On the horns of a dilemma: to do or not to do.
Posted , 4 users are following.
I saw an opthalmologist in August, as I was having trouble seeing. Happily it was NOT GCA, but cataracts. He advised surgery in 'about 6 months time.' At that time I was on 10 mg Prednisone. I mentioned that I would not be off the Prednisone at that time and how would Prednisone affect the healing, etc. I also mentioned I would be tapering. (I have successfully tapered to 8 mg at this time). He told me that Prednisone helps reduce inflammation and I would actually be better off on a higher dose. He said that they give steroid eye drops to reduce inflammation. I saw my rheumy yesterday. She advised my continuing with my slow rate of taper. She also told me that the Prenisone slows healing and I should wait to be down to 5 mgs of Prednisone before I have cataract surgery. The earliest that this could happen, at my current rate, would be April or May of next year, as I intend to slow my taper of 1/2 mg per month as I go on lower doses (10% reduction scheme). In the meantime, I am having trouble driving at night (giant halos around the headlights of oncoming cars). Am climbing into the computer to write. Can't see details without squinting. So: wondering two things: Which of the Drs is right? Since I can't taper faster, how fast do cataracts get worse? Thank you in advance. (BTW, I will certainly get other opinions, before I let anyone slice into my eyes).
0 likes, 18 replies
EileenH paula63201
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I can't remember anyone being told this for cataracts but I do know that one lady was told by one doctor she had to get off pred altogether to have a hip replacement - another said she just needed to be stable on whatever dose she was on and she finally had the surgery whilst on 10mg! Then, the pain of the hip being gone she got off pred in the next year without a problem.
This is a reply from a lady on another forum: "I am having cataract surgery tomorrow. Been on medium and high dose prednisone for about nine years now. Yes, you can have the surgery unless you are ill in some other way with an infection of some sort. I have prednisone caused cataracts, regular ones have barely started in one eye. They started in the middle of the lens for me."
Medium dose is above 10mg, high is above 20mg.
Has your rheumy thought about the fact you may not get down to 5mg for a long time? Your reduction is not heading relentlessly for zero - it is looking for the lowest dose that will manage your symptoms. It took me 4 years to get to 5mg even with a slow reduction. if the underlying autoimmune problem is still active you will need some pred. How much will depend on how active the disorder is.
For the cataracts - ignore the rheumy and ask a few eye people. They don't have to wait for the cataracts to get to a certain stage these days as they used to and if it is affecting your life badly then they may bring it forward. If you can't drive it will make life with PMR difficult - as I found to my distress. Am I right in thinking you are in the USA?
In the meantime - maybe there are people on the forum who have been in your position.
paula63201 EileenH
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Yes, you remember well, I am in the U.S. Thank you for your response. I agree about the slow taper and who knows when I will get to that lower dose of Prednisone. The cataracts are bugging me as I work visually: art, photography, etc., and not seeing detail is an issue (not that it is not an issue for all folks). My current opthalmologist was an MD before specializing in Eyes. He does not do the surgery himself, but his partner does and he is not on my health plan, so I have to find a different cataract surgeon, anyway. Your are right in suggesting I get other opinions from those who actually work with eyes. Makes total sense. Thank you for getting me off those horns!
EileenH paula63201
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paula63201 EileenH
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I'll probably still have to have glasses for computer distance and reading, unless those cataracts come back over the new lenses...due to Prednisone???
EileenH paula63201
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"Cataracts occur when there is a buildup of protein in the lens that makes it cloudy. This prevents light from passing clearly through the lens, causing some loss of vision. Since new lens cells form on the outside of the lens, all the older cells are compacted into the center of the lens resulting in the cataract."
"Because a cataract is a clouding, or opacification, of the natural lens, and cataract surgery entails removal of the natural lens, a cataract cannot come back after surgery. Fortunately, artificial lenses do not form cataracts.
However, the lens capsule, which is the small "sac" or membrane that once enclosed the natural lens and held it in place, can become cloudy after surgery. This is called capsular opacification and it develops in approximately 25% of patients after cataract surgery."
If they become cloudy again then it isn't a new cataract, it may be something called posterior capsular opacification - and is simply lasered away if it does happen.
Light EileenH
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Are you implying that a cataract op would actually improve my eyesight itself, apart from creating more light by removing the opaque screen that slowly covers them?
Or did I misuderstand you?
EileenH Light
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jean_b EileenH
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Light EileenH
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My purse will decide too!
One more question.... from what I read here, people with catarcts are aware of the opaque film and loss of vision. I am not. I've only noticed that I tend to need more light at night, especially to read and see detail...
Could this mean I'm not yet in need of the op?
I have a very enthusiastic eye doctor!
constance.de Light
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EileenH jean_b
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They used to wait until they were quite bad "to ripen" it was sometimes said. In some people they don't progress to a stage where they interfere with what they want to see. In others it matters more if they need to see well to do their work. And at a certain point it is bad enough to make driving dangerous. Some people just don't get that far so there isn't any point taking up a space at the hospital.
it certainly isn't anything to get upset about - it is the most common operation done all over the world and is mostly done as an outpatient these days, not even a night in hospital. They do one eye at a time and within a few weeks of each other. Lots of people are amazed just how much they were affecting their vision once they have been done - "Why did you let me buy those awful curtains?" and "Oh dear - everything is so faded/dusty/worn" are common comments!
EileenH Light
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WHEN you need the operation depends on what you can't see and what you need to do. If you must drive at night you will probably need the operation sooner than someone who doesn't drive at all. Or if you need to be able to read for your work the same applies. There is some that can be done with stronger specs - but only so much.
Oregonjohn-UK paula63201
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paula63201 Oregonjohn-UK
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constance.de paula63201
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paula63201 constance.de
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EileenH paula63201
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Laser-surgery-removed-my-cataracts-in-the-blink-of-an-eye
and you will get a link to a newspaper article about it being used in the NHS in the UK a surprisingly sensible article it has to be said!).
It's quite interesting - I didn't know about it until Constance mentioned it.
There are a few ways of dealing with cataracts - depends on the type and the surgeon.
paula63201 EileenH
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