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.
• 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.
Cataract surgery is the most frequently performed operation in the NHS.
Raise suspicion particularly in those with:
• Increasing age, smoking or diabetes.
• Long-term corticosteroids (oral, high-dose inhaled, or topical/periocular).
• High myopia or previous ocular trauma or surgery.
• 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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