Cataract Surgery - Now or Later?

My mother, who is 83 years old, has been struggling with the decision whether to have cataract surgery sooner or later. The task of educating her on reasons for or against has fallen to me because the ophthalmologists she has seen have taken the time to diagnose her cataracts and ask her if she wants to have the surgery now, but have not given her the information she needs to make an informed choice. So we had a telephone conference (she lives in another city), in which I shared with her the following points.

According to The American Academy of Ophthalmology (https://www.aao.org), lots of elderly people have cataracts. Various sources list 50% or more of the senior population having cataracts, with smoking, diabetes, and high UV exposure being risk factors. According to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120237/, there are some questions on whether cataract surgery should be performed in those aged 85 years and over, and some reasons for caution are given. Basically, the risks of cataract surgery increase as one ages while the benefits become less certain.

My mother wasn't clear on the procedure for cataract surgery either, or what she'd need to do during recovery, or even how long recovery might take. She said she'd been asked whether she wanted cataract surgery done on one or both eyes, and was trying to make a decision about that as well.

Let's take a look at a diagram showing the steps involved in cataract surgery.

Basically, an incision is made, the diseased lens is removed, and an artificial lens made of silicone or acrylic materials is implanted. The surgery is usually safe (90%+) and there is usually an improvement in vision, although glasses are usually still required. Risks include inflammation and infection, and although such complications are rare, it is common to require additional laser eye surgery in a few months. Surgery is generally performed on one eye at a time, to see how the individual recovers, and to minimize post-operative issues.

After surgery, the patient should not drive the first day. An eye-patch should be worn, especially when sleeping, to reduce the risk of rubbing or infecting the eye while it is healing. The patient should not sneeze or swim the first week, or lift heavy objects for several weeks afterwords. Full recovery should occur within about eight weeks.

Is surgery advised as soon as cataracts are noticed during an eye exam? Not really. The key deciding factor should be how severe the cataracts are, and how much the patients' daily activities are affected by the cataracts. Can the patients' vision still be corrected with eyeglasses, or is the myopia too severe for correction? Other factors that indicate the cataracts are becoming serious include:

1. Blurry vision, in which objects appear foggy, filmy or cloudy
2. Glare, increased sensitivity to light, problems with night vision, halos appearing around bright lights
3. Double vision, or diplopia. A single object appears to have a shadowy twin, even when seen with only one eye open
4. Changes in colour vision. Objects take on a brownish or yellowish tinge, colours appear faded
5. Hardening of the cataracts

(http://www.webmd.com/eye-health/cataracts/ss/slideshow-cataracts)

My mother thought these factors over. Since her vision can still be corrected by prescription eyeglasses, her daily life isn't really being impacted, her sight is still clear, and she is not currently experiencing sensitivity to bright light, double vision, or changes in colour vision, she has decided not to have cataract surgery at the present time. Her doctors did not mention any particular medical reason that would demand that she have the surgery now.

For the time being at least, cataract surgery is a future option.

Note from March, 2017: At this point, having met a number of people who have had good cataract surgery experiences, and having experienced further decline in her vision, mother is planning to have the surgery done sometime this year.