Cataract – Causes, Symptoms, Surgery
In this article, Germany’s leading ophthalmic surgeons explain what a cataract is and how it is treated. They describe how cataract surgery is performed, why the condition develops, and which clinics in Germany are considered the best for cataract removal, as well as the cost of surgery.
What is a cataract?
A cataract is a clouding of the eye’s natural lens that typically develops after the age of 50 and can eventually lead to partial or complete loss of vision. A healthy lens, located behind the iris and pupil, normally allows light rays to pass freely and focus on the retina. When the lens becomes cloudy due to cataracts, less light reaches the retina and the resulting image becomes blurred.
In the early stages, cataracts affect only a small area of the lens, but over time the clouding spreads. In advanced stages, the entire lens becomes white and completely impermeable to light.
How is a cataract treated?
The only definitive treatment for cataracts is the implantation of an artificial intraocular lens. Cataract surgery is the most commonly performed surgery in ophthalmology. In Germany alone, approximately 700,000 cataract operations are performed every year.
Symptoms of a cataract
As the lens becomes cloudy, vision becomes blurry and hazy, as though seen through a veil. The ancient Greeks believed this veil resulted from fluid flowing inside the eye and named the condition “cataract,” meaning “waterfall.” In more advanced stages, the clouding may even be visible from the outside.
The clouding of the lens disrupts the refraction and focusing of light on the retina, leading to typical cataract symptoms:
- increasingly blurred or hazy vision
- faded or dull colors
- heightened sensitivity to bright light and glare
- slow adaptation to changes in lighting
- reduced depth perception and distance vision
- halos and glare around light sources
These symptoms are particularly uncomfortable for drivers. At first, most people do not notice the slow, painless progression of cataracts, but with time it significantly reduces visual quality.
How does lens clouding develop?
The eye’s lens contains no nerves or blood vessels. It consists of a capsule and a central nucleus. Like a camera lens, it is transparent and convex, refracting incoming light and focusing it on the retina.
The lens can change shape flatter or rounder to adjust focus, a process known as accommodation. Throughout life, new cells accumulate in the lens nucleus, making it thicker and less elastic with age. This leads to a loss of accommodation, which can be corrected with glasses or refractive surgery.
In cataracts, structural changes occur inside the lens. Proteins within the lens remain transparent thanks to protective crystallin proteins (cryAA and cryAB). If these crystallins fail, the proteins clump together, causing clouding characteristic of cataracts. Eventually, the lens becomes almost opaque, producing blurred vision. Reading glasses or laser vision correction cannot stop lens clouding only cataract surgery can.
Causes of cataracts
The exact causes of cataracts are not fully understood. One suspected factor is oxidative stress, which alters the lens fibers. Other contributing factors include:
- natural aging processes
- ultraviolet sunlight exposure
- infrared radiation
- insufficient physical activity
- smoking
- diabetes
- malnutrition
- eye trauma
- certain medications
- rubella during pregnancy (leading to cataracts in infants)
Types of cataracts
Age-related cataract (Cataracta senilis)
This is the most common form of cataract. Many people begin noticing symptoms after age 50. About 5% of those aged 70 and 10% of those aged 80 require cataract surgery. Age-related cataracts account for 90% of all cases. If left untreated, they can lead to blindness. Physical activity has a protective effect and can slow progression.
Cataracts in diabetes
Among cataract-causing diseases, diabetes is the most common. Diabetics develop cataracts earlier than non-diabetics.
Cataracts due to trauma or medication
Eye injuries can trigger cataract formation. Long-term corticosteroid use is also a major risk factor.
Postoperative cataract
Surgeries involving removal of the vitreous body often cause cataracts. For this reason, cataract surgery and lens replacement are frequently performed together. Cataracts may also develop after a filtering procedure such as a trabeculectomy.
Congenital cataracts
Maternal infections during pregnancy—such as rubella, mumps, hepatitis, or toxoplasmosis—may result in cataracts in the unborn child. Rubella carries the highest risk, at 40–60%.
Cataract surgery
The fastest and safest treatment for cataracts is surgery in which the inner, cloudy part of the natural lens is removed and an artificial intraocular lens is implanted into the capsular bag. This routine procedure is performed 600,000–800,000 times per year in Germany. Unlike glaucoma, lens damage from cataracts can be fully corrected with surgery.
Different surgical techniques exist, and surgeon experience varies widely.
The choice of surgeon is critical for the outcome of your procedure.
Phacoemulsification – a proven micro-incision technique
Most cataract surgeries in Germany are performed using phacoemulsification, a microsurgical method in which the cloudy lens is broken apart with ultrasound and removed through a small probe.
The minimally invasive incision usually does not require stitches.
A foldable plastic intraocular lens is inserted through this micro-incision. Standard monofocal lenses provide excellent vision with glasses, while premium lenses—especially multifocal ones—offer spectacle-independent vision.
Thanks to its safety and effectiveness, patients can usually go home the same day, and vision begins improving immediately.
Femtosecond laser cataract surgery – high-precision innovation
Femtosecond laser surgery uses ultrashort light pulses (10⁻¹⁵ seconds) to create thousands of microscopic plasma bubbles that separate tissue with extraordinary precision, without thermal damage.
The laser performs key steps such as capsulotomy and lens fragmentation. The surgeon then removes the fragmented lens and implants the new one. Astigmatism correction can also be performed.
This procedure should be carried out only in certified ophthalmic centers.
To book a consultation: +49 170 62 47 020
Advantages of femtosecond laser cataract surgery:
- maximum surgical precision
- minimal corneal contact
- enhanced patient safety
- reduced risk of postoperative complications
When should cataract surgery be performed?
At first, the clouding is unnoticeable and progresses slowly over years. Surgery is recommended once symptoms interfere with daily life.
You should not delay surgery too long, especially if you drive frequently. Poor vision increases accident risk. Elderly patients should also avoid postponing surgery due to a higher risk of falls.
Early-stage surgery is easier and carries fewer risks than advanced-stage procedures. As a general guideline, surgery is recommended when visual acuity drops below 70%.
Cost of cataract surgery in Germany
The cost of cataract surgery in Germany ranges from €1,000 to €3,000 per eye, depending on the type of intraocular lens and the surgical method.
Source: https://augenchirurgie.clinic/erkrankungen/grauer-star
https://www.augenklinik-wittenbergplatz.de/grauer-star-katarakt/
