Planning Cataract Surgery? Questions to Ask

The National Eye Institute (at NIH), reports that most cataracts are related to aging, although there are other types. Secondary cataracts form after surgery for other eye problems (e.g., glaucoma) or occur in people with diabetes or are sometimes linked to steroid use. Traumatic cataracts can develop after an eye injury, sometimes years later. Congenital cataracta are when babies are born with cataracts or develop them in childhood. Radiation cataracts develop after exposure to some types of radiation. http://www.nei.nih.gov/health/cataract/cataract_facts.asp

Common symptoms of cataracts include cloudy or blurry vision; colors seem faded; headlights/lamps/sunlight appear too bright; halo may appear around lights; poor night vision; double vision or multiple images in one eye (symptom may clear as the cataract gets larger); and frequent prescription changes in eyeglasses or contact lenses. http://www.nei.nih.gov/health/cataract/cataract_facts.asp

Treatment for Cataracts: “symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti- glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.” “A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together.” “In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.” http://www.nei.nih.gov/health/cataract/cataract_facts.asp If surgery is done, it is performed on each eye at separate times (approximately 4 to 8 weeks apart (depending on recuperation and health of patient). Another viewpoint about waiting to have surgery is from the New York Times health section: “Unlike other eye diseases, there’s no advantage to treating cataracts early,” says Dr. Peter Egbert, professor of ophthalmology at Stanford University. “You don’t miss your chance if you wait. Cataract surgery isn’t urgent. You can always wait until the time is convenient.” http://www.nytimes.com/ref/health/healthguide/esn-cataracts-ask.html Cataracts do progressively interfere with vision, so one’s ability to drive or get around safely may begin to be impaired.

Two types of surgery: Phacoemulsification, or phaco. “A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification,. Extracapsular surgery: “doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.” (http://www.nei.nih.gov/health/cataract/cataract_facts.asp

Types of replacement lens: monofocal (covered by Medicare and most insurers) and multifocal lenses (becoming more popular but are not recommended for people with macular degeneration or diabetic retinopathy. Newer types are being are being use and more than likely in the future other types of lens will be readily available.

Questions to ask your ophthalomolgist.

• Do you have an eye problem such as age-related macular degeneration or diabetic retinopathy?
• Do you have astigmatism? Where is the astigmatism located in the eye? Is it in both eyes? Are you a candidate for toric lens due to your astigmatism?
• Do you have glaucoma?
• Which type of surgery is best for you?
• Can contact lens be worn after surgery?
• Will reading glasses be needed after surgery? “Whether you will still need glasses or contacts depends on what correction you need and what kind of lenses were implanted. There is no way to test replacement lenses before they are implanted” (NEI).
• How competitive in price are the recommended ophthalomgists in your geographical location?
• How often does the eye specialist perform cataract surgery and what is the success rate for the ophthalomogist? To gather information about potential eye surgeons, this site might help: http://www.healthgrades.com/ophthalmology-directory
• Do you need special lens (e.g., toric lens. These lenses correct for astigmatism. “They can be made from HEMA (soft), silicone hydrogel, or gas permeable materials” (http://www.eyehealthweb.com/toric-contact-lenses/
• Have you had lasik surgery?

Information about LASIK surgery (from http://www.mayoclinic.org/medical-edge-newspaper-2011/dec-16a.html): “Successful cataract surgery is possible for most people who have had laser-assisted in-situ keratomileusis (LASIK surgery) or other types of refractive surgery that reshape the cornea to correct vision. There is one important caveat, though. To ensure the most predictable vision outcome following cataract surgery, you need to provide your cataract surgeon with specific information about your eyes and eyesight from before and after your LASIK surgery.”

“For people like you who have had LASIK surgery, providing the appropriate lens implant for cataract surgery takes additional calculations to determine the correct lens power. In addition to taking measurements of the eye, the surgeon also needs an accurate record of your prescription before and after LASIK surgery, as well as an accurate measurement of the curvature of your cornea before LASIK. The records from your LASIK surgery should contain this information.”

Local health-related program that may be of interest to members: “Putting Pain in Its Place” (an hour long presentation about osteoarthritis and self-management techniques). Let Evelyn Ames know if you would attend a brown bag lunch arranged for WWURA members in January/February.

Historical note: Did you know that during the time of Colonial America (on eve of the revolution) the average life expectancy at birth was 34.5 years for men and 36.5 for women? Fifty percent of deaths occurred in those under 10.