The ne­ces­sity of cataract surgery

The Guardian (Charlottetown) - - HEALTH - Dr. Gif­ford Jones The Doc­tor Game

Do I get a lot of email? Yes, tons of it.

Do I get letters? Prac­ti­cally never, par­tic­u­larly those with­out a re­turn ad­dress.

So I was sur­prised by a re­cent one. All I know is the writer lives in Leth­bridge, Alta., and is el­derly. She has writ­ten that she wants to be an in­formed pa­tient, so is ask­ing for my stand on cataract surgery.

“Ms. X” sim­ply be­lieved she needed read­ing glasses, but was told by an op­tometrist that she re­quired cataract surgery. She re­marks, “I hes­i­tated, so he sent me to an oph­thal­mol­o­gist for a sec­ond opin­ion. He also agreed that surgery was needed, sug­gested I sim­ply sign on the dot­ted line, then called, “Next pa­tient, please”.

But the writer asked for a copy of what she had just signed, read the fine print (in­ter­est­ingly, she could read the fine print!) and now has sec­ond and third thoughts about the dan­gers in­volved.

Ac­cord­ing to the Na­tional Eye In­sti­tute, by age 80 half of North Amer­i­cans ei­ther have a cataract or have had cataract surgery to re­place a foggy lens. The lens al­lows light to pass through the eye to fo­cus on the back part of the eye, the retina, which then sends im­ages to the brain.

Ag­ing is the main cause of cataracts. Di­a­betes and glau­coma in­crease the risk. So does ex­po­sure to strong sun­light such as liv­ing closer to the equa­tor. High al­ti­tude also plays a role as the peo­ple of Ti­bet have the high­est rate of cataracts in the world.

Many peo­ple don’t know they have a cataract in its early stage. And since cataracts nor­mally grow slowly, some peo­ple can live for years with­out sig­nif­i­cant ef­fect on vi­sion.

But when symp­toms first oc­cur, the lens has be­come tinted, mak­ing it dif­fi­cult to iden­tify blues and pur­ples. For in­stance, you may think you are wear­ing a pair of black socks, only to be told by friends that you’re ac­tu­ally wear­ing pur­ple ones. Oth­ers com­plain of the glare of head­lights, sun­light too bright or a halo around lights.

This pa­tient in ques­tion be­lieved she only needed read­ing glasses and this may be the case. But if a cataract is present, interfering with her daily ac­tiv­i­ties such as read­ing, driv­ing or watch­ing TV, then cataract surgery is the only ef­fec­tive treat­ment for her.

Some pa­tients worry that de­lay­ing cataract surgery will re­sult in long-term dam­age to the eye or make the op­er­a­tion more dif­fi­cult. But this is not the case, so there is rarely any hurry to rush into surgery. Be­sides, some peo­ple never need an op­er­a­tion and can be helped by new glasses or bet­ter light­ing.

The writer is cor­rect in won­der­ing about the risks, how­ever. As with any surgery there’s al­ways the risk of in­fec­tion or bleed­ing prob­lems. For in­stance,

sur­geons may ask you to tem­po­rar­ily dis­con­tinue any med­i­ca­tion that may cause bleed­ing dur­ing surgery.

Cataract surgery also in­creases the risk of reti­nal de­tach­ment, a po­ten­tially se­ri­ous com­pli­ca­tion that can cause loss of vi­sion. One sign of this prob­lem is a sud­den in­crease in “floaters” or cob­web struc­tures that ap­pear in the vi­sion.

Ms. X can be re­as­sured that if an op­er­a­tion is truly re­quired, the risk of com­pli­ca­tion is small and the ma­jor­ity of pa­tients have bet­ter vi­sion.

There’s no sure way to pre­vent cataracts. But de­creas­ing ex­po­sure to sun­light by wear­ing sun­glasses, eat­ing fruits and veg­eta­bles is be­lieved help­ful. And be sure to wear pro­tec­tive glasses for ten­nis and other sports to pre­vent trau­matic cataracts.

Does the use of vi­ta­mins help? Some re­searchers be­lieve vi­ta­min C is a pro­tec­tive agent in vi­sion. The cornea and lens of the eye have the high­est con­cen­tra­tion of vi­ta­min C in the body. In one study, those with low blood lev­els of C had 11 times greater risk of de­vel­op­ing a cataract. In another study, those who took vi­ta­min E re­duced cataract risk by 50 to 70 per cent. This is why I take nat­u­ral vi­ta­min E and high doses of C daily.

At 91 I have had no cataract surgery.

So I hope Ms. X is now an in­formed pa­tient and re­al­izes that the de­vel­op­ment of a cataract need not be a rush to surgery. Rather, surgery is done only when qual­ity of life is af­fected.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.