# Why the wait for cataract surgery? **URL:** \ **Category:** Factual Questions\ **Created:** [August 13, 2012, 1:50pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375 "2012-08-13T13:50:49Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Ruby\_Slippers](https://avatars.discourse-cdn.com/v4/letter/r/94ad74/32.png) [@Ruby\_Slippers](https://boards.straightdope.com/u/Ruby_Slippers)\ **Post date:** [August 13, 2012, 1:50pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/1 "2012-08-13T13:50:49Z")
On a recent visit to an optometrist, I was told that I had the beginnings of a cataract in my left eye but that it was too soon to schedule surgery. It seems to me that I’ve heard for most of my life that cataracts are allowed to progress before surgery. Why is this? I had lens replacement surgery a few years back on one eye that had developed cloudiness following a vitrectomy (replacement of the vitreous with a gel). Prior to that lens replacement, my night vision had become so poor that driving after dark was almost impossible. I don’t want to go through that again. It seems to me that once the cataract is detected, it would be wise to proceed with the surgery quickly so as to avoid the problems associated with worsening vision. So why wait? ---
**Author:** ![benbo1](https://avatars.discourse-cdn.com/v4/letter/b/e19adc/32.png) [@benbo1](https://boards.straightdope.com/u/benbo1)\ **Post date:** [August 14, 2012, 10:34am UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/2 "2012-08-14T10:34:09Z")
Because any surgery has risk. IANAD, but most likely, the doctor wants to wait until the point where normal vision ain’t possible. It may never progress either, thus no need for surgery. Cataract lens replacement is the safest and I think most commonly performed procedure in America; but don’t kid yourself about it being ‘risk-free’. FWIW, I have 2 small ones (1 in each), which may be congenital; they don’t bother me a bit - when I’m outdoors in sunlight I wear RayBans, & in all other lighting everything loox fine. Should that change, I’ll try it 1 eye at a time. 1 important thing - wear polarized shades or lenses when ur outside - UVbs can worsen cataracts. ---
**Author:** ![hogarth](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hogarth/32/1773_2.png) [@hogarth](https://boards.straightdope.com/u/hogarth)\ **Post date:** [August 14, 2012, 3:13pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/3 "2012-08-14T15:13:38Z")
I can’t speak for the U.S., but in Canada there is a long waiting list for cataract surgeries. They’re in high demand (lots of old folks nowadays) and so if it’s not an emergency you have to wait in line. ---
**Author:** ![Rhaegar](https://avatars.discourse-cdn.com/v4/letter/r/51bf81/32.png) [@Rhaegar](https://boards.straightdope.com/u/Rhaegar)\ **Post date:** [August 14, 2012, 3:23pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/4 "2012-08-14T15:23:29Z")
Because Medicare and the Insurance companies will pay for cataract surgery only when it is considered “bad” enough to warrant surgery. My personal suspicion is that they expect a certain number of cataract sufferers to pass away before they can get their cataract surgery, thus saving them a few bucks. ---
**Author:** ![panache45](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/panache45/32/64_2.png) [@panache45](https://boards.straightdope.com/u/panache45)\ **Post date:** [August 14, 2012, 3:44pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/5 "2012-08-14T15:44:50Z")
I had cataract surgery last year. Nobody told me to wait, but I did wait until I turned 65 and my Medicare kicked in (I had no insurance previously). Other than that, there was no discussion about waiting. ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [August 14, 2012, 9:34pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/6 "2012-08-14T21:34:21Z")
> [@Rhaegar](#): > > Because Medicare and the Insurance companies will pay for cataract surgery only when it is considered “bad” enough to warrant surgery. My personal suspicion is that they expect a certain number of cataract sufferers to pass away before they can get their cataract surgery, thus saving them a few bucks. This is not true. Medicare will pay for cataract surgery, unless it is solely cosmetic to improve vision. A few years ago it was illegal to perform cataract surgery until the cataract was “ripe.” FDA did not allow this surgery solely to improve vision. That law was changed and the surgery can now be done just to improve vision, but it will not be covered by Medicare if it is solely cosmetic. OTOH, it no longer has to be “ripe.” Eye doctors will tell you that when the cataract(s) interferes with your vision, the surgery should be done. ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [August 14, 2012, 9:36pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/7 "2012-08-14T21:36:57Z")
> [@hogarth](#): > > I can’t speak for the U.S., but in Canada there is a long waiting list for cataract surgeries. They’re in high demand (lots of old folks nowadays) and so if it’s not an emergency you have to wait in line. Cataract surgery is like an assembly line here. There is no long wait, but one doctor will perform dozens in one day. The opthalmologists will set aside one or two days a week in which they do nothing but cataract surgery in the morning. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [August 14, 2012, 10:09pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/8 "2012-08-14T22:09:42Z")
Old surgical techniques required waiting for the cataract to mature. Insurance guidelines and even opthomologists’ own opinions haven’t all caught up to the newer techniques which allow for earlier surgery. > [@](#): > > Only a few decades ago, cataracts condemned sufferers to a life of near total blindness. Due to limitations in surgical techniques, cataracts were typically only operated on when they were very dense and “mature” and the patient virtually blind. Complications were not uncommon and thick glasses or contact lenses were often required following surgery in order for the patient to see. > > Today, thanks to the development of artificial intra-ocular lenses and “key-hole” (small-incision) surgical advances such as phakoemulsification (ultrasound lens liquefaction), cataract removal in experienced hands is one of the safest forms of surgery with excellent results. In the US alone, over 1,250,000 procedures are performed per annum. Most people regain their lost vision within a day of surgery and the quality of life experienced before they developed cataracts. Only very rarely is the final result compromised, usually by other non-treatable aging or pathological conditions, such as macular degeneration. The benefits associated with modern cataract surgery are numerous and there is now no need for anyone to change their lifestyle as a consequence of developing cataracts. > **[Cataracts](http://davidobrart.co.uk/cataracts.html)** > > Cataracts are a natural feature of aging. ---
**Author:** ![CrazyCatLady](https://avatars.discourse-cdn.com/v4/letter/c/dfb087/32.png) [@CrazyCatLady](https://boards.straightdope.com/u/CrazyCatLady)\ **Post date:** [August 14, 2012, 10:19pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/9 "2012-08-14T22:19:26Z")
I work for an ophthalmologist, and there are multiple reasons. Here are the ones I know of off the top of my head, in no particular order. 1. Money. Most insurance won’t cover the procedure unless the cataract is “visually significant” --that is, the best corrected vision (with or without glare) is 20/50 or worse, or you can document that the cataract is interfering with “activities of daily living” like reading, driving, dressing, etc. It takes a while for a cataract to progress to that point, often decades after you can see the beginnings of lens sclerosis. 2. Complications. The surgery is harder to do with a non-mature cataract. There’s greater risk of the surgeon tearing the capsule or zonules, and that makes placing the implant a much bigger, messier deal with worse outcomes. 3. Implant calculations and later vision. This part I’ve heard explained to patients but don’t really get the ins and outs of how it all works. The calculations to figure out which implant to put in are pretty complex, and essentially you work it out so the patient has good distance correction (or sometimes distance correction in one eye, and mid-distance correction in the other), and then they use reading glasses for near work since they can no longer accommodate. For some reason, the calculations tend to change as your presbyopia worsens, so if you do the calculations and surgery on, say, a 50 yo, they’ll have good results at the time of surgery but progressively worse results over the next 10-15 years. Of course, you could always go back in, remove the first set of implants, and put new ones in, but why expose the patient to the surgical risk and expense when the cataract isn’t really impairing their vision in the first place? ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [August 15, 2012, 1:09am UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/10 "2012-08-15T01:09:28Z")
I object to the notion that elective aphakic lens replacement (or other phakic vision enhancement procedures) should be characterized as cosmetic. If I lose my glasses or contacts, I cannot function beyond a few feet. Also, with glasses, I am prettymuch stereoblind, though contacts seem to serve well to correct that. I would not pursue this kind of surgery for cosmetic reason, I would just like to open my eyes in the morning and be able to clearly see the spider crawling across the ceiling above my head. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [August 15, 2012, 1:34am UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/11 "2012-08-15T01:34:21Z")
> [@Rhaegar](#): > > My personal suspicion is that they expect a certain number of cataract sufferers to pass away before they can get their cataract surgery, thus saving them a few bucks. :dubious: Considering that most people with cataracts will have impaired vision starting in their 60s (and comparatively rarely before age 60, but it happens), you would have to die awfully young to save them a few grand. ---
**Author:** ![Ruby\_Slippers](https://avatars.discourse-cdn.com/v4/letter/r/94ad74/32.png) [@Ruby\_Slippers](https://boards.straightdope.com/u/Ruby_Slippers)\ **Post date:** [August 15, 2012, 9:43am UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/12 "2012-08-15T09:43:04Z")
Thanks to everyone for the informative responses. It may be that the optometrist I saw isn’t completely up to date. The ophthalmaologist I had seen previously has since retired, but I’ll see if I can find another one if/when the condition worsens. ---
**Author:** ![Daylate](https://avatars.discourse-cdn.com/v4/letter/d/9dc877/32.png) [@Daylate](https://boards.straightdope.com/u/Daylate)\ **Post date:** [August 15, 2012, 10:41pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/13 "2012-08-15T22:41:02Z")
I’ve heard for years (not from the Doctors, however), that the wait is so vision will be very bad, and the patient will be really grateful in the improvement resulting from the surgery. This is probably, however, an old wives tale. BTW, I’ve had cataracts in both eyes for years, (am now in my 80’s) and still have corrected vision to 20/20. If they don’t bother me, I’m not going to bother them. ---
**Author:** ![svd678](https://avatars.discourse-cdn.com/v4/letter/s/53a042/32.png) [@svd678](https://boards.straightdope.com/u/svd678)\ **Post date:** [August 16, 2012, 4:08am UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/14 "2012-08-16T04:08:15Z")
Its hinted at, but not explicit above: it used to be that cataracts (lens) was removed in one piece, as with tweezers; now they are liquified and removed by suction. Tweezers required they be hard (“Mature”), suction requires soft. I don’t understand what a small cataract is (#2). I wouldn’t think a lens starts to cloud up in sections. ---
**Author:** ![phreesh](https://avatars.discourse-cdn.com/v4/letter/p/9fc29f/32.png) [@phreesh](https://boards.straightdope.com/u/phreesh)\ **Post date:** [August 17, 2012, 5:39pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/15 "2012-08-17T17:39:06Z")
I still don’t understand why there’s this huge wait for even ‘mature’ cataract patients. As noted above, a doctor can perform one of these in about 15 minutes. If one doctor can perform, say 25 surgeries a day, that’s at least dozens a day per major city. Are there really that many cataract patients? Even at only 50 per day per city, that’s something like 4000-5000 patients (two eyes) per year in one (large) city. ---
**Author:** ![hogarth](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hogarth/32/1773_2.png) [@hogarth](https://boards.straightdope.com/u/hogarth)\ **Post date:** [August 17, 2012, 5:59pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/16 "2012-08-17T17:59:28Z")
> [@phreesh](#): > > I still don’t understand why there’s this huge wait for even ‘mature’ cataract patients. As noted above, a doctor can perform one of these in about 15 minutes. If one doctor can perform, say 25 surgeries a day, that’s at least dozens a day per major city. Are there really that many cataract patients? I doubt that a hospital would have one operating room that is devoted to cataract surgeries only, so there’s the necessity of scheduling the room. No doubt emergency operations would have higher priority than cataracts. From my vague recollection, I thought that a hospital might have one or two days a week devoted to doing cataract surgeries assembly-line-style like you’re suggesting. EDIT: Oops! I see that barbitu8 said exactly the same thing in response to me further up! ---
**Author:** ![tim-n-va](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tim-n-va/32/3001_2.png) [@tim-n-va](https://boards.straightdope.com/u/tim-n-va)\ **Post date:** [August 17, 2012, 6:29pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/17 "2012-08-17T18:29:15Z")
At a recent appointment I was told that everyone would eventually develop cateracts and it was just a matter of when they got bad enough to treat. I was told that mine were “minor league” and told what things to watch for - trouble driving at night was a big indicator. Of course, my doctor could have just been incompetent. ---
**Author:** ![Taomist](https://avatars.discourse-cdn.com/v4/letter/t/53a042/32.png) [@Taomist](https://boards.straightdope.com/u/Taomist)\ **Post date:** [August 17, 2012, 6:54pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/18 "2012-08-17T18:54:58Z")
I got new glasses last year, and during the exam my doc made a point of letting me know my cataract was bad enough for insurance to cover. She suggested waiting until my other eye had one, though, and doing them both at once. She was waiting for that for herself, actually. As I don’t relish the idea of being blind in BOTH eyes after surgery, I’m thinking one at a time would be better, yes? I have no idea how cataract surgery really works, though, so maybe you can see immediately afterwards. Any thoughts? ---
**Author:** ![phreesh](https://avatars.discourse-cdn.com/v4/letter/p/9fc29f/32.png) [@phreesh](https://boards.straightdope.com/u/phreesh)\ **Post date:** [August 17, 2012, 7:22pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/19 "2012-08-17T19:22:45Z")
> [@hogarth](#): > > EDIT: Oops! I see that barbitu8 said exactly the same thing in response to me further up! Ha! I also missed part of that post. If they only devote a part of the week to such surgeries, I can see why there’s a backlog. ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [August 17, 2012, 8:16pm UTC](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375/20 "2012-08-17T20:16:35Z")
> [@hogarth](#): > > I doubt that a hospital would have one operating room that is devoted to cataract surgeries only, so there’s the necessity of scheduling the room. No doubt emergency operations would have higher priority than cataracts. > > From my vague recollection, I thought that a hospital might have one or two days a week devoted to doing cataract surgeries assembly-line-style like you’re suggesting. Usually the opthalmologists belong to a clinic and the surgery is done at the clinic. [Next page](https://boards.straightdope.com/t/why-the-wait-for-cataract-surgery/631375.md?page=2)