Cataract Pre-Surgery Questions

Cataract Pre-Surgery Questions (31)

Cataract Pre-Surgery Questions: 56 Things that you wish you knew before your cataract surgery

Can I go blind from cataracts or cataract surgery?


Can I go blind from cataracts?

Not all cataracts progress to completely limit sight.  However cataracts often progress to a level that severely limits daily functions like driving, reading and watching TV.  It is loss of this functional vision that motivates even the most nervous folks to proceed with cataract surgery.

I tell patients that if they had to choose something wrong with their eyes... cataracts are the best choice.  Cataracts are 'easy' to fix compared to most other eye health issues.  Results from cataract surgery are very predicable and successful.


Can I go blind from cataract surgery?

As with any surgery, you will discuss all risks with your surgeon’s team prior to you agreeing to proceed with surgery. 

The most serious complication of cataract removal that will be discussed is endophthalmitis.  This is an infection inside the eyeball and can be sight threatening.   In thousands of cataract surgery co-managements, I have never seen this in my practice but it certainly will be discussed as a risk.

The most common complications that I see are: Increased eye pressure (treated with drops), retinal inflammation (treated with time and/or drops) and foreign body sensation (treated with drops and time).



Are my cataracts and my glaucoma related?


Are my cataracts and my glaucoma related?

Sometimes.   There are eye conditions (e.g. pseudoexfoliation syndrome) in which these typically unrelated ocular pathologies are very much related.  These conditions must be identified early and treated accordingly by your eye care professional team.

The typical form of glaucoma is unrelated to cataract.  Although not a treatment for glaucoma, removing the natural lens of the eye can increase intraocular fluid outflow and lower pressure.


When should I do cataract surgery?


When should I do cataract surgery?

There is no exact answer here.   The factors that are typically considered are :

1] Visual Acuity.  
Albeit low risk, there are risks involved with cataract surgery.  The benefit of the surgery has to exceed the risk.  A decision to proceed with cataract removal is based on many factors but in general terms, most surgeons in this area will discourage a patient from proceeding until visual acuity falls below 20/50-ish.

2] Visual Demands and motivation
If you are a retiree and spend a limited amount of time at a computer, your visual demands may make it acceptable for you to tolerate less-than-perfect best vision.   If you are working as e.g. a full-time accountant or transport truck driver, your high visual demands would require you get cataract surgery sooner.
Some folks are just simply queasy about eyes and have low motivation to proceed.  You can procrastinate with cataract surgery (most) without worry however there will likely be a point where the procedure simply needs to be done (e.g. failed driving requirements)

3] Status of other eye
If you see well from your other (no or low cataract) eye.   There may be less rush to a surgical solution.

4] Driving status / Caregiver status
If you have a standard driver’s license or a special license or if you are caregiver to others… these things should be taken into consideration for when to do cataract surgery.

5] Symptomology
Years of looking in eyes has taught me that you cannot always predict someone’s symptoms based on the objective look of the cataract.   Some folks have minor cataract changes but are devastated by the blurry vision.  Others have what objectively appears as a advanced cataract, but are getting along fine with their day-to-day lives.    With low symptomology, a surgeon is much less like to proceed.

6] Interest in enhanced refractive improvement
For a patient to consider the increased expenses of enhanced cataract procedures, they are generally going to be highly motivated and anxious to proceed as soon as possible.

7] Secondary ocular health factors
There are some eye conditions where removing cataract early is important.  If the surgery is left too long, there is greater risk for a poorly placed or dislodged implant.  Your doctor will tell you if you have a condition that requires early cataract surgery.

8] Payor
Albeit a controversial topic, payors can influence decisions when cataract surgery is done: Personally funded vs. co-funded vs. government-funded vs. third-party funded
Payors also ultimately influence the type of cataract surgery: Basic vs. enhanced (premium or astigmatic or multifocal implants)

9] Large prescription swing of one eye
As a cataract develops it can cause a large shift in a prescription.  E.g. If one eye experiences a dramatic nearsighted shift the imbalance will not likely be tolerable and cause issues that are hard to fix with glasses.   The recommended solution is to restore the right/left balance through surgery to one or both eyes).

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