Update on Diagnosis
Posted , 5 users are following.
Good evening
So today I had a very informative appointment with my optician. He confirmed I have a grade 2 Posterior Subcapsular cataract and has recommended we watch and wait for six months. He cautioned against me rushing in and going private due to my age (48) and the risks that younger patients have - does this sound like good advice? I mentioned how poor my night vision is and he said he cant advise on how slowly or quickly my cataract will progress. Really confused as to what to do now
0 likes, 17 replies
RonAKA AndiPandi
Posted
I have never looked into the variations of cataracts before, so did a quick check at the Mayo Clinic site. Here is what I found for the type you have:
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"Cataracts that affect the back of the lens (posterior subcapsular cataracts). A posterior subcapsular cataract starts as a small, opaque area that usually forms near the back of the lens, right in the path of light. A posterior subcapsular cataract often interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night. These types of cataracts tend to progress faster than other types do."
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I think I would base the timing on when to go forward on your vision. If it is affecting your vision poorly then I would go ahead. Not sure how things go with the AHS, but in Canada it can be many months or years on the wait list for operations done in public hospitals. If you have an option to go ahead more quickly with a private clinic, I would at least investigate it. I think the other aspect is the choice of lens types. Not sure if the NHS will let you select a toric lens if it can be helpful or not. I think I would go ahead at least to the point of determining what your options are under your private insurance. It never hurts to get another independent opinion. Also a surgeon will be more qualified to comment than an optometrist. They should be able to tell you if you would benefit from a toric lens or not.
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I guess the hope is that new and improved lenses will become available if you wait longer, but I would not put a high probability on that in the 2-3 year horizon.
AndiPandi RonAKA
Posted
Thank you - fortuntately I will be able to go private so could get it done in about four weeks
soks AndiPandi
Edited
yes i got those. PSC are common among younger people. have you used steroidal medication over a period of time for other conditions. wait if you can but they develop very fast. u will need surgery when they get in your line of sight.
AndiPandi soks
Posted
thank you - I had a pentrating eye injury when i was a child so assume that is the cause ? Is the surgery harder on younger people?
soks AndiPandi
Posted
i dont think the surgery itself is harder but the improvement in vision compared to natural vision for younger people is not that great as their natural vision is still very good. also their pupil still enlarges more at night which can cause more glare and other positive dysphotopsia artifacts. if you go with monofocal then the loss of near vision is sudden and stark for younger patients as they still have accommodation for their natural near vision.
PSC patients are also prone to faster post cataract condition of posterior capsular opacification (PCO). PCO treatment can cause retinal detachment in younger males below age of 50.
RonAKA AndiPandi
Edited
I have seen no evidence that cataract surgery is harder on younger people. If anything, you are more likely to recover faster. I recall you are using readers or computer glasses already? If so, a monofocal is not going to be a big change to you as you are already familiar with presbyopia which comes with age. One factor to think about is that you will have this lens for a long time, and at some point when a significantly better IOL comes along you may suffer a little "buyer's remorse". But changes are not that frequent. Probably the biggest improvement in IOL's came a couple of generations ago or so when the switch was made from hard IOL's (like hard contacts) to foldable IOL's. They allow for a smaller incision in the eye, and faster recovery. Multifocal lenses are making slow progress, but still have issues especially at night. I think the next big advance in IOLs will be when an adaptive lens that the body can focus closer is developed. There have been some attempts at this but they are more in the dream stage in my opinion.
AndiPandi RonAKA
Posted
Thank you for this info - i think ive pretty much decided to take the safe option of a monofocal lens as i would prefer less light problems as opposed to less glasses - now all I need to get a grip with is my nerves !
RonAKA AndiPandi
Edited
My opinion is that the safe choice is also a good choice. One thing that you could try once you have recovered fully from the cataract surgery (6 weeks or so) is an under correction in your natural eye. I recall you have said it requires a -3.0 D correction for myopia. If you under correct the myopia by about 1.25 D you will gain some reading ability in that eye. So instead of using a -3.0 contact, you would get a -1.75 D contact. You will lose some crispness in the distance vision with that eye, but your IOL eye if the surgery turns out well should make up for it. I use that arrangement as I only have one IOL eye, and it lets me go eyeglass free for at least 95% of the tasks. I do very occasionally reach for my +1.25 readers for extremely tiny print, but other than that I am fine without glasses. Computer is no problem, and I can read my iPhone 8+ screen quite well. This arrangement is called mini monovision. Not everyone likes it but I do. It is something best done on a trial basis with contacts when you can still see well out of the natural lens eye. Then later down the road you can decide if that is what you want to do when it comes time to deal with a cataract in the second eye.
AndiPandi RonAKA
Posted
goodness you know your stuff! I am very grateful for your advice ... am hoping my other eye remains cataract free - im very nervous about the procedure and risk of complications
RonAKA AndiPandi
Posted
Cataract surgery is much less uncomfortable than one might expect. Some say it is less discomforting than having your teeth cleaned, and I would agree. One choice you will likely have is on the use of a sedative, or just a topical anesthesia via drops in the eye. My surgeon recommends and I agree that getting a mild sedation via an IV is the best way to go. As he says, he wants the patient to be comfortable and still while he is doing the surgery. A patient flinching during the surgery is not conducive to getting a good result. You are aware of what is going on, but don't feel any pain or pressure at all -- or at least I do not remember it. Also be aware that the actual operation probably only takes about 10 minutes once it starts.
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My wife is now scheduled to have her first eye done on Nov 9, and the second on Dec 1, with the same surgeon that I had. So, she is starting to get a little anxious about it. I keep telling her that it is nothing to be worried about... I think that the most important thing you can do to get a trouble free recovery is to take the post op eye drops exactly as instructed for the full length of time that each is prescribed. It is a bit of an annoyance and it is worthwhile to make yourself a chart showing when you are to take each type of drop and for how long.
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Hope that helps some,
lucy24197 AndiPandi
Posted
Another thing to keep in mind is that every eye is different--even for the same person. I have monofocal IOLs, one set for near and one for far. My "far" eye is a little more myopic than many people target at -0.5D, but even though I have a closer focal point, my near vision isn't as good as some people have experienced with vision set closer to Plano. (The closest I can read anything off a Jaeger chart is about 30" on a good day with my distance eye. Most days it's closer to 36".) My near eye is targeted for -1.75, but it's still healing so I'm not sure exactly where it will end up. I can read everything on a Jaeger chart at 17" (again, this varies a little from day to day) but if I get closer than that things start to blur. I am using readers for books, but day to day activities--checking what's in the mail, reading labels, etc works fine. Something to note is that I had unhealthy eyes going in to the surgery and I'm having some complications, so there's no telling what my vision will be when everything settles, but just be aware that results can vary greatly from person to person.
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Since you have some time, you might want to get more educated on the optics of IOLs and put some thought in to what range of vision is most important to you. Defocus curves are incredibly helpful, even if they take a little puzzling over.
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I also had Posterior Subcapsular cataracts, combined with nuclear sclerosis and cortical vacuoles. My vision had been deteriorating for several years, so you may have some time to think about this unless the vision problems are affecting your ability to function.
AndiPandi
Posted
thank you - ive just turned 48 and have had a crappy few years so this just feels like yet another thing to have to do deal with - am very scared of the procedure
lucy24197 AndiPandi
Posted
The procedure is really not very bad at all. The analogy to getting your teeth cleaned is pretty good--especially if you floss regularly! My first eye was zero pain at all--the worst part was the bright light shining in my eye. I really wanted to blink and couldn't. But it didn't last very long at all. There was a little pressure a couple times--not as bad as pressing on a bruise, but a similar sensation. I had a couple valiums and the topical anesthetic (drops).The prep time took far longer than the surgery itself. It's scary and you can't help but being nervous about your eyes getting operated on, but it really is not bad at all.My second eye was a tiny little bit worse--just a couple little twinges, and I let the doctor know and they added more drops.After surgery there was a feeling like there was a little bit of grit in my eye, but it went away probably within a few days. Again, not really painful, more of an annoyance. So sorry you're having to go through this, but the surgery is really not bad at all.
AndiPandi lucy24197
Posted
Thats so reassuring, thank you
Sue.An2 AndiPandi
Edited
That is type of cataracts I had ad well at 53. Likely due to steroid creams for atopic eczema etc . It was nor a welcome diagnosis for me.
If your vision can still be corrected with glasses I would hold off and research all you can and find a good surgeon. I had a long wait between diagnosis and surgery - normal for Canada.
AndiPandi Sue.An2
Edited
Sorry to hear that Sue ... I checked with my mum and she said that she was also given topical steroid cream for my face when I was very young ... fortunately we know the risks now. Was your procedure successful?
Sue.An2 AndiPandi
Posted
Yes - i see better than when I had cataracts. Day vision is good - I do see concentric circles around certain lights at dusk/ night. I was aware of that prior to surgery. Given my need to work on computers and spreadsheets for work this was a good decision for me.
Not sure there is much that can be done for atopic eczema outside of steriod creams so O guess it is pick your poison.