Due to our increasing life expectancy, cataracts have become a common issue, mainly for elderly people. Cataracts have only one solution: surgery. This word sounds quite scary but current surgical techniques for cataracts have increased its safety to the highest levels ever. Despite this, there may be some misconceptions when someone is told to be developing cataracts.
Cataracts are usually caused by the aging process. Our skin changes according to our age and our lens do the same. The human lens is key for the eye to focus the images. All the incoming light to our eyes passes through it.
As we age, the natural clear lens inside the eye becomes progressively harder and cloudier. Cataracts develop at different rates for different people, and even between the two eyes of the same person. Although some varieties of cataracts tend to grow more quickly, most of them use to have a slow development and can take years to give symptoms. The vision becomes blurred and some activities are more difficult to perform, as night driving, the patients refer glare with bright lights or increased photophobia and he can complain of difficulty with seeing the small print on TV or the newspaper.
Any surgery, as any human activity, is not 100% safe. But the technology available now has made this procedure today the safest ever. When you complain about progressive increasing blurred vision and you are told to have cataracts there is only one option: go for surgery. Of course, this is not an emergency and the surgery can be arranged on the next weeks but if we tell the patient to wai, it is not usually a good advice because the vision will not improve with the time and he is complaining already of the effects of the cataract on his vision and activities.
There are health reasons to advise to do the surgery the earliest possible. The older the patient, the worse the recovery. The recovery for any surgery is better when you are 60 than when you are 80. Some diseases, as diabetes, can develop with the aging and may have effects on the health and the wound healing.
There are also technical reasons. A long time ago, it was normal practice to delay the cataract surgery as much as they could because the procedure was different. With the development of phacoemulsification and the technology available, the sooner, the better. With the time, the cataract lens becomes harder and it is more difficult to break, melt and aspire. A hard cataract was an advantage a long time ago, but it is a disadvantage today.
We also have to consider the speed of evolution. Cataract development changes the focus of the eye thus changing its refraction. If the development is slow, updating the glasses can improve the visual symptoms for years. But when a new glasses prescription no longer improves the sight adequately or the development is fast, this is when surgery is indicated.
Once we reach a point where the quality of life is getting worse, the patient should balance the risks and the benefits. Delaying the surgery increases the risks especially in some circumstances, such as in Fuchs’ dystrophy, pseudoexfoliation or narrow-angles. The Ophthalmologist should point them out. When you feel you are frequently impaired, the benefits will outweigh the risks, and it’s time to go for surgery. You should not feel any hurry but also have enough information to be sure this is the right decision.