When Should I Have Cataract Surgery?

Should I Wait to Have Cataract Surgery?

When I was a resident, my attendings would teach us to tell patients to wait to have cataract surgery until they could no longer drive or read. Many times they would tell patients that their cataract were not “ripe.”

Many things have changed.

My well meaning surgical teachers did this because the benefits may not outweigh the risk of cataract surgery. We did not have Laser Assisted Cataract Surgery, we did not have the innovative implants we have now. We did not have the very low rates of infection or loss of eye. Now we have these benefits and in most cases the benefits do outweigh the risks.

Once an eyeMD diagnoses a Cataract and shows the vision is affected either with best corrected glasses or with a glare test (vision usually limited to 20/40 or worse), there usually no benefit of waiting. In fact, there may be other risks of waiting for cataract surgery which are noted in a well respected article below. Generally the only guarantee an eye surgeon can give the patient is that if you wait to have the cataract surgery, the cataract will get denser and the risks below can increase. Now we should add in the risk that your risk of falling and getting hurt, especially if you are around 75 years old, increases dramatically, as the paper below reports.

The Risks of Having Cataract Surgery:
1. Needing glasses: this risk depends on which type of implant you choose and what distance you are talking about. If you choose insurance-covered monofocal lenses, your change of needing reading glasses (unless you specifically asked your surgeon to be glasses free from reading but then you would need distance glasses, AND assuming minimal astigmatism [<1.00D or so], is 100%
If you choose one of the innovative Implant options, your risk of needing reading glasses depends on the IOL/implant chosen. For the Symfony Lens, about 74% of patients did not need glasses to read, see computer, and distance. For the Crystalens, studies vary, but usually about 20-45% of patients will need some type of reading glass from time to time.
2. Needing Yag laser after cataract surgery to open opacified capsule (back part of lens): happens in about 30% of patients
3. Rebound Iritis: inflammation comes back after surgery
4. Need for 2nd eye surgery: less than 2% of patients in general. This can be due to:
a. Need to repoistion IOL (Intraocular Lens)
b. Retained Cortex: the outside covering of the nuclear cataract was not able to be removed completely.
c. PBK: pseudophakic bullous keratopathy: the need for a corneal transplant after the cataract surgery because the patient’s endothelial cells have stopped working or are no longer present. This used to be more common, especially in patients who have very dense cataracts,, but has no become very rare in patients, especially those who have Laser Assisted Cataract Surgery
Retinal hole, tear, detachment: rare
d. Needing a second surgery because of an infection/Endophthalmitis: very rare
5. Falling after surgery and breaking a bone: very rare
6. Infection/Endophthalmitis: very rare
7. Heat Attack, Stroke or Death: this is usually unrelated to the cataract surgery but could potentially occur due to the added stress of any new procedure: very rare and likely may have happened if surgery had not been done.

Sandra Lora Cremers, MD, FACS

2016 Nov 1;57(14):6003-6010. doi: 10.1167/iovs.16-20582.

While We Waited: Incidence and Predictors of Falls in Older Adults With Cataract.

Palagyi A1, McCluskey P2, White A3, Rogers K1, Meuleners L4, Ng JQ5, Morlet N5, Keay L1.

Author information

1The George Institute for Global Health, Sydney Medical School, University of Sydney, New South Wales, Australia.
2Save Sight Institute, Sydney Medical School, University of Sydney, New South Wales, Australia.
3Save Sight Institute, Sydney Medical School, University of Sydney, New South Wales, Australia 3Westmead Institute for Medical Research, Sydney, New South Wales, Australia 4Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.
4Curtin-Monash Accident Research Centre (C-MARC), Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia 6Eye & Vision Epidemiology Research Group, School of Population Health, University of Western Australia, Perth, Western Australia, Australia.
5Eye & Vision Epidemiology Research Group, School of Population Health, University of Western Australia, Perth, Western Australia, Australia.

Abstract

PURPOSE:

Strong evidence indicates an increased fall risk associated with cataract. Although cataract surgery can restore sight, lengthy wait times are common for public patients in many high-income countries. This study reports incidence and predictors of falls in older people with cataract during their surgical wait.

METHODS:

Data from a prospective study of falls in adults aged ≥65 years who were awaiting cataract surgery in public hospitals in Australia were analyzed. Participants underwent assessment of vision, health status, and physical function, and recalled falls in the previous 12 months. Falls were self-reported prospectively during the surgical wait.

RESULTS:

Of 329 participants, mean age was 75.7 years; 55.2% were female. A total of 267 falls were reported by 101 (30.7%) participants during the surgical wait (median observation time, 176 days): an incidence of 1.2 falls per person-year (95% confidence interval [CI] 1.0-1.3). Greater walking activity (incidence rate ratio [IRR] 1.06, 95% CI 1.01-1.10; P = 0.02, per additional hour/week), poorer health-related quality of life (IRR 1.12, 95% CI 1.05-1.20; P < 0.001, per 5-unit decrease), and a fall in the prior 12 months (IRR 2.48, 95% CI 1.57-3.93; P < 0.001) were associated with incident falls. No visual measure independently predicted fall risk. More than one-half (51.7%) of falls were injurious.

CONCLUSIONS:

We found a substantial rate of falls and fall injury in older adults with cataract who were awaiting surgery. Within this relatively homogenous cohort, measures of visual function alone inadequately predicted fall risk. Assessment of exposure to falls through physical activity frequency may prove valuable in identifying those more likely to fall during the surgical wait.