Healthy Aging

When Is the Right Time to Get Cataract Surgery?

By Erica Manfred Friday, December 4, 2015 14 Comments Share This:

Cataract surgery is one of those miracles of modern medicine that we take for granted. We forget that cataracts were once the leading cause of blindness in this country and that having cataract surgery required a monk-like ability to lie in bed with your head perfectly still for a week or more while the incision healed. The results weren’t terrific either. They would take out the lens and give you coke-bottle thick glasses with prisms to focus the eyes. I remember my father wearing a pair of those.

Still, that was an improvement on cataract surgery ancient times-style. They used a process called “couching,” where the doctor hit the eye with a blunt object, forcing the cataract to move to the back of the eye.

Nowadays, the cataract complication rate is one percent and a variety of lenses can be implanted to allow accommodation to near and far distances. Unfortunately, as the surgery has improved, the public’s understanding of it hasn’t. A lot of misconceptions about modern cataract surgery — especially the misconception about “ripe” cataracts —inhibit people who need it from getting it when they need it.

What Exactly Is a Cataract?

A cataract is a clouding of the eye’s lens. When we look at something, light rays travel into our eye through the pupil and are focused through the lens onto the retina, a layer of light-sensitive cells at the back of the eye. The lens must be clear in order to focus light properly onto the retina. If the lens has become cloudy, this is called a cataract. As cataracts advance, they become more opaque and harden, eventually causing blindness.

The “Ripe Cataract” Myth

The major misconception is that your cataract needs to be “ripe,” —in other words, advanced to a certain point—before you can get it removed. The concept of ripeness had validity not long ago, when you had to be nearly blind to get a cataract removed safely—but techniques have changed.

“When my dad did this surgery there was a different technique,” ophthalmologist Brett Katzen MD explains, “the incision wasn’t microscopic like it is now. To get access to the lens they’d use a hook to get the cataract out. It was like removing a watermelon seed–you wanted it hard so it didn’t break apart.”

Technology advanced rapidly in the late ’60s when small-incision surgery was invented. An instrument was used to break up the cataract in a process called phacaoemulsification so the cataract could be removed without damaging the eye. With this type of surgery, the less ripe the better, since the softer the lens is, the easier it is to remove it with the ultrasonic instrument. “Now we don’t use stitches or a patch on the eye. Patients can walk out seeing perfectly.” says Dr. Katzen.

In fact, explains Dr. Roy Chuck, Chairman of the Department of Opthamology at Einstein Montefiore Medical Center, “When a cataract gets rock hard it’s technically difficult to remove. This is a good reason not to let cataracts get worse.”

How’s Your Vision?

So, if waiting as long as possible is no longer the answer, when is the right time to have cataract surgery? Doctors today say you should get your cataracts removed when your vision is 20/40 or worse, and more importantly, when cataracts affect your daily activities, like reading, sewing or driving at night.

That also happens to be when Medicare and private insurers will begin to cover the surgery. According to Dr. Chuck, they want your vision to be “significantly impaired” before they’ll kick in. Since cataracts develop so slowly and we tend to adjust to impairment from day to day, that means staying aware of your changing vision.

“Some people have decent clarity of vision, but the glare starts to bother them—they realize things look dimmer,” he notes. That’s when they should come in for testing to see if they have a cataract. “When we remove a cataract, people are aghast at how bright their wardrobe is. They didn’t realize they’d been living with a wardrobe malfunction.”

Which Lens to Choose

Unless you can afford to pay for what Medicare won’t cover, there is not much choice: Medicare will cover a single vision lens that can be calibrated for either distance, reading or something in between, which means you’ll probably need bifocals or glasses with progressive lenses after surgery. There are newer lenses that correct astigmatism and also allow almost normal vision, but they’re quite expensive and Medicare doesn’t cover them. If you can afford to pay an extra thousand or more per eye, ask your surgeon about the new multifocal or accommodative lenses.

How to Pick a Cataract surgeon

I developed cataracts very young because I had diabetes and was referred to one of the best surgeons in New York because I was so myopic. I saw a lot of botched cataract surgery cases in his office because he was the go-to guy for repairs.

Despite the fact that the complication rate is very low with cataract surgery, do choose the best doctor you can find. This is your eyes we’re talking about; find a surgeon that does a lot of cataract surgery, not just the occasional case.

Have you had cataract Surgery? How long did you wait? Share your experience in the comments below.

COMMENTS

14 responses to “When Is the Right Time to Get Cataract Surgery?”

Judy:

Tuesday, March 16, 2021 at 4:11pm

I Am Terrified. I Am Going To Get Right Eye Done First. I Really Need To Know If Lasik Or Manual Is Better. And Also What Type Of Lens. Please Someone Help. I Am Pathetic. Scared To Death. I Mean It Is My Eyes. God Bless.

Reply to Judy
John:

Monday, July 29, 2019 at 11:32am

If you like to play golf, do not get the Multi-focal lenses implanted. The lenses are also not good for night driving because of the rings around the lights. Make sure you do the research before getting the implants because once they are in your eye, it is a done deal.
i now have to wear a contact Lens in my eye that has the close vision for playing golf.

Reply to John
Callum Palmer:

Wednesday, July 3, 2019 at 9:37pm

My dad’s eyes are pretty bad and we think it might be cataracts. As you said here, it would be good to have his eyes looked at when it affects his daily activities. He is struggling to drive at night as I don’t want him to get into any crashes.

Reply to Callum Palmer
Arya Smith:

Monday, July 16, 2018 at 9:02pm

Thanks for pointing out that the Medicare will be able to cover the single vision lens. With that in mind, I will be sharing this information with a friend of mine since their mother just started having cataracts. They don’t want their mom to get blind in such an early stage, so this will really help them since they also don’t have much money for the surgery.

Reply to Arya Smith
Kyle Wayne:

Wednesday, April 4, 2018 at 7:33pm

I appreciate that you talked about how you should get advice from a professional for when is best for cataracts to have surgery. One of my cousins is looking to get surgery but wants to be smart about the timing. I think I will talk to him about working with a professional to find a good time for him.

Reply to Kyle Wayne
Paula A. Blissett:

Sunday, March 4, 2018 at 10:17pm

I found out last November 20th, 2017 that my right eye with the cataract, is ready to be removed, my Doctor told me i could do it then or wait a year, i chose to wait the year, she also said the left eye was still good, no removal yet, i’m hoping by the time i get the right one done, the left one will be ready. My concern is the time off work, and not being able to lift or bend for a few weeks, my job is both physical and clerical, i’am more physical, and lift 20 to 30 lb. garbage bags, lots of bending, it’s like cardio, which i like. I plan on having the surgery on a Friday, i will be off that job and another, (accounts), on the weekend, but i can not miss more work than that, these 2 things i mentioned are very deep concerns for me, as far as the one account, i can get someone to help me with the heavy garbage, the bending, well, that’a different scenario, the other 2 accounts, i’m pretty much on my own, the one also has heavy garbage involved, no one to help there, i have 3 accounts i do all together, and paper work which is not a problem i sit for an hour. Is 3 weeks or more really required to refrain from these duties? Thank You, Paula A. Blissett

Reply to Paula A. Blissett
John Bucciachio:

Tuesday, February 14, 2017 at 1:18am

Very nice post and thank you so much for the useful information and yeah LASIK is often recommended to patients who suffer from hyperopia (farsightedness) myopia (shortsightedness) or astigmatism (a vision defect associated with distorted or blurry images).It can also correct vision problems caused by glaucoma disease, but only if there is no damage to the optic nerve and intraocular pressure remains normal when wearing contacts or eyeglasses. A vision test will determine the severity of glaucoma symptoms and determine whether this refractive surgery is a viable treatment option or not.

Reply to John Bucciachio
Zachary Tomlinson:

Thursday, January 26, 2017 at 8:42pm

I like that you talked about how you don’t need a ripe cataract anymore. I bet it’s important that you find the right surgeon as well. I would try as hard as I could to find the right eye doctor so that my eyes would work perfectly after cataract surgery.

Reply to Zachary Tomlinson
Dennis Sanchez:

Monday, December 12, 2016 at 5:24pm

Thanks for the very informative read. You insisted that when you have 20/40 vision, you should consider cataract treatments. My uncle’s vision has been worsening and perhaps it’s time we have him go to a professional and see if cataracts is the right procedure for him. Being able to give him good vision back would greatly benefit multiple aspects of his life, such as his love for bird watching.

Reply to Dennis Sanchez
Maggie:

Thursday, June 23, 2016 at 3:12pm

It’s good to know that you don’t have to wait for the cataract to advance to get it removed. I’m glad that i could go get surgery as soon as I was diagnosed with the condition. In fact, it sounds like the treatment for very mild cataracts could be something done in-house during a routine appointment! However, I’m not a professional, so I wouldn’t know.

Reply to Maggie
Nash Rich:

Wednesday, February 17, 2016 at 3:09pm

I think it’s great that technology has gotten better that you can get cataracts removed before they are really bad. I actually didn’t even know you could get them removed. I agree with finding the best doctor you can, in any health situation. Even if that doctor is more expensive, it’s still better to get quality work done than save a few bucks and have lingering problems afterwards.

Reply to Nash Rich
Jenny Gygi:

Monday, December 21, 2015 at 2:47pm

Thank you for your great article, Erica! I’m hoping to have my cataracts removed, but I wasn’t sure which surgeon I should go to. I liked how you mentioned that as I’m looking for a surgeon, I should find the best one that I can. I don’t want just anyone doing surgery on my eyes! I’m going to look for a cataract surgeon that has performed the operation many times, like you suggest, so I can get the best results possible from the surgery. Thank you for the advice!

Reply to Jenny Gygi
Judith Kerman:

Thursday, December 10, 2015 at 3:13pm

Great article, Erica. I had mine done 6 months apart (just before turning 70). I chose “monovision,” since I’ve been dealing with my contaact lenses that way for years. I was surprised to find the “reading” prescription that I wanted has a narrower focal range than a natural lens – my doc, who is otherwise excellent, didn’t tell me that. But otherwise, it’s such a pleasure not to have to mess with contact lenses, and to have 20/25 or better in the “far” eye and functional, if uncomfortable, reading of type even when the light isn’t great. And yes, apart from 4 weeks of multiple eye drops, the recovery period was totally comfortable. It is amazing how blue natural light is when it’s not filtered through the yellowish tinge of a cataract.

Reply to Judith Kerman
Lifesart:

Monday, December 7, 2015 at 11:05am

I had cataract surgery on both eyes at age 44. I had worn glasses since I was 3 years old, as I had terribly myopia from birth.

My Opthalmologist said I had what he called “Oil Drop” cataracts. They were tiny and difficult to diagnose, and I had been prescribed stronger and stronger contact lenses for years, but my vision was still nowhere near 20/20 and I had near night blindness. Several stupid doctors threw up their hands and tell me they could not refract my eyes, as if I were being recalcitrant on purpose. When I found my wonderful surgeon I was so thankful that he could determine the problem.

I had the right eye done with no problems at all, resulting in excellent distance vision in that eye. But then my beloved doctor had his own problems and had to retire. His replacement… Well, the best I can say is that I have excellent distance and close vision, but I had not been informed that my left eye would be lensed for reading, so in effect I have monovision. I am very happy with it, after more than 20 years, but I was nonplussed to not have been informed about it. I do have regular checkups and have twice had to have ‘laser shots’ to the lenses to keep my vision clear.

After 40+ years of glasses and contacts though, I was surprised by “floaters”. I had never seen them before! My vision had been so bad that I could not see them. I have adapted to them, but they are strange and I sometimes reach to swat that ‘fly’ that has newly appeared, only to realize it’s a floater, not a fly!

I am so vexed that they do not offer this surgery for vision correction in the US, which I know some countries in Europe do. With my original vision, I was never corrected with glasses or contacts to anywhere near 20/20, and was not a candidate for laser correction (at least, I was not, back in 1994, that may have changed with progress in that area over the years.) I know several people who would be over the moon to have this kind of success.

Reply to Lifesart