Cataract Surgery at age 72 and with Pseudoexfoliation

[rybn]

Hello,
I am 72 Years old. The eye doctor keeps telling me for the last 20 years that I have cataract and (for the last 6 years) I also have pseudoexfoliation (PXE). He "drilled" holes in my iris (with a green laser) to prevent a sudden dangerous high pressure in the eyes. My IOP is only 14mmHg. I don't have any signs of glaucoma.
I have no symptoms of the cataract. I can drive and see everything during days and nights. But my doctor urges me to have the cataract surgery as soon as possible because of the PXE. He says that the lens becomes harder and the zonules can break while attempting to remove the lens. If this happens, than there is nothing to hold the capsule (with the IOL) in place. I also read that the zonules may break later if not broken during the surgery.
I found out on this forum that in a cataract surgery with PXE the risk of complications maybe 10-15% or even higher, compared to 1-3% without PXE.
My question: Should I have the cataract surgery now, or wait until symptoms interfere with my life.
I have to mention that I am taking warfarin for my atrial fibrillation (mitral valve repair and unsuccessful atrial ablations) and also aspirin for the stent placed in my RCA, as well as other medications for my heart.

[John C Hagan III, MD, FACS, FAAO]

Your vision is not good if you can't drive at night, especially if this keeps you from doing the things you need to do and want to do. Actually pseudoexfoliation (PXE) does make cataract surgery more difficult due to the weak zonlules that hold the lens in place. It is usually better to remove a cataract EARLY in the course of PXE, earlier than regular cataracts. Two good reasons: 1. It make surgery easier and safer when the cataract is small and  soft  2. Removing the cataract often "cures" the glaucoma associated with PXE or at least makes it easier to treat.

Go to Dr. Hagan's blog and read the entry on macular degeneration.

JCH MD

[catbreath]

I am 73 female and have glaucoma, pseudoexfoliation, beginning of macular degeneration, and early cataracts.  This is all frightening and very confusing.  I am alone with no family and am so worried about my eyesight.  I was told laser for the glaucoma is very risky as is catract surgery because of the speudoexfoliation.  My vision is good now.  20/20 and 20/25 with glasses.  I am not able to drive now at night because of the car lights and I just feel trapped.  Any suggestions would be immensely appreciated.  Diane

[AnnaE]

I am a community leader here, not a doctor. I am also an experienced eye patient. Welcome to our community

Dr. Hagan is always great with patients. He is so experienced and knowledgeable.

Let us know how you are doing.

[John C Hagan III, MD, FACS, FAAO]

It depends on what your cataract looks like from the Eye MDs side. If the cataract is getting moderately hard then I will recommend to my PXE patients that they go ahead and have the surgery earlier than they would if they did not have PXE. Trying to take a hard, brown cataract out of a PXE patient is quite difficult and risky compared to taking the cataract out when its softer. I think you are being given good advise.


Also with PXE there is a 25% chance of developing pseudoexfoliative glaucoma.

JCH III MD