Glaucoma & Cataract, Prof. Eytan Blumenthal | I've been told that I have mild cataract, what should I do?

I’ve been told that I have mild cataract, what should I do?

It is quite common that during a routine eye http://wahres-sein.de/ performed by an ophthalmologist, a patient over the age of 60 is notified that they have mild cataract, which does not justify surgery, but does explain a small to medium decrease inthe sharpness of vision. These patients would like to know, after having discovered they have mild cataract, what should they do?

My response, surprising as it may be, is:’do nothing’. There are no necessary actions, except for maybe two things: one is to continue visiting your ophthalmologist for routine examinations every 6 to 12 months, and second, if you think your glasses may not be accurate (and even if you hadn’t noticed this happening), it is advisable to see an optometrist every 6-12 months in order to check the accuracy of your glasses, even if you had replaced them just one year or two ago. More so, when cataracts develop, in the stage when the cataract is still mild to medium and does not require surgery, it is advisable to see an optometrist much more often in order to check whether your glasses need adjustment. Why is that so? You will learn more about that later, while reading this page.

The natural, transparent lens that each of us has in their eye

Between the arrows you can appreciate the natural, transparent lens found in every healthy eye. When this lens turns opaque, the resulting condition is called a "cataract".

Early cataract seen as yellowing of the lens

An early-moderate cataract is seen as yellowing of the lens. The picture on the right shows more details

Initial (very mild) cataract first appears in each and every person around the age of 40 (yes, forty), and develops very slowly during the course of three decades. At an average age of 65-75, this person will need cataract surgery.Hence, there is an extremely long period in which the lens is not clear as it was when the person was 20, but on the other hand, the condition of this lens (which exists in every one of our eyes,that we were born with), still does not justify cataract surgery, which would be performed only when it becomes necessary.

In this period which could last between a few years to a few decades, vision is not at its best, but is still good enough to watch television, read and even drive safely. In this period, in addition to gradual blurriness (which is barely felt), a patient might gradually feel that their vision is turning slightly darker and would like to increase the light of theirdesk lamp, as well as the lights in the kitchen, living room, office and study room.I recommend to every person who has mild to medium cataract (which does not justify surgery, yet) to increase the amount of light in their environment, because it will allow sharper vision than with dimmer lighting. Practically, one should replace the light bulbs with more powerful bulbs and sometimes additional lamps are needed around the house, especially in locations that feel dark, and in locations where the patient reads and writes.

When a cataract is present but not advanced enough for surgery, one very common phenomenon is a constant change in the eye glasses prescription. It could be a change of half a diopter, one diopter (one number), and sometimes even 2-3 diopters. The change can be either a decrease or an increase (depends on your luck) and it can be rather quick, so that some people may need to replace their glasses every 1-2 years, and in rare cases even every 6 months.

In closed captions, those who wear ‘multifocal glasses’, which probably make up most of mypatients, you have undoubtedly discovered already that replacing them ‘ain’t cheap’, …to say the least, such that you could be charged hundreds of dollars just for one lens. In these cases a compromise is reached, balancing the patient’s need to see as clearand crisp as possible, which might require replacing their glasses even a few times a year, and their desire not to spend so much money on lenses that are temporary at most.  Consequently, tha individual will replace his/her glasses only when their vision is significantly blurred.

During this period, which can last a great number of years, it is very hard for the patient to feel whether the decrease in vision clarity is due to the change in refraction (the glasses prescription), or due to an opacitation of the lensthat cannot be fixed by glasses. The way to find out which of the two is correct is to visit your optometrist, usually at a glasses store. If the optometrist manages to improve vision significantly by changing one’s glasses, he/she will suggest replacing the lenses. If not, he will explain to the patient that it is probably cataract which underlies the blurriness felt by the patient, and the timing for cataract surgery might be approaching. This is particularly true when the maximal vision that your optometrist can obtain is lower than the vision required for that individual to perform their everyday activities, such as driving, watching television and reading.

In conclusion, each and every individual, before reaching the inevitable stage where cataract surgery is needed, will have to deal with an extended period that could last anywhere between a few years and several decades, in which they suffer mild to medium cataract which is felt as a mild ot moderate decrease in visual acuity, but does not (yet) require surgery. In this extended period there is not much to do to slow down the progression of cataract, as we, western medicine ophtalmologists, believe that eye drops, nutritional supplements and even lifestyle changes, do not really effect the progression rate of this disease. One exception might be wearing sunglasses when out in the strong sunfor extended periods, so that too much sunlight and especially UV radiation will not penetrate our eyes. But practically speaking, even wearing sunglasses when needed would probably have very little effect on catarct progression; an effect that is unlikely to be noticeable by the individual.

So, next time that your eye doctor mentions to you that have ‘initial (or early, mild) cataract’, simply carry on with your life just as you would have done before. Remember to see your eye doctor every 6-12 months (or as frequent as they tell you), and remember that you will have to change your distance and reading glasses (or your multifocal glasses) much more often than in the past decade.

As to the timing of cataract surgery- my guideline on this topic is that it isn’t right to rely exclusively on an objective test that will determine when precisely is surgery required, but there must also be a siginificant subjective effect on vision, as experienced by the patient, on his/her daily living; translated to an effect on the patient’s quality of life. For example, a person who drives often and surely a person who works as a professional driver, would need cataract surgery when their abilty to drive safely is jepourdised. Similarly, a patient that reads often, works, studies and/or has hobbies that require sharp vision, would be referred for cataract surgery when their quality of vision decreases, and with it the ability to drive, read comfortably, and engage in their hobbies and daily activities.

Last, even if the cataract’s state requires surgery, a state we refer to as ‘ready for surgery’ , or ‘mature for surgery’ it does not mean that the person is also ‘ready for surgery’. What I mean to say is this: many patients, upon hearing for the first time that cataract surgery is required, still do not concieve this necessity and therefore are frightened by the need to undergo delicate eye surgery. That is why a few weeks to months are someitmes required until the patient fully grasps this need and agrees with the diecision to undergo cataract surgery. In my clinic, it isn’t rare that a patient which had the catract in one of their eyes declared “mature for surgery” asks to postpone the surgery for quite some months, or alternatively asks to set an appointment for six months ahead, which would allow them an adjustment period, to get used to the idea. Luckily, when it comes to cataract, the vast majority of cases can withstand a few months’ wait (and sometimes even more) without any damage to the eye’s seeing potential (stated differently, the wait will not lessen the eye’s visual potential, which is the attainable vision following the surgery).

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