Cataract surgery is the most common kind of elective eye surgery that is performed among Medicare beneficiaries in the United States. In fact, an estimated 25.7 million Americans over the age of 40 have cataracts right now with the number projected to increase to 45.6 million by 2050.

The prospect of eye surgery can seem daunting and many affected people may wish to delay cataract surgery until they absolutely need it. So when is the right time to have cataracts surgically removed? As a practicing ophthalmologist in Fort Worth I have helped many patients answer this question.

When Do I Need Cataract Surgery?

Since changes in a person’s natural lens occur over a lengthy amount of time, most people reach their sixties or seventies before they require cataract surgery. This does not mean, however, that people younger than this age cannot get cataracts or that they do not need cataract surgery. The rate of progression of the disease varies from person to person and every case has to be assessed individually.

A simple rule that ophthalmologists follow while deciding on when to conduct cataract surgery is to ask the patient if the cataracts are hindering them from conducting their daily routines or tasks. Some professions may require a higher degree of visual acuity than others and thus the patients may find even smaller cataracts very disturbing while others may be able to manage for a while with non-surgical methods.

Four questions that the American Academy of Ophthalmology developed to help determine when the patient should get cataract surgery are quite helpful in making this decision.

(1) Are Your Cataracts Impacting Your Daily Life?

Cataracts can cause double vision as well as dim or blurred vision along with a yellowish hue to everything you see making it very difficult to carry out daily activities. People whose occupation involves driving, cooking, sewing, or even reading from a computer screen will be unable to perform at an optimum level.

(2) Are Your Cataracts Affecting Your Ability to Drive Safely at Night?

A combination of low light in the environment and bright lights from the headlights of other cars can make it very difficult for people affected with cataracts to drive at night. Looking into a bright source of light can result in the formation of a halo that makes decision making very difficult while driving and potentially puts your life and that of your family or others at risk.

(3) Are Your Cataracts Interfering With Outdoor Activities?

Outdoor activities like playing golf, skiing, surfing or just taking a walk can become difficult for people that are affected by cataracts. The reason for this is that the eyes become very sensitive to light and are unable to tolerate direct glare. People who enjoy outdoor sports notice that they find judging distance to be a lot more difficult than it once was.

(4) Are the Cataracts Manageable in Other Ways?

Cataracts can be managed through the use of prescription eyeglasses, protective sunglasses, wide-brimmed hats to protect against the glare and magnifying glasses to help read, however, these measures only work up until a certain point. Once these measures have been tried and are no longer sufficient, the time for cataract surgery has arrived.

Should You Get Cataract Surgery Sooner or Later?

There was an earlier school of thought that advocated a wait and watch approach with cataracts. The primary reason for this was that the cataract needed to progress to a certain level after which it could be safely removed. The idea was that the lens would be easier to remove as it hardens.

Now, however, with the advent of newer techniques and far more advanced equipment, this is no longer necessary. Even small cataracts can be easily and predictably removed. In fact, many studies now show that a larger harder cataract in its advanced stages can be more difficult to remove.

Cataracts have also been found to increase the intraocular pressure in the eyes which can lead to the development of glaucoma. Patients, where cataracts exist with glaucoma, are encouraged to have the surgery earlier to prevent further complications which can include a complete loss of vision due to the advanced progression of their glaucoma.

There can also be certain situations where cataracts do not affect the vision of the person but the doctor still advises removal. The most common reason why this would happen is when the cataract is interfering with the examination or treatment of other eye diseases.

Cataracts can develop in either eye or both the eyes at the same time. If the patient has been diagnosed as needing cataract surgery in both eyes, the doctor typically schedules them 1 to 2 weeks apart.

Recovery After Cataract Surgery

Most patients can resume their normal activities after 24 hours. Patients can expect some light sensitivity and some mild itching or discomfort for a few days. Eye drops will be prescribed for 3 weeks to make the patient more comfortable, minimize inflammation and to avoid the risk of infection.

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About the Author

Dr. David Nethery is a licensed ophthalmologist in Fort Worth, TX and has been practicing ophthalmology since 2000. Dr. Nethery’s primary focus is cataract surgery and he has participated in numerous clinical trials for advanced cataract lens implants.