For the vast majority, cataract surgery is not urgent and can be safely delayed until the person wants to undergo surgery. Delaying surgery does not damage the eye, but vision worsens over time until the cataract is removed. When I advise patients about the time of cataract surgery, I generally assure them that they will know when the time is right: they will begin to notice the deterioration of their vision and, when this affects their quality of life, that is the time to continue with the surgery. If you suffer from cataracts, it is recommended that you undergo cataract surgery before the cataracts begin to seriously affect your vision.
If you wait too long, cataracts can become overripe, making them more difficult to remove and cause surgical complications. In general, the best results of cataract surgery are achieved when the surgery is done soon after vision problems occur. We conducted a systematic review to understand the relationship between waiting time for cataract surgery and patient outcomes and the variables that modify this relationship. The results of studies that examined variables that modify the relationship between the waiting time for cataract surgery and the outcome are shown in table 2.15—17. The variables that modify the relationship were identified through expert consensus and empirical research.
Some patients, especially those with young children, are concerned about how the recovery time from cataract surgery will affect their lives (although most patients can get on with their normal day within 24 hours). When deciding the right time for cataract surgery, you'll also need to consider the recovery process and make sure that you can avoid certain tasks, such as strenuous activities and swimming, usually for the first month after surgery. Overall, the results are still very good, but ideally, these cataracts should be treated before they are so advanced that they increase the risk of problems during surgery. Patients who wait more than 6 months to undergo cataract surgery may experience negative outcomes during the waiting period, such as loss of vision, reduced quality of life, and increased rate of falls.
There are two ways in which the initial steps of cataract surgery can be performed: manually or with a laser. Two randomized controlled trials presented the highest quality data included in this review and found that patients who waited less than 6 weeks to undergo cataract surgery experienced better visual and quality of life outcomes and fewer adverse events (falls) than patients who waited 6 months or more. Patients who waited more than 6 months to undergo cataract surgery experienced greater vision loss, a lower quality of life, and a higher rate of falls compared to patients who had waiting times of less than 6 weeks. In fact, clinical trials have shown that patients who undergo cataract surgery within 6 weeks achieve better visual results and quality of life8,9 and suffer fewer adverse events (e.g., if you wait too long, cataracts can become “hypermature”, making them difficult to remove and cause surgical complications).
If the cataract is not treated until it is very advanced or very dense, this can make surgery difficult and increase the risk of complications.