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