Why Is One Cataract Worse Than the Other?
You might expect that if cataracts are part of the natural ageing process, they would develop at the same rate in both eyes. However, that’s often not the case.
Many people are surprised to learn that although cataracts often develop in both eyes, it’s perfectly normal for one eye to have a more advanced cataract than the other.
This can also raise another important question: If only one eye needs surgery now, is it okay to wait before having the other eye done?
The answer depends on several factors, including your vision, your lifestyle and the difference between the two eyes.
Although ageing is the most common cause of cataracts, each eye ages independently.
Sometimes, previous eye injuries, inflammation, surgery, steroid use or even natural differences between the eyes may mean one cataract progresses more rapidly than the other. However, in many people, there is no obvious reason at all. It’s simply part of the natural variation between the eyes.
Not necessarily, but it often does.
The decision isn’t based solely on how the cataract looks during your eye health examination. Your ophthalmologist will also consider:
Sometimes one eye is causing most of the visual problems, while the other still provides excellent vision. In these situations, cataract surgery on one eye may be all that’s needed for the time being.
Yes.
It’s very common for cataract surgery to be performed on one eye first, with the second eye monitored until surgery becomes necessary.
Some people don’t need surgery on the second eye for months or even years, particularly if the cataract is mild and isn’t affecting their vision or quality of life. However, the decision to wait should always be guided by regular eye health examinations, as cataracts continue to progress over time.
Sometimes they do.
After surgery, the operated eye often sees much more clearly, with brighter colours, sharper contrast and improved clarity. Because of this, the cataract in the other eye can suddenly become much more noticeable.
Many patients comment that they didn’t realise how cloudy their vision had become until after their first cataract was removed. The eye that previously seemed “quite good” may now appear dull, yellow or blurrier by comparison.
This doesn’t mean the second cataract has suddenly worsened, it simply reflects the difference between the newly clear vision in one eye and the cataract still present in the other.
After cataract surgery, the prescription in the operated eye often changes significantly, or is no longer required.
If the other eye still has a cataract and a very different prescription, the brain may find it difficult to combine the images from both eyes. This difference between the two eyes is known as anisometropia.
Depending on the amount of difference, some people notice:
Not everyone experiences these symptoms. Some people adapt very well, while others find even a moderate difference between the eyes bothersome. If the difference is significant, your ophthalmologist may recommend proceeding with surgery on the second eye sooner rather than later to restore more balanced vision.
No.
Some people have only one visually significant cataract and continue to see well with the other eye for a long time. Others develop cataracts in both eyes that progress at a similar rate, making cataract surgery on both eyes appropriate within a relatively short period.
The timing is individual and depends on your symptoms, visual needs, overall eye health and how well the two eyes work together after the first procedure.
It’s completely normal for one cataract to be more advanced than the other. While cataracts usually develop in both eyes, they rarely progress at exactly the same rate.
Having cataract surgery on one eye while continuing to monitor the other is a common and appropriate approach for many patients. However, after the first eye is treated, the remaining cataract may become much more noticeable, and some people experience symptoms related to the difference in vision between the two eyes.
Your ophthalmologist will consider your vision, lifestyle, overall eye health and how well your eyes are working together to determine the most appropriate timing for surgery on each eye. The goal is to
achieve the best possible visual outcome while ensuring treatment is tailored to your individual needs.
Cataracts are a natural part of the ageing process and, once they begin to develop, they generally continue to progress over time. While wearing UV-protective sunglasses, avoiding smoking, and managing conditions such as diabetes may help support overall eye health, they cannot stop or reverse a cataract. The only effective treatment is cataract surgery, which is recommended when the cataract begins to significantly affect your vision or quality of life.
The need for glasses after cataract surgery will depend on the type of lens implant chosen, your prescription, and your individual visual needs. Some people will no longer need glasses, while others may still require them for reading, distance, or both. Your ophthalmologist will discuss the most suitable lens options with you to help achieve the best visual outcome for your lifestyle.
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