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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I'm 87 years old. I need to have cataract surgery on my left

Resolved Question:

I'm 87 years old. I need to have cataract surgery on my left eye. I also have a hole in my retina in the same eye. Previous cataract surgery on my right eye was not successful and a second surgery on the same eye to remove a membrane left me with an eye with only some peripheral vision. I'm afraid to have any surgery on my left eye for fear the same result would happen. If I am fortunate enough to have a good result on the cataract surgery, would it be necessary for me to have the hole repaired? And if it was necessary, could the hole be repaired by laser surgery?
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

Hello and thanks for your question.

I can understand your plight and how scary this must all seem to you. Certainly when you've had a bad experience with cataract surgery on the first eye, I can understand not wanting it for your other eye. I think it is important to understand how the retina works in relation to your lens (cataract) and the rest of your eye.

Imagine your eye was a camera. Your lens in your camera has become cloudy and dingy and doesn't work as well as it used to or needs to (it has become a cataract). Ideally, replacing that lens with a new, clear lens would enable that camera to function well again and provide good pictures. However, if you take that camera with a new, clear lens in it and put film in it that has a defect right in the middle of each frame in the film, the picture quality would suffer because of that defect in the film, no matter how good the rest of the camera is. Your eye is the same. The macular hole in the retina of that eye will limit your vision no matter whether the cataract comes out or not. The retina doctor probably either thinks the cataract should come out to improve your chances of seeing well after the surgery, or it may be that he/she recommends it to come out so they can see better to do the surgery.

The retina surgeon is correct, though, in saying that this retinal hole cannot be repaired by laser, but needs a bubble of gas to help close the hole. You can certainly choose to have the cataract taken out and see how your vision does afterwards, knowing though that the vision may not be much better even with the cataract out if the retinal hole is significant enough. Most macular holes that a retinal surgeon is recommending surgery to close are usually bad enough that it will limit the vision to a significant degree unless they are closed. You are in a difficult position because it sounds like the vision in the other eye is not very good either. This, combined with the fact that there is the possibility that the retina may not function as well as it did before even after closing the hole, makes it a particularly difficult situation.

I think it is reasonable to try the cataract surgery first and see how much that improves the vision. If your vision in that eye is functional right now (even with the cataract and the macular hole), then it may be reasonable to just wait and see if it worsens or stays the same). But if you get the cataract surgery and the vision doesn't improve much, it is likely the fault of the macular hole and would therefore need to be repaired to have hope for improved vision from that point.

Does that make sense and does that help address your concerns?

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must be examined by your doctor.

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