Why do cataracts have to "ripen"?

I know a number of people who have early-stage cataracts and whose doctors have told them that eventually, they’ll need surgery when the cataracts “ripen” (Hate that term!), i.e., get bad enough. And I’ve had lens replacement surgery in each eye due to medication-induced cataracts. I was amazed at how clear colors were and how much brighter the world was post-surgery.

Why do people have to wait until their vision is really impeded by cataracts before surgeons will remove them (the cataracts, not the patients)? I know surgery always carries risks, but it seems impeded vision carries its own risks. So why not perform surgery when the cataract is still in the early stages? I’m assuming there’s a good reason, but I can’t figure out what it is.

I presume because you can still function adequately, so why risk a surgery that has some potentially serious complications when you have a minor condition.

A bigger reason is likely just the insurance company. If your cataracts aren’t bad, and your vision is good enough to function normally, its understandable they wouldn’t want to toss out the money just so someone can see more vibrant colors.

Presumably, if you had the money, you could probably find a doctor to do it earlier.

I work in ophthalmology (IANAD/N), though cataracts aren’t really my area. Our docs do see a lot of older patients with cataracts, and (though I haven’t ever heard the term “ripen,” they use “worsen”) they do tend to recommend putting it off, but typically they just say something to the effect of, “As long as it’s not bothering you that much, there’s no need to rush into it.” So they do allow for a fair amount of patient preference/input in sending them to a cataract specialist.

Cataract surgery is really, really common these days, so I think the recommendation is typically more so that the patient can get used to the idea that they’re going to have eye surgery (which is definitely a rough thing to think about for most people). Plus if you have a really bad lens removed and replaced, the contrast in improved vision is pretty dramatic and probably makes patients feel a lot better about getting the surgery done. :smiley:

Edit: Cutter John may have a point regarding insurance, as well. I don’t know what the standards are, though I suspect the ophthalmologist’s description of the patient’s relative discomfort/distraction from the cataract may factor in.

I’m having cataract surgery on my right eye in a few weeks, and the only reason I’ve waited this long is that I didn’t have insurance, until now that I have Medicare. My left eye has the beginnings of cataracts, but not yet noticeably symptomatic. I’m an artist, and need to see colors accurately, so if this surgery goes well, and if Medicare approves, I plan on having the left eye done as soon as possible.

In one of the Travis McGee novels (The Long Lavender Look, as I recall), the author has McGee ruminate on this - his claim is that cataract surgery (at least at that time) did not produce a great result, so the “ripening” was to allow the patient to get used to seeing very, very badly, so that the post-surgery result would be seen as a great improvement.

No idea if this is or was correct.

It was once the case that the cataract had to be “ripe.” This is no longer the case. My opthalmalogist says he’ll do it whenever I’m ready; viz., when it bothers me enough. (I have an appointment this month.)

I believe the reason is that formerly the FDA would not allow cataract surgery merely to improve vision. (That policy has changed. You can have the surgery now without cataracts, if that is the way you want to go to improve vision; however, Medicare and most insurance companies would not cover that, being “cosmetic” (glasses sufficing). I believe, but do not really know, that since FDA has changed its policy, Medicare and other insurance companies will cover the surgery if you have cataracts, even if not “ripe.” I know Medicare will covery my surgery, else I wouldn’t have it done.

It should be pointed out that there is a considerable downside to cataract surgery (which I have had, on both eyes). After the surgery, you cannot change the focus of your eye any more. After surgery you will have to wear glasses (and probably bifocals or progressive lenses), either for distance vision or for close seeing or for both. Contacts won’t cut it, because you need to be able to change from one focus to another. Unlike ordinarily long or short sighted people, the same lenses will not be the appropriate ones for all circumstances. It really makes no sense inflicting this on yourself before the cataracts are giving you serious trouble.

In my case I wound up with pretty good distance vision in my left eye (which is my dominant eye), so I do not bother with distance lenses. I have some glasses with progressive lenses, but I don’t like using them in most circumstances. This means, however, that if I want to read or see anything up close I have to find my reading glasses, and when I use the computer I wear bifocals with the bottom part of the lens set close, for reading papers on the desk and seeing the keyboard, and the top focus set at about 2ft for seeing the screen (and getting an optometrist to write the proper prescription for this has proven a real problem).

My brother, 68, recently had cataract surgery in both eyes, and for the first time in his life he doesn’t need to wear glasses. He can see perfectly well, both close and distance.

Yeah, my eye doc told me that once I get cataracts (and she said it is likely that I will if I live long enough) they will replace my lenses and I will likely not need glasses after.

I detest progressives, I have the old school bifocals, one scrip on top, solid line, one scrip on bottom. I am either looking up or down, I don’t need to lose any of the field of vision with the wooby intermediate area. I also have distance only glasses for normal wear while driving [regular and sunglasses] because I rarely need to read while I drive. I use a GPS, or if someone is in the car, they do the navigating. If I print out directions for something, I use a font big enough to comfortably read it at a normal glance.

And any eye doc worth their degree can write any freaking prescription that you need - and believe me, a custom pairing of short and med distance instead of short and long distance makes perfect sense for desk work. I would be willing to bet that s/he was worrying that you would try to drive in them. Go to a doc in a box at a lenscrafters, and get them to give you a set of scrips for the short/med and more normal short/long, that makes it plain you do not intend to drive in the short/med glasses.

Cataract surgery will, of course, only correct the vision problems associated with cataracts, and there are some potential downsides. I get “flaring” of oncoming headlights, for instance. But it shouldn’t change the ability to focus or to switch focus. My other eye problems continue unabated, so I’ll never be able to go without contacts. (Glasses cannot correct my particular problem.)

So are some eye doctors telling patients they need to wait when, in fact, they don’t?

I guess I’m confused as to the generalization here because my Doctor told me that I was developing catarcts in my right eye and that removing them would be like getting another Lasik on that eye. Basically it would clear up the cataract and improve my vision back to 20-20 or better. I haven’t needed glasses for six years now and don’t plan on going back yet.

Unless the technology has radically changed since I had mine done (about 10 years ago), it certainly does change the ability to switch focus - indeed, it totally eliminates it! The normal eye can change focus because the natural lens is flexible and has muscles attached to it that can stretch it, changing is shape and thus its focus. Cataracts form in the lens, and cataract surgery (at least when I had it) involves removing the natural lens and replacing it with a plastic one that is not attached to the relevant muscles, and probably would not stretch and deform in the right way even if it was. I can assure you that I do have to wear different glasses for different purposes, and that this as a result of my cataract surgery. I am not making this up.

I understand that if you have both eyes done, they are sometimes able to set the focus of one eye for reading and the other for distance. Maybe people who have it successfully done that way can get by without glasses (but my guess is that they would still have problems, as I do, at intermediate distances). In my case, as I said, my left eye emerged from the surgery with good distance vision (but lousy close-up vision), but my right eye was not so lucky, and is not in good focus at any distance without glasses. Furthermore, as I said, I need bifocals in order to be able simultaneously and comfortably to read papers 1ft away and the computer screen 18"-2ft away.

I repeat, unless the technology has improved radically over the past 10 years (without me hearing about it), if you have cataract surgery on both eyes you will need glasses for good, strain free vision at some distances.

That is exactly what I did last January. I made it very plain to the doc that they were for computer use, and he still set the focus at 3 or 4 feet away (usable but uncomfortable for the computer, quite unusable for driving). That is the third time this has happened. (I do not wear glasses at all for driving, or walking around. My left eye distance vision is fine and it passes the DMV eye test without trouble.) Some years ago I also went to Lenscrafters for some plain reading glasses and they set the focus at about 2 feet away, so I would have to hold everything I read at arms length. (In that case, though, I was able to spot the problem before I left the store, and got it fixed.)

For the last 10 years, since the surgery, I have had only one pair of glasses that I can comfortably use with the computer, a pair of bifocals that were prescribed for me by the associate of the surgeon. Just last month I was going through some old papers and I came across a copy of the prescription that was written for me then. I went to eyebuydirect.com and got a pair made to that prescription, and, lo-and-behold, I finally now have a backup pair good for computer use (and for under $40). My conclusion: the “doctors” at Lenscrafters and other chains (it hasn’t just been there) are a bunch of incompetents.

I quite agree in hating progressive lenses, but some people seem to like them.

Optometric insurance should cover lasik. Get your eyes fixed and don’t need glasses every year. Glasses are expensive. They would long term save a bundle.

Lasik is irrelevant to what is being discussed here. It corrects the baseline focus on otherwise healthy eyes with a naturally functioning lens. It is an alternative to glasses and contacts for people with healthy natural lenses in their eyes, but will not fix cataracts, and it it will not enable change of focus for an eye that cannot change focus due to cataract surgery.

Insurance won’t cover lasik. It is considered cosmetic since glasses can correct the problem.


I don’t believe you meant what you said because of your later posts. They can insert any prescription lens to replace your cataract, so that not only does it correct the problems associated with cataracts, but can improve your vision to 20/20, as others have noted.

In addition, much progress has made with the prosthetic lenses in the last decade. For example, it can be inserted with only a microcut. The lenses themselves are better, and I believe they can insert a lens to correct for near distance; but I’m not certain of that. In any event, if they can correct my distance vision to 20/20, wearing reading glasses when necessary is no big deal for me. Now I do wear progressive lenses, and I find them better than bifocals because of the double vision at the line. Because of that, when playing tennis with bifocals, I used to see two balls at one point. Progressive (or transition) lenses eliminates that problem.

Then my eye doctor isn’t telling it to me straight because he definitly said that I am developing a cataract and that when I have it removed they willl redo the lasik to correct my vision. Yes, it’s two procedures at the same time but I’m being told that they can correct your vision after cataract surgery. The downside may be that they can only do this one or two times, so I may want the cataract to stay as long as possible (ripen).

I had cataract surgery in both eyes, one month apart, earlier this year.

The surgeon offered to correct one eye for reading and one for distance. I’m a competitive pistol shooter and after discussion we determined that it would not be the bast choice for me. My SIL had her’s corrected in this manner and is quiet happy with the results.

My surgeon and I discussed the Crystalens. He said that patients with my degree of nearsightedness had not been satisfied with the results, so he couldn’t recommend that device in my case.

Both of my eyes are corrected for distance. I don’t need glasses to drive, watch TV or any other activities that don’t require sharp vision closer than about 2 1/2 feet.

As always YMMV! :smiley:

Yes, they could (if necessary) use lasik after the surgery to correct your vision for one distance, to give you good distance vision without glasses, for instance. Lasik remoulds your cornea to correct your baseline focus. That is nothing to do with what I was talking about, however: being able to refocus the treated eye as you look at things different distances away. Lasik will not give you that (unless you still have a healthy, natural lens in your eye).

However, I rather suspect that your doctor did not say “lasik” at all, but was talking about the laser treatment that is sometimes necessary after surgery to remove the film that can sometimes form on the surface of the prosthetic lens. I had this done, some months after one of my surgeries. Although it involves a laser, this is not the same thing as lasik. It has nothing to do with focus.

On the other hand, the Crystalens mentioned by GaryM does appear to be a technology (presumably developed since I had my cataracts done) that does allow for some degree of refocusing. But as Gary notes, its not suitable for everyone, and even their advertising does not guarantee it will completely eliminate the need for glasses (and, of course, who knows whether any particular insurance plan will cover it).

The older you are the harder your lens becomes over time, with or without cataracts. This is why past 45 or so most people start needing reading glasses - with the lens getting harder/stiffer the eye muscles are no longer able to focus it sufficiently for close up work.

A harder lens is, apparently, easier to remove. Thus, while cataracts/lenses can be removed at any age, it’s easier to do it when the patient is older.

Back in the old days, when surgical technology was less developed, there was a definite preference for waiting to make the operation easier. The results were also inferior to today’s outcomes, so the initial stages of cataracts were not as bad/impairing as the post-operation results. This made sense back then, and was the “good reason” you are looking for.

A lot of rules regarding insurance payment for cataract surgery were made decades ago, back before modern technology and techniques made this surgery easier and more successful. Thus, there is a definite lag. We should be replacing defective lenses earlier, but because of various factors named we don’t.