Too late for cataract operation?

[Tomo999]

My mother has cataracts that should that were originally planned to be opearted on last year.
However she has had to nurse my terminally ill father and had to postpone the operation.
Is it possible to get to a point where the cataracts are inoperable?

[SoftwareDeveloper]

Cataract surgery should be possible no matter how advanced the cataract is, since the cataract is contained within a natural lens, the issue is merely the difficulty and an increased risk of complications. Almost all patients still get a good result, and  since the alternative is going blind, most people consider it worth it.

Cataract surgery is taking out the natural lens and replacing it with an artificial lens, which is possible no matter how advanced the cataract. One of the problems with the cataract being more advanced is that it may be harder for them to estimate the power of the lens implant they will need to insert since the cataract prevents them from seeing the internal eye structures behind it. That would merely mean there is a higher risk of needing correction afterwards (glasses, contacts or laser correction).

Part of the added difficulty is that the natural lens is contained within a bag, the  capsular bag which they try to leave intact for better results (its just more complicated if the bag breaks).  They take out the natural lens from the bag and put the new artificial lens back in the bag. In modern surgery they  break the natural lens up into smaller pieces to take it out through a tiny incision (rather than decades ago when they used a large incision which required stitches and more healing time).  The problem is the bag is fragile, and the act of breaking up a harder advanced cataract involves more risk that the bag will tear while breaking up the cataract. There is also the risk the cataract has grown to where it is sticking to the bag so there is no way to remove it without tearing the bag.

Although it is cleanest to just put the lens back in the bag the old lens came out of, if the bag is damaged they can put the lens implant outside of the bag and suture or glue it to other parts of the eye to hold it in place. Although there is a higher risk of complications, most people have good results with that approach. There are fewer lens choices available for placement outside the bag (they use 1 piece lenses typically for placement inside the bag, but they usually require a 3 piece lens for placement outside the bag), but that is mostly an issue for those looking for a "premium" lens, but if your dad postponed things due to budget issues I suspect he would just be using a standard monofocal lens and there are many options for that for placement outside the bag.

If it were possible to splurge on newer technology for anything, it may be that getting laser cataract surgery would be something to consider. Usually insurance/medicare doesn't cover newer technology like that (or like premium lenses) and the difference is paid out of pocket. There are debates among  surgeons over whether for the typical patient using a laser for the surgery provides a benefit (or a benefit worth the added cost). However I heard from someone with an advanced cataract who researched the issue and discovered there seems to be credible evidence that laser cataract surgery is useful for someone with an advanced cataract which has caused the lens to become harder. The laser can be used to soften and cut the lens to allow it to be removed with less trauma to the capsular bag (less risk of tearing it) and less trauma to the eye in general.

[Hanson4]

So my question is, I had catract surgery in my right eye and it was amazing, now I have been having problems with my left eye its to the point all I can see is shadows, I put it off for a number of reasons caring for my  mother then insurance reasons now I fear its  to late, is it? :(

[JohnHaganMD]

If the reduction in vision in your LE is due to cataract then surgery should restore good vision like you have in your RE however the surgery will be more difficult as the cataract is larger and harder. If its due to another problem obviously you will see better (cataract problem) but maybe not normal (other problem) See your cataract surgeon as soon as possible to find the cause and get the other eye scheduled.

[CBCT]

Cataract surgery is truly a modern miracle and it has certainly advanced since the previous posts from 2009!  Depending on your father's age and health, it is absolutely worth investigating.

Perhaps my experience will help you frame your thinking.  My dad, who in his late 60's,  needed cataract surgery.  He had the complete work up at a top notch surgical center in FL, and then backed out.  He already had poor hearing, and eventually, advancing cataracts resulted in low vision.  He lived to 88, but I think that his quality of life was seriously diminished by a lack of sensory input.  I wish that he had the cataract surgery.  I think that he would have a a fuller life.

[Jcook123]

My dad put off for budget reasons as well, and now they are saying it is fully blown cataract which may be much more difficult. I have to believe that there is good technology now regardless how long he let that eye go. thoughts?

[Ray T Oyakawa, MD]

Very unlikely.  However, more advanced cataracts are more difficult to remove and recovery may take longer.  Complications also increase.

Dr. O.