Philip C Hessburg MD
What are the indications for cataract surgery? In short: One should consider having cataracts removed when one’s vision has fallen to levels where he/she cannot do the things one needs – or wants – to do.
If a Delta pilot’s vision drops a line or two, perhaps to 20/25 on the chart due to advancing cataract, it is time for surgery if he /she wants to maintain flying status. While my very elderly illiterate European-born grandmother, whose main joy in life was knitting mittens for 37 Minnesota-based grandchildren, didn’t need cataract surgery though she was probably legally blind (i.e. 20/200 or lower), she was happy knitting mittens.
But what if the patient also has AMD? For many years, ophthalmologists delayed surgery almost until the patient was blind before surgery. Today that is not the case. Today the indications for surgery are no different for patients with or without macular degeneration.
Why the difference?
The difference lies in the revolution which has occurred in cataract surgery over the past 50 years. In the early years of cataract surgery with intraocular lens implantation, the surgery itself was so traumatic that it frequently was associated with profound post-operative inflammation which would – and did – worsen the macular degeneration by inducing inflammatory changes throughout the eye.
Modern cataract surgery, as practiced today by our many fine American cataract surgeons, is so atraumatic that the eye barely knows it has been operated on. In days gone by the incision in the eye was 12-15 mm in length and required six or ten sutures to adequately close. Today cataract surgeons work through a 1.5 mm incision, usually requiring NO sutures to affect a watertight closure.
So today even patients with far advanced macular degeneration are advised to have their cataracts removed. And, although there may be no measurable improvement in the measured central vision on the wall chart, these patients are often among the happiest and most grateful because of their improvement in color vision, in peripheral vision, and in overall “performance vision”. Such patients are also far less prone to stumbles and falls after such surgery.
In summary, forget the old guidelines. Today, cataract surgery often makes a tremendous difference even in patients with far-advanced macular degeneration.
Modern cataract surgery truly can be a modern miracle.