Except for the rarest circumstances, no harm comes to an eye from cataract. Although the lens can be removed surgically, the operation can be safely per- formed at any time, whether the cataract is mild or advanced. Thus, there is usually no medical necessity for the operation. Nevertheless, cataract surgery has become of the most widely performed operations, and one of the costliest to our society.
Why did this cataract surgery epidemic occur? The problem can be attributed to the lack of ethics in medicine today and to the gulli- bility of the public. Ethical physicians always do
what is in the best interests of their patients. They do not advertise but build their practices through referrals from other physicians and from their patients as their reputations grow. In 1982, however, the Federal Trade Commission ruled that medicine is a trade and that there should be no restraint on advertising.A plethora of advertising followed, initiated by the most unscrupulous doctors, who saw the
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Too much sunlight can increase your risk of cataract.
Many of the cataract operations performed have been unnecessary.
opportunity to make a fortune from cataract surgery. They labeled themselves “cataract specialists,” even though it is absurd to regard a single operation as a specialty in itself. With total abandonment of reason, people who would nor- mally shy away from free brake lining checks have flocked to these clinics, which often label themselves as “institutes.” There they are greeted by public relations experts in the guise of medical personnel, who try to persuade them to have cataract surgery as soon as possible. Needless to say, this has resulted in a huge volume of unnecessary surgery.
Cataract surgery is indicated only when a person is no longer able to carry out everyday functions in a satisfactory manner. Therefore, the decision to have surgery should be primarily that of the patient, who is the only person who knows the degree of disability the cataract causes. Some people have expressed concern that poor vision may increase the risk of falling and break- ing a hip, especially in elderly women. That may be a factor in people who have moderately reduced vision in both eyes or who have poor vision, say, 20/100 or worse, in just one eye, but ultimately it is the patients who should decide just how impaired they feel.
As part of a complete eye examination, a very careful refraction (check for glasses prescription) needs to be done, because cataract can often result in a change in the prescription. Simply changing the glasses will often result in the restoration of satisfactory vision. If difficulty reading is a problem, the cause should be determined. If a person can read easily at first, but the words start to blur and run together after a short while, we would suspect a form of dry eye problem as the cause of the symptoms rather than cataract. Even if decreased reading vision can be attributed to cataract, the bifocal portion of the glasses can often be strengthened to provide satisfactory vision. I have seen the records of many patients for whom cataract surgery had been recommended because they had complained of difficulty reading, and I have found that in many cases, the reading vision was never even checked as part of the examination.
The examination must also determine whether any other eye problems are present that might account for the vision problem. Of these, the most com- mon would be age-related macular degeneration. This affliction of older peo- ple can cause blurring or distortion in straight-ahead vision. In a patient who has both cataract and macular degeneration, it can sometimes be difficult to determine how much each one is contributing to the decrease in vision. Nevertheless, it is important to attempt to make such an assessment, because
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the condition of the retina is usually the limiting factor that determines how well the eye sees after cataract surgery. In some cases, this may mean that no improvement in vision occurs after cataract
surgery, and any surgery performed in such a situation will have been in vain.
To determine whether improvement in vision is likely after cataract surgery, the
physician must carefully evaluate the cataractous lens to determine whether the cloudiness is sufficient to cause the patient’s complaints. One way to do this is to look into the eye through an undilated pupil with an ophthalmoscope, the instrument used for examining the retina. If what a person sees through an eye seems blurred, then what the physician sees looking into the eye should be blurred as well. The macula must also be carefully checked for changes in its appearance that would signify the presence of macular degeneration.
In short, cataract surgery is indicated if a person, even with the best pos- sible glasses, is unable to see well enough to perform everyday activities, and only if the cataract is severe enough to explain the poor vision, with no other disorder in the eye that would prevent improvement of vision. Clearly, if these criteria were followed, the number of cataract surgeries performed would be a fraction of what they are today.
My recommendation is that when your doctor discusses the possibility of cataract surgery, get a second opinion. From whom? From yourself! Because only you can decide when you should have
the surgery. Remember, any surgery can have complications. If you are functioning well with the vision you have and the cataract
symptoms are only a mild annoyance or minor inconvenience, surgery is inad- visable. However, if the vision problems are interfering significantly with your work, driving, reading, or ability to function in general, then you should con- sider the surgery. Except in rare situations (such as mature or totally opaque cataracts), there is no medical necessity or urgency for the surgery.