What are reasons some doctors remove cataract when it is not fully mature vs some who make patients wait for vision to go lower and cataract to mature? What is the basis for when cataract should be removed?

Cataract surgery should be considered when you (as the patient) decide you need to see better and glasses/contact lenses are no longer doing the job.

The word "cataract" is itself misleading. What we are talking about is the natural human (or "crystalline") lens that sits right behind the pupil. As we age, the natural lens gradually becomes (at a very slow pace) harder and increasingly resistant to the surrounding muscle being able to squeeze it into proper shape for reading (presbyopia). But this is just the early manifestation of the developing discoloration and clouding of that lens. When the hardening, discoloration, and/or clouding of the lens gets bad enough, we call the whole thing a "cataract." But there is no "bright line" separating cataract from simply an aging lens.

Rather than "removing a cataract" as if it were some kind of growth or tumor, it is more accurate (and more understandable) to think of surgery as "removing the dysfunctional natural lens of the eye and replacing it with an artificial lens implant."

Since it is also possible to "fix" nearsightedness, astigmatism, and even presbyopia now with lens implants, there is a growing trend to earlier surgical intervention for cataracts even if they are not "mature."

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