I need my cataracts doing... should I have lenses put in too?

QI’ve just had my routine eye test and my optician has said I would benefit from having cataract surgery. I have to use distance glasses for driving and reading glasses. I also take sunglasses wherever I go, so I always seem to have a bag full of specs. A friend mentioned that when I have surgery I could have new lenses that mean I don’t need glasses. Are there any problems with them?

AWhen you have a cataract, the lens inside the eye, which is normally clear, develops cloudy areas, due to a change in the structure and clumping together of proteins contained within the lens. It’s a common problem that occurs with increasing age, and one in three people over the age of 65 have at least one cataract.

Though both eyes are usually affected, one is typically worse than the other. While most develop for no apparent reason, they are more common in those who have smoked, have diabetes, high blood pressure or a family history of cataracts.

Exposure to UV light is another risk factor, which is why wearing good-quality sunglasses is important, especially at this time of year when the sun is strong.

In the early stages, cataracts often go unnoticed, but as they develop they can cause blurred vision, with fading of colours, halos around bright lights, and worsening vision that cannot be corrected by glasses.

Once this has occurred, cataracts are best treated by removing the cloudy lens and replacing it with an artificial plastic one, a quick operation performed under a local anaesthetic.

The standard lenses available on the NHS have a single focus, so you will still need to wear glasses for either near or far vision. However, multifocal lenses are available privately with different zones set at differing focusing powers, which allow you to see both near and distant objects.

The different zones of the lens split the light entering the eye and this means that 100 per cent of the light is not being used when you focus on distance or close up, which some find difficult to tolerate. You may also see halos or sparkles around lights, particularly when driving at night.

Multifocal lenses are not suitable for those who are very short sighted or have a large amount of astigmatism (due to a curve on the cornea, the front membrane of the eye).

They are also not suitable for those with other eye diseases such as glaucoma or macular degeneration.

I suggest you discuss them when you see the eye specialist at the hospital who will be able to tell you if they might work for you and provide more details.

QI am 53 and it seems everyone my age is going on HRT. I went through the change at 44 and hardly had any symptoms then and don’t have any now, apart from sometimes feeling a bit tired (though that could be just because I’m busy running my own business). I feel well, am slim and healthy, take regular exercise and have a great sex life. A friend suggested HRT could help reduce my risk of heart disease and dementia, but is this correct? If it’s going to do me good, I’ll go for it, but I’m concerned about the risks too.

AThe main reasons women of your age are taking HRT is to relive troublesome symptoms of the menopause, such as flushes, sweats, mood changes and disrupted sleep. It can also help to maintain your libido, but none of those reasons appear to apply here. In terms of cardiovascular disease, there is some evidence that starting oestrogen before the age of 60 or within 10 years of the menopause may help to reduce the risk of cardiovascular disease, but as yet there is no concrete evidence that it can reduce the risk of dementia.

In terms of risk, the combination of oestrogen and progesterone (which all women need unless they have had their womb removed) is associated with a small increased risk of invasive breast cancer.

Some women also find they put on weight on HRT, feel bloated, or have breast tenderness, but this can often be eased by changing dose or formulation.

Taking oestrogen by mouth (in tablet form) can slightly increase the risk of a deep vein thrombosis or a stroke, but this does not happen when it is given via the skin, which is why nearly all women now use oestrogen gel or patches.

Many women, however, feel that the benefits in terms of symptom relief outweigh this risk, but for you the situation is rather different as you do not have any menopausal symptoms and maintain a normal weight. Taking regular exercise would suggest that you are of low risk of heart disease too.

Having your blood pressure and cholesterol checked could be helpful in assessing your overall risk. One important benefit though, that you have not mentioned, is the positive effect of oestrogen on bones – when oestrogen levels fall at menopause, so does density, with some women losing as much as five per cent of their bone mass each year after their periods stop.

The fact you had an early menopause at 44 suggests you may be at increased risk of osteoporosis and I would certainly encourage you to speak to your doctor about having a bone density scan.

If this shows you have low bone density for your age, taking HRT would help prevent further bone loss and help prevent you developing osteoporosis and breaking any bones.

So my advice is that you should not feel rushed into taking HRT, but instead it would be helpful for you to undergo investigations that will give you more information about your health. You can then make an informed decision after that.

● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.