Cataracts are at first simply observed and can be treated with a change in spectacle correction. It is also important to emphasize that cataract progression can be slowed with better control of underlying diseases. Once the opacification is visually significant and the patient’s vision is no longer improved with spectacle correction, the opacified lens can be surgically removed and replaced with a synthetic intraocular lens (IOL).
There are no specific cut-offs for surgery based on visual acuity, and the decision is based on patient preference. Cataract surgery is highly encouraged if the opacity prevents appropriate monitoring of ocular disease, such as diabetic retinopathy. However, insurance companies may cover surgery only when vision reaches 20/50 or worse. Alternatively, vision better than 20/50 but which decreases to 20/70 with glare may also qualify.
Patients should be counseled that cataract surgery will only partially restore vision if there are comorbid ocular diseases such as diabetic retinopathy or glaucoma.
Surgery is usually performed in ambulatory surgical centers on an outpatient basis. Local anesthesia is used (if patients will be able to cooperate and remain still during the procedure). Surgery is often performed on one eye at a time, separated by several weeks. Several trials have found that second eye surgery is cost effective, improves patient visual symptoms, and may reduce the risk of falls and automobile accidents.