When to Operate

Even though the decision to operate on a cataract must be made by the ophthalmic surgeon, optometrists and the nonspecialist general practitioner need to understand the reasoning behind this decision. Elderly patients tend to forget what they have been told in the clinic and might not, for example, understand why cataract surgery is being delayed when macular degeneration is the main cause of visual loss. An operation is usually not required if the patient has not noticed any problem, although sometimes the patient can deny the problem through some unexpressed fear. The requirements of the patient need to be considered; those of the chairbound arthritic 80-year-old subject who can still read small print quite easily are different from the younger business person who needs to be able to see a car number plate at 20.5 m in order to drive. The visual acuity by itself is not always a reliable guide. Some patients who have marked glare might need surgery with a visual acuity of 6/9, whereas others with less visual demands might be quite happy with a vision of 6/12 or 6/18. Early surgery might be needed to keep a joiner or bus driver at work for which good binocular vision is needed.

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