How to Manage Cataract - Doctor Q&A

Cataract is a condition where the natural lens in the eye becomes progressively cloudy.

It (cataract) affects one's vision and makes it difficult for one to go about performing your daily activities.

Most forms of cataract develop in adult life, causing the lens to harden and become cloudy as you age.

Although most cataracts are age-related, there are other types which include congenital (present at birth), drug induced (steroids), and traumatic cataracts (injury to the eye).

Cataracts are also more common in people who have certain other conditions such as diabetes (see this article), which tend to occur at an earlier age than those without the disease.

While cataracts cannot be prevented, it can be treated by a surgical procedure — cataract extraction and intraocular lens implantation, where the cloudy cataract lens is removed and replaced with an artificial lens implant. 

If the amount of cataract is little and does not disturb one's vision or daily activities (e.g. driving or reading), it can be left alone. Spectacles may help at this stage to allow one to see better. If using spectacles does not help, and the cataract interferes with one's vision, an eye doctor may suggest doing a cataract surgery.

In this month's 'Ask the Specialist' Q&A, Dr Yap Guan Hui answers your questions on the causes, symptoms and treatment for cataract. Submit your questions now!

Dr Yap Guan Hui is a Consultant with the Cataract & Comprehensive Ophthalmology Department at the Singapore National Eye Centre (SNEC).

He obtained his Medical Degree from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery (MBBS) in 2014 and obtained his post-graduate Master of Medicine in Ophthalmology in 2021. In 2023, he attained his Ophthalmology Specialist accreditation and was admitted as a Fellow of the Academy of Medicine, Singapore.

He has also completed his fellowship at the Cataract and Comprehensive Department under the Advanced Clinical Specialist Programme.

His interest and expertise are in Cataract Surgery, and he also practices general and comprehensive ophthalmology, dealing with floaters and flashes, dry eye syndrome, diabetic retinopathy and glaucoma screening.

Dr Yap has published scientific papers in peer-reviewed medical journals and has presented his research work in local and international conferences.

Dr Yap also regularly volunteers at community eye screening projects. These projects screen for cataract, glaucoma, diabetic retinopathy for the elderly in various nursing homes and Senior Activity Centres.

1. Question by Karen

Dear Doctor,

Every now and then I may get vision loss for about 10 minutes and comes on suddenly but with no other symptoms.

I do have dry eyes and I am 63 years old. I either have missing vision in small spots or grey spots or flashing lights.

I was previously told it is aura migraine and to use eye drops or wet towel over my eyes.

I get panicky especially if I am driving and encounter missing spots of vision. Is there any permanent fix for this? Thank you for your advice.

Answer by Dr Yap Guan Hui

Hi Karen,

Cataracts do not cause intermittent visual blurring of vision.

With regards to your dry eyes, I would advice use of lubricant eye drops to moisturise your eyes. Preservative free lubricants would be more advisable if you want to use the lubricants more than 4 times a day.

With regards to your symptoms of intermittent blurring of vision, missing spots, grey spots or flashing lights, you will require an ophthalmological consultation and examination to work up the condition and get the appropriate treatment. If you have already been seen, do follow the medical advice and follow up with your doctor.

If you do have missing spots of vision, it may not be safe to drive and you may need further assessment to assess for safety, and if it meets legal standards of driving.

2. Question by Francine

Dear Dr,

My Optometrist recently pointed out that I have the early stages of cataracts forming, especially in my left eye.

What can I do to slow down their development? I'm presuming that what I have now is irreversible, correct?

Thank you for your advice.

Answer by Dr Yap Guan Hui

Hi Francine,

Yes, you are right that cataracts are reversible. In the meantime you can wear spectacles or contact lenses to correct for any refractive errors to optimise your vision. To slow down their development, ultraviolet (UV) protection such as sunglasses, wearing a hat and reducing outdoor exposure at peak hours of sunlight will be helpful.

3. Question by Margaret

Hi Dr,

I had both of my cataracts removed 3 years back. Today I am having difficulty in focusing in my right eye. It shifts about and I see crooked lines instead of straight. I am 80yrs this year. Pls advise if Pco or Yag is suitable or necessary.

Thank you for your advice!

Answer by Dr Yap Guan Hui

Hi Margaret,

Seeing crooked lines when you are looking at straight lines is called metamorphopsia, commonly due to causes in the retina, unlikely related to your cataract surgery.

Difficulty focusing may be due to multiple causes, posterior capsular opacification (PCO) may be one or them, and a YAG laser capsulotomy can be performed if you do have PCO. However, it may also be due to other common conditions like dry eyes or refractive error.

In view of both symptoms, I would recommend an ophthalmological evaluation to assess for the underlying condition, and then the appropriate treatment can be carried out.

4. Question by Peter

Dear Doctor,

I have opted for monovision for my cataract op.

Doctor has advised me that my dominant eye will be corrected for near vision, and the other one for distance vision.

I read from online that the dominant eye is the usual choice for distance vision.

Should I be concerned? Thank you for your advice.

Answer by Dr Yap Guan Hui

Hi Peter,

The monovision strategy is employed so one eye sees far and the other sees near, and the dominant eye is corrected for distance while the non-dominant eye is corrected for near.

If your doctor says otherwise, do clarify again with him, and also check with him if the underlying reason, and to ensure there is no miscommunication.

5. Question by TL

Dear Dr,

A Specialist Eye Surgeon would usually advise on when is the right time for cataract surgery. 

Very often, a patient who has some blurred vision at a distance would expect cataract surgery to correct the problem.

However, the specialist could view that the contract is not “ripe for harvest”.

On what basis would the specialist make that determination? Thank you for your advice.

Answer by Dr Yap Guan Hui

Hi TL,

Usually we evaluate the patient’s cataract and patient holistically, taking into account patient symptoms from the cataract such as blurring or glare, their visual requirements, how much their function has been affected, the visual acuity, and type and density of the cataract.

Other visual co-morbids and the fellow eye are all evaluated to formulate the best management plan for the patient.

It is difficult to comment on why your cataract is “not ripe” without seeing you in person, however common causes would be milder forms of cataract that are less likely to cause significant visual symptoms or good visual acuity — such that risks of surgery may outweigh the benefits.

Ref: F26