Cataract surgery switches cloudy lens for a clearer view

DEAR DR. ROACH: When should a person have cataract surgery, and can you ever have them removed? I am concerned, as I am a 65-yearold male with cataracts. Can glasses be prescribed so I never need surgery? I ask because I know people who had surgery and had a special lens put in (may I add, not covered by insurance) and did well at first then lost some sight because of inflammation behind the eye and had to use prescription eyedrops for weeks. I do not want this same issue.

ANONYMOUS ANSWER: The lens of the eye, along with the cornea, bends the light coming into the eye so it is perfectly focused on the retina. The lens should be completely translucent. However, as people age, they are likely to develop an opacity in the lens, called a cataract. (A cataract is another name for a waterfall, called such due to the foamy white appearance of an advanced cataract.) Cataract surgery replaces the opaque lens with a synthetic lens. Glasses do not help specifically with a cataract, although even a person with a cataract may need corrective lenses.

Not all cataracts require surgery: A cataract should be removed when it interferes with a person's daily function. There is no age limit on cataract surgery. Cataract surgery has been shown to have significant benefits, including reducing risk of serious traffic accidents and of hip fracture.

There are different types of lenses that can by placed by the ophthalmologist, the doctor who does this type of surgery. Some of these do have increased cost to the patient compared with the “regular” monofocal lens. The results are generally good: 96% of people without eye problems before surgery had visual acuity of 20/40 or better after surgery. The rate of serious complications (hospitalization or death) is about 0.3% in a large review. It sounds like the person you know may have had endophthalmitis, inflammation due to infection, which often impairs vision. It happens only about 0.04% of the time. Lens implants should not need to be removed.

DEAR DR. ROACH: I am having a total knee replacement operation and I am concerned that I have a very large hiatal hernia and when laying completely flat, I feel the hernia moving higher up my esophagus. At home, I have the head of my bed raised up about 6 inches, and that helps me tremendously. For my operation, the bed will be completely flat for several hours in preparation, during surgery, and in recovery. Should I be worried that there would be complications while lying flat for that long?

J.R.

ANSWER: The “hiatus” of the diaphragm is a hole — a normal structure that allows the esophagus to go from the chest into the abdomen so your food can go into the stomach.

In people with the most common form of a hiatal hernia, called a sliding hiatal hernia, the hole has become large enough that the top of the stomach can drift up into the chest, where it doesn't belong. This often is asymptomatic, but can make reflux symptoms worse. Sliding hiatal hernias (more than 95% of hiatal hernias are this type), where the stomach can move up and down through the hiatus, are not dangerous.

During the operation, the top of the stomach may indeed migrate into the chest, but it is very unlikely to cause you any problems.