GPAtlas🧭 When to suspect
Suspect cataract in an older adult presenting with gradual, painless blurring, glare and haloes around lights (classically oncoming headlights at night), dulled or yellowed colours, and worse vision in bright sunlight. A cataract is simply an opacity of the crystalline lens; it is the commonest cause of treatable visual impairment in UK adults, and cataract surgery is the most frequently performed operation in the NHS.
Raise suspicion particularly in those with increasing age, smoking, diabetes, long-term corticosteroids (oral, high-dose inhaled, or topical/periocular), high myopia, previous ocular trauma or surgery, and a family history. In an infant, suspect congenital cataract where there are concerns about vision from birth or a white pupil.
| Morphological type | Typical association | Clinical clue |
|---|---|---|
| Nuclear sclerotic | Ageing (most common) | Gradual blur, faded colours, and an index myopic shift – the "second sight" in which a presbyope can briefly read without glasses |
| Cortical | Ageing, diabetes | Spoke-like opacities; glare and haloes are prominent |
| Posterior subcapsular | Corticosteroids, diabetes, younger patients | Faster progression; disproportionate glare and difficulty with near vision (reading, bright light) |
Source: NICE NG77 · Royal College of Ophthalmologists
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