Is cataract sugery necessary?

[Temmytee31]

I had a retinal detachment in my right eye Aug. 2014 where my Dr. inserted silicon oil(PPV). Six months after, I had the silicon oil removed and long lasting gas was inserted in the same eye again.  Now cataract is detected in the eye. I'm so angry with myself. My vision hasn't improved in the operated eye but rather gone worse. Presently I'm monocular as it's only my left eye that is  100% active.  I've heard of retinal redetachment after cataract surgery and this makes me skeptical in having a cataract surgery. I need to know if I should attempt the surgery and in case I decide not to do it, what are the negative consequences?

Drs. say my low vision can't be restored again cos 1. the retinal has been detached for long before surgery and gone lazy, 2. there is a macular hole and 3. Exotropia .. So I'm presently confused if I the cataract surgery will improve a bit of vision and if it won't, can I stay without doing it and just continue with my left active eye. Will need response of Dr. Hagan and other Experts

[SoftwareDeveloper]

The risk of retinal detachment is only slightly increased after modern cataract surgery, but I don't know how much exactly in someone with your situation. For the most part waiting for cataract surgery isn't a problem. However if  you wait *too* long to when the cataract is hard then there may be more trauma to the eye to try to extract it which might increase the risk of retinal detachment at least a bit depending on what surgical techniques they use (e.g. some surgeons resort to the  older techniques they used to use for hard cataracts a few decades ago, though I suspect laser cataract surgery is a better approach these days for a hard cataract if its not too far gone). If the cataract is developing at a typical slow rate they will be able to tell you  before it gets that bad since it has to be very advanced for that to happen. Few people in developed countries ever let it get that bad since by that point there is little vision in that eye, so its usually only in rare very rapidly developing cataracts that they see that, which is why its important for them to get a sense of how fast this is developing if you don't have good vision in the eye to be able to assess that easily yourself.  

Many  sites that express a concern about the issue of retinal detachment in high myopes after cataract surgery use figures that are from studies done a few decades ago before modern surgical techniques became common that greatly reduce the trauma to the eye. That said, someone who has had a retinal detachment in the other eye may be at higher risk in general and I don't know what the statistics would be. I don't know if there are good recent statistics on that, I won't take time to search for those (but if you find any papers I'd be curious, be sure to check to see if they are recent and if other studies confirm it if possible to be sure it wasn't a statistical glitch since rare events are harder to get good stats on), but you could ask your doctor if they have a good source of recent data on what the odds are to help you decide.

[Temmytee31]

I really appreciate your responses both. I've consulted various ophthalmologists and retinal specialists. Vision is greatly reduced in the affected eye because the retinal hasn't been active for years before surgery due to this, the eye has gone lazy and squinted outwardly leaving the brain to focus and process images on the active eye(This I heard from Drs.)

However, I still see little light reflection and bits of blurry image
images. I saw a Md last Monday and he says the cataract is still very new and slowly developing and presently, doesn't pose a further treat to the present condition of the eye.  

I just wonder why vision has depreciated more compared to what I had before the surgery since the cataract hasn't fully developed and now I'm pessimistic of having a redetachment after cataract surgery. Though I heard it will affect my vision positively (I don't mind restoring to the pre-surgery vision). I'll do anything to have my vision 40% back IF possible.

[CBCT]

Wow, you have already been through a lot.  As I am sure you know, rapid development of a cataract is common after vitrectomy.  It is also true that the risk for retinal damage increases with multiple surgeries.  What is your current corrected visual acuity in that eye?  Has your doctor indicated how cataract surgery will improve your vision or quality of life?  Although you have low vision in that eye, do you still have stereo depth perception?  

[SoftwareDeveloper]

Cataracts usually take years to develop to the point where they have a noticeable impact on vision, though occasionally they can develop within a few months to have a large impact on vision. So the question is whether this cataract is new and slow developing and isn't really an issue yet and you should perhaps focus on going to other MDs to get opinions on dealing with your other eye issues, or if it has gotten worse quickly in the last year (or even before that) and is the reason your vision has gotten worse and if removing it will have a major impact on your vision (though you say this doctor doesn't think so).

Cataracts do get worse over time and eventually lead to total blindness, usually taking many years to do so but in rare cases it can happen much faster so it really depends on the details of your case. However the point is that eventually if you wish to have any hope of regaining vision in that eye the cataract will need to be taken care of, but when you do it really depends on how bad it is now and how quickly it is developing, and whether you can get any useful vision from that eye. If that eye is effectively going to be blind  forever regardless of what you do, then cataract surgery would be a waste. However you indicate it isn't "100% active", but the question is whether you get any useful visual input from that eye at all which you should work to retain, or whether treatments invented in the foreseeable future that aren't yet available might be able to restore vision in that eye.

Even if your other eye is better now, there is always the possibility you will have problems with that good eye as well. So if there is any chance of retaining some vision in the bad eye that would seem to be useful to do to play it safe for the future in case you ever need to rely on vision from that eye.


In this case to give a good prognosis for whether your vision can be improved, a doctor would need to examine your eyes or at least rely on scans and internal images of your eyes from other doctors, a brief description online isn't enough.   So I'd suggest you try to track down the best doctor you can to get another opinion.Doctors can vary greatly in their knowledge and experience and so its possible you might hear something new from another doctor. Unfortunately doctors rarely post to this site now, most people posting are self-educated patients who have needed to research things for their own treatments, so even if you had scans&photos they wouldn't likely be useful to post here.