By itself, the age of the patient need have little influence on the decision to operate. Many people over the age of 100 years have had their cataracts successfully removed. The general health of the patient must be taken into account and this can influence one's decision in unexpected ways. Occasionally, one is presented with a patient who has difficulty with balancing, perhaps as a result of Meniere's disease or some other cause. The patient asks for cataract surgery in the hope that this will cure the problem. Unless the cataracts are advanced, the result might be disappointing. Sometimes cataract surgery is requested in a nearly blind, demented patient on the grounds that the dementia will improve with improvement of the vision. Although this occasionally happens, often the patient's mental state is made worse even though the sight is better. This raises some interesting ethical problems for the surgeon and relatives.
In the case of the child with congenital cataracts, the indications for surgery depend largely on the degree of opacification of the lens. An incomplete cataract might permit a visual acuity of 6/12 or 6/18 and yet the child could be able to read small print by exercising the large amount of available focusing power. Such a child could undergo normal schooling, and cataract surgery might never be required. A complete cataract in both eyes demands early surgery and this can be undertaken during the first few months of life. There is a high risk that one eye could become amblyopic in these young patients, even after cataract surgery.
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