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When should you have Cataracts removed?

cataract surgery

When should you have cataracts removed?

A cataract is the lens of the eye getting cloudy.  The natural lens in our eyes is very clear when we are first born and slowly gets more yellow and opacified as we get older.

Cataracts are part of the natural aging process.  Everyone gets them to one degree or another if you live long enough.  Cataracts, as they progress, create increasing difficulty with the normal activities of living.  The symptoms vary from one person to another.  Some people have more difficulty with their distance vision, some with reading.  People may report difficulty with glare, foggy, blurry, or hazy vision.

How does cataract surgery improve your vision?

The timing of when a cataract should be removed needs to be based on the degree of visual impairment you have with your normal activities of everyday life.  Just having a cataract is not a reason to have cataract surgery. It needs to be creating some degree of symptoms or impairment for surgery to be the appropriate decision.  

What varies from person to person is when do they feel they are having enough trouble to want to have surgery.  Some people, especially those who drive at night frequently, are disturbed by their cataract symptoms fairly early in the process.  They may decide that they are impaired enough by glare symptoms, even though their vision is good in other situations, to have surgery when they can still read the eye chart in an exam fairly well.  

What type of anesthesia is used for cataract surgery?

Others function very well with their vision slightly impaired with mild cataracts so there is no reason for them to have surgery at that stage.  People are fairly universal in having difficulties when their vision gets to about 20/40 or worse on the eye chart.  

About 80% of the patients on whom I operatenfor cataracts come in to the office and tell me that they are having trouble with everyday activities and they tell me (not me tell them) that they are having enough trouble to want to go ahead and have their cataracts removed.

Why would I have to pay out of pocket for Cataract Surgery?

There is a minority of people who don’t recognize (or want to admit) that they are having trouble seeing. Sometimes it’s because the problem has come on slowly, sometimes it’s because they are just not paying careful attention and sometimes it’s denial.  When the vision gets down to 20/50 (which is the legal driving requirement here in New Jersey) then I start to push a little more to getting the surgery done, especially if you are planning to continue driving.  

The other critical issue when deciding on whether or not you should have cataract surgery is that there has to be a reasonable expectation that removing the cataract is going to result in a significant improvement in your vision.  That is not always an easy statement to be sure of.  If you have other problems like Glaucoma, Macular Degeneration or Diabetic Retinopathy, those might also be causing some of the decreased vision.  If you have a second problem besides the cataract you and your surgeon need to have a discussion about how much improvement to expect with cataract removal. It’s not an easy call to make but you should be able to get some idea of what to expect - 90% improvement?  50%? 25%? Anything less than 25% probably isn’t worth taking the risk of surgery.

Is it wise to have cataract surgery if I have Macular Degeneration?

There are some instances where a dense cataract might need to be removed even though the above criteria are not being met.  One example is when a cataract gets so bad that it starts causing glaucoma.  Another instance would be if the cataract interferes with treating a retinal problem because the retina cannot be well visualized if the cataract is severely hampering the view of the retina.  Those conditions are VERY rare in the US.

How to care for your eye after cataract surgery

If you have been told you “have to” have cataract surgery but feel you are not having any significant visual problem, you should consider getting a second opinion.  If you would like a second opinion from us, we would be happy to assist you with arranging that appointment. Please give us a call at any one of our convenient Ocean or Monmouth county offices.
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Saturday, 25 September 2021

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