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Feb 16

Do I Qualify for Cataract Surgery?



A common question we receive from patients is “how do I know when I qualify for cataract surgery?”. Patients will typically ask me to look at their lens to see if it is cloudy enough to perform surgery. The problem with doing this is that the appearance of the cataract does not always correlate with the vision the patient has through the cloudy lens (cataract). In some cases, the cataract looks very cloudy, however, the patient may still have good vision. In other cases, the cataract doesn’t look so bad to the ophthalmologist, but the patient’s vision is affected so much that they are having problems with their activities of daily living (ADLs). The phase “activities of daily living” is important, so hang on to it for a moment. I will describe what it means in greater detail later.

A patient’s vision must be 20/40 or worse before they qualify for cataract surgery. This is determined by Medicare and other insurance companies, but there is a good reason for this cut-off point. To be a legal driver, one must have 20/40 or better vision. Because we are so dependent on motor vehicles for transportation, this cut-off point makes a lot of sense. Obviously, there will be some people who have 20/40 vision or worse and they may feel that they can function fine and don’t note any difficulty. These people may be confined to their home environment and no longer drive on their own. In these cases, there is no need to proceed with surgery. This is where “activities of daily living” enters the picture. One must have (1) 20/40 vision or worse and (2) problems with their “activities of daily living” before they qualify for cataract surgery. Activities of daily living includes things like reading, sewing, watching TV, driving -or- any activity one might do during the course of a day in their life.

Your doctor will need to document that your vision is 20/40 or worse (an objective finding) and document that you are having problems with an activity of daily living (a subjective finding). When both of these criteria are met…one meets the criteria for cataract surgery. It’s important to understand that cataract surgery is an elective surgery which means that it is the patients decision to undergo cataract surgery. Even when both criteria are met, it doesn’t mean that the patient needs surgery. The patient may choose to continue living with cataracts as they do not damage the eye (in most cases) and surgery performed later will yield the same results.

Like everything in life, there are always exceptions to the rules. Some patients may have vision which is better than 20/40 in normal conditions, but when tested with glare, the vision may decrease to 20/40 or worse. In these cases, the patient can still qualify for cataract surgery. There are also some situations where cataract surgery may be necessary as opposed to elective. Some cataracts become very thick and can cause the anterior chamber of the eye to become very shallow. This can change the way that aqueous humor drains into the trabecular meshwork (a drainage structure inside the eye) and cause the eye pressure to rise. This is called phacomorphic glaucoma. The cure for this problem is extracting the cataract. There are also cases where patients have other diseases like glaucoma, macular degeneration, or diabetic retinopathy. In these cases, the ophthalmologist needs to be able to clearly see into the back of the eye to monitor the progress of the disease(s). To do this, there needs to be a clear view into the back of the eye. To obtain this clear view, the cloudy lens (cataract) may need to be removed.

I hope this post helps you understand the decision making process ophthalmologists use in deciding if you are a good candidate for cataract surgery.

If you have further questions, I am located at the San Antonio Eye Institute, PLLC in San Antonio, Texas. Please feel free to give us a call at (210) 485-1488.


Relief Jones, III, M.D.

Relief Jones, III, M.D.
Board-Certified Ophthalmologist
Harvard-Trained Glaucoma Specialist
Adjunct Assistant Professor of Ophthalmology, University of Texas Health Science Center at San Antonio
Team Physician, San Antonio Rampage Hockey (American Hockey League)

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