What might be a reason to do cataract surgery before the cataracts are “ripe”?

07 Dec What might be a reason to do cataract surgery before the cataracts are “ripe”?

Many years ago it was said: You have to wait until cataracts are “ripe” to do surgery. What that meant was that the discolored natural lens (which is the “cataract”) needed to reach such a state of complete density that it could be manually pushed out of the eye in one piece (through a very big wound -about 10-15 mm long) without it crumbling into small pieces. Retained lens fragments could often create a severe inflammatory reaction in the eye that would complicate the outcome.

Given the relatively unsophisticated technology used then, that was an entirely appropriate standard. But that was before the introduction of small incision (2-3mm) phacoemulsification and the use of intraocular lens implants (IOLs). As ophthalmic technology advanced, cataract surgery became quicker, safer, and provided much better optical outcomes.

The general trend is for cataract surgery to be performed at ever earlier stages of development than back then. Besides the greater safety and better visual outcomes, earlier surgery usually makes it easier for the eye surgeon and younger patients tend to heal more quickly. Furthermore, it is often possible nowadays to correct vision problems like nearsightedness, astigmatism, and even presbyopia at the same time. These “refractive” eye problems are not really related to the cataract, but by using specialty IOLs rather than older monofocal models. Many patients can now achieve 20/20 distance vision even without requiring glasses post-operatively.

So in many situations it makes sense to consider earlier surgical intervention with cataracts than would have been the case many years ago. All eye surgery, however much safer and easier, still has risks which need to be considered in making that decision, however.

_Written by J. Trevor Woodhams, M.D. – Chief of Surgery, Woodhams Eye Clinic