Cataracts That Don’t Need Surgery Yet

With aging, the lens changes into a state called cataract.

“Being diagnosed with cataract” does not mean “needing surgery.”

Many people say they do not want cataract surgery yet.

In early cataract, changes in vision are slight, and properly prescribed glasses can often handle it.

The ability to focus on far and near (accommodation) is also a very important function of the natural lens.
Cataract surgery at a young age takes away accommodation.

That is why I do not recommend surgery at an early stage.

When cataract progresses to a “mature cataract,” it severely impairs vision and greatly affects daily life.

Cataracts That Don’t Need Surgery Yet

In US Medicare (the public health insurance for older adults), cataract surgery is one of the most frequently performed operations.¹。

Cataract surgery has been shown to improve quality of life and lower the risk of falls (hip fracture),²and to reduce traffic accidents³.

It has also been shown that people who had cataract surgery had a 40% lower long-term mortality than those who did not.⁴。

[Four questions to ask when considering cataract surgery]

This is from the American Academy of Ophthalmology’sdescription.

1. Does it greatly affect your daily life?

Are your cataracts impacting your daily or occupational activities?

Symptoms such as blurred vision, things looking yellow, or double vision in one eye:

This matters especially for people who drive for work, and for those who need clear, high-contrast vision for reading, cooking, or sewing.

2. Is it affecting your night driving?

Are your cataracts affecting your ability to drive safely at night?

With cataract, you may also see halos (rings of light) around lights,

which can interfere with driving in the dark.

With advanced cataract, you may not reach the vision required to renew a driver’s license.

3. Is it getting in the way of enjoying time outdoors?

Are your cataracts interfering with the outdoor activities you enjoy?

Cataract causes glare, which can spoil enjoyment of skiing, golf, surfing, and more.

It also affects the sense of distance seen with each eye separately, and the effect is greatest in golf.

4. Can something else solve the problem?

Can you manage your cataracts in other ways?

Brighter lighting and using high-contrast colors for things around the house

Polarized sunglasses and wide-brimmed hats reduce glare.

Using a magnifier makes reading easier.

Cataract treatment should not be affected by the treatment of other diseases:

CataractWhen to have surgery (timing)

Surgery is recommended only when it is judged that surgery will improve “how you see.”

What happens if a diagnosed cataract is not operated on?
At no stage of cataract progression is it too late.

Here is what the Japan Ophthalmologists Association says:

When should I have surgery?

Cataract cannot be cured with medicine. The only way to treat an advanced cataract is surgery. So when should you have surgery?

Cataract is not a disease that you can be too late for,so there is no need to rush into surgery. There is also no rule that surgery is required once vision falls to a certain level.

The time to have surgery is when you start to find it inconvenient in your daily life.This differs for each person’s lifestyle. People who often look at fine details or who drive a lot may do well to have surgery earlier. Conversely, people who spend most of their time indoors and do not read fine print much do not need to hurry.

Even if the vision test result is good, you may find it hard to see outdoors because of glare, or have double vision that interferes with daily life. Even if your vision is good, if you feel any kind of inconvenience, please consult an eye doctor.

Japan Ophthalmologists Association website

The remarkable development of surgical equipment over the last 20 to 30 years has contributed to improved surgeon skill,
and day-surgery cataract operations have become common.
It has become a very good time for patients who need surgery.

On the other hand, it also uses a great deal of medical and economic resources.

When I joined an ophthalmology department, I heard the term “volume surgeon.”
I am told there was an era when a limited number of famous surgeons performed dozens of operations every day.

There are many cataracts that do not need surgery yet.

With regular follow-up, you will not become too late (surgery becoming extremely difficult, or the right timing being missed or delayed).
It is rare for urgent cataract surgery to be needed.

If your vision is inconvenient, I may also discuss treatment while your body is still healthy.

» About the explanation of diseases

» Ophthalmic “preventive medicine”: care tailored to the community (update)

✔ When to have cataract surgery

(when to start considering surgery, and how to avoid raising the risks of cataract surgery)

I am often asked whether it would be better not to have cataract surgery.

Modern ophthalmology has seenadvances in imaging diagnosticsthat make it possible to understand the current “state of the eyes” in detail.
With each patient, I take time to discuss together whether and when cataract surgery is indicated.

References

1. Schein, O.D., Cassard, S.D., Tielsch, J.M., Gower, E.W., 2012. Cataract surgery among Medicare beneficiaries. Ophthalmic Epidemiol 19, 257–264. https://doi.org/10.3109/09286586.2012.698692
2. Tseng, V.L., Yu, F., Lum, F., Coleman, A.L., 2012. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA 308, 493–501. https://doi.org/10.1001/jama.2012.9014
3. Meuleners, L.B., Hendrie, D., Lee, A.H., Ng, J.Q., Morlet, N., 2012. The effectiveness of cataract surgery in reducing motor vehicle crashes: a whole population study using linked data. Ophthalmic Epidemiol 19, 23–28. https://doi.org/10.3109/09286586.2011.628776
4. Fong, C.S., Mitchell, P., Rochtchina, E., Teber, E.T., Hong, T., Wang, J.J., 2013. Correction of Visual Impairment by Cataract Surgery and Improved Survival in Older Persons: The Blue Mountains Eye Study Cohort. Ophthalmology 120, 1720–1727. https://doi.org/10.1016/j.ophtha.2013.02.009

* The above is about age-related cataract:

　Other cataracts call for different decisions.

•Open-angle glaucoma(cataract associated with it)
• Cataract with a risk of a glaucoma attack (narrow angle / angle closure）
• Congenital cataract, cataract in children
• Cataract associated with diabetes (diabetic retinopathyfundus management)
•Uveitis(cataract associated with it)
• Cataract associated with atopic dermatitis
• Cataract after an eye injury (traumatic cataract), and more