I'm going to go blind? What?
February 22, 2017 5:35 PM   Subscribe

This week my ophthalmologist told me that I have a cataract in my left eye, and she asked me point-blank whether I wanted to be scheduled for surgery ASAP. I've deferred on the surgery for a year. I'm fifty years old. What am I in for, short-term and long-term?

I've worn glasses since third grade, so I have worn eyeglasses for over 40 years. Both eyes are myopic. Vision in my left eye has been significantly worse than my right eye for decades. I have not been diagnosed with cataracts previously, but I have also mostly been seen by optometrists, not ophthalmologists.

My immediate options as laid out by the ophthalmologist are either surgery now and then a new eyeglass prescription, or re-discuss surgery next year and visit an orthoptist now to measure prism correction for my current pending eyeglass prescription. She expected an answer on the spot so I chose the orthoptist. A follow-up on the cataract's progress will be done as part of my vision check next year February.

As explained to me, cataract surgery would be performed on both eyes even though only the left has a cataract. The surgery would be in two sessions, one session for each eye, two weeks apart. Aside from her verbal information I've been given no materials, guidance or recommendations. In hindsight I realize that I should have at least requested the time to seek a second opinion, and I plan to ask the orthoptist for advice, but the orthoptist's appointment is still two months away.

So... I have nothing more to go on, and this has left me emotionally flailing and fearing the worst if I start researching this myself. Is there good, non-woo, non-scaremongering, laypeople's information resources on cataracts? Setting aside how the information was delivered, does what the ophthalmologist said sound credible? I'm on the young side for developing cataracts, so are there long-term consequences of getting surgery done at this time in my life?
posted by Subaru drwxrwxrwx to Health & Fitness (26 answers total) 4 users marked this as a favorite
I would see another doctor and get a second opinion. The pressure to decide on the spot and the apparent plan to do a lens replacement in both eyes when there's only a cataract in one eye are big red flags.
posted by Blue Jello Elf at 5:40 PM on February 22, 2017 [20 favorites]

You might want to start with something like the American Academiy of Ophthalmology and look at their section on cataracts, especially cataract treatment. They are definitely no longer a "You're going blind!" sentence. They are treatable. You can even change your mind and schedule surgery sooner if you feel more like that's the way you want to go. Doctors can be sort of abrupt about this sort of thing, I am sorry you felt pressured.

If you prefer reading you might want to order this book from Amazon or ILL it from your library: So You've Got A Cataract?: What You Need to Know About Cataract Surgery. It talks a LOT about eye surgery in really straightforward ways and will help you understand how it all works. I would, if I were you, stay away from reading patient stories at this time. People online have a tendency to be more "worst case scenario" folks and cataract surgery is generally safe though some people do experience side effects. This is a very good summary page from the National Eye Institute with a bit more information.

On a personal note: my mom got both of hers done over the past year. She was very apprehensive beforehand, which is normal, but afterwards her vision was markedly improved, her color vision got completely different (the cataracts yellow as well as impair vision) and she's happy to didn't put it off.
posted by jessamyn at 5:46 PM on February 22, 2017 [8 favorites]

I have nothing more to go on, and this has left me emotionally flailing and fearing the worst if I start researching this myself. Is there good, non-woo, non-scaremongering, laypeople's information resources on cataracts?

And on this note, cataracts can make you go blind if you let them go, but the mechanism is that the lens in your eye becomes increasingly opaque (due to age, UV light, genetic inclination, etc.) and blocks/blurs the light. Which is to say, it is 100% fixable by getting a lens replacement.

Unless you have something else going on in your eye too, a regular ol' cataract isn't going to cause permanent vision loss if you'd rather put up with the blurriness for a few more years and postpone the surgery. The main problem is that glasses become less and less able to correct for it and you can have trouble with night vision and increased sensitivity to glare.

The surgery itself is really really easy for most folks. My mom had her lens replaced in the morning and went on a five mile walk in the afternoon.

(I'm actually super-annoyed at your doctor for freaking you out like this; probably another red flag about that doc!)
posted by Blue Jello Elf at 5:56 PM on February 22, 2017 [8 favorites]

Surgery is surgery, and sometimes things surface in the workup. My father had a slow heartbeat which led to getting a pacemaker before they would go ahead with the cataract surgery. So far as I know, he had no problems relating to the eye surgery.
posted by SemiSalt at 6:01 PM on February 22, 2017

My father-in-law had cataracts in both eyes removed a few years ago, and his vision improved so much that he was able to stop wearing glasses full-time for the first time in his adult life. Like Blue Jello Elf's mother, his surgery was a breeze other than the minor inconvenience of having to go twice. I appreciate why you're freaked out, but personally I would not wait a whole year, even though I might go look for a somewhat less aggro opthamologist.
posted by briank at 6:04 PM on February 22, 2017 [2 favorites]

My dad said that the hardest thing about cataract surgery was getting used to not needing glasses afterwards. He had terrible vision before the surgery, and it was almost totally corrected afterwards. My grandmother didn't complain about her cataract surgery, and she complained about everything. My mom is getting hers done in a few months, and she's totally not freaked out about it, because she saw her mother and husband do it, and it wasn't a big deal. I think if you ask around, you'll find that a lot of older people you know have had it done, and you probably didn't even hear about it because it wasn't a big thing. You're a little young for cataracts, so you're probably the first of your friends to get it, but if you talk to people in their 60s and 70s, you'll probably hear things that will reassure you.
posted by ArbitraryAndCapricious at 6:12 PM on February 22, 2017 [1 favorite]

I'm starting to get some cloudiness in my lenses; my doc said there's no need for immediate correction since it will gradually get worse.

And basically, I'll know when its time became it will be my decision about vision clarity, or lack thereof.

Everyone I know who's had cataracts has not been pushed into surgery by docs: only you can look through your perspective and decide when you're ready.

It seems this is a sudden revelation. Is there a marked worsening from last year or did you not even notice much? If it's not sudden then you have the opportunity to get a reassuring second opinion.
posted by mightshould at 6:18 PM on February 22, 2017

I'm another amazed recipient of 20:20 vision after cataract surgery, having been extremely near-sighted for 70+ years. Wonderfully, not only was my myopia fixed by the new lenses, but also the surgeon corrected severe astigmatism in one eye.

I had put the surgery off for a couple of years thinking it would really not help much, but in retrospect that was just foolish. The surgery was a breeze, no pain even the same day, and the change in my vision is just astonishing and lovely.

Like ArbitraryAndCapricious's dad, I still try to take my specs off when I get in the shower or wash my face, and that's the only hard part.
posted by anadem at 6:18 PM on February 22, 2017 [6 favorites]

I would get a second opinion only because this doctor sounds weird in terms of pressuring you, not explaining things properly, and wanting to do surgery on both eyes even though only one is impacted (what?). But, if it does turn out to be cataracts and need surgery, it is definitely nothing to panic about! Just in my close family, my dad, father-in-law, and grandma have had cataract surgery in the past few years and all of them rave about it -- it really improved their vision (especially night vision), and my dad actually doesn't need to wear glasses at all anymore! (My FIL and grandma only need reading glasses now.) It was a quick recovery and overall they're all quite happy with it and seeing just fine.
posted by rainbowbrite at 6:49 PM on February 22, 2017 [2 favorites]

About 5 years ago (I'm 62), my doctor casually mentioned that I had a cataract, which I assumed was very bad news. He assured me that it's a normal part of aging and that I could easily go another decade or so before we needed to talk about surgery. Obviously, your case may be completely different.

Regardless, I would press your doctor for more information and also get a second opinion. You're considerably younger than the typical cataract surgery patient.
posted by she's not there at 6:53 PM on February 22, 2017 [1 favorite]

fwiw, everyone I know who's needed cataracts surgery (1) delayed it out of fear and (2) were thrilled out of their minds with the results once they finally got it. And (3) felt silly for having been afraid before. Each and every one of them would go on and on about happy they were with their surgery.
I hope that helps.
posted by Neekee at 7:31 PM on February 22, 2017 [2 favorites]

My Dad got both eyes done in his 70s and it went very smoothly. I would look at getting another doctor because yours doesn't seem very caring. A second opinion is good, but the operation per se is essentially a low-risk, modern miracle.
posted by storybored at 7:53 PM on February 22, 2017 [2 favorites]

Take a very deep breath. Seriously.

I just had cataract surgery in both eyes at 46. I was certain I would go blind. I was certain there was no way this would end well. I wanted to delay it. Maybe there were glasses I could try. Blah Blah Blah.

When we all took a look at how it actually affected my vision, I had them schedule it for the following week.

It takes 10 minutes per eye - they do them about a month apart (if they do both). You are not even under twilight. The lady in the bed next to me didn't take off her sneakers.

10 minutes. I am not exaggerating. There is no pain. There is no nothing. You wear a patch to sleep for a couple weeks so you don't rub it. That's it. Your vision the very next day is like a miracle.

(OK, there are a lot of drops. It's annoying. But that's the worst of it.)

It is not to say you need to have it. I am not your doctor. But I can say you are panicking over absolutely nothing. Though I know exactly how you feel. Walking into surgery was like walking the green mile.

If you end up having the surgery, you will spend hours and hours talking about it with all of your friends' parents. The difference in your vision will be overwhelming. OH THE COLORS! Your friends will grow tired of your babbling about it.
posted by crankyrogalsky at 9:13 PM on February 22, 2017 [7 favorites]

Cataracts are a normal part of aging-- everybody gets them; it's just a matter of time. 50s is on the younger side to have cataracts severe enough to warrant surgery. People in their 60s and 70s get cataract surgeries because that is when cataracts become bad enough to interfere with vision. This brings me to the most important question right now: is your vision getting in the way of your daily activities, like driving and walking around? If not, and especially if you only have cataracts in one eye, you most likely do not need surgery right now, and it shouldn't be the first thing they offer you. In fact, the eye doctors sometimes try to correct their patients' vision with glasses and document those efforts first, before opting for surgery, so that insurance will actually cover the procedures as medically necessities.

There is no medical indication for having surgery in both eyes if you have a cataract only in one eye. Based on what you've told me, it doesn't seem that your provider is being very responsible about this. The reason why cataract surgeries are performed in two sessions is due to the health insurance reimbursement scheme (they pay more for two separate sessions). It's a low-risk and very quick procedure, on the scale of 15-25 minutes. It's an outpatient procedure and you do not need general anesthesia; they just give you a Valium and have a family member drive you home that same day. There are no long-term risks for getting the surgery done. But it's not risk-free, and there's no need to undergo this now when your lenses still have at least 10-15 years before your vision is really affected.
posted by gemutlichkeit at 9:19 PM on February 22, 2017

Actually, if you have a cataract in one eye, and you're a myope (specifically, if your eye 'power' is negative 3 or more negative), many ophthalmologists will recommend lens replacement for both eyes. This is basically because when you get a new lens in one eye, that eye now has perfect vision, and the other remains myopic. A large difference can be difficult to correct with contacts/glasses due to potential image size differences between the eyes.

However, if your cataract is not causing you any real issues, there is no reason to get it done immediately. On the other hand, there is no particular reason not to. Cataract surgery is scary but an easy and small operation, and as far as I know there are no long term complications with getting it done early. Your lens does not expire. The only issue I've occasionally heard people complain of is increased dryness and the need to use eye drops pretty frequently.

(not an ophthalmologist)
posted by and her eyes were wild. at 9:50 PM on February 22, 2017 [5 favorites]

I have a mild cataract in one eye. I was given the opposite advice - to wait for surgery. The reasoning was that my vision is only minorly affected, and in 5-10 years artificial lenses will be much better than they are now.
posted by jb at 5:37 AM on February 23, 2017 [2 favorites]

Cataract surgery is straightforward and has an excellent success rate. My mother had it last year and was amazed by just how bad her vision had gotten before and how extraordinarily good it was after. Seriously this was a massive improvement to a quality-of-life issue she wasn't even realizing had gotten so bad.

So, no, this doesn't mean you're going blind or anything like that. But your vision will get progressively worse until you have surgery, and that will likely dramatically improve your vision. Actual blindness is not going to happen to you as a result of cataracts, now or later, unless you absolutely refuse to ever have the surgery.
posted by jackbishop at 5:46 AM on February 23, 2017

To provide another data point, I was diagnosed with cataracts when I was in my early 30s, and it was suspected I had been born with them, but just learned to compensate. Eventually, in my late 50s I had the surgery on both eyes and can see fine now, though I need reading glasses.

Between the time I was diagnosed and the time of my surgery I was assured by multiple eye docs that it was totally up to me when to have the surgery, and actually beneficial to put it off as long as I could see reasonably well with corrective lenses. The idea is that even though there have been millions of cataract surgeries, there is also continuous improvement to techniques and replacement lens implants. The bottom line from the guy who eventually did the work was that having the surgery is more a quality of life issue than a medical necessity.

As others have mentioned, I seems a little strange that your eye doc would recommend having the surgery on an eye that doesn’t currently have a cataract. I would strongly suggest a second and maybe even a third opinion. One of my docs recommended finding a surgeon that has done a lot of successful cataract lens replacements, as experience counts.
posted by SteveInMaine at 6:10 AM on February 23, 2017 [2 favorites]

I am in my 50's and had cataract surgery in both eyes. I noticed my vision was getting worse -- I thought I needed a new prescription, but I decided to look into Lasik surgery. After the tests, the Lasik doctor told me I had cataracts and was not a candidate for Lasik but needed other surgery. I was shocked! I wasn't 80. I didn't have hearing aids and walk with a cane. How could I have cataracts?

The doctor explained to me that there are two types of cataracts: slow growing that most everyone gets as they age and fast growing which is the kind I had. The fast growing kind can happen any time after 40. He referred me to a cataract surgeon.

It took a while before I had the surgery -- I don't recall exactly why at the moment. During this time, I became increasingly aware of just how poor my vision was. Especially at night, driving was scary as hell. I realized I was essentially blind in the eye that was affected. The cataract surgeon operated only on the bad eye, but told me that eventually the other eye would be affected enough to require surgery. A couple of years later, the other eye started getting bad and I had surgery on that eye.

One of the innovations that happened between my two surgeries is that they had the option of injecting the eye drop medication into your eye when they did the surgery. This greatly reduced or eliminated the need for drops altogether, and I would recommend that option if it is offered to you.

Like everyone upthread said, the surgery is painless, recovery is quick, and it is nice not to need glasses for distance although I do need them for reading and other close work. I would recommend finding a doctor you are comfortable with to evaluate your situation.
posted by elmay at 6:20 AM on February 23, 2017 [1 favorite]

I had a very bad cataract in my left eye (my vision was all clouded in that eye like when your glasses fog up) and my doctors made me wait almost a year before getting surgery. It got worse while I waited but it's completely fixed now. No one seemed worried that waiting would do anything bad. (I had a lot of other eye crap going on that caused the cataract and made them wait on the cataract surgery.)
posted by artychoke at 7:07 AM on February 23, 2017

Thanks for the help and advice. A couple clarifications:
The ophthalmologist was seen at a hospital clinic, not private practice. The hospital is a teaching institution affiliated with a university med school.
My right (stronger) eye's eyeglass lens diopter is in excess of -6 as of the last vision prescription I have at hand (since the current one is pending the orthoptist visit).
posted by Subaru drwxrwxrwx at 7:22 AM on February 23, 2017

elmay: "The doctor explained to me that there are two types of cataracts: slow growing that most everyone gets as they age and fast growing which is the kind I had."

There is actually another kind as well - juvenile cataracts! I was born with them and had the surgeries as a teen.
posted by cp311 at 7:47 AM on February 23, 2017 [1 favorite]

I had cataracts removed in both eyes in my twenties. (Yes, I am a freak.)

The surgery was done under heavy sedation rather than general anesthesia, but I slept through most of it and it was very quick. They did one eye at a time. The improvement was dramatic; when I went to the doctor's office the next day to get the bandages off, it was like Saint Paul having the scales lifted from his eyes. I had to wear a rigid plastic cup taped over my eye for another, I think, week or so to protect it, and dark glasses outdoors. But the Improvement was incredible - the curtains in my house that I thought were solid turned out to have been floral the whole time.

You may want to tell your doctor that you only want to have the one done now and wait on the other, but you may find you want to get the other one done once you see how much better your vision is in the first.

I totally get what you're talking about regarding the pressure from your doctor, though. For a long time, I went to a large Ophthalmology practice where I started feeling like I was on an assembly line and not getting the personal attention I thought my complicated case merited. I went to get a second opinion at a smaller practice, felt very happy there, and ended up having my records transferred and going there full time. A second opinion certainly couldn't hurt when you only get one pair of eyeballs.
posted by The Underpants Monster at 11:50 AM on February 23, 2017 [1 favorite]

Anecdote not data: my mom just had hers removed and was in and out of the docs office in under 90 min. She said it was easier, faster and less painful than getting her teeth cleaned. YMMV
posted by tristeza at 2:47 PM on February 23, 2017

Just to add a few things: I know lots of people who've had it done in one or both eyes. If both eyes, the procedure here (where I live in New England) is done one week apart and no one wears a patch. The main downsides right after surgery are that you can't bend down for a while (like to tie your shoes or pick up something that's fallen), which is hard to remember not to do, and you have to put drops in every 4 hours. I guess there was one other downside: everyone commented on how dirty their house suddenly looked!
posted by mmw at 9:31 AM on February 24, 2017 [1 favorite]

I am just coming in here to tell you to wear sunglasses.

My mom had cataracts removed about ten years ago and this year had a detached retina. The doc told us cataracts and myopia were risk factors for this problem.

Nthing everything everybody has said about cataract removal being not a big deal with spectacular immediate results, but the detached retina treatment was by contrast agonizing. They put oil in your eye to smush the retina back into place and hope that it heals. You have to sleep sitting up and maybe it'll reattach and maybe you'll never see right again, you just have to wait four months with weird blurry oil in your eye putting in drops to lower the pressure four times a day because you could bleed and then you'd go seriously blind, and then you have to go in and have the oil removed and all of this hurts and then you get more delightful suspense while you wait to see if your vision improves. Mom is fine, now, but dang. Wear sunglasses. Not that I follow my own advice, but I mostly huddle inside in the dark like a cave cricket, so I may be spared.
posted by Don Pepino at 11:46 AM on February 24, 2017

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