Fast developing cataracts

[MarSharky]

In Feb, I was diagnosed with cataracts and offered surgery.  I have never had any surgery so I was shocked and turned down the offer.  She shrugged her shoulders and said let her know when I was ready.  By April, I was more than ready as my vision was getting increasingly worse.  I work on a computer all day for myself, and my vision is obviously crucial to my income.  I finally got scheduled to start the process, in the meantime I have had to stop driving completely because I can't see traffic lights, road signs, traffic signs, and anything that is in the shadows along the roads.  It is pretty scary how close to me some things got before I even knew they were there.  I can't see contrast, so Word and pdf documents are a big blank white square.  I can't read labels on groceries, I couldn't even tell the difference in a bag of shredded cheese vs sliced cheese in the grocery store last week.  I can see big stuff, like a restaurant, but I can't see the sign on the building to tell me it was Chic-Fil-A.  Everything appears as if I am looking through a very dirty yellow tinted window.  Any sort of light is very painful.  So as I did the pre-op workup for my surgery in July, everything came to a screeching halt.  I have severe anemia (HCT 27.1, HGB 7.6, iron 25, iron sat 5%, Ferritin .7), my doc will not give medical clearance to do cataract surgery until the cause of my anemia is determined and resolved.  I have to get my iron levels up.  As a result of my first ultrasound to start investigating, they found some things that appear to need surgery to correct...it looks like it will be months before I can see properly again.  I am a 47 year old female, no diabetes, no drugs or steroids, no trauma.  Was told there are multiple cataracts, both nuclear and subcapsular posterior in both eyes.  Certain family members have them, but not until they were quite a bit older than me.  I have taken alot of Ibuprofin over the years along with Excedrin for headaches.  Could these have contributed to the cataracts?  I am at a loss as to what to do now, I am having to start turning customers away because I can no longer see well enough to do the work, and I am having to rely on family to drive me where I need to go and fill out paperwork for me, read grocery store aisle signs, etc.  Anybody have some advice for me?  I am about to close my company because of this and it is my only source of income.

[dori76]

I am not that old considering the average age for cataract surgery (had my surgery a year ago at 58 and I definitely needed it since I couldn't drive legally anymore), never smoked, wear expensive Rayban sunglasses all the time, no heavy alcohol, no steroids and it doesn't run in my family (my mother did get them in her 70s, but my father didn't have them). I did have lasik though 15 years before (when I was in my early 40s and my cataracts probably started not long after that) and my brother also had lasik and we both got cataracts earlier than the usual age. We have 2 older siblings who never had lasik and didn't get cataracts. I know most doctors don't think lasik causes cataracts, but I tend to believe it does (and if it doesn't outright cause them, it could make them occur earlier in my opinion).

[dori76]

Also no diabetes and no obesity in either of us (and all those things I noted about myself above apply to my brother as well - no heavy alcohol, no smoking, no steroids, no excessive sun exposure other than the norm, etc.).

[JohnHaganMD]

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[dori76]

In case you didn't see it, I sent you a private message.

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

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[MarSharky]

I receive my healthcare through the VA.  After understanding their position for postponement of surgery until iron levels are higher, I called several community eye centers (we were considering going the cash route) for cataract surgery throughout our state and was told by all of them that they needed medical clearance from my pcp before they would do surgery.  My pcp will not grant clearance due to the anemia.  I believe it is their own professional/liability insurance providers who require this, as if you do research online, every major eye organization no longer recommends these pre-op tests and consider them to cause more problems and cost than necessary for the care of the patient, but evidently the insurance providers do not agree with that position...I suspect it is either risk driven or revenue driven.

[JohnHaganMD]

That is sad.  Cataract/IOL surgery can be done even in patients of full blood thinners that cannot be stopped (for example aortic valve replacement) and with severe anemia if sight is poor and anemia hard to fix such as people with blood diseases, etc.  It is only general anesthesia and long procedures where this is important.   Anemia not affect healing.  

[MrPresley]

@MarSharky my PCP had no involvement with my cataract surgery before the procedure, either regarding medical clearance or referral. That being said I did have a referral from my optometrist for the procedure, and was released back to him a week after the surgery was done.

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

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[dori76]

I was told by my cataract surgeon that I needed to have tests, but I told my primary care physician I didn't want them especially since I'm relatively young and have no ongoing health problems, so he signed off on it without requiring any tests.

[JohnHaganMD]

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[MarSharky]

MrPresley-my PCP was not involved with the initial pursuit of cataract surgery either.  It was the opth who would have done the surgery that sent me to get the pre-op testing.  Upon getting the bloodwork back, the anesthesiologist is the one who said I was not a candidate for surgery with them due to my anemia.  My PCP was also flagged at the same time.  I was even referred out to the community by my opth to see if they could do something for me afterwards, to which the community provider then required a medical clearance from my PCP, who now refuses to grant the clearance until finding the cause of the anemia and getting my iron back up.  I have had my eyes dilated, measured, tested, etc. 3 times now since July for this surgery, yet it keeps getting killed by my PCP who was never invited to the party in the first place.

dori76-Believe me, I've tried and tried, my livelihood is at stake here, as well as that of my husband who works with me.  I'm not one to jsut take no for an answer, but I haven't found a way around this yet.  I guess my state is one of those states that require the pre-op work or I haven't had success in locating an eye surgeon that will do it without clearance.

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

If you live in the USA.  1. try changing physician  if the doctor is this difficult to work with now over a simple surgery think how difficult he/she would be with something serious that requires close work with doctor. Fire him/her.

[MrPresley]

@MarSharkey pre-op blood testing was never part of my own cataract surgery or the retinal surgery that preceeded it. The cataract procedure was done under light anesthesia and the retinal surgery was done under full anesthesia. A complete list of all my Rx meds and OTC supplements was however provided before both.

[dori76]

You need to find a primary care physician who will sign off on the surgery without requiring any tests even if you have to see someone else and pay out of pocket for the visit. The surgery takes around 20 minutes and you're awake during it. When I asked my cataract surgeon's office about the tests they told me I didn't need to have them if my PCP didn't require them.

[dori76]

And p.s. I don't think ibuprofen or Excedrin causes cataracts (in answer to your question).

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

Causes of cataracts:   AGE, diabetes, steroids, nicotine, heavy alcohol, heavy sunlight exposure, steroids, obesity, some families hereditary, some unusual medical syndromes, severe trauma, AGE,   those are the most important.

[MarSharky]

I am 47 years old, never smoked, do not drink, not obese, never used drugs or steroids, and so pale I look like Casper so I avoid sun like the plague.  No one in my family has cataracts.  No trauma and no diabetes.  Other than NSAIDS use, there is nothing in my history to suggest a cause.  Im a little overweight, but certainly not obese.

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

It may just boil down to "bad luck"   I used to do pediatrics but no longer. One of my neighbor's brought in her 13 year old daughter complaining of distance vision problem. This is usually myopia. She had cataracts.  We sent her to Children's Mercy Hospital where they worked her up for every disease associated with cataracts as child. She was perfectly healthy. Had two healthy sibs that did not wear glasses. She had cataract surgery on both eyes age age 15.  No accounting for bad luck.