Cataracts in the Adult Eye

Publication Date: November 11, 2021


Symptomatic cataract is a surgical disease. Dietary intake and nutritional supplements have demonstrated minimal to no effect in the prevention or treatment of cataract.

The standard of care in cataract surgery in the United States is a small-incision phacoemulsification with foldable intraocular lens (IOL) implantation. It is a standard of care that has withstood the test of time.

Refractive cataract surgery has the potential to reduce a patient’s dependence on eyeglasses and contact lenses for distance, intermediate, and near vision.

Intraocular lens technologies and surgical approaches to implanting lenses continue to improve.

Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and reduces the amount of ultrasonic energy required to remove a cataract. However, the technology may not yet be cost-effective, and the overall risk profile has not yet been shown to be superior to that of standard phacoemulsification.

The use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) is controversial, with evidence suggesting that NSAIDS only be used for the prevention of cystoid macular edema (CME) in patients with diabetic retinopathy or other high-risk ocular comorbidities.

Increasing evidence demonstrates that intracameral antibiotics reduce the risk of postoperative bacterial endophthalmitis.

Surgeons should recognize and prepare to manage high-risk characteristics that may complicate cataract surgery. New risks may become apparent as new technologies come to market. One example is capsular damage with rapid development of a complicated cataract associated with intravitreal injections.

Toxic anterior segment syndrome (TASS) may be confused with infectious endophthalmitis. However, TASS has an earlier onset, is associated with limbus-to-limbus corneal edema, and responds to corticosteroids.

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Recommendation Grading




Cataracts in the Adult Eye

Authoring Organization

Publication Month/Year

November 11, 2021

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Optometrist, nurse, nurse practitioner, physician, physician assistant


Prevention, Management

Diseases/Conditions (MeSH)

D002386 - Cataract


cataract, eye exam, blurred vision, eye disease, vision loss

Source Citation

Kevin M. Miller, Thomas A. Oetting, James P. Tweeten, Kristin Carter, Bryan S. Lee, Shawn R. Lin, Afshan A. Nanji, Neal H. Shorstein, David C. Musch, Cataract in the Adult Eye Preferred Practice Pattern, Ophthalmology, 2021, ISSN 0161-6420,