If your cataract does not impair vision, is it best not to remove it?

If a cataract is truly not affecting your vision at all, you don't need to have anything done. Cataracts typically advance, but very slowly. So when it does become an issue for you, you can safely wait until then and still get the same good result.

Are there situations where it might be good to go ahead and fix the cataract sooner rather than later? Yes. One reason would be a slowly growing cataract causing the angle to narrow. If this is left alone, you could be at a greater risk for developing an acute, closed-angle glaucoma attack. Removing and replacing a progressively thickening lens would permanently remove this threat. But these are quite rare.

Another reason might be refractive:

A certain type of farsightedness (hyperopia) will affect distance vision once Presbyopia (loss of near focus) has developed. Hyperopic presbyopic people are usually very unhappy even with glasses because they had "perfect" vision all their life. It is sometimes appropriate to go ahead and operate on even an early cataract in this situation because a lens implant can fix several vision problems at one time -the hyperopia, presbyopia, any astigmatism, and the cataract, no matter how early or advanced. This would be an elective procedure, though, not a "medically necessary" one.

Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic