Timing of cataract surgery

Age alone is not a contraindication to cataract surgery.
Accordingly, cataract surgery and the improvement in vision it achieves may have important benefits for adults.
And for reference, data from a large American database comparing hip fracture rates in patients with cataracts who underwent or did not undergo cataract surgery found a 16 percent decrease in the adjusted odds ratio for hip fracture within one year in patients who underwent surgery and a 23 percent decrease among patients with severe cataracts.
In addition, a longitudinal study of over 550,000 adults noted a 9 percent relative decrease in serious traffic accidents in the year after first cataract surgery.

The indication and timing of surgery depend to some extent on the presence or absence of additional eye disease.
For example, patients without additional eye disease – the choice of whether and when to proceed with the surgery should be determined by the patient after receiving a detailed explanation about it and not by the surgeon.
But in cases where the cataract limits the follow-up of retinal or optic nerve diseases, or in the rare case where it causes glaucoma – there is an indication for surgery even if the patient does not “feel” that the cataract is interfering with his vision.

For some patients, the aggravating myopia following the cataract can be corrected with a change in spectacle correction.
It used to be widely believed that cataract surgery should be considered deferred as long as the reduced visual acuity can be corrected with glasses to meet the patient’s needs.
However, today, there is a whole field called refractive lens exchange that is gaining momentum and in such a situation it is not really a cataract surgery but a lens replacement surgery because a real cataract has not yet developed. In rare cases, the patient cannot tolerate the complete correction of the refraction because the result is unbalanced in relation to the other eye.

Patients with another eye disease – the ophthalmologist must assess the proportion or aspect of vision reduced by cataracts in the presence of a common pathology such as age-related macular degeneration (AMD), glaucoma or diabetic retinopathy.
Even if a cataract appears to be only a partial loss of vision, surgery can be considered if the other disease process is under control and the patient understands that the prognosis for a complete recovery of visual acuity is partial. Many patients with visual impairment from cataracts and AMD or diabetic retinopathy have a significant improvement in visual function after cataract surgery, even when concurrent retinal disease prevents recovery of vision up to 20/20.

Ancillary tests that can be done before surgery, such as the potential acuity meter (PAM), may provide useful information in advising whether cataract surgery may result in improved vision in patients with additional pathology.
Retrospective data suggest that cataract surgery for patients with “wet AMD” can improve vision, but close postoperative follow-up is necessary because of a trend toward increased macular thickening or cysts.

When do cataract surgery – pre-operative assessment

After making the decision to have surgery, several factors must be taken into account when planning the surgery:

1. The timing of surgery in the second eye and bilateral cataract surgery

Bilateral cataract surgery is not routine because of concerns related to the possibility of bilateral infection, optimization of postoperative refraction, and potential for treatment modification based on any complications in the first eye.
However, there is potential to save costs, improve patient comfort and minimize the need for medical care.
A retrospective study compared immediate surgery (same day) to delayed surgery (within a year) in the other eye and found no difference in visual acuity, refraction or the rate of complications.
In contrast, another study found that visual outcomes were better for bilateral, compared to unilateral cataract surgery only when the other eye had a significant cataract or poor visual acuity.
In addition, bilateral cataract surgery has been reported to be more cost-effective.

2. Preoperative planning

There is no need for routine tests (laboratory, imaging, ECG) in patients undergoing cataract surgery.
A systematic review of randomized trials comparing routine preoperative examinations with no examination or selective examination revealed that routine preoperative medical examinations increased the costs of surgery, but did not reduce the risk of medical side effects during or after surgery.
Nevertheless, certain patients may require targeted tests before surgery, for example, patients with recent cardiac interventions or those with an increased risk of metabolic disorder or coagulation parameters outside normal values.

3. Anticoagulants and cataract surgery

Cataract surgery is considered a procedure with a low risk of bleeding.
In general, antiplatelet or anticoagulant treatments can be continued. However, the decision to continue or stop these medications should be made after discussion with the ophthalmologist who performs the surgery. Individual considerations should be weighed in this decision.
For people with a higher risk of bleeding (patients with previous bleeding complications, or in cases where a larger incision is planned) it is possible to consider stopping the oral anticoagulants before the operation in a joint consideration with their treating family doctor.

As you can understand, cataract surgery is done according to each person’s medical condition, do you need advice? Contact us.