Types of Cataracts
How Cataracts Form in the Eye's Lens
A cataract is a clouding of the eye's natural lens, the clear structure that sits just behind the iris and focuses light onto the retina at the back of the eye. Knowing where in the lens a cataract forms helps explain why different types cause different symptoms and progress at different rates.
The lens is made of water and proteins arranged in precise layers that keep it transparent. When light enters the eye, the lens bends it so it lands sharply on the retina, producing clear vision. The lens also adjusts its shape to shift focus between near and distant objects, a process called accommodation.
The lens has three main regions: the nucleus at the center, the cortex in the surrounding fibers, and the posterior capsule on the back surface. Different risk factors affect each zone differently. Age-related protein changes tend to begin in the nucleus. Ultraviolet light exposure and elevated blood sugar more commonly affect the cortex. Long-term corticosteroid use and certain medical conditions are linked to changes at the back surface of the lens. Because the zones are distinct, the symptoms that develop also differ depending on where clouding first appears.
Regardless of type or location, all cataracts reduce the amount and quality of light that reaches the retina. No eye drop, supplement, or medication can reverse a cataract or stop it from progressing once it has formed. The only effective treatment is surgical removal of the clouded lens and replacement with a clear intraocular lens (IOL), a small artificial lens implanted inside the eye. Surgery is recommended when vision loss begins to interfere with the activities that matter most to you.
Nuclear Sclerotic Cataracts
Nuclear sclerotic cataracts are the most common form of age-related cataract. They develop gradually in the center of the lens and are often the first type of cataract that people experience as they grow older.
As a nuclear cataract forms, the center of the lens slowly hardens and takes on a yellow or amber hue. In advanced cases, it can become brown. This color shift alters how the eye perceives contrast and color, though the change is usually so gradual that many people do not notice it until it is quite pronounced. A cataract surgeon identifies nuclear cataracts during a slit-lamp examination, an exam that uses a bright light and magnification to inspect the lens in detail.
Nuclear cataracts most noticeably reduce distance vision in the early stages. They can also cause colors to look faded or yellowed and make it harder to see clearly in dim light. An interesting early effect called 'second sight' sometimes occurs, where the hardening nucleus temporarily increases the lens's focusing power and briefly improves near vision. This change is not permanent and reverses as the cataract continues to develop.
Because nuclear cataracts progress slowly, many people can manage the early stages with an updated glasses prescription for a period of time before surgery becomes necessary. Surgery becomes the recommended next step when vision changes begin to affect driving, reading, or other daily activities. The gradual nature of this cataract type generally allows time to plan surgery at a pace that fits your schedule and lifestyle.
Cortical Cataracts
Cortical cataracts form in the outer fibers of the lens, the layer surrounding the nucleus. They tend to be associated with specific risk factors and produce a characteristic type of visual disturbance that can be particularly noticeable at night.
Under examination, cortical cataracts appear as white, wedge-shaped or spoke-like streaks that radiate from the outer edge of the lens toward the center. A cataract surgeon can detect these patterns during a dilated eye exam long before they affect central vision. As the spokes extend inward toward the visual axis, the point directly in line with the pupil, they begin to interfere more significantly with vision.
The hallmark symptom of cortical cataracts is glare, which is most disruptive when driving at night and facing oncoming headlights. Light scatters as it passes through the spoke-like opacities, creating halos or streaks around light sources. UV-B exposure and diabetes are more closely linked to cortical cataracts than to other types, so patients with these risk factors may benefit from earlier and more frequent monitoring. Color perception may also fade gradually over time.
Cortical cataracts vary in how quickly they progress. Some remain at the periphery of the lens for years without affecting central vision, while others advance toward the visual axis more quickly. Your cataract surgeon monitors progression at regular visits and recommends surgery when the opacities begin to interfere with function. In the meantime, anti-glare coatings on glasses can offer some relief from nighttime glare.
Posterior Subcapsular Cataracts
Posterior subcapsular cataracts, often abbreviated as PSC, form on the back inner surface of the lens directly in the central path of incoming light. Even a small PSC can cause significant visual symptoms because of its location, and this type tends to progress more quickly than nuclear or cortical cataracts.
A PSC appears as a granular or plaque-like opacity on the back surface of the lens. Because it sits in the central light pathway, it affects vision early and noticeably, even when it is still quite small. PSC is the cataract type most closely associated with long-term corticosteroid use in any form, including oral, inhaled, and topical preparations, as well as with diabetes, prior eye injury, and radiation exposure.
PSC cataracts tend to affect near vision more than distance vision, making reading and close-up tasks particularly difficult. Bright light causes severe glare because it focuses directly through the opacity, which means vision can actually feel worse in sunny conditions than in softer indoor lighting. This pattern is the opposite of what most people with nuclear cataracts experience and can be a useful clue for your cataract surgeon during evaluation.
- Reading and screen use become difficult earlier in the course of PSC than with other cataract types
- Bright sunlight, headlights, and overhead lighting can cause significant discomfort and glare
- Patients who use corticosteroids regularly for conditions such as asthma or arthritis are at elevated risk and should have their lens monitored regularly
Because PSC can advance from a mild opacity to a visually significant one in months rather than years, your cataract surgeon may recommend surgery sooner than they would for other cataract types. The impact on reading and bright-light situations can be substantial even at an early stage. Regular monitoring is especially important for patients with ongoing corticosteroid use or other known risk factors.
Other Types of Cataracts
While age-related cataracts are the most common, cataracts can also develop in children, after eye injuries, and as a result of other medical conditions or treatments. These types require the same careful evaluation as age-related cataracts, with attention to the specific cause and circumstances.
Congenital cataracts are present at birth or develop in early childhood. They can result from genetic mutations, chromosomal conditions, metabolic disorders such as galactosemia, or infections during pregnancy. Early detection is critical. If a cataract prevents normal visual development in an infant or young child, amblyopia (sometimes called lazy eye) can develop, a condition in which the visual pathways in the brain do not form properly because the eye is not receiving a clear image. Prompt treatment and rehabilitation are essential in pediatric cataract cases.
Cataracts can form after blunt trauma, penetrating eye injuries, chemical burns, electric shock, or radiation. A blunt injury often produces a distinctive rosette or petal-shaped opacity within the lens. A cataract may appear shortly after the injury or develop years later, depending on whether the lens capsule was damaged at the time. Surgical planning for traumatic cataracts can be more complex when the lens capsule or supporting structures were affected by the original injury.
Secondary cataracts develop as a result of other eye conditions or treatments, including chronic uveitis (persistent inflammation inside the eye), long-term corticosteroid use, or radiation therapy directed near the eye. The term 'secondary cataract' is also used informally to describe posterior capsule opacification (PCO), a separate condition that can occur months or years after cataract surgery when cells grow on the capsule left behind to support the IOL. PCO is not a true cataract and is treated quickly and painlessly with a brief in-office laser procedure.
Cataract Surgery at Our Practice
At Associated Eye Physicians & Surgeons of NJ, our cataract surgeons offer laser-assisted cataract surgery with a range of premium intraocular lens options. Every patient's surgical and lens plan is developed in close consultation with their cataract surgeon based on their individual eye anatomy, lifestyle, and vision goals.
Laser-assisted cataract surgery uses a precisely guided laser to perform key steps of the procedure, including creating the incisions and softening the lens before it is removed. Dr. Garrana, our cataract surgeon with fellowship training in cornea and refractive surgery, performs laser-assisted cataract surgery for patients across our practice. The laser component is designed to add a level of precision that supports consistent, reproducible outcomes, though individual results always depend on each patient's unique eye health.
After the clouded natural lens is removed, a clear intraocular lens (IOL) is placed inside the eye to restore focus. Standard IOLs correct vision at one distance, while premium IOLs are designed to address a broader range of distances and, in some cases, correct astigmatism. Dr. Hershkin, our cataract surgeon with fellowship training in premium IOL selection, works with patients to identify the lens that fits their visual priorities and overall eye health. The choice of IOL is always made together with your surgeon and is based on your personal eye measurements, lifestyle needs, and expectations. We do not guarantee that any lens will eliminate the need for glasses entirely, as outcomes vary from person to person.
Our practice offers an IOL Guide to help patients learn about their lens options before their surgical consultation.
For patients who have both cataracts and glaucoma, cataract surgery can sometimes be combined with a glaucoma procedure at the same time. This approach, which may include Minimally Invasive Glaucoma Surgery (MIGS), can reduce the number of separate procedures a patient needs. Dr. Tchorbajian, Dr. Natale, and Dr. Hosler all evaluate patients for cataract consultations and can help coordinate care when both conditions are present.
Dry eye is common among cataract patients and can affect both the accuracy of pre-surgical measurements and the comfort of recovery. Our team evaluates dry eye as part of the cataract workup and addresses it as needed before and after surgery. Treating dry eye before surgery helps ensure the measurements taken to select your IOL are as precise as possible.
Frequently Asked Questions
These questions address common points of confusion or concern that come up after learning about cataract types, and offer practical guidance for your next steps.
Yes, and this is actually quite common. Most cataracts involve a combination of types, with one pattern tending to drive the main symptoms. Your cataract surgeon identifies which type is most affecting your vision and uses that to guide the conversation about timing and treatment. Regardless of how many types are present, surgery removes the entire natural lens and replaces it with a clear IOL, so the procedure addresses all of them at once.
It can influence the timing. Posterior subcapsular cataracts often progress quickly and affect reading and bright-light vision early, which may lead to an earlier recommendation for surgery. Nuclear cataracts develop slowly, and many patients manage them with updated glasses for a period of time. Ultimately, surgery is recommended based on how much your vision loss affects the activities that matter to you, not on the cataract type in isolation. Your cataract surgeon will walk you through the considerations specific to your situation.
Yes. Your cataract surgeon identifies the type during a dilated slit-lamp exam and can explain what they found in plain language. Knowing your cataract type helps you understand which symptoms to expect as it develops, why certain tasks are harder than others, and what the likely timeline looks like before surgery becomes necessary. Asking questions at your exam is encouraged.
The core procedure, phacoemulsification with IOL implantation, is used for all cataract types. However, some variations require added attention. Dense nuclear cataracts may need more ultrasound energy to break apart the hardened center. Traumatic cataracts may involve weakened support structures inside the eye that require a modified technique. Your cataract surgeon reviews your full eye health history before surgery and tailors the approach to your specific anatomy.
No supplement or treatment has been proven to stop cataracts from forming or progressing. That said, protecting your eyes from UV light with sunglasses that block UV-B rays, avoiding smoking, managing blood sugar if you have diabetes, and using corticosteroids only as directed by your physician may all play a role in reducing risk factors associated with certain cataract types. Regular eye exams after age 40 allow early detection and help your care team track any changes over time.
After cataract surgery, some patients notice their vision becoming hazy again months or years later. This is called posterior capsule opacification (PCO), and it happens when cells grow on the thin capsule that was left in place to hold the IOL. PCO is not a new cataract and is not related to the original cataract type. It is treated with a brief, painless in-office laser procedure that clears the clouding quickly, and the improvement is typically immediate.
Schedule Your Cataract Evaluation
If you have noticed changes in your vision, increased glare, or difficulty with activities you once found easy, a comprehensive eye exam is the right first step. The cataract surgeons at Associated Eye Physicians & Surgeons of New Jersey serve patients across New Jersey with fellowship-trained expertise in laser-assisted cataract surgery and premium intraocular lens selection. We welcome you to contact one of our offices to schedule a cataract evaluation and begin the conversation about what treatment may be right for your eyes.
I adore Dr Khan. He has been my Dr. since 2020 and I highly recommend him to anyone. He does my regular check-ups, helps me manage my chronic eye issues, did my cataract surgeries and did my corrective lenses.
Lara Corsets
My experience at Re Focus was great . Waiting time was short, staff was also professional . They have optical shop as well. Highly recommend
Marianne
Dr. Hosler is the best.
Alan Serrins
Dr. Garrana is fantastic! She gave very clear and thoughtful instructions for pre and post surgery. she is very responsive even outside of office hours. I Would highly recommend if anyone wants to get lasik surgery.
Lynn W.
Doc Hosler is the best! Dr. Kahn also on the list. Lucky to have them locally.
Patti DeSena