Dr. Goldman is a specialist in cataract surgery with Eye Associates of Boca Raton, Boca Raton, Florida.
Dr. Kiffel is the Medical Director of Optimal Anesthesia, Boca Raton.
Dr. Weinstock is Professor of Ophthalmology, Northeastern Ohio Universities College of Medicine, Canton, Ohio.
Disclosure: The authors state that they have no conflicting interests to disclose.
ABSTRACT
Cataract surgery with intraocular lens implantation is the most frequently performed operation in the Medicare Part B population.
Such patients will seek the advice of their primary care practitioner, and the safety of the procedure may depend on the information
the practitioner provides to the surgeon and anesthesia team. This article reviews pertinent issues surrounding the decision
to operate; how various intraocular lens implants are selected; how surgery is now performed; postoperative complications,
activities, and care; the role of the primary care physician; and the issue of medical clearance for this procedure.
Goldman HB, Kiffel S, Weinstock FJ. Cataract surgery and the primary care practitioner. Geriatrics. 2009;64(5):19-26.
Key words: astigmatism, cortical, intraocular lens implantation, nuclear sclerosis, posterior subcapsular, presbyopia
Cataract images
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Cataract is defined as any opacification of the crystalline lens of the eye. The basic types of cataract include nuclear sclerosis,
cortical cataract, and posterior subcapsular cataract (see Figures 1-6). Nuclear sclerosis is a feature of the aging process
and a result of the continued growth of lens fibers, which causes compacting and hardening of the central portion of the lens.
Protein denaturization yields the yellow to brown color seen at slit-lamp examination of the lens. Although there are racial
variants in the incidence of cataract types, all lens opacities lead to degradation of the quality of vision.
Intraocular images
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All cataracts progress, but the rate is unpredictable. Progression is related to type, with posterior subcapsular cataract
generally progressing the fastest and being the most visually debilitating.1 Much has been written about the benefit, or lack thereof, of nutritional supplements. Recent randomized, controlled trials
show little benefit of multivitamin supplements in preventing cataract or cataract progression.2,3 There are studies, however, that show a direct relationship of nuclear cataract with smoking.4,5 Cessation of smoking has also been shown to reduce the incidence of cataract at any age, demonstrating the value of quitting
smoking at any time.6Use of inhaled or oral corticosteroids is associated with a higher risk of cataract formation. When these drugs can be avoided
or alternatives found, that helps to reduce the risk of developing posterior subcapsular and nuclear cataract.7 Diabetes is also associated with a higher risk of cataract formation. Recent efforts to modify behavior to avoid the development
of type 2 diabetes may have an effect on the incidence of cataract in the United States.
It has been estimated that 20.5 million Americans (17%) over the age of 40 years have cataract in either eye, and more than
6 million (5%) are pseudophakic or aphakic.8 In fact, a recent study indicates that the number of persons affected by cataract and having cataract surgery will markedly
increase as the US population ages over the next 20 years.8 Surgery is primarily indicated when vision is decreased, causing the patient to have difficulty carrying out normal activities,
but most patients first diagnosed with cataracts do not require surgery. A small number of patients may have complications
such as glaucoma from dense cataract and may need emergency surgery.
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