Why do cataracts happen?

29 June 2020

From age to eczema to diabetes or eye injury – there are many possible causes for cataract, a condition which affects one in three of us.  Optegra surgeon Mr Shafiq Rehman explains.

At Optegra we provide cataract surgery services to support the NHS across all seven of our main hospitals.

We also provide a more bespoke service to help patients undergoing cataract surgery to also achieve spectacle independence. This “cataract refractive surgery” utilises a whole raft of technologies and principles including advanced technology lens implants.

Our access to the full range of technologies combined with our leading-edge vision correction philosophy means our cataract patients can be sure of an excellent result which meets the goals that they set in conjunction with their consultant.

That’s all fantastic news of course, but one question I am often asked by patients who present with cataract formation is:

‘Why me?’ … ‘Why have I developed a cataract?’

This is of course perfectly understandable so here I will outline some of the underlying causes of cataract.

Firstly, in medicine we often refer to ‘risk factors’ when it comes to explaining disease causation – also known as ‘aetiological factors’. This is because many health conditions arise as a result of many different factors. This is also referred to as multi-factorial aetiology.

Cataracts are classically multifactorial in their causation. Nevertheless we now have a really good understanding of the major risk factors that are implicated in the development of cataract.

Firstly – the top three risk factors for the development of cataract are:

Age

Age

Age

Unfortunately, as we traverse the slippery road of life we are simply more likely to develop cataract as we get older. In many ways cataract can be thought of as a degenerative condition – indeed the underlying processes that lead to cataract formation are linked primarily to the protein chains which make up most of the natural lens accumulating damage over the years.  This leads to these ‘crystalline’ proteins clumping together leading to reduced transparency and eventually areas of clouding in the natural lens – which of course is what a cataract is!

We now recognise that there are a multitude of metabolic conditions that can accelerate the formation of cataract.  The main one being diabetes mellitus – both type 1 and type 2 – which is known to accelerate cataract onset due primarily to alterations in glucose metabolism.

A number of different eye conditions such as Iritis/Uveitis (inflammation of the inside of the eye) can also be closely linked to the development of cataract.

Also, some of the medications that are used to treat Iritis – principally steroid eye drops such as Prednisolone – can independently lead to cataract formation.

We have also established that people with some skin conditions such as eczema – especially if severe and even more so if located around the face and eyelids – can increase the chances of developing cataract at a younger age than would otherwise be the case. It is possible that some of this risk increase may be linked to the use of steroid skin creams such as Hydrocortisone as well as the underlying condition itself.

Something I have noticed over the past 25 years of my clinical practice is the greater numbers of people who are short sighted developing cataract at an earlier age than is typical. It is now well recognised that myopia (short sightedness) is itself an independent risk factor for the development of pre-senile cataract.

Finally, one additional cause that should be remembered in the development of cataract is eye trauma. In fact, even a fairly mild eye injury – such as being hit by a tennis ball, can lead to a higher chance of developing cataract in the affected eye. Interestingly we often see a delayed response with some patients showing cataract signs consistent with previous injury – but the injury may have occurred many years earlier!

As part of your cataract assessment, your surgeon will always be considering whether your cataract is likely to have a specific development factor.  Occasionally we may run some additional tests to rule out underlying conditions such as diabetes, because the presence of cataract may indicate a yet to be diagnosed medical condition. This is especially so when we are assessing patients under the age 40 who present with cataract.

Of course, irrespective of the underlying risk factors for the development of cataract, its really important to remember that cataract surgery is an incredibly safe and effective surgical solution to the misery that cataracts can cause.

So please work with your surgeon to establish clearly the goals that you wish to achieve with your treatment and there should be every prospect of attaining those goals for you.

To find out more visit about treatment options for cataract, click here or enquire about your personal treatment options .

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