July 9, 1997

Clinical Crossroads Update: An 82-Year-Old Woman With Cataracts-Reply

Author Affiliations

Beth Israel Deaconess Medical Center Boston, Mass

JAMA. 1997;278(2):116-117. doi:10.1001/jama.1997.03550020048030

In Reply.  —We asked Dr P, the patient's ophthalmologist, to reply:Dr P: It is true that small-incision cataract surgery using phacoemulsification and a foldable lens results in rapid visual rehabilitation for many patients.Mrs K had an advanced cataract accounting for vision diminished to the hand motions level. She tolerated such an advanced cataract because her other eye retained some useful vision. Her cataract had a dense, hard nucleus, the cortex was opacified, the red reflex was obscured, her anterior chamber was shallow, and her pupil did not dilate well. Each of these factors individually makes phacoemulsification more difficult to perform. Together they made phacoemulsification a longer and potentially riskier procedure than planned extracapsular cataract extraction.The decision to proceed with cataract surgery, which is an elective procedure, is different for each patient and is based on the patient's individual needs, his or her general health, and the support systems available.