There are no known medications, eye drops, diets, or other regimen which will prevent formation of a cataract or cause it to go away once it has formed. Neither do cataracts go away spontaneously. At present the only solution is to remove the cataract surgically and replace it with a small plastic, acrylic, or silicon lens.

WHEN SHOULD SURGERY BE DONE?

The decision to remove a cataract is based mainly upon how much it is bothering the person who has it. A cataract need not be removed simply because it exists. However, the earlier the cataract is removed the better the visual results and the earlier the visual recovery, This is because the new technology can be used, decreasing phacoemulsification time and complication rates.

Cataracts rarely need to be removed for any reason other than that they are causing problems with seeing. Occasionally a cataract that has been present for a long time can become hypermature and leak lens protein into other parts of the eye. If this occurs, the cataract causes inflammation and needs to be removed on an emergency basis. If a person has intermittent elevated intraocular pressure from narrow angles or glaucoma, many times simply removing the cataract results in lower pressure in the eye. It also allows us to monitor the advancement of glaucoma more precisely with visual fields, stereo disk photos, optic nerve fiber layer photos and optic nerve head scans.

As a general guideline, the time to consider surgery is when vision has decreased to the point that it significantly interferes with your way of life. For example, if you need to drive and can no longer see well enough to get a drivers license, if you no longer feel safe to drive a car at night, or if you love reading and are having trouble doing so, it is reasonable to have your cataracts removed.

A common mistake most people make is waiting too long. If you wait too long the cataract hardens and it becomes very difficult to use the new technology. The longer you wait the harder the cataract becomes. The phacoemulsifier must then act like a jack-hammer on cement, increasing the possibility that the lens capsule will rupture. Higher phaco time and power is needed and damage to the cornea (front window of the eye) will occur.

It is for this reason that we no longer recommend letting the cataract “ripen”. The earlier a cataract is removed the better your results will be. If you wait too long the old form of cataract surgery, with large incisions and sutures, becomes necessary. With the original form of cataract surgery marked visual distortion occurred because the entire lens was removed and no synthetic lens was put in its place. Instead, thick coke bottle glasses were used to correct the vision, but only to a certain point. In this case it was better to let the cataract advance to the Snellen visual acuity of 20/50, (“ripe”), and then remove it because the visual distortion from the thick coke bottle glasses was better than 20/50 cataract vision.

In addition, the large incision (11 to 13 millimeter) frequently resulted in suture induced astigmatism immediately after surgery and wound creep two to three years later, resulting in poor vision without glasses. Wound Creep occurs when the large cataract incision slides or stretches under normal intraocular pressure loads. Although the thick coke bottle lenses are no longer necessary, as a synthetic lens can be inserted, a “ripe” cataract still poses greater risks and it is better to remove a cataract before it “ripens”.

These problems from the old form of surgery have all contributed to ophthalmologists stating, “wait until your cataract ripens”. While it is correct that it was once better to wait until a cataract was far advanced, modern techniques have changed this. Today a cataract may be safely removed at any stage of its development. As you can see, at what time the ophthalmologist recommends cataract surgery depends a large part on the level of technology that he or she currently uses and his or her level of experience with it.