top of page

Ask the Expert: When does a cataract require surgery?

Answers provided by Dr. Mitchell Gossman, M.D., ophthalmologist at Eye Associates of Central Minnesota, St. Cloud

If left untreated, cataracts leave a white appearance on the pupil (as pictured). Most cataracts cannot be seen with the naked eye. Contributed photo

Question: When does a cataract require surgery?

Answer: A cataract is a cloudiness of the natural lens within the eye that develops normally with aging. This lens focuses light, and cloudiness in the lens produces blurry vision. The cataract of the eye is in this way much like a smudged camera lens – both produce a blurry image. However, the blurry image does nothing to actually harm the eye or the camera. Therefore, it is possible to have an advanced cataract with very blurry vision to the point where you are unable to read and drive, and yet the eye is otherwise unharmed. But do you want to have blurry vision or have a camera that takes blurry pictures? Of course not. So, the time that a patient may be a candidate for cataract surgery is when the blurry vision causes symptoms that interfere with activities of daily life. Things that may be affected are driving, reading, performing your job, recreational activities and hobbies. Once the effects of blurry vision interfere with your quality of life it is a good time to consider surgery and weigh the benefits versus the risks of surgery, something to discuss with your eye doctor. Cataract surgery is “elective” which means the person making the decision when to do surgery is you, the patient. It is uncommon for a cataract to “require” surgery for medical reasons.

Question: When would a cataract in fact “require” surgery?

Answer: Under some situations, it is possible for the clouded lens to become thicker and affect the drainage channels within the eye to become obstructed with resulting high pressure and threat of loss of vision from glaucoma. In this case, surgery may be strongly recommended to correct this. Another situation is a cataract that is becoming far advanced such that it is becoming more challenging to remove, in which case a patient might be asked to factor this into their decision making. Finally, if a cataract progresses to a certain stage, it may cause the vision on the eye chart to decrease to worse than the legal minimum required to hold an unrestricted driver’s license. Even in that situation, it is not medically necessary to have surgery, but a patient might be more inclined to ask for surgery when the driver’s license is threatened.

Question: We used to hear about cataracts needing to be “ripe” and that surgery involved having sandbags placed around the head afterward, is this still true?

Answer: It used to be so. A cataract had to be advanced far enough that it was removable with less advanced methods, and this required a cataract to become liquefied, i.e. “ripe,” before removing it. Also, before the days of modern surgery with the ability to use sutures to close incisions or have sutureless incisions, the eye had to be left to heal with a minimum of head movement. Sand bags were used to immobilize the head while being hospitalized.

Question: Are there any limitations on physical activity after cataract surgery?

Answer: This depends on the surgeon, his or her technique, and opinions on this matter. Some limit the amount a patient may lift, restrict bending over, and minimize general physical activity. Generally, we at Eye Associates impose no limits of physical activity after routine cataract surgery.

Find Out More

Dr. Mitchell Gossman and Dr. Andrea Joplin, ophthalmologists at Eye Associates of Central Minnesota, can diagnose and treat cataracts. The office is located at 628 Roosevelt Road, Suite 101, in St. Cloud. To make an appointment or to learn more, call 320-774-3789 or email

5 views0 comments

Recent Posts

See All


bottom of page