It’s a question quite often asked by those who have cataracts of various degrees. Such questions arise because of patients’ lack of understanding of factors which determine when a cataract should be removed. Such questions also probably arise because of an assumption that there is a set of medical rules which prescribe surgery only in some medical scenarios and not in others.
There are also some patients who think that the doctor will decide whether or not and/or when the cataract should be removed. They presume that the patient himself/herself has no role in decision making for cataract surgery.
It is important to understand here, especially for those who are not familiar with the development and symptoms of cataract, that most common type of cataract is senile/age-related which is usually progressive over several months or years. The vision usually worsens gradually. In many cases, the progression of cataract is so slow that the patients have enough time to adapt to their deteriorated vision by changing their habits and lifestyle. This adaptation may not be a conscious process and therefore the patient may not feel the need to ‘do something’ about it.
The truth about timing of surgery for age-related cataract (with no significant concurrent ocular disease) is that the patient is the best person to decide when the surgery should be done. The doctor can only inform the patient that the surgery is needed to achieve better/normal vision. There are only a few rare or infrequent conditions where the doctor would decide when the surgery should be done.
In situations where the ophthalmologist would like to examine the severity of concurrent diabetic retinopathy for instance and the treatment is required with laser photocoagulation (cataract removal will make it possible to see the posterior segment of the eye) and in cases of glaucoma caused by a swollen cataractous lens (phacomorphic glaucoma) or inflammation caused by liquefied lens material (phacolytic glaucoma), the ophthalmologist would like to remove cataract as soon as possible. In such cases the ophthalmologist’s decision/opinion will be more important than that of the patient.
In many cultures, there is a belief that cataract surgery is done when the cataract becomes mature. This belief also implies that cataract surgery cannot and should not be done if the cataract is immature. These people tend to believe that the doctor will examine the eye and decide whether or not the cataract has matured. They do not take day-to-day difficulties caused by poor vision into consideration.
When cataract surgery should be done must be decided mainly by how much your everyday activities and lifestyle are getting affected. The visual needs of a farmer may be very different from those of a person whose work involves a lot of reading and writing, for example.
Therefore you should get the cataract surgery done when you experience difficulty in your day-to-day work/routine. How immature or mature your cataract is, does not really matter. As an aside, complication rate of surgery in immature cataracts is much lower than that of surgery in mature or hypermature cataracts. So the earlier the surgery is done, the better.[Image by National Eye Institute/ CC BY 2.0]