When an ophthalmologist instructs you to return when your cataracts have gotten "bad enough," what are some concrete signs that has happened?

Yours is a really good question! If I re-phrase it, I expect the question is: How will I know when my cataracts need surgery?

The answer, as vague as it may sound is simply: When you are ready to see better than you are now even with new glasses. Except in unusual cases, the development of cataract is glacially slow and the visual symptoms are equally gradual, though always in the direction of overall worsening. There simply is no "cataractometer" that can objectively measure the point at which surgery needs to be done. The typical symptoms I hear are a gradual reduction in the ability to drive at night comfortably along with an increased loss of enjoyment (or ability) to read as easily as was once the case. While objective loss of actual vision on the eye chart is often measurable, this is not always necessary to be the case for you to reap significant benefit from cataract/IOL surgery.

Ultimately, it comes down to an educated decision based on cost+risk to expected benefits. Your doctor should be able to guide you in this but may feel uncomfortable that he may be pushing you.

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