In general, the decision to proceed with cataract surgery is a function of determining a patient's visual acuity and finding out if the cataract itself is responsible for the decline in visual function, or is it secondary to a systemic or ocular condition?

The surgeon will perform a thorough pre-operative exam to determine the source of a patient's difficulty with seeing and recommend surgery for patients with symptoms that disrupt their daily activities.

Symptoms of a cataract can include a gradual decline in visual acuity over years, though in some cases a decline may appear over a matter of days. Often a decline in the ability to see clearly near (reading) is greater than the decline in far visual acuity (driving). Other sight issues impacted by the presence of cataracts include:

Glare -- in which patients experience night driving problems or see halos around light sources at night.

Myopic shift -- in which patients experience "second sight", especially in the case of a nuclear sclerotic cataract.

Diplopia -- in which patients experience monocular vision (lack depth of field vision).

In rare cases, cataract surgery may be appropriate for patients with lens induced disease such as phacomorphic glaucoma, or if there is a medical need to visualize the fundus to help examine for conditions such as diabetic retinopathy.

The appropriate cataract surgery candidate must be able to lie on their back for 30 -- 60 minutes, which makes the procedure more complicated for patients with back pain, chronic obstructive pulmonary disease, or Congestive Heart Failure. In addition, the cataract patient must be able to remain still throughout the procedure, which can raise issues for surgery on young children, patients who experience tremor and those with claustrophobia.

Patients taking certain anti-coagulant drugs such as coumadin, Plavix, or aspirin should discuss with their surgeon the advisability of reducing or stopping such medication prior to surgery and those taking FLOMAX for prostate issues should understand that FLOMAX has been associated with intraoperative floppy iris syndrome.