There are several causes of cataracts, although in the United States, age is the leading factor. (Learn More) Most people who develop cataracts receive their diagnosis after age 40; they will not need treatment beyond regular eye exams and some lifestyle changes until they are at least 60 years old.
There are some types of cataracts that can progress more rapidly, requiring treatment within a few years of the initial diagnosis, rather than decades. These cataracts are more likely to occur in younger adults, and they are more likely to be caused by trauma, illness, or radiation exposure than just age.
We’ll help you learn more about fast-developing cataracts and how they are treated. Ultimately, they will be treated with surgery. (Learn More) Cataract surgery has a great track record of success, improving vision and preventing blindness. You may end up getting surgery sooner with rapidly developing cataracts compared to other types.
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What Causes Cataracts?
Cataracts are a condition affecting the lens of the eye due to several factors, including age and trauma. Generally, this condition clouds the lens of the eye, leading to white, yellow, or even brown pigment of the lens. This leads to blurry, fuzzy, grainy, or yellowed vision, or spots in the eye, making it hard to see some areas in the field of vision.
Most people believe that cataracts are a slow-moving, progressive disease. In many instances, this is true. Especially among people who develop cataracts from aging, symptoms will not begin to limit lifestyle or safety until age 60 or older.
However, anything that damages the proteins in the lens, leading to changes, can cause cataracts. Sometimes this takes decades, but in some cases, progression can be rapid. Other causes of cataracts include:
- Trauma to the eye or head.
- Corticosteroid medications.
- Radiation exposure or treatments.
- Some genetic conditions.
- Consistent, long-term exposure to ultraviolet (UV) light.
- Smoking cigarettes, drinking too much alcohol, and some other forms of substance abuse.
There are several types of cataracts, based on where in the lens the condition begins to form. These include:
- Nuclear cataracts, which begin in the center of the lens and spread out.
- Cortical cataracts, which begin at the edges of the lens and move inward.
- Posterior subcapsular cataracts (PSC), which develop on the bottom of the lens.
- Congenital cataracts, which are formed in utero.
Of these, PSCs develop fastest. With any cataract diagnosis, it is important to make lifestyle changes like quitting smoking and wearing sunglasses to protect against UV radiation, and it is important to vision your eye doctor regularly to monitor the progression of the cataract. However, posterior subcapsular cataracts require more aggressive approaches, and they may lead to surgery faster than other types of cataracts.
Posterior Subcapsular Cataracts (PSCs)
The opaque or damaged area of the lens in a PSC is located directly under the lens capsule. While other types of cataracts are either formed in utero or develop with age, posterior subcapsular cataracts typically appear in younger adults, and they are more likely to be the result of trauma, disease, or radiation exposure. While they may appear similar to nuclear cataracts at first, PSCs move faster.
Symptoms most often associated with posterior subcapsular cataracts include:
- Glare or halos.
- Difficulty focusing up close, similar to farsightedness.
- Rapidly diminishing vision.
Illnesses, especially when untreated, can impact vision and cause cataracts. Diabetes is one of these diseases, and a diabetic snowflake cataract is a rapidly progressing problem. These are a specific type of subcapsular cataract, which form striations in a ring in the lens that appear to have a snowflake shape.
This snowflake shape forms in younger diabetic patients who experience more fluid pressure or stress due to the accumulation of sorbitol, a sugar molecule, in the lens after consistently elevated blood sugar. Diabetic snowflakes are a particular risk among younger diabetes patients who have type 1 diabetes, with very elevated blood sugar that may be difficult to control.
In many cases, an accident leading to head or ocular trauma can result in a cataract because the proteins in the lens are damaged. While this is not likely to happen within days or even months after the trauma, it may occur a few years after the experience. Most traumatic cataracts take decades to form, but each trauma is unique, and each person’s biology deals with this tissue damage differently.
- Visual acuity test: This is the classic eye chart with a series of letters in different sizes to measure how well you can see. Starting here, your eye doctor will be able to compare your current eye chart results with previous tests and understand how your vision has been impacted. They can then determine what other tests to run, to understand if this problem is progressing rapidly or slowly.
- Dilated eye exam: Your eye doctor will use special eye drops to dilate your pupils, allowing them to see into the back of your eye, including the organs and vasculature in the eye. The doctor will examine your retina and optic nerve for damage to rule out severe trauma that may cause vision changes. While your eyes are dilated, they may be able to see whitening, spotted, streaked, or yellowing areas in your lens, which they can diagnose as potential cataract.
- Tonometry: This test may involve numbing drops placed into the eye; then, an instrument is applied directly to the eye itself to measure internal pressure. High pressure is a glaucoma risk, or it may be related to other problems like a recent accident. This test can help your eye doctor know whether your vision changes are related to another condition besides cataracts.
How Will Your Eye Doctor Determine Your Cataracts Are Fast-Developing?
The only way to determine if any kind of cataract is fast-moving is with regular eye exams. Your eye doctor will use some diagnostic tests to determine if your vision problems are caused by a cataract.
Once you receive an accurate diagnosis and you learn that you do have cataracts, your ophthalmologist will determine what type of cataracts are affecting your vision based on their shape and location in your lens. This may also be based on your age, if you have had an accident or illness that impacts your vision, and how rapidly your vision changes.
If your cataracts advance rapidly — particularly a risk in cataracts that form in people under the age of 40 — then your doctor may monitor them for a little while, but they are more likely to recommend surgery sooner. All cataracts, whether they advance slowly or quickly, will result in surgery at some point because the lens will be too cloudy or yellowed for vision to function normally. However, in people under the age of 40, and who have the above listed types of cataracts, surgery may be the preferred treatment compared to monitoring the progress of the cataracts for years.
Cataracts: Overview. (June 23, 2018). Mayo Clinic.
What Are Cataracts? Wilmer Eye Institute, Johns Hopkins Medicine.
Cataract. (June 17, 2018). EyeWiki, American Association of Ophthalmology (AAO).
Management of Traumatic Cataract. (August 2016). American Association of Ophthalmology (AAO).