Cataract Awareness (cont.)
Pain is not normal with cataracts. Some people are more sensitive to glare than
others. When we say pain, there's a broad spectrum between pain, discomfort, and
annoyance. Pain, per se, is never the result of a cataract. I think you need to
be sure you have pain, because it can be very annoying to have glare. There's a
big difference between pain and discomfort.
Do all cataracts grow at the same rate?
No, all cataracts do not grow at the same rate, and it's impossible to predict
the progression of the lens' opacity. It can vary vastly from one eye to the
other, even in the same head, and when patients ask me, "How long will it be
before I need cataract surgery once the diagnosis is made?" I quickly look at my
watch, and they get it. You can't predict when. It's like telling someone how
long they're going to live. When patients get really concerned about the fact
they may have to have cataract surgery in the future, I tell them I just hope
they live long enough to need it, because it's very relative.
Is cataract surgery painful?
Cataract surgery is normally not painful, takes less than 20 minutes to do, and
results in good vision. If I had not had the confidence in the technology and
the procedure, I would not have had surgery just to avoid the use of spectacles.
The operation doesn't just work most of the time, it works almost every time.
But we're not living in a perfect world, so it cannot work every single time,
and each patient has to take some risk for gain.
Is there a greater chance of cataracts in a person who has diabetes than with
everyone in general?
Probably. That's the simple answer, but I don't know of any huge study that's
My husband had one attempted cataract procedure that could not be completed
because his pupil would not dilate enough (he had a stroke that affected the
occipital lobe of the brain and he has limited vision) now the doc wants us to
go to another facility with more modern technology. My question: Are the risks
higher for this than normal cataract surgery?
The risk is slightly higher, but I think your doctor is giving you a very good
recommendation. There are some centers that can deal with these problems better
than others. It's important to seek out these locations for treatment once you
realize you have a special problem.
Can anything be done to prevent cataracts or are they an inevitable part of
I tell patients when they ask me what causes cataracts that they're the result
of three things: age, hereditary, and bad luck. Almost everyone develops some
loss of clarity of the lens as they age, and the metabolic changes of the lens
epithelial cells that undergo these opacities are being studied. The visual
needs of the patient really dictate when they will require surgery for cataracts
Dr. Knolle, before we wrap things up, do you have any final words for us?
Another consideration, with respect to clear lensectomy, or lens exchange in the
patient without cataracts, is the cornea normally doesn't change as we age, and
the axial length of the eye doesn't change unless surgery or injury changes it.
So if we replace the lens with a fixed known entity that won't change, the
visual acuity should remain basically the same throughout life, because the
light that's focused on the retina is the direct result of the corneal
curvature, the axial length of the eye, and the power of the lens.
When patients undergo LASIK, the refractive power of the eye is adjusted by
changing the shape of the cornea, and this can remain stable for an indefinite
period of time, but the lens continues to change as we age, which can again
change the refractive power of the eye.
I appreciate the opportunity to answer questions, and I hope I have helped
you to understand cataracts and refractive surgery, especially with respect to
refractive surgery, because patients that are presbiopic that require reading
glasses have a way now to surgically correct this normal aging deficiency in
their vision, and at the same time we can correct farsightedness,
nearsightedness, and astigmatism.
Our thanks to Guy Knolle, MD, for sharing his expertise with us.
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