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

In My Humble Opinion
21

For sure it’s totally awesome that @CairoCarol has been saved from functional blindness by modern medicine, even if “modern” was a few years ago.

I too have developing cataracts that have been cooking in there for a decade or so, and are now beginning to be annoying even in daytime. I also have astigmatism and ordinary age-related presbyopia. Right now I manage the latter two with monovision (one near + one far) contacts or glasses. The glasses offer sharper vision, at the annoyance of glasses. I found switching to monovision to take about 3 hours to get used to. It truly is amazing how well that worked. For me; perhaps not for you (any you). FWIW I wore progressives for years and had no problem adapting to them either. I suspect the ease of those two adaptations are related somehow.

Back in the day I had excellent eyesight, 20/12 uncorrected both sides. That started fading in college.

Prior to the cataracts becoming an issue I had looked at LASIK, RK, etc. In each case the choice amounted to trading [OK-minus uncorrected vision plus excellent corrected vision] for [OK-plus uncorrected vision with no chance to further improve it by correction, plus the medium risk of visual artifacts and the small risk of disaster]. I stood pat because I had a lot to loose and the gains seemed incremental at best.

The cataracts are changing that calculus now because they’re finally getting obvious and seem to be gaining speed. Or at least the perceptual consequences are gaining speed even if the mechanical deterioration is as slow as ever.

At my last visit with the optho the advice was “not yet”. I bet that changes this time.

But I’m still looking at trading a good hand for a maybe better one, a maybe equivalent one, and a maybe worse / just mediocre one. With a small chance of disaster. Anyone who’s ever played 5-card draw poker certainly knows the feeling of discarding what turned out to be better cards than you drew.

Our own @pullin suffered an ocular surgical disaster just within this last year-ish. He’s written about it a time or two and anyone considering ocular surgery ought to search up those posts. IIRC, one eye came out fine, while the other had a major league surgical oops that left him functionally blind on that side. It’s since been fixed mostly, so no longer disastrous in his view. But still an awful experience with a poor total outcome.

A sobering reminder that low odds of a failure are not zero odds of a failure.

One of the “advantages” of starting out already screwed, as dear @CairoCarol seems to have been from birth, is that they have relatively little to lose long term, so the vagaries of chance are almost all to the upside. Similar considerations apply to treatments for other disastrous diseases. e.g. chemotherapy does a lot of collateral damage, but it (often) beats the alternative.


With all that long-winded intro, here’s sort of the TLDR I personally came to and that will guide my own decisions going forward.

If the failure / disaster rate is X%, then I need to be suffering now from more than X% degradation from my non-cataract case to make the trade even worth thinking about. And once the degradation is worse than the risk, we start the conversation, but actually doing something probably needs the degradation to be 3 or 4x what the risk rate is. Because glasses, contacts, and halos are all very minor impositions in my life, whereas a serious failure would be a serious imposition.

In truth, I’m more concerned about getting a merely adequate result that can’t be as well-corrected as my current natural vision more than I fear the true disaster. When those lines cross is when I act. As of today that seems to me to be a reason to wait, not act.

22

My doctor is willing to do that, although she didn’t use that word to describe it to me. In fact, she suggested it as an option, and i have some contact lenses she gave me that i can use to experiment with it. Maybe today is a good time to try it.

I had enormous difficulty adjusting to progressive glasses, until i switched to the “premium” type, which have been great. I actually have used monovision lenses, though, as you can’t buy progressive swim goggles/masks. And i wanted to be able to read my watch and see nearby fish as well as be able to find my family on the beach. I adjusted to those fairly quickly. I’ve never tried it for a day, though, or for things like trimming my nails or using a computer.

My hesitation, like @LSLGuy , is that i have something to lose. Until recently, my corrected vision has been excellent, not just good. It’s still pretty good, so I’m frustrated about it no longer being excellent. But I’m not sure i can get excellent, and there’s a significant risk of just okay. (And a very small risk of disaster. My uncle went nearly blind from complications following cataract surgery. But his doctor screwed up, and he didn’t complain soon enough or loudly enough.)

And i wonder if the lenses still in development would increase my odds of an excellent result.

23

Yeah, I think having excellent eyesight + cataracts is a tougher proposition, because you’ll be giving up some visual flexibility; for me, however, a life of terrible nearsightedness has gone away, and yeah I could use readers for close-in reading, but it’s a trade I’d make any day.

All that said, if you’re getting visual halos, it might be time regardless. I let mine go too far and almost had a car crash because of cataracts + unexpected sunlight.

24

What bobsmom101 said.

I had mind done in my late 50’s and early 60’s. I wore glasses, contacts, had LASIK, then needed reading glasses.

Then cataracts.

The surgery is very simple. The actual process took perhaps 20 minutes. Of course I had to be prepped first. And IV and stuff. Ya get a bunch of eye drops. And I guess that takes a little time to work. I did have to take my shirt off, but left my pants on. It’s one hell of a lot easier than say an MRI.

Now after… 53 years of having to wear some type of eye correction, I see great. I see better than I ever have. No glasses, no contacts no reading glasses.

Now, if only tinnitus could be figured out…

25

Well, this thread has inspired me to try another set of contacts. Today i have “intermediate” vision in the dominant eye and “near” vision in the other. And i have a cheap pair of supplemental glasses i picked up online in case i want to drive.

It’s… A little frustrating, and everything is a bit fuzzy. Of course, the contacts don’t correct the cataract, and my ophthalmologist thinks that even the current generation of replacement lenses will accommodate more than my natural lenses do today, so my expected vision would be a bit better than this.

I’m currently reading the dope on my phone, and it’s easy to do stuff like wander around the house, make breakfast, etc.

26

Absolutely! In fact I miss that part of my bad eyesight. People always asked me to remove tiny splinters from their fingers, and I had the best-plucked eyebrows in town. There were definitely some advantages to being that nearsighted.

27

The other bonus I will add for cataract surgery, which I mentioned over in the other thread, is all the colors I didn’t realize I was seeing as vividly. It seems like my cataracts were cutting out a lot of the blue end of the spectrum.

28

My wife had cataract surgery in both eyes earlier this year. She had worn reading glasses for several years, but her vision was deteriorating to the point where she was afraid to drive at night. Plus, her vision was bad enough that the ophthalmologist warned her about driving at any time.

As I recall, the procedures were about six weeks apart. She opted for the multi-focal lenses, which cost $2300 for each eye. She had no side effects. She no longer needs reading glasses, and she has no qualms about driving at any time of day or night.

Based on my wife’s experience, the answer to the OP is ‘now’!!

29

I waited until my vision deteriorated and changing my optical prescription wouldn’t help.

Glasses can only compensate so much.

Everyone I’ve talked to has said they were shocked at the improvement in vision.

That was certainly true in my case. I couldn’t believe the sharpness of the road signs. Colors were bright and vivid.

It takes a few days to adjust to new vision.

I’m due to get a follow-up procedure. Remove the protein film that accumulates on the lens.

Looking forward to sharp vision again.

30

Not everyone is capable of adapting to monovision. If you get monovision lenses but can’t adapt them you’re back to wearing glasses or contacts forever and ever.

There are also some niche areas where monovision either isn’t allowed or definitely frowned upon, but that doesn’t apply to everyone.

It can mess with your depth perception. Again, that may or may not be a problem for a particular person.

One would hope that if someone was getting surgery a doctor would evaluate the individual situation.

31

My experience is entirely second-hand, but this was my parent’s opinions expressed to me if I ever needed to get it done and based on these recent experiences:
Step-mother - got cataract surgery in her late 60’s. Tolerated it extremely well, had complications mostly unrelated to the surgery due to additional eye issues, but is very glad she got it done.
Father - had surgery a few months ago is his early 80’s. I drove him, it took 15 minutes per eye a week apart and he is very happy with the results. However the post-surgery recovery was considerably rougher on him than on my step-mother.
A friend of theirs - Put it off, put it off, put it off, then had surgery in his early 90’s and could only tolerate having one eye done. Couldn’t go through with the second because he simply couldn’t bear it.

Their opinion? Get it done ASAP after your doctor says you’re going to need it, because the younger you are the easier it is to deal with. My father went with far vision for driving and vistas, figuring since he is already used to using reading glasses up close he could continue to do so. My step-mother got progressive lenses and wishes she hadn’t - she’s never truly adjusted to them.

32

I asked my husband to find what he paid (with his Medicare Advantage plan) for his uncomplicated cataract surgery, and if I had the same plan, I’d pay a few hundred dollars out of pocket (he went to the same place I will go for this if/when I decide to do this). If I use the insurance I have now, the $3,000-$6,000 would be in line with my out of pocket. I’m on the fence about whether to go with the Advantage plan he has (which is offered through our former employer) or doing the Medigap thing (which through our employer would leave me with whatever they choose to use as their Medigap provider, which looks like it might change soon).

So, financially at least I could end up with a better deal with waiting if I wait that long (it’ll be a few years).

Because your perspective (the lens with which you view these issues, if you will) is VERY different than the one with which I am viewing it, as someone who has had healthy eyes and pretty good vision for most of my life. If the only issue one has is aging eyes, it’s pretty different.

Remember in my case that the ophthalmologist mentioned that if I get surgery at this point, I might be LESS satisfied with what I get than what I have now, and my husband was as well. You don’t want to have something worse than what you already have, which wasn’t going to happen for you unless something really terrible occurred. I’m not envisioning (err) monovision working for me either. For all I know, I might not ever need cataract surgery in my right eye, just for starters.

If I can afford to wait (and at this point I can, remember glasses correct my problem for the time being), it might be a good idea to do so. That’s what this thread is about.

33

I had the advanced lenses put in. Trifocal, I think? Cost a good bit more, but was told I’d likely need no glasses, not even readers. They were right. Absolutely life changing.

I didn’t wait at all. After my doctor explained the benefits and risks, I asked what I was missing—why would anyone wait? He said “low risk” is not the same as “no risk,” and some people simply will not assume the risk until there’s no real choice.

This seems silly to me. If I’m destined to get the surgery, why wouldn’t I enjoy the benefit for as long as possible? Best decision ever. I was reading without glasses two days after the first eye was done. And the world is in Technicolor again!

34

This is interesting, because when I went to get my new glasses the optometrist mentioned that the new progressives have gotten better. I hated the last ones I got when I first became presbyopic and haven’t tried them since. Though weirdly, my presbyopia has gotten better while the cataract has made my distance vision worse.

QFT. My ENT PA said I am the worst patient for this kind of thing because I want to do something about it, but there’s nothing to be done but Zen out and accept it (or be dragged).

This is awesome, and I am thrilled for your wife!

I’m in my early 60s. I have no intention on waiting until my 80s or 90s (if I make it that long). I figure I got a few years to figure this out!

35

This is an interesting point. With the way our medical system in the US is, I expect a lot of people opt for what their insurance will pay for vs. what may be most beneficial for them. I also wonder if the different lenses require different levels of surgical experience and follow-up care to work out well.

36

It’s an enormous difference. With the original progressive lenses, the world moved around weirdly every time i moved my head, and it gave me headaches. Also, the “sweet spot” where i could actually see was tiny. These don’t have the weird distortion in my peripheral version, and have a much wider sweet spot.

Ditto. Also, my doctor warns that if i get the current generation of multifocal lenses i will probably lose some of the sharpness of vision i still have with correction. (Or up close, for that matter.)

There will definitely come a time when the surgery will be an unambiguous improvement. But I’m probably not there, yet. And the technology is getting better.

37

Yes, this sucked - the reading area was way too small.

Interesting. Thanks for this point. I’ll have to read up on these lenses to find out more about them. I don’t think my husband was offered this, though since I wasn’t present at the appointments I don’t know for sure.

It’s possible that doctors may not even mention lenses that patients’ insurance won’t pay for, come to think of it …

38

Lenses that aren’t fully covered by insurance are quite popular, and not out of reach to people used to paying a lot for corrective lenses. I expect most doctors mention them.

39

Depends I bet a lot on which SES that doc and clinic is used to dealing with. And/or where they assess your SES based on dress, demeanor, vocabulary, etc.

I take no chances and say right up front: “I have insurance but can pay the freight for stuff they won’t cover. Now what’re the best options after taking price off the table?”

I do recall discussions w staff at the eye clinic about cataracts as I was approaching age 65, retirement from work, and Medicare, that Medicare won’t pay anything towards fancy cataract replacement lenses and also won’t even give you credit on the work for whatever the cheapo ones they do cover would have cost. Which seemed pretty chintzy to me.

I can vouch that that’s what the clinic said and that I understood them correctly. I can’t vouch that they were correct, nor how a Medicare Supplement or Replacement policy might interact with that info.

40

And if you’re destined to get the surgery and also destined to have a shitty outcome far worse than the vision you walked in with, why would you hasten making that trade and losing the decent, albeit deteriorating, vision you have for the many future years you would have had it until your eyes eventually become so bad that even a bad surgical outcome is better than your much older much reduced natural sight?

You’re certainly correct that a good outcome is the way to bet. But it’s not the only possible outcome. Loss aversion is a valid bit of human psychology.