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What Are the Different Types of Cataracts?
By Dr. Mayank Bansal | MD (AIIMS, New Delhi) | FRCS (Glasgow) | Cataract and Retina Specialist,
Claritas Eye and Retina Institute, Panchsheel Enclave, New Delhi
I have been treating cataract patients for over 15 years now. And in all that time, one thing has stayed consistent. Most patients who walk into my clinic already know they have a cataract. What they almost never know is what kind.
That distinction matters more than people realise.
The type of cataract you have determines how fast your vision is likely to worsen, which symptoms you will notice first, and what your surgical plan should look like. It also explains why two people with cataracts can have completely different experiences. One patient might struggle to read a newspaper. Another might find night driving nearly impossible. A third might not notice much at first, and then suddenly lose significant vision within a few months.
Same diagnosis. Completely different experience. Because the type of cataract is different.
In this post, I want to walk you through each type in plain language so you understand what is happening inside your eye, what to watch for, and when it is time to take action.
Book a Cataract Consultation with Dr. Mayank Bansal
at Claritas Eye and Retina Institute, Delhi
Nuclear Cataract: The Most Common Age-Related Type
If you are over 50 and your vision has been getting gradually hazier over the past few years, there is a good chance you are dealing with a nuclear cataract.
This is by far the most common type I see at our eye hospital in Delhi. Nuclear cataracts develop in the central part of the lens, called the nucleus. Over time, this central zone becomes harder, denser, and progressively more yellow or brown in colour. It is a slow process. Most patients with nuclear cataracts notice the change happening across months and years, not days.
What makes nuclear cataracts a little tricky in the early stages is something called “second sight.” As the nucleus hardens, it temporarily increases the focusing power of the lens. Some patients find that their reading glasses, which they have used for years, suddenly do not seem necessary anymore. This feels like good news. It is not. It is simply a sign that the cataract is progressing, and this temporary clarity rarely lasts.
The most common symptoms patients describe to me:
Colours begin to look more washed out or yellowish. Driving at night becomes uncomfortable because of glare. Distance vision gets progressively blurry. Reading may feel easier at first, then harder again as the cataract advances.
Nuclear cataracts are strongly linked to age, but smoking, prolonged UV exposure, and certain medications can accelerate their development significantly.
The good news is that nuclear cataracts respond exceptionally well to surgery. Because they progress slowly, most patients have time to plan the procedure without urgency. That said, I always advise not to wait until vision is severely affected. The denser and harder the nucleus becomes, the more technically demanding the surgery, and the longer the recovery.
Cortical Cataract: The Spoke-Like Opacity
Cortical cataracts are easier to describe visually than they are to explain. Imagine looking at a bicycle wheel. The spokes radiate outward from a central hub. That is almost exactly what a cortical cataract looks like to an ophthalmologist examining your eye.
These cataracts begin at the outer edge of the lens, in a layer called the cortex, and extend inward toward the centre in spoke-like streaks. Because of where they sit, cortical cataracts interfere particularly with the way light enters the eye and scatters within it.
The symptom that brings most patients with cortical cataracts to my clinic is glare. Bright lights, especially at night, become almost unbearable. Headlights from oncoming vehicles create halos that make driving genuinely dangerous. Contrast sensitivity, meaning the ability to distinguish objects from their background, also reduces significantly.
Cortical cataracts are more common in people with diabetes, and research has shown a clear link between blood sugar control and the rate at which cortical opacities develop. They are also more common in people with prolonged sun exposure without proper eye protection.
One thing worth knowing about cortical cataracts is that they can be somewhat unpredictable. In some patients they progress very slowly. In others they move faster. Regular monitoring by an eye specialist is important if you have been diagnosed with this type.
Surgical outcomes for cortical cataracts are excellent. Removing the clouded cortical material and replacing it with a clear intraocular lens restores vision very effectively in the vast majority of cases.
Posterior Subcapsular Cataract: The Fastest Progressing Type
Of all the types I discuss with patients, posterior subcapsular cataract, commonly shortened to PSC, is the one that requires the most urgency. And it is often the most frustrating because it tends to affect people who are younger than the typical cataract patient.
PSC develops on the back surface of the lens, directly in the path of light travelling to the retina. Because of this location, even a small cloudy patch causes symptoms that are disproportionately severe. A patient with a mild-looking PSC on examination might have vision significantly more affected than a patient with a much larger nuclear cataract.
The hallmark symptoms of PSC are difficulty reading and near work, severe glare in bright sunlight or artificial light, and halos around lights at night. Many patients notice that their vision actually seems worse in bright conditions, which is the opposite of what most people expect with eye problems.
PSC is closely associated with long-term steroid use, whether in the form of tablets, inhalers, nasal sprays, or even topical creams used over many years. I see a significant number of PSC cases in patients with asthma, rheumatoid arthritis, and other conditions requiring long-term steroid treatment. Patients with diabetes and those who have had prior eye inflammation are also at higher risk.
What makes PSC particularly important to address promptly is the speed of progression. While nuclear cataracts may take years to significantly affect vision, PSC can progress noticeably within months. If you have been diagnosed with this type, I would not recommend adopting a “wait and see” approach for too long.
Cataract surgery in Delhi for PSC has excellent outcomes. Because these cataracts tend to affect patients in their 40s and 50s, many opt for premium intraocular lenses that reduce or eliminate the need for glasses after surgery entirely.
Other Types of Cataracts You Should Know
Beyond the three primary types, there are several other forms of cataracts that deserve mention. I see these less frequently, but understanding them is important.
- Congenital Cataracts
Some children are born with cataracts, or develop them in the first year of life. These are called congenital cataracts and they require prompt treatment. If left untreated, they can prevent the visual system from developing properly, a condition called amblyopia or lazy eye. When a child is diagnosed with a congenital cataract, early surgery followed by proper visual rehabilitation is critical.
- Traumatic Cataracts
A significant blow to the eye, a penetrating injury, or exposure to certain chemicals can cause what we call traumatic cataracts. I have treated these in patients ranging from young athletes to people involved in workplace accidents. These can develop immediately after an injury or, in some cases, years later. If you have had any significant eye injury in the past, regular eye examinations are worth doing.
- Secondary Cataracts
This is perhaps the most misunderstood type. Secondary cataracts, medically called posterior capsule opacification or PCO, are not actually cataracts in the traditional sense. They occur after cataract surgery when the thin membrane behind the new intraocular lens becomes cloudy over time. Patients often think their original cataract has come back. It has not. PCO is treated very simply in clinic with a quick, painless laser procedure called YAG laser capsulotomy. It takes a few minutes and vision typically improves within a day or two.
- Radiation Cataracts
People who have undergone radiation therapy to the head or neck area, or who have had significant radiation exposure, can develop cataracts as a delayed effect. These typically develop years after exposure and are an important reason why regular eye check-ups are recommended for cancer survivors.
How Is Cataract Type Diagnosed?
A cataract cannot be properly diagnosed or classified without a dilated eye examination. This is something I want to emphasise clearly, because a standard vision test at an optician will tell you that your vision has changed. It will not tell you why, how advanced the cataract is, or what type it is.
At Claritas, a cataract evaluation typically involves:
- Slit-lamp examination: A specialised microscope that allows me to examine the lens in detail, identify the location and pattern of the opacity, and classify the cataract type accurately.
- Dilated fundus examination: We dilate the pupil with eye drops to get a complete view of the lens and the retina behind it. This is important because cataracts and retinal conditions can coexist, and I need to be sure that the retina is healthy before recommending surgery.
- Biometry and IOL calculation: If surgery is being planned, we take precise measurements of your eye to calculate the power of the intraocular lens that will give you the best vision outcome after surgery.
- OCT scanning where indicated: In patients with diabetes or other risk factors, we may use optical coherence tomography to check for any retinal issues such as macular degeneration or diabetic changes that might affect the surgical outcome.
The entire evaluation typically takes about 45 minutes to an hour. I always make time to sit with patients and explain exactly what I have found, what it means for their vision, and what I recommend going forward.
When Should You Consider Cataract Surgery?
This is the question I get asked most often, and my answer is always the same: when the cataract is affecting your quality of life in a meaningful way.
There is no universal timeline. I have patients in their 60s with nuclear cataracts who are functioning perfectly well and are happy to monitor for another year. I have patients in their 50s with PSC who cannot safely drive and need surgery within weeks of diagnosis.
That said, here are the situations where I typically recommend not waiting:
Your vision has dropped below the legal standard for driving and you are still driving. Night driving has become genuinely dangerous due to glare and halos. You cannot carry out your daily work or hobbies because of vision deterioration. You are at risk of falls because of poor depth perception. You have been diagnosed with a PSC cataract that is progressing quickly.
On the other hand, if your cataract is mild, stable, and not significantly affecting your daily activities, regular monitoring every six to twelve months is a perfectly reasonable approach.
The cataract surgery cost at Claritas is transparent and discussed in detail before any decision is made. We offer a range of intraocular lens options to suit different lifestyles and budgets, and I always take the time to explain the pros and cons of each so patients can make an informed choice.
Modern cataract surgery is one of the most successful procedures in all of medicine. At Claritas, we perform bladeless micro-incisional cataract surgery using the latest phacoemulsification technology. The procedure takes approximately 15 minutes, is performed under local anaesthesia, and most patients notice significant improvement in vision within 24 to 48 hours.
Complications are rare but real, and I always discuss them honestly with every patient. The most important thing is that you are well-informed before you agree to proceed.
FAQs
How many types of cataracts are there?
Which type of cataract is most dangerous?
Can cataracts be treated without surgery?
At what age do cataracts typically develop?
What is the difference between a cataract and a secondary cataract?
Is cataract surgery safe for elderly patients?
How do I know which type of cataract I have?
You cannot tell from symptoms alone. You need a proper slit-lamp examination with dilated pupils done by an ophthalmologist. If you are in Delhi, visit us at Claritas Eye and Retina Institute for a full cataract evaluation. We will tell you exactly what type you have, how advanced it is, and what we recommend.
Disclaimer:
The information shared in this content is for educational purposes and not for promotional use.