Stages of Cataract Progression: Knowing Where You Are At and When to Get Surgery

Last Updated: August 21, 2024

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Your doctor uses a process called staging to understand when to take action on your cataracts. Doctors also use a system called grading to help guide their surgical approach.

The stages of cataracts include:

Stage 1: Early Cataracts – Slight blurry vision.
Stage 2: Immature Cataracts – Blurred vision in low-light.
Stage 3: Mature Cataracts – Difficulty driving at night.
Stage 4: Hypermature Cataracts – Eye appears yellow and cloudy.

Here’s what you need to know about these two important medical processes.

Key Facts
Cataract Stages
Cataract Pictures
Cataract Grading
Cataract Stages FAQs

Key Facts on Cataract Stages

By age 80, most people either have cataracts or have undergone cataract surgery.
After cataract surgery, 9 in 10 people can see better.
Cataracts usually begin to form when people are in their 40s. But most people don’t need surgery until their cataracts keep them from doing things they normally do (like driving at night).
More than 5 percent of Americans 40 and older have had lenses replaced due to cataracts.

old man with vision problems — It can be difficult to pinpoint exactly how, and how quickly, a cataract will progress, but the general rule is that when they form later in life and due to aging, they typically form slowly over a period of years, while those that begin earlier in life and due to other circumstances can progress more rapidly.

Cataract Stages 1 to 4

A general timeline for cataract progression is broken down between an early and a late stage. In the early stages, a cataract can be small and not impact vision too drastically. In the later stages, the eye can turn milky white, and vision can be significantly impaired.

This breakdown of common cataract stages can help you understand how these eye problems progress.

	Name	Description	Symptoms
Stage 1	Early Cataracts	Only minor changes to your eyes; hardly noticeable differences.	Slightly blurry vision, headaches, difficulty focusing
Stage 2	Immature Cataracts	The lens is growing cloudier and harder to see through; the pupil seems less clear.	Blurred vision especially in low-light conditions, difficulty with close work, including reading, headaches
Stage 3	Mature Cataracts	The cataracts are visibly larger; the pupil changes from a deep black to a deep green.	Blurred vision becomes more common, difficulty in activities like driving at night
Stage 4	Hypermature Cataracts	The eye appears yellow and clouded, significantly impacting appearance and vision.	Extremely blurred vision, eye color changes

Cataract Pictures by Stage

The CDC warns that cataracts are the number one cause of vision loss in the United States and blindness worldwide. If cataracts continue to progress without treatment, vision will worsen until the eye’s lens is so clouded that vision is significantly impaired or lost altogether.

Most adults, ages 65 and older, need eye exams every 1 to 2 years. Your doctor will use special tools to examine your eyes, and if cataracts are found, you can develop a treatment plan together. Your doctor might look for these symptoms to stage your cataracts.

Stage	What It Looks Like
1	Lens is clear, but there’s a subtle shading in the center. Pupil is still black.
2	Shading brightens to white in the center of the eye. Pupil is black around the edges.
3	Entire lens bulges a bit. Pupil shifts from black to green, with a brighter spot in the middle.
4	Lens swells even more, and it looks a little rough or crispy. It begins shifting from green to an amber color.

Happy Woman Enjoying Nature on meadow on top of mountain with sunrise. Outdoor. Freedom concept. — **Cataract Surgery**
Cataract eye surgery is a very common and medically necessary procedure to remove and replace the eye’s natural lens when the vision has been clouded by a cataract. We offer laser-assisted cataract surgery and lifestyle lenses as options for our patients.
Learn More

Cataract Grading

Cataract surgery is common and can be done in an hour or so. It is relatively fast-healing, safe, and widely accessible. An artificial lens can provide clarity and improve your quality of life, helping to restore vision.

Before your surgery, your eye doctor will grade your cataract. This process allows your doctor to understand how significant your cataract is and how it should be approached in surgery.

Grading is an art, and doctors use measurements and visual exams to get it right. Many different grading techniques exist, but most follow a progression from 1 to 5:

Grade 1: Your nucleus and the back of your eye are clear, but doctors can see a subtle cataract forming.
Grade 2: Your cataract is hardening, and your nucleus and the back of the eye are green or yellow instead of clear.
Grade 3: Your cataract hardens even more, and your nucleus and the back of the eye are yellow or a reddish-brown color.
Grade 4: Your cataract is very hard, and your nucleus and back of the eye are brownish-red or white.
Grade 5: Your cataract is very hard and pushing into the eye. The nucleus and back of the eye are black or white.

Again, cataracts often form slowly. As they do, your doctor can identify them and devise a treatment plan to delay their progression, manage your vision, and even replace the lens to restore and improve vision while removing the cataract completely.

Cataract Stages Frequently Asked Questions

At what stage should cataracts be removed?

Your ophthalmologist can help you determine when it is the right time for surgery. You may not need treatment in early stages, but waiting too long could impair your vision.

What is the last stage of a cataract?

The staging system only goes up to Stage 4 (or hypermature). Cataracts at this stage are deeply disabling, and you will need surgery to see clearly.

How quickly do cataracts progress?

Cataracts typically progress slowly. Cataracts can initially be managed with magnified prescription eyewear and polarized sunglasses, but these methods will often only delay the progression of the cataract and not stall it altogether. Cataract surgery is often the optimal choice for treating cataracts and improving vision.

How many stages of cataracts are there?

Doctors typically recognize four cataract stages.

References

Cataracts. (January 2023). National Eye Institute.
What Are Cataracts? (September 2022). American Academy of Ophthalmology.
Common Eye Disorders and Diseases. (December 2022). U.S. Centers for Disease Control and Prevention.
How Often Should I Have an Eye Exam? Prevent Blindness.
A Simple Pre-Operative Nuclear Classification Score (SPONCS) for Grading Cataract Hardness in Clinical Studies. (October 2020). Journal of Clinical Medicine.

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