When Is the Best Time to Have Cataract Surgery?

Do you think you may have a cataract? Maybe two? If so, you wouldn’t be alone. Nearly 26 million Americans over the age of 40 have cataracts, and this number is estimated to almost double in the next 20 years. While the only way to remove cataracts is surgery, the best time to have cataract surgery is each patient’s personal decision.

As an ophthalmologist with Westchester Health, I feel strongly that it is my responsibility to educate my patients about cataract surgery and give them the knowledge they need to make an independent and well-informed decision regarding cataract treatment. That said, I offer this blog as a way to educate and inform anyone contemplating cataract surgery.

What causes cataracts?

Dr Dieck

William B. Dieck, MD, FAAO

A cataract is a clouding of the eye’s lens that affects vision. Cataracts occur as part of the body’s natural aging process and are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. A cataract can occur in either or both eyes but cannot spread from one eye to the other.

In the early stages, cataracts may not change vision significantly and vision issues may be improved with prescription glasses. But as cataracts mature over time, they may cause vision loss that can interfere with a person’s daily life.

The lens in the eye (located behind the iris and the pupil) works similarly to a camera lens, focusing light onto the retina at the back of the eye where an image is recorded. The lens also adjusts the eye’s focus, enabling you to see things clearly both up close and far away. The lens is made of mostly water and protein, with the protein arranged in a precise way that keeps the lens clear and allows light to pass through it.

As you age, some of the protein may clump together and start to cloud a small area of the lens, which is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Signs that you may have a cataract

The most common symptoms of a cataract are:

  • Cloudy or blurry vision
  • Colors seem faded
  • Poor night vision
  • Double vision or multiple images in one eye
  • Frequent prescription changes in your eyeglasses or contact lenses
  • Glare from bright lights
  • Headlights, lamps or sunlight may appear too bright
  • A halo may appear around lights
  • Difficulty reading fine print
  • Difficulty following a golf or tennis ball
  • Difficulty with seeing street signs
  • Difficulty with visual tasks such as threading a needle

These symptoms also can be a sign of other eye problems besides cataracts. If you have any of these symptoms, check with your eye care professional.

Who is at risk for cataracts?

Certainly, the risk of cataracts increases as you get older but other risk factors include:

  • Certain diseases, such as diabetes)
  • Smoking and alcohol use
  • The environment, especially prolonged exposure to ultraviolet sunlight

4 questions to ask yourself

The American Academy of Ophthalmology has developed a list of four questions which people should ask themselves to help determine if they’re ready for cataract surgery:

  1. Are your cataracts impacting your daily or occupational activities?
    The lack of contrast and clarity can be difficult for those who need clear vision for work, driving or who enjoy hobbies like reading, cooking or sewing.
  2. Are your cataracts affecting your ability to drive safely at night?
    Cataracts can cause halos around lights and difficulty seeing in low-light settings, impacting the ability to safely drive at night. Advanced cataracts can even cause enough vision loss to fail the vision test required for a driver’s license.
  3. Are your cataracts interfering with the outdoor activities you enjoy?
    Cataracts can increase sensitivity to glare, which can be especially troublesome for those who enjoy skiing, surfing and many other outdoors activities. They can also cause visual differences from one eye to the other which can affect the distance vision golfers need.
  4. Can you manage your cataracts in other ways?
    People who decide to delay cataract surgery can make certain adjustments to improve their vision, such as installing brighter lighting and contrasting colors in their home or office, wearing polarized sunglasses and a wide-brimmed hat to reduce glare, and using magnifying glasses to make reading easier.

What I often tell my patients is if cataracts aren’t disrupting your life, they can probably wait and have surgery when the cataracts really start to bother them. But for people who are truly feeling impeded by blurry or dulled vision, cataract surgery can have a significant impact on their vision, quality of life, risk of falling and automobile crashes.

How cataract surgery is performed

Cataract surgery is the most common elective surgery among Medicare beneficiaries in the United States. If there are cataracts in both eyes that require surgery, the surgeries are usually performed several weeks apart. Cataract surgery is done as an outpatient procedure but you will need someone to drive you home.

Once you have determined you are ready to have cataract surgery, your eye surgeon will discuss your options for implanting a lens in your eye to replace the lens that is being removed. These include astigmatism neutralizing lenses, standard distance or near-vision lenses, multiple focal distance lenses, accommodating lenses and others.

First, your eye surgeon will numb your eye with anesthetic (you are awake during the procedure). You may also receive medication to help you relax. Next, the surgeon makes a tiny incision in the front of your eye. Through this, he/she inserts a small tool to break up the cataract and gently suction it out. Then, he/she inserts a lens implant made of plastic, silicone or acrylic, and closes the incision, possibly with a few stitches.

The procedure only takes a few minutes and has a very short recovery time.

Think you may have a cataract(s)? Please come see us.

If you think you have a cataract in one or both eyes, or may be developing one, please call (914) 232-1919 to make an appointment with one of our Westchester Health ophthalmology specialists for an accurate diagnosis. The sooner we determine if you have a cataract (or are at risk of developing one), the sooner we can determine the best course of treatment and if surgery would be beneficial for you and your quality of life. Whenever, wherever you need us, we’re here for you.

By William B. Dieck, MD, FAAO, Director, Ophthalmology Division, Vice President, Westchester Health, member of Westchester Health Physician Partners

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