In YOUR opinion, when’s the best time to get cataract surgery?

In My Humble Opinion
1

I have cataracts in both eyes, but only one has become an issue, mainly with my distance vision. For now, I have glasses that can correct it, but the day will come when that isn’t possible any more.

It’s disturbing to have haloes around bright lights – it’s bad enough that I don’t like to drive at night, and seeing my own personal rainbows around white text on black backgrounds isn’t as cool as I would have imagined it.

On the other hand, I went to the ophthalmologist to have my eyesight evaluated today, and she told me that some surgeons might be reluctant to operate at this point because other than the cataract, my eyesight is actually pretty good. There are risks to any surgery, and at this point it’s possible that even if everything goes well, I’ll still be disappointed in what an artificial lens might be capable of giving me.

My husband says that he feels like his distance vision isn’t as good as it was prior to his cataract surgery – everything’s brighter now, but the distance lens he asked for just doesn’t do as good a job as the one that he was born with. So that’s one data point at least.

I know over time as this problem gets worse, I’ll have to buy new glasses to compensate, but maybe it’s worth the price to wait until things get bad enough that an artificial lens will be more likely to be a real improvement. And I’m sure as time goes by these things get better as well.

I think part of the reason I’m as bothered by this as I am is that I am a photographer and I am left-eyed. That’s where this cataract is - I can no longer tell when something is in focus with my left eye. I can certainly teach myself to be right-eyed, but it is annoying for sure.

Anyone got some thoughts about this?

2

I can provide a little perspective because I just had a cataract removed two days ago.

A few weeks ago my vision seemed to be getting worse, I had a routine eye exam and got a slightly stronger prescription. All was fine until one evening when I was driving after dark and I realized I was seeing bright lights (streetlights and traffic signals) double. I went back to the optician who ran a bunch of tests and sent me straight to an ophthalmologist, who ran a bunch more tests and determined I had a cataract in my left eye severe enough to distort my vision. There’s also a cataract in my right eye, but it’s nowhere near as serious.

Since the surgery was literally two days ago I can’t tell you how my eye will eventually adjust (the doctor says it could take as long as two weeks, friends of mine who’ve had the surgery say it could be as little as five days) but I can say there’s already a definite improvement. The view from my left eye is definitely brighter - in photography terms I’d say one to two f-stops brighter - and the entire color spectrum has shifted somewhat to the blue side of the scale, compared to my right eye. I’ll try driving tomorrow, and if that works out, I’ll try driving at night.

My advice is that at some point your eyes will get bad enough that you won’t just dislike driving at night - you’ll actually be afraid to do it. As a photographer, you’ll notice that what you see through the viewfinder is not the same as what comes out of the printer. And you’ll immediately realize that a good artificial lens is superior to a deteriorating natural one.

3

FWIW, I had the equivalent of cataract surgery just over a year ago, sans-cataracts. It’s called Refractive Lens Exchange, but it’s the same thing. So your cataracts not being bad enough should not be a blocker. But the fact that your vision is still pretty good might be the important decision point. For me, I had always said I would look at surgical options when I couldn’t read in bed without glasses. I reached that point a few years ago. Figuring out something like that might be useful for your case.

I’m generally happy with the outcome. I went with a high-end replacement lens, because I was specifically doing it to get rid of my glasses. I think they got the rx slightly off (it’s not as simple as glasses or contacts - there’s a but of guesswork involved). My computer vision requires me to lean forward a little more than I want. But I can read in bed again. I can drive. I don’t have fine granularity at distance that I used to have. It’s a trade-off.

Upsides in my case that don’t really apply to you is that I’ll never develop cataracts, and I should never need glasses again. And I’m in my early 50s, so hopefully that’s going to be a nice benefit for many years to come.

4

Your vision will not improve on its own, but guaranteed it will get worse. You are already bothered by the decrease in acuity. So I guess I don’t understand the reluctance.

As far as the hazards go, no surgery is risk -free but cataract surgery is one of the most widely performed and successful medical procedures and is IMO one of the most significant medical advances to make aging a little more bearable.

So since you asked, IMO get it done as soon as you are annoyed, and before you are incapacitated, by the symptoms. Your photographic skills will be vastly enhanced by the ability to see colors distinctly, if no other benefit.

After a lifetime of being seriously myopic, I can now see well enough to drive without glasses, though my residual astigmatism (which I chose not to have corrected) means my vision is not perfect. There are other cataract surgery threads on the board you may want to check out, but the overwhelming outcomes are positive.

5

I hear you on this - and I think something like this will be the decider. I have a bit of the seeing double when looking at something bright thing going on already. Glasses correct it, but there will be a point where that might not be the case any more.

6

My ophthalmologist says that there’s no way to know for sure exactly how your eye will heal around the new lens, and that affects your final vision. She also says that how one eye heals is very predictive of how the other will, so she always starts with the non-dominant eye, so her odds of getting the dominant eye right are better.

7

I’m also waffling about when to get cataract surgery. One consideration for me is that the technology is still improving, and the options in 3 years might be better than the options today. Also, I’m not sure whether i want to optimize near or far vision.

8

There are different types of lenses that might be put in depending on special situations. If you do not think your ophamologist is paying attention to your needs as a left-eyed photographer, I would find another eye surgeon.

I do not need cataract surgery yet, but my personal strategy is to use an optometrist who is affiliated with an eye hospital. I’m thinking that when I do need an eye surgeon, she will be able to send me to the right one. I realize that if you live far from such a facility, this may be impractical. It also might be a cost issue, although my optometrist is now charging U.S.$75 for an exam for patients without relevant insurance, and I think that’s a hard to beat price. YMMV.

9

Yep. I’m taking this into consideration too.

10

I didn’t bring this up because for right now it doesn’t matter. I go to a university eye center and I saw a resident, who wouldn’t be doing the surgery. I just wanted to get evaluated and get an idea of the pros and cons at this point. I have insurance so an eval isn’t costly. The surgery (whenever it happens) will be, though, since I’ll have a deductible and co-insurance. If I put it off until I am eligble for Medicare, I’m not sure what wll happen then.

11

Right now, this is what would happen if you have traditional Medicare (not Medicare Advantage):

A quick scan shows a general range of $3,000-$6,000 per eye for laser surgery. If you have a Medigap or supplemental plan, it will pick up that 20%. A fancy multi focal lens (if you choose one-which Medicare won’t pay for). Then that is another $1,500-4,000 per lens.

12

It does looks like there are several accommodating lenses on the horizon (an accommodating lens is one that can be focused–that’s in comparison to fixed-focus lenses that generally require either reading or distance glasses afterward). Right now, Cystalens and Trualign are the only two available, but they’re fairly old at this point.

There are some more under development, though:

FluidVision, Juvene, Atia ision, Lumina, Opira are a few of them undergoing trials. In a few years we might know more.

13

Those look more like 5 years out than 3 years out, but that’s an exciting list of potential future options.

14

The article was from 2022, so maybe there’s still a chance :slight_smile: . But yeah, I’m not expecting all these things to drop within three years. Just pointing out that there are a fair number of options under development.

I’m hoping at least a few of these become available before I start needing reading glasses.

15

As a person born with pathological myopia and a congenital cataract, which later led to retinal degeneration and two unusually young-forming “regular” cataracts, I have no idea why anyone would wait to get corrective surgery.

I had to wait a couple of years past when it could have made sense to get my IOL due to a Series of Unfortunate Events (my travel schedule, the need to be 100% sure I had eyesight that let me drive so I could take care of my elderly mother’s needs, my wonderful ophthalmologist having surgery of his own he had to recover from, whatever blah blah).

Honestly, I cannot imagine what “improving technology” one might wait for. Personally, I went from

  • being a young child whose eye doctor told my adoptive mother “she’ll be blind by the time she is 40’”

to

  • learning enough about my biological history to find out in my 30s that yes indeed, my bio mom was actually functionally blind by the time she was in her mid-40s, but having eye doctors tell me, “wow, you are lucky - your retinas aren’t as degraded as I’d expect given your myopia”

to

  • constant “surgeries” (I’d settle for the word “procedure” myself as surgery seems overly dramatic) for retinal tears

to

  • being barely able to see, thanks to worsening cataracts and needing to delay surgery for various reasons

to

  • FINALLY getting both eyes, one by one, done. Each time, it was a Big Deal, sort of - I had to get advance approval from my insurance, and that involved a fair bit of effort on my part, plus it had to be done under general anaesthesia because of the high risk of retinal detachment I face.

But wow, just wow. My life is completely different than it was as a coke-bottle-glasses kid and adult. No eyeglasses, reading or otherwise. No contact lenses, with associated hassle and expense.

I now have monovision lenses implanted, which I understand many US physicians dislike prescribing. Lucky me, my Singapore physician had no problem with it.

My vision is 20/20 (I do prefer to wear distance glasses at night, but that is such a minor inconvenience it is laughably insignificant compared to what I went through most of my life) and I could not be happier.

I cannot imagine the value, for me, of waiting for some “technological improvements” before fixing my vision. Those improvements are here. Yes, according to what was available in 1965, I would indeed be blind today. But thank goodness, the future is here. Not a day goes by that I don’t thank modern medicine for making my life and my vision a thousand times easier.

TLDR version: what the heck is anyone waiting for? If your eyes suck even half as bad as mine did, you have an incredibly improved world waiting for you if you get the cataract surgery/IOL. Even if you have to pay something out of pocket, you’ll never need expensive eyeglasses again and you won’t have to buy contact lenses and fluid, plus take the time to take them in and out every day - that’s worth something, isn’t it?

16

My understanding is that i will need glasses after cataract surgery, for either near or far, but not both. And that there are multifocal lenses available, but you pay for them with fuzzy vision at every distance, and artifacts like rings around lights.

I gather that’s not been your experience. What kind of lenses did you get?

17

I got monovision lenses - in other words, one eye has a lens for far vision and the other for up close. The brain, wonderful organ that it is, chooses whichever eye needs to be the dominant one in any situation, so my sight works for both near and far vision quite smoothly.

My doctor recommended that approach and it’s been perfect for me. But, as I said, he is Singapore-based. I’ve had a couple of American friends tell me that their eye doctor refuses to do monovision lenses, despite being begged to do so.

I’m sure there are reasons not to, but (a) whatever they are, they obviously don’t apply in my case; and (b) I’d certainly ask a doctor to explain WHY they are recommending against monovision.

18

Not everyone takes well to monovision. Their brain never quite merges the images and they get headaches.

It is available in the US, at least for LASIK patients, which have the same choice if they’re older and have presbyopia. They can focus for distance or closeup or a mix. I know of one person that got monovision LASIK and wasn’t particularly happy with it. That was nearly two decades ago, though.

I suppose it might have to do with liability. If they focus for distance, then they can say absolutely that you’ll need reading glasses. Focus for close-up and you’ll need glasses for distance. With monovision–well, maybe you’re lucky and it works perfectly, or maybe you aren’t and you need glasses for both distance and close-up.

It’s probably worth some preliminary testing to see if you’re well-suited to monovision.

19

A couple of things about my case that might not apply to others:

  • I wore contact lenses for a few years before surgery that gave me monovision, so in my case there had already been “preliminary testing” proving it worked for me; and

  • At the time I had the IOL implanted, my vision was -13 in one eye and -18 in the other. As I understand it, that degree of nearsightedness is vanishingly rare.

20

Were you able to see individual atoms? Or just virus particles as they landed on your nose?