When should I have cataract surgery? Do they need to be ripe?

A lot of patients ask me, are my cataracts ripe enough for surgery? And,
really, that’s an old concept. The ripeness of a cataract means that the cataract’s very dense, it’s very white and as a consequence, the vision is very poor. And years ago, when cataract surgery wasn’t sophisticated and recovery was slow, and people needed to wear very thick, milk bottle spectacles after surgery
because we didn’t put lenses in the eye or they had to wear contact lenses, one
would wait until the vision was really very poor before operating.

Modern cataract surgery is less invasive.

The next step was to put intraocular lenses in the eye, so a new lens implant in
the eye, but using much bigger incisions which required lots of stitches. So at
that point, we intervened at an earlier stage. The next progression has been to
small-incision cataract surgery with teeny weeny, two-millimetre nicks in the eye,
so no stitches required. And the quality of the lenses that we have, the
technology available, is excellent.

Benefits of modern cataract surgery technology.

As a result, we’re operating at an earlier and earlier stage on cataract patients.
So we no longer rely on how far down the chart they can see to decide when to
operate. What’s important is their symptoms. Sometimes we have young patients
who have cataracts. And if they’re active and working, any reduction in the
quality of their vision is important. Cataracts can also cause glare. So just like a dirty car windscreen, with light coming towards you, they can scatter light and cause glare. So if somebody’s
saying, the quality of my vision is poor, either because they can’t see to do what
they need to do or they’re experiencing glare, or sometimes they’re seeing
double vision from one eye, then that would be a reason for considering cataract

Risks vs. Benefits.

So it’s all about risks-benefits. Years ago, the risks of cataract surgery were high,
the benefits were nothing like the benefits that patients get now. Now, the risks
are very low and the benefits are very high so we operate at an earlier stage and
we no longer wait for cataracts to be ripe.
And interestingly, in younger, you would operate in an earlier stage in the
development of a cataract because they may have a much more active lifestyle
then an 85-year-old who would have the same kind of cataract causing the same symptoms, but doesn’t drive a car and doesn’t have such demanding distance
visual requirements, for example.

More about Robert Morris

Rob Morris is a Consultant Ophthalmic Surgeon at The Grange Eye Consultants. His special expertise is in cataract and refractive surgery, including Refractive Lens Exchange, and adult squint. He has over 30 years experience in treating people with eye problems. Rob Morris founded Grange Eye Consultants to manage the increasing demand for more complex refractive surgery. He leads clinical trials investigating novel eye treatments. He is currently Medical Director at Optegra Eye Hospitals.