Thinking about canceling my cataract surgery.....

[jmjr77]

I am a 67 yr old male who is very nearsighted (-15/-12) but have successfully worn hard, gas permeable contacts for years. Have not had any problem at all with day vision but lately seem to have some problem with night time vision (low light situations). At routine visit to ophthalmologist, he said he didn't see any significant cataract issues. Then I mentioned my somewhat less than stellar vision at night (basically seems like I could use a little more light). He then indicated he would like to do a "cataract evaluation." Afterwards, he said I had a moderate cataract problem and I was a great candidate for cataract surgery since he could correct (using a single vision IOL) my lifelong nearsighted issue. He warned of an increase but still acceptable risk of detached retina due mainly to my severe nearsightedness. I have since done a lot of reading about the risk of detached retina, many of the problems/complications have been stated here on this forum. I am considering canceling the cataract surgery even though now is a very favorable time to do it based on my current medical insurance, etc.

My question(s), the answers to which may help me decide, are:

1) I would like to know how many of patients with > -12 d, who have cataract surgery, develop detached retinas, not how many of ALL patients develop detached retinas; a very important distinction. In other words, 4 out of 100 may develop a detached retina, but 3 of those 100 might have had > -12 d, and of those 3, 2 might have gotten a detached retina peri-operatively, or a 66% incidence -- not very good. Anyways, one gets the idea here. Can anyone shed some light here. Since I see fine during the day with my contact lenses, is it too risky to go ahead with the surgery even though it would be great not to have to wear glasses (may need some minor correction) anymore, plus might (?) be able to see better at night.

2) if one with severe nearsightedness did get a detached retina from the surgery, I understand it would usually (not always, maybe) be of one specific type: thus, what type of corrective procedure would likely need to be done for that type; i.e. would laser surgery correct or would you need to go with the band, etc.?

Any insights would be extremely welcome. And, it's the old adage: what would you advise your mother or father to do if they were in the same exact situation? Sincere thanks for any kind input that you might have!

[AntonReiser]

If I were you I won't have surgery now for several reasons:
- not much vision loss (the doctor didn't noticed your cataract at the first exam)
- IOL calculation not accurate as you always wore contact lenses
1. IOL Calculation is difficult because of high myopia
2. corneal curvature needs to be measured when cornea has its "natural" shape: this means no contacts for weeks to months

RD: from what I have read I think risk of RD is 5 to 10 %.
It very much depends on the individual eye, axial length, present myopic degeneration, vitreous attachment/detachment.

[Ray T Oyakawa, MD]

These are questions you need to discuss with your doctor and his statistics.

1)  Good data is not available since techniques have changed.  A > -12 depends on the corneal curvature and axial length.  The axial length is the risk factor.  Also,  the incidence of retinal detachment in males is probably less after age 52  and with the presence of a posterior vitreous detachment.

2) Repair depends on the locations of the tear and detachment.

You should be out of your hard contacts until the corneal curvature is stable.  This can take months.

You should also know that as the cataract gets more advance the complications increase.

One should have cataract surgery when it hinders your lifestyle.

Dr. O.