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Ask Dr. A.S. Desai Your Own Question

Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2070
Experience:  MS Ophthalmology with 11 years of surgical expereince
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I have an early diagnosis of cataracts at 55 yrs (F) that my

Resolved Question:

I have an early diagnosis of cataracts at 55 yrs (F) that my doctor says can go for years before surgery is needed. However he is suggesting early treatment as a means of improving quality of life. I am a very active professional who has worked outdoors in bright sunshine my entire career. I have checked various websites but cannot find anything on having this surgery at such an early age and would like feed back on the pros and cons. What are the possible complications, possible negative effects, positive effects (could it actually improve my vision beyond relieving the existing symptoms of the cataracts that I currently have). I had very successful lasik surgery nearly 15 years ago to correct astigmatism and hyperopia and have always been left eye dominant (a lazy right eye that was treated late as a child), am currently left using progressive lenses OD +0.75 -1.25 x 160 , OI +1.00 -0.50 X 35, ADD +2.00, DI 61.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 1 year ago.

Dr. A.S. Desai :

Hello, Welcome to Pearl.com

Dr. A.S. Desai :

Are you available for chat now?

Dr. A.S. Desai :

Do you have any known history of diabetes? Are you taking any medicines for any systemic ailments? Have you taken oral steroids in the past?

Customer:

I am

Dr. A.S. Desai :

My screen shows that you are typing.... I'll wait for your reply....

Customer:

No histpry for me but am susceptible with a long family history, last tests are fine. Take 80mg Micardis for pre-hypertension 120/85. Taking 25mg Eutirox for thyroid for over 15 years. Last profile was normal. Have taken steroids by injection for sports injury. Administered by orthopedic surgeon. Apologies for the spelling errors.

Dr. A.S. Desai :

Though 55 years is not considered as pre-senile cataract , I was wondering if the cataracts have started a bit earlier in your case ? due to steroids taken for the sports injury ( in case it was a long course along with oral steroids too).

Dr. A.S. Desai :

In such instances the type of cataract is a bit different than the usual senile cataracts. It is usually the posterior sub-capsular cataract (PSC).

Dr. A.S. Desai :

Such cataracts interfere more so with the day vision and is worsened when outdoors in bright sunlight. This occurs because the PSC starts in the centre of the natural lens. However these cataracts are very slow to progress and may take years to mature further.

Customer:

No the steroids was a one time thing when I developed a running injury, I can't recall exactly why now other than I was probably in pain and needed help! :-). If that i the reason for it what are the implications of that. Also, there is a family history of cataracts in both parents. I am caucasian if that makes a difference

Dr. A.S. Desai :

Ok.

Dr. A.S. Desai :

In that case it may not have been due to the steroid injection. A single injection would not have been contributory. Family history of cataracts is significant however.

Customer:

I am really looking for answers to my questions to help decide the right course of action. I am not looking for a "you should" or a "you shouldn't" do this, I am looking for answers to my questions as a second opinion. I live in a remote area and do not have the luxury of having many consulting options available without extensive travel to make appointments.

Dr. A.S. Desai :

But I guess the decision to undergo cataract surgery should be based on the vision at present in both the eyes, your visual requirement ( for example some individuals require very precise and clear vision due to their profession such as pilots. Early surgery is definitely is recommended in such individuals). You have not mentioned the vision in both eyes with the correction given. Does the vision interfer with your routine work?

Dr. A.S. Desai :

Your age is certainly not a thing to get concerned regarding decision for surgery. Cataracts can come at any age and is operable at any age. Outcome of a routine cataract surgery is excellent in most cases in experienced hands.

Customer:

Good question, yes my vision is affecting my work, but am unsure if that is from cataracts or because I am aging. I am a geologist and find that I can no longer distinguish the fine scale features I need to. Even with a 20X handlens. I certainly need a lot more light taht is not always available, and I do have blurring, amoung others. At this stage it is more of an irritant than a disticnt handicap but I do find myself compensating.

Dr. A.S. Desai :

Depending on your visual requirements and whether you would want to do away with glasses after surgery, you can decide with the type of intraocular lens(IOL). Monofocal IOL will only correct distance vision and one would need to wear glasses for near vision. The other option is to go with multifocal IOL which take care of both distance and near vision.

Dr. A.S. Desai :

It looks like the quality of vision is getting affected in your case due to the cataracts ( it would be due to aging for sure). Improvement in the quality of vision is the main reason why you should be undergoing the surgery even if you feel it is early.

Dr. A.S. Desai :

Sorry please read - it would NOT be due to aging.

Dr. A.S. Desai :

In an otherwise healthy eye but for the cataract, the outcome is usually excellent. There should not be any complication arising out of cataract surgery even if done in early stage of the cataract. The good thing would be clarity of vision would improve.

Customer:

OK on the outcome at my age and you are anticipating my questions before I can type them! How about the different lenses then. I have read that the multi focals have some night vision issues. I have used glasses my entire life except for a brief few years immediately following Lasik, so I have no issues to continue using them.

Dr. A.S. Desai :

Since you are very clear about being alright with glasses after surgery, it make sense to go for monofocal IOL.

Dr. A.S. Desai :

I have re-read your question and am trying to answer to each query one by one!!

Customer:

Sounds good. On elast question, is there a possibility of secondary procedures as I continue to age?

Customer:

OK :-) I will wait.

Dr. A.S. Desai :

The only secondary procedure one can anticipate is that of posterior capsular opacification(PCO) needing Nd:YAG laser.

Dr. A.S. Desai :

PCO tends to occur in younger individuals and is due to clouding of the capsule behind the IOL.

Dr. A.S. Desai :

It is not considered a major complication and is fairly common in occurance. It can be easily treated at the surgeon's office itself with laser treatment.

Dr. A.S. Desai :

Are you there?

Customer:

OK I have read about it and it is good to go into this informed. I will expect I will undertake the surgery and to eventually need a secondary procedure. Now there is the day after to manage. As an example I use the lasik surgery I had and the learning to live with the difference between the pre-surgery assurances and the reality of what the post surgery results give. There is always some adjustment to make to expectations. How will this affect what I see or do not see. What sort of side effects such as night vision issues, dryness, complictions, coudl I have an allergic reactiont o the lens , could it be rejected etc

Dr. A.S. Desai :

No, unlike lasik there are no complications such as dryness or tear film issure here. There is no known complcation of IOL such as allergy from it or it being rejected.

Dr. A.S. Desai :

If you are going ahead with monofocal IOL, there should not be any problems with night vision ( unlike that experienced with multifocal IOL).

Customer:

OK, you have confirmed everything my doctor has said so I feel more confident about it now. I think I am good to go. Thank you very much for your input. This is an excellent service that fills a very real need for people like me who otherwise would not have easy access to medical experts. I think we can conclude this now.

Dr. A.S. Desai :

I am glad to have assisted you today.

Customer:

Adios

Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2070
Experience: MS Ophthalmology with 11 years of surgical expereince
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