When should a cataract surgery be avoided?

A cataract surgery should only be performed if the patient's quality of vision is troubled significantly by the cataract to warrant a surgery. Because every surgery its risks, no matter how small or minute the risks may be, therefore the decision to undertake surgery must be carefully considered.

Cataract surgery itself has very small risks and has an excellent safety profile. Hence there are not many reasons to avoid cataract surgery completely. Usually we like our patients optimized for surgery so that they can achieve the best outcome.

By that, I mean that we tend to avoid doing any surgery if patients have concomitant eye infections or any problems of the surface of the eye. For example, if patients have eyelid infection or dry eyes, I would treat the infection and dry eyes first so that patients have a good outcome after cataract surgery.

Patients with pre-existing weak corneas may also be at risk of damaging the cornea further because of cataract surgery. Even in such patients, they may still be able to undergo cataract surgery if the surgeon takes special steps to perform the surgery delicately to avoid further injury to the cornea. It is important to be aware of such situations so that the appropriate steps can be taken to optimise the cornea and still achieve good post-cataract outcome.

Hope that helps!

Dr Claudine Pang

Cataract surgery has evolved in recent years into a highly successful eye surgery, capable of removing a hardened lens and even improving one's eyesight free of power like myopia, hyperopia, astigmatism and even presbyopia.

For that, it is really a type of refractive surgery, when a customized lens implant is chosen. When there is minimal cataract, one should weigh the pros and cons of the surgery before deciding for or against it. There may be benefit in a cataract surgery even when there is no cataract, such as when there is a threat of narrow angle glaucoma.

Some real reasons not to undergo a cataract surgery:

1) when there is an active eye infection, such as conjunctivitis (red eye), cornea infection or even infection of the eyelid and tear duct (the connection between the eye and nose).

Having a cataract operation in such situations can put the eye at high risk of becoming severely infected during the surgery, and may even cause the loss of sight.

Even infections in other parts of the body such as skin, legs and bloodstream can potentially jeopardize the cataract surgery. So the infections need to be treated and cleared before cataract op proceeds.

2) when the patient is suffering from other health problems such as uncontrolled high blood pressure, uncontrolled diabetes and other diseases. In these situations, the operation and recovery may become complicated by problems such as bleeding and swelling at the back of the eye and other side effects. So these other illnesses need to be managed before a cataract operation is performed.

3) when the patient is unwilling or uncooperative. Cataract surgeries are elective surgeries, and potential candidates need to agree to the surgery after full discussion of risks and benefits of the operation with their eye doctor.

Other eye problems may co-exist with the cataract, and the cataract operation may affect them and vice versa. Some of them can be treated concurrently with the cataract operation. They should be discussed with the surgeon too, before the cataract operation is carried out.

I hope my answer clarifies some of your doubts.

Cheerio

Dr Daphne Han

First and foremost, there must always be an indication for cataract surgery.

Cataract surgery should be performed when the patient’s vision is being affected by cataract, and/or when the cataract is dense and affecting the patient’s daily living activities.

Surgery should also be performed in instances where poor vision poses danger, such as an elderly patient with the risk of falling and/or patients who drive frequently and have difficulty seeing street signs and other cars when they are on the road.

Cataract surgery is not recommended when surgery is performed for correcting one’s refractive errors and there is no cataract seen during the eye examination.