Cataracts: What They Are & What to Do

If colors look duller than they used to, headlights at night make halos and glare, or your glasses prescription seems to need updating more often than usual, you may have early cataracts. They’re among the most predictable parts of aging — by age 80, more than half of Americans have cataracts. They’re also one of the most fixable conditions in modern medicine. Cataract surgery has a roughly 95% success rate and remains one of the most common surgeries performed worldwide.

Most patients see us for cataracts in one of two situations. The first: a routine eye exam picks up early lens changes you weren’t aware of, and we monitor them year over year until they need treatment. The second: your vision has changed enough that activities are getting harder — reading, driving, watching TV — and you’re ready to do something about it.

What is a cataract?

The lens inside your eye is normally clear, like a glass marble. It focuses light onto the retina so you see sharply. A cataract is a gradual clouding of that lens — protein in the lens slowly clumps together and the lens loses its transparency. Light that used to pass through cleanly now scatters, and vision becomes hazy, dim, or glare-prone.

Cataracts develop slowly. Most are age-related and start sometime in the 50s or 60s, becoming visually significant in the 70s for many people. Less commonly, cataracts can develop earlier due to diabetes, eye injury, long-term steroid use, or genetic factors.

Symptoms

Cataracts don’t cause pain. The symptoms are all visual, and they tend to creep up so gradually that patients often don’t notice until vision has changed quite a bit:

If your vision has gradually changed and you’re finding excuses for things you used to do easily — reading the menu in dim restaurants, driving at night, recognizing faces from across the room — cataracts are worth ruling in or out.

How we diagnose cataracts

Cataract diagnosis happens during a comprehensive eye exam. We dilate your pupils, examine the lens directly under high magnification, and grade the type and severity of any lens changes. We also assess whether the cataract is the actual cause of your vision change, or whether something else (macular degeneration, glaucoma, dry eye) is contributing.

That second part matters. Some patients come in convinced they need cataract surgery, when the real issue turns out to be something simpler — a stronger glasses prescription, dry eye treatment, or another condition. We’ll tell you what we find honestly and won’t recommend surgery unless cataracts are genuinely the cause of your visual problems.

When is it time for surgery?

Cataracts don’t need to be removed just because they exist. The right time for surgery is when:

• Your vision is interfering with things you want to do. Reading, driving, hobbies, work, watching grandchildren’s sports. The threshold is functional, not numerical.
• Updated glasses no longer help much. If a new prescription gives you significant clarity, you may not need surgery yet.
• You feel ready. Cataract surgery is elective except in rare cases. Some patients want surgery as soon as they’re eligible; others prefer to wait. Both are reasonable.

One nuance worth knowing: night driving is often the first activity meaningfully affected by cataracts, because the combination of low light and bright headlights creates conditions where cataracts cause the most glare. If you’ve started avoiding night driving, that’s often a sign the cataract is more advanced than your daytime vision suggests.

What cataract surgery involves

Cataract surgery is one of the most refined procedures in medicine. It’s done as an outpatient procedure under local anesthesia (you’re awake but the eye is numbed), takes about 15-20 minutes per eye, and recovery is fast. Most patients see noticeably better within a day or two.

The surgery itself: the surgeon removes your cloudy natural lens and replaces it with a clear artificial lens called an intraocular lens, or IOL. The IOL choice matters because it determines what you’ll see after surgery:

• Standard monofocal IOLs — clear vision at one distance (usually far), with reading glasses still needed for close work. Covered fully by Medicare and most insurance.
• Premium IOLs — multifocal, extended depth of focus, or accommodating lenses that reduce the need for glasses at multiple distances. Better visual freedom but only partly covered by insurance, with significant out-of-pocket cost.
• Toric IOLs — correct astigmatism along with cataracts. Reduce the need for glasses at distance.

We may discuss the IOL options with you before referral so you can ask informed questions when you meet your surgeon. There’s no universally right answer — the choice depends on your visual needs, your budget, your tolerance for glasses, and other eye conditions you may have. Your surgeon will go over the options in detail at your pre-op consultation.

How we work with your cataract surgeon

We don’t perform cataract surgery in our office — that’s done by ophthalmologists in a surgical center. But we provide everything around the surgery:

• Pre-operative evaluation. Once you decide to proceed, we coordinate the measurements your surgeon needs and complete the medical eye exam.
• Surgeon referral. If you don’t already have a preferred ophthalmologist, we’ll refer you to whichever cataract surgeon you choose to work with. Most of our Mason County patients see surgeons in Olympia, though we’re happy to refer wherever works best for you.
• Post-operative care. The day-after, week-after, and month-after follow-up visits are typically done with us, not at the surgical center. We monitor healing, adjust your prescription as the eye stabilizes, and address any post-op questions.
• Second-eye coordination. Most patients have surgery on one eye at a time, with the second eye scheduled a few weeks later once the first has healed. We coordinate the timing.

Insurance coverage for cataract care

Cataract diagnosis, monitoring, and standard surgery are covered by:

• Medicare and Medicare Advantage — cover cataract evaluation, surgery with a standard monofocal IOL, and post-op follow-up. Premium IOL upgrades cost extra.
• Apple Health (Washington Medicaid) — covers medically necessary cataract care, with coverage details that vary by plan and managed-care organization.
• Most major medical plans — Premera, Regence, Blue Cross Blue Shield, Kaiser, UnitedHealthcare, Tricare, and others cover cataract surgery as medically necessary care.

To schedule a cataract evaluation, call us at (360) 427-8324. If your vision has been getting worse and you’re not sure why, an exam will tell you whether cataracts are the cause and what your options are.