Cataracts may be slow to affect vision
DEAR DOCTOR: I’m 62, and during my routine eye exam yesterday, the doctor said that I am showing the first signs of cataracts. She wants to see me in six months. Does that wait make sense?
DEAR READER: Cataracts, which cloud the lens of the eye, are slow to develop, with initial symptoms amounting only to difficulties with night vision or an ability to read highway signs. But over the years, untreated cataracts can lead to blindness. Before the advent of simple surgical procedures to remove the opacified lens and replace it with an artificial lens, cataracts were the most common cause of blindness in the United States.
Your eye doctor, in addition to monitoring your cataracts, also has probably tested for glaucoma. On occasion, cataracts can lead to increased pressure in the eye and glaucoma.
If your cataracts are slowly progressing, I agree with your doctor about re-evaluating them at a later time. If the cataracts are creating glaucoma, or if your doctor cannot evaluate your retina because the lenses are too cloudy, that may be an indication to remove the lenses now. Otherwise, surgery to remove cataracts is based on how they’re affecting vision — meaning, how they impact daily life.
Previously, ophthalmologists didn’t recommend cataract surgery until the cataract was considered “ripe” for removal. This philosophy was in place for many years because previous surgical techniques for cataracts led to many more complications than today’s techniques. However, cataract surgery today is a simple outpatient procedure, often done without anesthesia. In addition, new focal lenses can be implanted to provide better reading or distance vision.
Simply put, you should have your cataracts removed if you’re having trouble reading road signs, seeing at night or deciphering fine print. If this is not occurring, you can wait — even for many years. It’s possible that removing cataracts too early could potentially expose the retina to more light damage and increase the risk of macular degeneration, but that association is from observational data, not clinical trials.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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