Slowly pro­gress­ing cataracts may not af­fect vi­sion at first

The Record (Troy, NY) - - YOUR DAILY BREAK - Robert Ash­ley

DEAR DOC­TOR » I’m 62, and dur­ing my rou­tine eye exam yes­ter­day, the doc­tor said that I am show­ing the first signs of cataracts. I know that cataracts de­velop slowly, but she wants to see me in six months. Does a six-month wait make sense?

DEARREADER » As you noted, 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. They are still the most com­mon cause of blind­ness world­wide, leav­ing nearly 15 mil­lion peo­ple un­able to see.

Cataracts de­velop be­cause the cells of the lens cre­ate a com­plex lat­tice that con­tin­ues to form even af­ter the cells die. Be­cause the lens does not shed th­ese dead cells, they are sus­cep­ti­ble to dam­age with­out any abil­ity for re­pair. Most of this dam­age sim­ply oc­curs with age, but other fac­tors can be in­volved. Smok­ing, al­co­hol, di­a­betes, dam­age from sun­light and poor nu­tri­tion can all cause cel­lu­lar dam­age that in­creases the risk for cataracts. So, too, can ex­po­sure to oral or high-dose in­haled steroids.

Di­ets that are high in fruits and veg­eta­bles — specif­i­cally those con­tain­ing high amounts of the com­pounds lutein and zeax­an­thin — are as­so­ci­ated with a lower risk of de­vel­op­ing cataracts.

Your eye doc­tor, in ad­di­tion to mon­i­tor­ing your cataracts, has also 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.

Many of my pa­tients who have cataracts wait an en­tire year to have their eyes rechecked, so six months should be fine. And re­mem­ber: To de­crease the pro­gres­sion of cataracts, avoid smok­ing, cut back on al­co­hol (if you drink) and fol­low a good diet. This will not only help your eyes, but also the rest of your body.

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