The Medicare Years

In my area of the country the population is heavily shifted towards that of “Senior Citizen”, those so-called golden years where one relies on past earnings and can enjoy the fruits of labor to bask in the warm tropical sun while the rest of the country freezes (at least in the winter). The problem is that besides having to rely on the government for a return on investment, i.e., Social Security, one also has to rely on Medicare for health needs. And there is plenty of that! In my opinion instead of calling it the golden years, it should be labeled the “Medicare Years” where every ache, pain, and condition requires some form of medical or surgical intervention. It is a sort of gold rush for medicine where a new practice springs up overnight, stays a while and then moves on to more fertile grounds or joins these mammoth multi-physician practices to help with overhead.

You Will Develop Cataracts

This brings me to the subject of this paper. Cataracts! First of all, if you live long enough you will develop cataracts. They develop over time. I have never seen an individual over the age of 70 that doesn’t have cataracts. So what are cataracts? Based on my experience as an optometric physician, cataracts are a poorly understood, commonly used term by the general public. Cataracts are not just on or off. Every normal eye has a natural lens often referred to as a crystalline lens. The lens looks like a very small round magnifying glass and if you could hold the lens in your hand like a magnifying glass, it could focus the sun’s rays and burn a hole in paper just like a magnifying glass can do.

Development of Cataracts

The crystalline lens is in a capsule held in place right behind the pupil of the eye. As a normal lens it is transparent but as a person is exposed to the natural rays of the sun, the center of the lens (nucleus) starts to change color, becoming more and more yellow or golden, much like the status of one’s age. There is lots of scientific evidence that the sun plays an important role in the development of cataracts. A large multiyear study called the Chesapeake Bay study compared sea captains who wore sunglasses regularly with those captains who didn’t. The results clearly demonstrated a significant reduction in cataract development with those captains who wore sunglasses.

Nuclear Sclerosis or NS

The yellowing of the lens is very slow and takes many years. In many cases, and this is an important point, the lens remains transparent and visual acuity (i.e., how well you see) is little affected until the lens color drops visual acuity in normal light. BUT IT IS STILL A CATARACT. The scientific term for this form of cataract is “Nuclear Sclerosis or NS”. So when you have your eyes examined and the doctor says you have a cataract, ask him or her is it a NS cataract and how does it affect me in normal light? There is a test that cataract surgeons often use to determine the effect of glare. This test may be of use in certain cases but unless you are bothered by glare normally, this should not be the defining test of whether cataract surgery is necessary.

Cataract Surgery Mills

Recently I examined a patient who was scheduled for cataract surgery the next day at one of the cataract surgery mills. He wanted a second opinion and when I dilated him, I found no cataract. No cataract? Hardly any color change and no other cataract formation. Three weeks ago a nurse who I knew was scheduled for surgery with the same results. This should be very embarrassing for cataract surgeons but although there are “rules” set by Medicare and other commercial insurance carriers, there is extreme pressure on certain surgeons to do the surgery. Millions of dollars are spent on advertising yearly by some cataract surgical practices to bring patients into their practices. Free exams, no charge for cataract surgery and other inducements are used to bring patients into the practice. I am not saying that these surgeons don’t have good surgical skills although I do know some that should not be in practice, just like any profession.

Other Types of Cataracts

There are other types of cataracts that are far more devastating to visual acuity than NS cataracts. Cortical cataracts occur when the lens fibers that surround the nucleus become swollen by fluids and insoluble salts. This process is far quicker than NS cataracts but is still considered to develop over a few years. Steroids and other medications taken over several months or years aggravate the development. The most devastating cataract is one that forms between the lens capsule and the back surface of the lens. This is referred to as a “PSC” cataract. In this case a white film covers a portion of the lens or in severe cases the entire lens back surface. It is like frost on a car windshield. It can develop over 6 months or less and it can completely obscure vision.

Unnecessary Cataract Surgery

So what can you do to protect yourself from unnecessary cataract surgery? I suggest that you obtain a second opinion from an eye doctor (either optometric physician or ophthalmologist) both of whom are independent of the surgical practice that has suggested the surgery. I feel that cataract surgery requires a second opinion. Don’t be embarrassed to tell the surgeon you want that second opinion. After all, it’s your eyes.

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