Cataracts -- what to expect in early stages

In My Humble Opinion
1

I visited my regular optometrist yesterday, as I do every year, to update my glasses prescription. I expressed a feeling that bright lights are not as bright as they used to be, and he confirmed that I have the beginnings of cataracts in both eyes. I’m 75, and have worn classes since I was 12 (I wore contacts instead for a few years in my 30s).

Three years ago (I think, or it might be two) a different optometrist said that I would notice visible indications of cataracts within 5 years. Looks like he was right.

I haven’t seen an ophthalmologist yet, I will some time in the next few months, unless folks think it is urgent to do so soonest. I assume I will need cataract surgery at some point, as this condition is usually progressive (according to my Optometrist). Are all OPH’s able to do cataract surgery? If not, should I be looking for a surgeon-type now?

I will be seeing my (almost new to me) primary care physician in December, so I will be talking to him about this then. I would like to be armed with at least some intelligent questions before then, so lock and load folks. Tell me what I need to know.

2

You definitely want a specialist. Your PCP probably has the name of a doctor that he’ll recommend.

Now, there are complicated options available like having the inserted artificial lens compensate for corneal issues, which (if you’re like me) you won’t want, and not all doctors can perform. A little online research will prepare you for that question. But in any case the specialist ought to interview you about that, and tell you what to expect in more detail.

Other issues that will be discussed include the possibility of something like a cataract coming back after surgery – the so-called second cataract (which I thought was a waterfall on the Nile, but never mind.) Sounds scary, but apparently isn’t much of a problem.

BTW, I had only one cataract removed, about two years ago; looks like the other eye will need surgery too, soon.

3

By coincidence I just finished up my cataract “procedures” this week.

Cataracts are not an emergency. You have time to find a surgeon (yes, it’s surgery), do your research, coordinate with whatever insurance you have (given your age I’m assuming Medicare), decide what implantable lenses you want/are appropriate/etc. The doc who did my eyes specializes in cataract surgery, which I gather is pretty common these days.

So… sure, take a couple months to see an ophthalmologist who will evaluate you and, if they don’t do the surgery themselves, will probably refer you or advise you about finding a doctor to do the job. At which point the surgeon will examine/evaluate your eyes (you only think you’ve had your eyes dilated before, eye surgeons use stuff that leaves you with what appears to be a gaping abyss into your skull for over a day) and discuss what will be done with you.

The procedure itself, at least for me, was about 45 minutes of prep and 15 minutes in an actual OR. I opted to be fully awake with sufficient medication to make me not care my eyeball was being operated on. There was no pain during the procedure although there was a feeling of pushing/prodding.

I am now in the midst of a 4-week program of eyedrops and adjusting to having better vision than I’ve ever had before. In a month or so I’ll get professionally fitted for eyeglasses to fine tune my vision (escaping “corrective lenses” altogether was not an option for me, it is for some people).

4

My ophtho first noticed my cataracts 10 years ago when I was 56. They’re still slowly growing but nowhere near needing surgery. So the mere fact they can be detected isn’t a reason to immediately pursue surgery.

So when should you do it? When you can no longer get acceptable vision with your correction, be that specs or contacts. Or when your perception is that everything is flat and dull. Or when you find bright lights at night to be difficult.

If you’ve always had crap vision they may well be able to give you much better vision; IMO that’d be a reason to pursue surgery sooner rather than later. Conversely, if you’ve always had excellent vision the outcome is far more likely to be sorta meh by your youthful or even current standards; IMO that might be a good reason to delay surgery as long as possible.


FYI, here are two fairly recent threads on the topic:
June 2024:

Apr 2023 on cataract-adjacent surgery:

And an oldie from 2012:

5

I think you’re referring to clouding that sometimes occurs to the back surface of the capsule containing the lens. That happened to both my wife and myself sometime after the surgery, By sometime I’m talking a year or two. A simple shot or two with a laser, in the office, and the problem is solved. No pain or anything. I had my surgery about 20 years ago, so there might be additional options.

I had a choice of one lens for near and one for distance. I chose to not do that as I’d worn glasses since about age 11 and reading glasses were no burden to me. Additionally it could interfear with some of my hobby activities.

6

I got mine done a few months ago. My left eye was getting cloudier, and I knew I’d fail my drivers license eye test if I didn’t do anything. I’ve know I would have to do them for a few years now.
I got them done two weeks apart, which was a pain because of the long period where I had to put drops in three times a day. I know someone who had both eyes done at once, but that seems risky.
I was theoretically awake during the procedure, and the surgeon said I cooperated, but I don’t remember anything about it. Which was fine with me.
I chose the option to fix my myopia, which meant I still needed glasses, but since I’ve worn them since third grade, 65 years ago, that was a feature not a bug. It also meant I paid nothing under Medicare, except for the drops.
Everything is much brighter.
My one issue was that I didn’t have glasses for the period between the second surgery and when I could get new ones, a month after the surgery. I found a really old pair of glasses with a decent prescription, so hoarding does pay off. (I donated them all right after this.) Now everything is bright and clear, and I passed my drivers license vision test with no problems.

7

Does this mean that you had to wait a month or so for your eyes to heal before you could be tested for a new prescription? How was your uncorrected vision during this period?

8

Yes, I had to wait until my vision stabilized, which took a month. I scheduled an appointment for then. Like I said, I was lucky enough to find an old pair of glasses which worked pretty well with my new vision. My near vision was good enough so that I could read without glasses, but my far vision was bad without glasses or with the ones I used before the operation.

9

I usually wander into cataract threads because I had early-onset “ordinary” (nuclear sclerotic) in both eyes and a congenital posterior subcapsular cataract in one eye. That plus retinal degeneration made for an inordinate number of ophthalmologist appointments and procedures for a few years, but in retrospect it all seems minor, given that my eyesight is now better than it was even in early childhood.

We live in wondrous times. Whatever your cataract situation, chances are good that there are many options and a high degree of success at preserving/improving your eyesight, without a huge amount of pain, inconvenience, or risk.

By all means, research and consider the different options available to you, but don’t lose any sleep over it or feel the least bit anxious. You’re gonna be just fine, and happy with the results.

10

I thank you all for these informative threads. I definitely have cataracts in my left eye that needs remedial attention, so I’m very receptive to all personal anecdotes. This was diagnosed a few years ago and I’ve yet to get myself over to an actual surgeon. To paraphrase Dave Barry, I hate the thought of having medical “care” inflicted on me.

One definite decision I’ve made, though. I don’t want my vision “corrected”. I’ve been happy my whole life being short-sighted, being able to read books and, in the modern age, my Kindle, tablet, and phone, with wonderful clarity without glasses, and only needing glasses to see clearly at a distance. This is what I want – my left eye to be the same as my right eye, as it always was, and both needing the same corrective (external) lenses.

11

Did they do both eyes at once? How long afterwards could you see well enough to drive, etc?

I am supposed to get the procedure likely next year, so this is great info.

12

I have some cataracts in my right eye; my opthamologist and optometrist agree that they aren’t bad enough to do anything yet. The surgery could cause more problems than it will solve. It’s been five or six years and they’re growing slowly.

My wife had them, but they were fast growing and the opthamologist scheduled the surgery as soon as she spotted them.

13

My surgeon told me how to order some cheap, imperfect but usable glasses for the healing period. I’m finding them essential for driving even though they aren’t perfect. Maybe folks should ask about that?

14

That’s something to discuss with the doctor. I’m opted to continue to be near-sighted (just much, much less so) rather than farsighted. So I need distance glasses, but overall I need less correction than before. Again, that’s something to discuss with the doctor.

No they did each eye two weeks apart. I wasn’t allowed to drive for 24 hours, but that was, I suspect, mostly to make sure any medications they used were out of my system.

After the first one I used my old glasses, but one eye was super blurry. Could still see well enough to drive. My surgeon tested my operated on eye and told me a strength for “driving glasses” and told me how to order them off Amazon. After the second eye was done I switched to the distance glasses (my old prescription is completely useless now!) and I’ve been driving without a problem from the day afterward.

I caution your mileage may vary and, again, these sorts of things need to be discussed with your doctor.

15

I’ve posted in a few of those threads, but I’ll chime in here too. I opted for Refractive Lens Exchange, which is effectively the same surgery, except I didn’t have cataracts. I was getting to the point that I could no longer read without glasses, and my vision was changing enough that about half the year my progressive lenses would be out of date making reading with them difficult. I had always said that when I couldn’t read in bed, I’d be interested in a surgical solution.

For various reasons - mostly to do with a dry eye condition - I’m not a good candidate for LASIK. So RLE was suggested by two different eye doctors.

I went with a surgeon that does a laser based process. Much gentler on the eye and smaller ‘wounds’. He did both eyes in the same visit.

I opted for fancy multi-focal lenses. If I hadn’t been drugged up, I would have been able to drive myself home without glasses. I did, in fact, drive myself to the follow-up visit the next day.

My vision is not as good as it was with a perfect pair of glasses. But it’s stable - I’m told I should never need glasses. I can read. I can drive. I can enjoy sporting events. I don’t see distance as well as I used to. I’ve considered getting a pair for glasses just for those occasions, but that seems like a lot of work now :rofl: I do have some halos at night, but my mind has learned to ignore them quite well.

I’ll never get cataracts.

I’m happy to answer any questions associated with the choice.

16

I was mostly 20/200 or thereabouts for most of my life. Didn’t like to swim because without glasses I could get lost in a large pool, much less a lake.

But, if I wanted to see something close up, just look over the top of my glasses! Like a 3X magnifying glass on hand all the time.

I did enjoy getting the corrective lenses endorsement off my driver’s license after 40 years or so.

17

Maybe not “soonest” - it’s certainly not an emergency. But the sooner you visit someone, the sooner you can get things in motion for bionic eyes!

For me, I didn’t notice an issue with lights and brightness - I happened to notice that with my right eye closed, things were NOT as clear distance-wise with my left eye. Now, that’s always been my weaker eye, but this was still surprising.

And then shortly after that, I noticed that my depth perception wasn’t quite as good as I’d like. As someone for whom stairs represent a constant danger, this posed a problem.

Doc basically took one look and said “CATARACT”.

It was still another year before she was willing to fix this (for a combo of bad and good reasons) and ultimately I went with someone else.

I had someone pop the left lens out of my glasses, so I didn’t have that painful-sounding overcorrection to deal with. It wasn’t ideal for the computer but it worked, for the 2 weeks it was an issue.

You can discuss the desired degree of correction with the doctor - and of course there are the fancier multifocal lenses now. I opted for a low-add multifocal, set for distance and intermediate. The result being I can see well enough to drive AND to see the dashboard. If you look at Enipla’s thread from 2017 or so, he opted for an even fancier lens than I did.

I can read my Kindle (might want the font a size larger than I used to, and that backlighting is helpful). I can do most things on my phone, though with reading glasses some tasks are easier. Small print on labels etc. is a problem, and requires reading glasses or a light. I’ve got a phone app called “reading glasses” which uses the phone’s camera and, optionally, the light - not something I’d care to use for reading a book, but for a label it comes in quite handy.

My mother-in-law, making decisions before HER surgery 15 or so years back, told the doctor “I want to be able to tweeze!”. So her vision was set for closer and she wears glasses for distance.

One advantage of better distance correction would be your glasses can be the sort you pay 10 bucks for 3 pairs at Costco. I’ve got a few of those lying around the house, as well as one pair of prescription glasses for the computer.

18

Did you (or are you concerned about, in the future) develop posterior capsular opacification? What some call “secondary cataracts”, it’s a clouding that develops in the back of the lens capsule.

IIRC you and I are similar in age, and I was told that the younger you are, the LIKELIER it is you’ll develop this. I don’t know if either of my in-laws developed it.

19

Kinda sorta started, but they aren’t “ripe” yet. My regular eye doctor noted they were starting about 6 months ago, but they haven’t progressed. She was actually surprised how quickly she saw the first signs.

It’ll just be a thing to deal with - the same surgeon that did my surgery will treat them, and he’s about 5 minutes from my house.

(And yes, I think we are about the same age)

20

Mine were visible within 6 months or so, IIRC.

The first one involved some numbing, some goop in the eye, a ring-shaped thing on the eye (painless) and maybe 5 minutes in front of a YAG laser. I took a Lyft to/from, as I wasn’t sure I’d be good to drive (vision was blurry for a bit).

The second one, same. But they also dilated the first eye for a recheck… which made using my phone to order that Lyft quite a challenge, LOL.