Even in very elderly patients, cataract surgery can be suitable and worthwhile when cataracts severely restrict vision and quality of life.
Balancing benefits and risks
Decisions are personalised, taking into account frailty, life expectancy, and what matters most to the patient.
- Severe visual limitation affecting mobility, falls risk, or ability to see family
- Ability to cooperate with brief local anaesthetic or need for tailored anaesthesia
- Potential for meaningful visual gain based on retinal and optic nerve health
- Willingness to attend follow‑up appointments or have home‑visit support
- Collaborative discussion with family, carers, and medical teams when appropriate
When surgery may not be appropriate
Sometimes the burdens of surgery and aftercare outweigh likely gains.
- Advanced dementia or illness where drops and cooperation are not feasible
- Severe macular or optic nerve damage leaving little potential for improvement
- Very high anaesthetic risk for a patient who is not distressed by current vision
- Patient preference not to undergo further interventions
- Focus instead on low‑vision aids, lighting, and environmental adaptations
