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Just how much cataract would you tolerate?
 Cortical cataract causing surprisingly few visual complaints in a 70-year-old patient. |
Sometimes I see patients with what may be considered "mild" cataracts — 20/40 or better vision with few reported difficulties in their activities of daily living — and I wonder just how much cataract I would tolerate. Because the cataract changes are often gradual, coming slowly over the course of years, patients can lose visual acuity and visual quality and not even realize it. I truly enjoy sharp, clear vision, and even a tiny smudge on my sunglasses bothers me.
I suspect that even a little bit of an opacity in my crystalline lens would convince me to start doing my own IOL calculations.
What's the best way of evaluating the level of cataract and the suitability for surgery? This has been studied, and I'm convinced that there's no one specific criteria that fits the bill. Using both objective measurements such as visual acuity and subjective questionnaires such as the VF-14 would seem to be the most accurate, but is this enough?
In the photo here, the patient has significant cortical opacities in the lens, but surprisingly, her vision is 20/30 and she has few visual complaints. But it made me wonder, just how much cataract would I tolerate? With my personality and my perfectionist mindset, I think that it would be very little.