Early signs of cataracts are often detected as early as the fifth to sixth decade of life for many patients.
The eye’s crystalline lens sits in a groove behind the colorful iris. This lens has approximately 20 units of refracting power. Over time, this lens starts to develop haziness or opaque spots within. We call this a cataract.
When that lens gets hazy enough to affect functional vision, then it is time for cataract extraction.
The average age for cataract surgery has gotten younger and younger over the years. We have made so many advances in this surgery that it has become much less invasive and has a much lower risk of complications.
Secondly, we see these patients are more active both recreationally and professionally, resulting in higher visual demands.
At the end of the day, surgery is surgery nonetheless. I never recommend cataract surgery for any patient who is not noticing functional vision effects from the cataract.
Even with the earlier push for cataract surgery, we do see significant vision loss from a cataract in seniors who have previously resisted surgery.
A new study with participants from the English Longitudinal Study of Aging has compared cognitive decline in seniors who have and those who have not had cataract surgery. The study found that those who had cataract surgery had improved memory, as well as a slower decline in episodic memory loss, even after adjustment for social determinants, behavioral risk factors, depression score, and chronic conditions.
One of the study’s authors even suggested limiting sensory deprivation could be protective against developing dementia.
The theory is that sensory deprivation impacts the brain, but can also adversely affect physical activity and social networks, which could play into cognitive decline as well.
That definitely gives me a different perspective into the cataract surgery debate for some of my more senior patients who have lesser visual demands. Maybe they already do not drive, but if cataract surgery could potentially buy them a few more years of better cognition, I would be more apt to recommend surgery.
No one wants to see a family member go through dementia, but it also can be a difficult decision for patients and caregivers to make when we discuss any surgery.
Cataract surgery is the most common surgical procedure done in the Western world and the rate of serious complication is very low. This study will change how I address the topic with certain patients, but cataract surgery remains a very individualized decision between us, the patients, and their caregivers.
Caroline Bundrick, O.D. is an optometrist practicing at Darling Eye Center, with offices in Bluffton and on Hilton Head Island.