When to have cataract surgery? Should every one diagnosed as having a cataract undergo an operation? Are there any treatment modalities/methods other than surgery? If so, then to whom are these modalities indicated?
These are some of the questions that a patient diagnosed as having cataract might be thinking of! We will try to clarify these issues throughout this page.
Is There A Medical Treatment For Cataract?
At this moment, there is no medical therapy or a drug distributed commercially capable of reversing the biochemical changes occurring in the crystalline lens or preventing their incidence. But a lot of research aiming to find a future pharmacological drug capable of reversing the progression of cataract and eliminating the need for surgical intervention is being conducted all over the world.
Does Every Patient Diagnosed With Cataract Need Surgery?
The answer is no. Provided that the ophthalmological examination of the patient revealed only the presence of cataract without any other concomitant pathologies, the decision to undergo a surgery in this case depends on many factors, most importantly the patient’s visual needs. It is always necessary to undergo the preoperative assessment prior to having the surgery.
Why Are The Patient’s Visual Needs The Most Important Factor In Deciding Whether Or Not To Go For An Operation?
Although the pathology might be the same in many patients, but the decision to undergo a surgery totally depends on your visual needs. A patient who is a pilot or an engineer or a driver might be annoyed by the presence of a very faint cataract since these jobs need a lot of precision. Meanwhile, an old lady might be satisfied by a spectacle prescription that allows her to watch TV and perform her usual daily activities thus eliminating the need for an operation, and avoiding the risks of general anaesthesia (the risk of anaesthesia problems increases with age) although having a significant cataract.
Are There Any Indications That Necessitate Surgical Removal Of Cataract? If So What Are They?
Yes, there are some indications that necessitate removal of cataract and they include:
1. Cataract developing in children below 12 years of age:
Cataract development in children whether congenital (the child is born with it and it might be in one eye or in both eyes) or developed after trauma to the eye, is an indication for surgery to guard against the development of amblyopia, (a condition in which the brain neglects impulses coming from the weaker or the not seeing eye and with continuation of this condition the brain irreversibly doesn’t accept impulses from this eye any more and this eye becomes a non seeing eye.
This condition can apply to one eye or both eyes as in cases of bilateral congenital cataract. This condition happens only in children younger than age 12 because the visual pathway achieves maturity around this age, meaning that the brain can’t choose to neglect impulses coming from one eye after this age even if this eye is cataractous).
2. Cataract developing after trauma to the eye:
Whether the cause is a blunt trauma or penetrating trauma to the eye as in bullets or foreign bodies, if the capsular bag of the lens is torn, the lens matter might escape to the anterior chamber. Cataract removal is mandatory to prevent the plugging of the trabecular meshwork (the tissue inside the eye responsible for draining the fluid inside the eye) leading to development of secondary glaucoma.
3. Patients with both glaucoma and cataract in the same eye:
This is not a mandatory indication for removal of cataract, but recent studies have shown marked decrease in the intraocular pressure of the eye after removal of cataract and implantation of an IOL. Further studies are being conducted to validate this issue which might yield a new modality for treating glaucoma in patients suffering from concomitant cataract.
In A Nutshell:
Hopefully you have gained a better idea of how to make that decision of when to have cataract surgery (it is not always necessary). There are few indications that necessitate the removal of cataract, but the most important one is the patient’s visual needs, and to this we factor in the surgical modalities and treatment options that are tailored to optimally fit those needs.