A cataract is a clouding of the crystalline lens inside the eye. They can range from a very mild clouding which barely affects vision to a very dense “brunescent” cataract that causes blindness. In the United States, some degree of cataract has been reported in 42 percent of those between the ages of 52 to 64, 60 percent of those between the ages 65 and 74, and 91 percent of those between the ages of 75 and 85. Therefore, if you are over age 60, it is more than likely that you have cataracts. However, if you do have cataracts, does this mean that you should rush out and have cataract surgery? Of course, the answer is no. There are generally two reasons to consider having cataract surgery. The first reason is that you are experiencing a decrease in your best spectacle-corrected vision which is affecting your ability to function at the level that you desire. This may mean that you are having trouble seeing road signs, particularly at night, or that oncoming headlights are causing distracting or even dangerous glare. It may mean that you are experiencing more glare on bright sunny days or that you are having more difficulty reading fine print. It may mean that details on television are harder to make out, particularly the “crawl’ that scrolls across the bottom of the television screen. If you have been diagnosed with cataracts, but are not noticing any functional impairment to your vision, then there is no good reason to proceed with surgery. Although the risks of modern cataract surgery are small, there are still some risks. The decision to proceed with surgery should be based on an evaluation of the “risk/benefit” ratio. If you have no noticeable impairment, there can be little benefit to justify even a small risk. Generally, only you can really determine when you are having difficulty with your vision. An exception to this rule of thumb would be when you rare driving a motor vehicle despite not having good enough vision to meet the safety requirement established by state law.
The second reason to proceed with cataract surgery, even when you are not experiencing visual difficulties would be when there is a medical reason, such as narrow angle glaucoma. When a cataract develops, the crystalline lens thickens making it push the iris forward. The peripheral iris then blocks the fluid or aqueous humor inside the eye from escaping through the trabecular meshwork, or outflow channel. Cataract surgery in these cases would allow the outflow channel to open and prevent the development of narrow angle glaucoma. Another reason to consider cataract surgery would be when the cataract causes a shift toward near-sightedness, such that the difference between the two eyes is such that wearing glasses to correct vision would not be tolerable.
There is an old axiom that states “if it ain’t broke, don’t fix it!” When it comes to having surgery, there is great wisdom in this expression.
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