On the horns of a dilemma: to do or not to do.

Hi Eileen,

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!

I think in the UK they would take your work into consideration when planning the surgery - and that is in a state system. It is not fair to tell someone they are going to have to wait if it affects their day-to-day living adversely - some people could lose their job if that happened. Maybe most people just want to leave it as long as possible. If there was one thing I wouldn't break my heart over it would be being told I need cataract surgery! I could have vision where I would only need reading glasses!!!!!!! No sore ears and nose - I've worn specs since I was about 7 years old. Had contacts for a long time until PMR struck and affected my eyes too but they aren't the same as being able to go to the swimming pool  and recognising other people ;-)

Me too. Have worn glasses since I was 12. Contact lenses were not my friends. Would be nice to not have to be '4 eyes' anymore. The over the counter reading glasses and sunglasses are so inexpensive I could have a pair to match various outfits!

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???

No, with the conventional technique the old lens is removed and an artificial lens replaces it. The artificial substance doesn't become cloudy like the origianl lens did:

"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.

Eileen, I have also been told to have my cataracts removed in a few months time.

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?

There is a choice with regard to the replacement lenses used these days. You are asked pre-op whether you would like lenses that are for near vision or distance vision - so if you choose distance vision, for everyday use you will not require specs, just for reading and possibly computer use. If you are having it done privately then there is even the option of multi-vision lenses, just like multi-vision specs (or whatever they are called these days!) but they are more expensive so don't come included in the basic-price offer that comes with state funded medicine. So not only is the cloudiness of the cataract removed but if you are (like me) very shortsighted and also having accommodation problems because of age, you can choose whether you can sit and read/sew without specs or do the housework and go for a walk/drive without specs. Either way - for me that is an improvement! I can't even get out of bed without my specs on - I might trip over on the way to the bathroom!

Thank you all for feed back on cataracts -only i have been told i have them coming due to pred.i have been trying to put it to the back of my mind as tge opticiion said no need for refral to hospital yet .i had only noticed a slight misting sometimes and thought it was mucus in eye so was bit upset -but now am forarmed with all information you all supplied thanks regards to all.

Thank you for this, Eileen. Very helpful. I will have to grill my opthalmologist about my options. I'm not in the UK so I'll be going private.

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!

 

I wasn't aware of opaque film either - just thought I needed new glasses.  Went to optician and he told me to go to a specialist eye doctor.

There is some dispute about whether the cataracts are entirely due to being on pred - some people don't develop them when on pred. Cataracts would come to everyone if they lived long enough and some people are just further along the cataract path than others. Pred does speed up the aging process in some things and in the case of cataracts so does UV light - so it is perfectly possible that you would have developed cataracts eventually and it has just happened a bit sooner because you are on pred. You can't tell which.

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!

At the beginning the effect is small - think of the amount you can or can't see when it is misty and it progresses to real fog. You would go out and drive happily in just a light mist, possibly not even realise it is misty, but with a real fog you see far less. The same with a cataract, at first it hardly registers that things are a bit misty - eventually there is enough cloudiness to interfere.

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.

Thank you!

I thought they removed the lens and plopped in a new one. Do cataracts grow back? Since we are on Prednisone, might they do that?

In the UK at least lasering cataracts is a new procedure. Google this:

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.

Thank you. Had no idea!!