Cataracts—a clouding of the lens in your eye—are the leading cause of blindness worldwide and in the United States, with an estimated 24 million Americans who have been diagnosed with cataracts, according to the National Institutes of Health. Hundreds of thousands of patients in the Military Health System are impacted each year by the condition.

According to the Defense Health Agency’s Vision Center of Excellence, there were 732,155 patients seen with cataracts throughout the MHS in 2020, and 804,730 patients with cataracts in 2021. In those two years, 225,275 cataract surgeries were performed on MHS patients.

A cataract can be very common as a person gets older. Most cataracts develop when aging or injury changes the tissue that makes up the eye's lens. Cataracts causes vision to become hazy or cloudy.

“Eye injuries are not much more common in the Military Health System than in the general population except in times of high military activity,” says Dr. David Eliason, deputy branch chief, VCE. “The majority of injuries among our patients currently occur at the workplace and at home in recreational and everyday activities.”

Service Members at Higher Risk for Eye Injuries

The condition can be the result of other eye injuries, with combat and traumatic injuries being the most common in service members.

According to a VCE study using data evidence from the Defense and Veterans Eye Injury Vision Registry, eye injuries in service members are most frequently associated with traumatic cataracts are blunt and penetrating injuries.

About 62% of workplace traumatic eye injuries happen on the battlefield, with 28% of injuries occurring during noncombat work and training. Recreational eye injuries occurred in 9% and assault-related injuries in 1% of circumstances, according to the VCE.

Due to the nature of serving in the military, service members are more likely to experience injury, particularly to their vision, than their civilian counterparts, according to the VCE. Cataracts occurring in military trauma can often lead to the loss of vision in one or both eyes, significantly impacting quality of life and medical readiness.

According to a study by VCE researchers, eye trauma affects young males more frequently than females in the military, partially due to more males than females serving.

U.S. Army and U.S. Marine service members, who are more exposed to close combat are at the highest risk of acquiring traumatic cataracts.

Following battlefield injury, occupational exposure to trauma is the second most common source of eye injuries, accounting for a little over 28% cause of cataracts to service members.

Symptoms of a traumatic eye injury can be a misshapen eye, eye pain, bleeding, swelling, inability to see well or to see at all or a swollen lens.

Cataracts Typical in Retiree Populations

Eliason said many patients with cataracts are over the age of 65, adding that cataracts are the leading cause of vision loss as people age. Less than 1% of cataracts in the MHS are in patients under the age of 40.

The most common types of the condition in the MHS are age-related. Less common, but still not infrequently diagnosed are cataracts associated with diabetes or steroid use.

Service Members Can Prevent Cataracts and Eye Injuries

Activity specific eye protection are key to avoiding eye injuries, as ‘an ounce of prevention is worth a pound of cure’,” says Eliason. “Wearing safety glasses is a worthwhile precaution not just on a job site but also for activities around the home such as yardwork and shop or garage work. The majority of superficial, or minor, eye injuries could be avoided with proper eye protection.”

In contrast, there is no equipment that can prevent the formation of cataracts as they are largely a consequence of genetic factors, disease, and aging.

“The nature of the environment in which service members work is not free of hazards. Service members need constant reminders regarding the use of eye protection and ocular safety as well as leadership enforcement to help prevent avoidable trauma,” Dr. Mariia Viswanathan, vision care research and readiness section chief of the DHA’s VCE.

“What worked today might not be working tomorrow. Changing environments bring a need to constant evaluation and adaptation of our protective material.”

Tips to Prevent Cataracts and Protect Eye Health

• Wear protective eyewear: When engaging in activities that pose a risk of eye injury, such as combat or training exercises, wearing appropriate eye protection can help prevent traumatic injuries that may increase the risk of cataracts. “While all service members need to use eye protection, this is especially true for the highest-risk population: ground, close-combat troops,” said Viswanathan. All eyewear used on duty must be approved by the Department of Defense or specified service component. A list of approved devices can be found on the Authorized Protective Eyewear List.
• Avoid smoking: Smoking has been linked to an increased risk of cataracts. Service members can reduce their risk by avoiding smoking and limiting exposure to secondhand smoke. TRICARE provides services, drugs and support to help service members quit smoking.
• Protect against ultraviolet radiation: Prolonged exposure to UV radiation from the sun can contribute to cataract formation. Wearing UV-blocking sunglasses and avoiding looking directly at the sun are advised.
• Maintain a healthy lifestyle: Eating a balanced diet rich in antioxidants, maintaining a healthy weight, and managing conditions such as diabetes can help reduce the risk of cataracts, and possibly add years to your life.
• Get regular eye exams: Routine eye exams can help detect cataracts early when they are easier to treat. Service members should schedule regular eye exams with an eye care professional.

“A lot of injuries happen when a person thinks, it will take just ‘a quick fix’ and nothing will happen for that short period of time,” said Viswanathan. “Wear protection even for one second of work.”

Treatment Options for Cataracts

Surgery is the only treatment for cataracts if glasses are not viable.

“If cataracts are nonprogressive and not visually significant, no specific treatment is required,” said Viswanathan. “The service member must be monitored with periodic reevaluations as clinically indicated.”

When visual detriment is present from cataracts, cataract surgery remains the standard treatment, although surgery might be challenging and complicated in case of eye trauma preceding cataract.

“While there is no common protection against the formation of cataracts, and there is no medical treatment to reverse or ‘cure’ a cataract, there is a very reliable surgical solution. Cataracts have been extracted for well over 100 years and the science of cataract removal and intraocular lens replacement continues to be refined,” Eliason said. “This definitive treatment is one of the most common types of surgery in the world.”