need glasses again.”
Reality: Cataract surgery replaces the cloudy natural lens with an artificial intraocular lens (IOL), but the need for glasses varies between individuals.
There are generally four main types of lenses used:
- Monofocal lenses – designed mainly for clear distance vision; reading glasses are often still needed.
- Multifocal lenses – can provide vision at more than one distance and may reduce reliance on glasses.
- Toric lenses – help correct astigmatism, which can improve clarity of vision.
- Extended Depth of Focus (EDoF) lenses – provide a wider range of clear vision, especially for intermediate tasks, and may reduce reliance on glasses.
Some lenses may reduce dependence on glasses for certain distances, but no single option fits everyone. The choice is best made after discussing your visual needs, eye health and lifestyle with your eye specialist.
Myth 5: “Eyedrops or supplements can cure cataracts.”
Reality: There is no scientific evidence that over-the-counter eyedrops, herbal remedies, or supplements can reverse or dissolve cataracts.
Cataract occurs when the natural lens becomes cloudy — and no medication can make that lens clear again.
These products may claim to “melt,” “shrink,” or “cure” cataracts, but such claims are not supported by clinical studies.
Be cautious of products that:
- Promise “instant results”.
- Use dramatic before–after images.
- Are sold mainly through social media or private messages.
- Avoid referencing real clinical studies.
- Claim to be “doctor approved” without naming a qualified practitioner.
Such products may delay proper care, waste money, or irritate the eyes. The only proven treatment for cataract is surgery performed by trained eye specialists.
When Is the Right Time for Cataract Surgery?
Many people ask, “When should I have cataract surgery?” There is usually no need to rush if vision is still adequate, but waiting until vision is very poor is also not ideal.
Signs It May Be Time for Surgery
You may be approaching the right time for cataract surgery if:
- Driving feels unsafe – glare from headlights or hazy vision makes it hard to see the road clearly at night or in bright sun.
- Daily tasks are affected – reading, recognising faces, cooking, sewing or using digital devices has become a struggle.
- Glasses no longer help – despite changes in prescription, vision remains blurred or cloudy.
- Your eye specialist recommends it – during an eye exam, the cataract is found to be advanced or affecting assessment of other eye conditions.
In general, if cataract starts to limit your independence or sense of safety, it is appropriate to discuss surgery.
Risks of Waiting Too Long
Delaying surgery for many years after cataract has already become severe can:
- Make the lens harder and more difficult to remove.
- Increase the risk of certain complications during or after surgery.
- Prevent proper monitoring or treatment of other eye diseases.
Modern Decision-Making
Around the world, eye specialists generally recommend timely surgery rather than waiting until cataracts are very advanced. The decision is tailored to each person and based on:
- Quality of life – how much vision affects work, home and social activities.
- Safety – whether poor vision increases the risk of falls or accidents.
- Medical factors – whether cataract interferes with the management of other eye problems.
Modern Cataract Treatment in Malaysia: Before, During and After Surgery
Cataract surgery is one of the most commonly performed eye procedures worldwide. In Malaysia, it helps many patients each year to regain clearer vision and maintain independence.
Before Surgery: Assessment and Preparation
1. Eye Examination
- Vision tests to assess how much cataract is affecting sight.
- Dilated eye exam (with eye drops) to examine the retina and optic nerve.
- Measurements of the eye’s length and the curvature of the cornea to calculate the most suitable intraocular lens (IOL).
2. Discussion on Intraocular Lens (IOL) Options
Together with the ophthalmologist, patients usually discuss choices such as:
- Monofocal lenses – designed mainly for clear distance vision; reading glasses may still be needed.
- Multifocal lenses – can provide vision at more than one distance and may reduce reliance on glasses.
- Toric lenses – help correct astigmatism, which can improve clarity of vision.
- Extended Depth of Focus (EDoF) lenses – provide a wider range of clear vision, especially intermediate tasks, and may reduce reliance on glasses.
The final decision depends on overall eye health, lifestyle needs and affordability. Not every lens type is suitable for every patient.
3. General Health Check
For patients with conditions such as diabetes, hypertension or heart disease, additional assessment may be required to ensure these are reasonably controlled before surgery. This supports a smoother procedure and recovery.
4. Pre-Operative Instructions
- Some medications (for example, blood thinners) may need adjustment based on medical advice.
- Arrangements should be made for someone to accompany the patient home, as driving is not permitted immediately after surgery.
- In some hospitals, a short period of fasting may be required if light sedation is planned.
During Surgery: What Happens in the Operating Room
Cataract surgery is usually done as a day procedure under local anaesthetic, meaning patients are awake but the eye is numbed.
- Anaesthesia – numbing eye drops, and sometimes an injection around the eye, are used so the procedure is comfortable.
- Small Incision – a tiny opening, often 2–3 mm, is made at the edge of the cornea (the clear front part of the eye).
- Phacoemulsification – an ultrasound probe gently breaks the cloudy lens into small fragments, which are then removed.
- Lens Implant – the selected IOL is inserted into the lens capsule and positioned carefully.
- Closing the Incision – the small wound is usually self-sealing without stitches. Occasionally, a stitch may be used to secure the incision.
The whole procedure commonly takes about 15–30 minutes per eye, and most patients go home on the same day.
After Surgery: Recovery and Follow-Up
1. Early Recovery
- Vision may be blurry on the first day, which usually improves over the next few days.
- Many people notice clearer and brighter vision within the first 1–2 days.
2. Eye Drops
Patients are normally prescribed antibiotic and anti-inflammatory eye drops for several weeks. These help prevent infection and reduce inflammation, while supports proper healing.
3. Do’s and Don’ts
- Do avoid rubbing or pressing on the operated eye.
- Do wear any protective shield or glasses given, especially while sleeping in the first few days.
- Do resume light activities such as walking when you feel comfortable.
- Do not swim, lift very heavy objects or expose the eye to dusty or dirty environments for a few weeks.
4. Common Experiences
Some people experience mild itchiness, tearing, temporary sensitivity to light or a foreign-body sensation (feeling as though something is in the eye). Colours may appear more vivid after surgery, especially primary colours such as red, yellow and blue.
5. Follow-Up Visits
- First day – to check the eye pressure and examine the wound.
- Within the first week – to monitor vision and healing.
- Around one month – to confirm recovery and, if needed, update glasses.
6. Recovery Timeline
Most patients recover well within 6–8 weeks. Depending on the type of IOL and overall eye health, some may still need glasses for reading or fine detail.
Possible Risks (Rare but Important to Know)
While cataract surgery generally has good outcomes when performed by trained eye surgeons, all operations carry some risk. Potential complications include:
- Infection inside the eye (endophthalmitis) – rare but serious.
- Swelling of the cornea or retina.
- Lens implant (IOL) position issues.
- Cloudiness of the lens capsule behind the IOL (“secondary cataract” or posterior capsule opacification), which can often be treated with a short laser procedure.
Attending scheduled follow-up visits and following the post-operative instructions carefully helps reduce the risk of complications.
Frequently Asked Questions (FAQ)
Can cataracts cause blindness?
Yes. If left untreated, cataracts can lead to severe vision loss or blindness. However, in many cases, vision can be reversed with timely surgery, depending on the overall health of the eye and the individual’s general health.
Can cataracts affect both eyes?
Yes, cataracts commonly develop in both eyes, although they may not progress at the same rate.
How long does cataract surgery take?
The procedure itself typically takes around 15–30 minutes per eye. Patients usually go home on the same day.
Is cataract surgery painful?
Cataract surgery is usually not painful. Local anaesthetic (eye drops and/or injection) is used so that patients remain comfortable throughout the procedure.
Can cataracts come back after surgery?
The cloudy natural lens is removed and replaced with an artificial lens, so cataract itself does not “grow back”. However, the lens capsule that holds the implant can become cloudy over time (sometimes called a “secondary cataract”). This can often be treated with a quick laser procedure performed in the clinic.
When Should You See an Eye Specialist?
You should consider seeing an eye specialist (ophthalmologist) if you notice:
- Cloudy, blurry or dim vision that makes daily activities harder.
- Glare, halos or difficulty driving at night.
- Needing much brighter light to read or do close work.
- Frequent changes in your glasses prescription without clear improvement.
- Sudden changes in vision, eye pain, or flashes and floaters (these may signal other urgent eye problems).
An eye examination can confirm whether cataract is the main cause of the symptoms and whether it is time to consider surgery or continue monitoring.
Conclusion
Cataract is common, especially as people get older, and many Malaysians will experience it at some point in their lives. Although it can significantly affect daily living, safety and independence, cataract is also treatable.
Modern cataract surgery is generally safe, and many people experience clearer, brighter vision after recovery. If you or someone close to you notices persistent cloudy vision, glare when driving, or difficulty with everyday tasks, it may be time to seek professional advice.
Article contributed by:
Dr Ling Heng Chuan
Consultant Eye Surgeon
MBBS (Mangalore, 1991) & MS Ophthalmology (University of Malaya, 1998)
Maria Hospital, Johor Bahru, Johor, Malaysia
© HCM. Please feel free to share this article. Reproduction or adaptation of the content without permission is not allowed.
