Cataract

This common condition in the elderly eye has already been considered, but it is important that every physician can identify and assess the density of a cataract in relation to the patient's vision. The physician must realise the potential of cataract surgery in the restoration of vision. Cataract surgery is required only if vision is sufficiently reduced so far as to interfere with the patient's normal lifestyle. The contraindications for cataract surgery are few and even in extreme old age the patient can benefit. Surgery might be delayed if the patient has only one eye or if there is some other pathology in the eye, which is likely to affect the prognosis. The need for someone to assist the patient in the instillation of eye drops and the domestic chores during the postoperative period might require some attention but is not a contraindication. About one-third of the population aged over 70 years suffers from a cataract, but the quoted figures vary according to the diagnostic criteria. If an elderly person has an opaque lens, which obscures any view of the fundus with the ophthalmoscope, and the pupil reacts quickly, then he or she is likely to do well after surgery. It is useful to remember that the reading vision is usually fairly well preserved even when the cataract is quite dense, and if the patient is unable to read, there might be coincidental AMD, except if the cataract is of the posterior subcapsular type.

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