Do I need to undergo cataract surgery?

Do I get a lot of email? Yes, tons of it. Do I get letters? Practically never, particularly those without a return address. So I was surprised by a recent one. All I know is the writer lives in Lethbridge, and is elderly. She has written that she wants to be an informed patient, so is asking for my stand on cataract surgery.

‘Ms. X’ simply believed she needed reading glasses, but was told by an optometrist that she required cataract surgery. She remarks, “I hesitated, so he sent me to an ophthalmologist for a second opinion. He also agreed that surgery was needed, suggested I simply sign on the dotted line, then called, ‘Next patient, please.’”

But the writer asked for a copy of what she had just signed, read the fine print (interestingly, she could read the fine print) and now has second and third thoughts about the dangers involved.

According to the National Eye Institute, by age 80 half of North Americans either have a cataract, or have had cataract surgery to replace a foggy lens. The lens allows light to pass through the eye to focus on the back part of the eye, the retina, which then sends images to the brain.

Aging is the main cause of cataracts. Diabetes and glaucoma increase the risk. So does exposure to strong sunlight such as living closer to the equator. High altitude also plays a role as the people of Tibet have the highest rate of cataracts in the world.

Many people don’t know they have a cataract in its early stage. And since cataracts normally grow slowly, some people can live for years without significant effect on vision.

But when symptoms first occur, the lens has become tinted, making it difficult to identify blues and purples. For instance, you may think you are wearing a pair of black socks, only to be told by friends that you’re actually wearing purple ones. Others complain of the glare of headlights, sunlight too bright, or a halo around lights.

This patient in question believed she only needed reading glasses and this may be the case. But if a cataract is present, interfering with her daily activities such as reading, driving or watching TV, then cataract surgery is the only effective treatment for her.

Some patients worry that delaying cataract surgery will result in long-term damage to the eye or make the operation more difficult. But this is not the case, so there is rarely any hurry to rush into surgery. Besides, some people never need an operation and can be helped by new glasses or better lighting.

The writer is correct in wondering about the risks, however. As with any surgery there’s always the risk of infection or bleeding problems. For instance, surgeons may ask you to temporarily discontinue any medication that may cause bleeding during surgery.

Cataract surgery also increases the risk of retinal detachment, a potentially serious complication that can cause loss of vision. One sign of this problem is a sudden increase in ‘floaters’ or cobweb structures that appear in the vision.

Ms. X can be reassured that if an operation is truly required, the risk of complication is small and the majority of patients have better vision.

There’s no sure way to prevent cataracts. But decreasing exposure to sunlight by wearing sunglasses, eating fruits and vegetables is believed helpful. And be sure to wear protective glasses for tennis and other sports to prevent traumatic cataracts.

Does the use of vitamins help? Some researchers believe Vitamin C is a protective agent in vision. The cornea and lens of the eye have the highest concentration of Vitamin C in the body. In one study, those with low blood levels of C had 11 times greater risk of developing a cataract. In another study, those who took Vitamin E reduced cataract risk by 50% to 70%. This is why I take natural Vitamin E and high doses of C daily.

At 91 I have had no cataract surgery.

So I hope Ms. X is now an informed patient and realizes that the development of a cataract need not be a rush to surgery. Rather, surgery is done only when quality of life is affected.

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