Don't rush cataract surgery, expert panel advises


Physicians and patients should not rush into cataract surgery if glasses or visual aids provide satisfactory vision and the patient's lifestyle is not compromised, a panel of eye and health-care experts announced recently.

Only when patients have conditions such as glaucoma is cataract surgery necessary, according to the panel, whose recommendations were released Feb. 25 by the Agency for Health Care Policy and Research (AHCPR), a part of the U.S. Public Health Service.

The panel's clinical practice guidelines, "Cataract in Adults: Management of Functional Impairment," encourage patients and ophthalmologists to consider stronger glasses, magnifying lenses, pupil dilation, or a delay until the cataract becomes more burdensome.

A cataract, the clouding of the eye's lens, impairs vision, often reducing a person's ability to participate in various activities. Cataract surgery, which involves replacing the clouded lens with a plastic intraocular lens, is the most common surgical procedure among Americans over 65. Younger people develop cataracts less frequently, but also require surgery at times.

Denis O'Day, M.D., the leader of the panel and chairman of the department of ophthalmology at Vanderbilt University School of Medicine, said, "The operating surgeon and patient should discuss the risks and benefits of cataract surgery, and then weigh them against the degree to which a cataract interferes with daily activities. Ultimately, the decision must be made by the patient."

During its research, the panel reviewed almost 8,000 published studies on cataract care, as well as information provided by consultants, specialty societies, and others. One study, which evaluated the incidence of retinal detachment after YAG-laser capsulotomy (a procedure to correct opaqueness of the remaining lens capsule), found the procedure to be associated with an almost fourfold increase in the risk of retinal detachment. Each year, more than 600,000 patients who previously had cataract surgery undergo this procedure.

The cataract guidelines are endorsed by the American Academy of Ophthalmology, Association of University Professors of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Registered Nurses, National Society to Prevent Blindness, and the Alliance for Aging Research.

Copies of Management of Cataracts in Adults, a quick-reference brochure for clinicians based on the guidelines, and a guide for patients, are available free from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907, or by calling (1-800) 358-9295.

(See also "Lifting the Clouds of Cataracts" in the December 1989-January 1990 FDA Consumer.)

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