What can be done for cataract with macular degeneration, macular hole, macular membrane or vitreomacular traction?

A cataract (cloudy lens) is one of the most common eye conditions in those over the age of 60 years, resulting in blurred, reduced vision. In addition, the macula (the centre of the retina responsible for your fine, detailed vision and your colour vision), can also become affected as we get older. In this article, leading ophthalmologist Dr Patel Gordon-Bennet discusses the treatment options for those with cataract and macular issues.

Conditions such as macular degeneration, macular epiretinal membrane, vitreomacular traction, and macular hole are not uncommon in people over the age of 60 years. These conditions are like a scratched film in a camera, affecting the quality of the central vision and resulting in not only blurred vision, but also distortion of straight lines, and patches in the vision.

If you have these symptoms of blurred vision or distortion, your doctor will dilate your pupils and perform a thorough retinal examination with macular OCT (optical coherence tomography) scan. Your doctor will be able to detect if there is cataract present, and if the cataract is not too cloudy, they may also be able to detect any problems at the macula.

What if I have cataract and macular problems?

If you have both cataract and macular conditions, do not fear. Your doctor will discuss with you your treatment options. You could have:

• the cataract surgery done alone
• cataract surgery, followed by a vitrectomy
• a vitrectomy, followed by cataract surgery
• cataract surgery combined with a vitrectomy

The route chosen will depend on how advanced the cataract and the macular condition are, how soon you would like to restore your vision, and the costs involved. Your vitreoretinal surgeon would be able to discuss these options with you and help you to make an informed decision.

What is the benefit of combined cataract surgery with vitrectomy?

Cataract surgery and vitrectomy techniques and instruments have improved tremendously over the years resulting in very good success rates. The main advantages of combined cataract surgery with vitrectomy are quicker visual rehabilitation, and one surgery instead of multiple surgery.

Can I have a multifocal lens implant or an EDOF lens implant with combined cataract surgery and vitrectomy?

This is certainly possible and should be considered on a case-by-case basis, and discussed. Factors to consider include the extent and severity of the macular condition and how likely you are able to restore your macula and your central vision with surgery. Some patients with macular membranes, for example, have done well with combined cataract surgery and EDOF lens implant.

In summary, there is still hope in restoring your eyesight, even if you have coexisting macular condition and cataract. Expectations of how much your vision will improve with either cataract surgery alone or cataract surgery combined with vitrectomy should be discussed with your vitreoretinal surgeon.

If you are struggling with your vision, or have more questions about the cataracts with macular degeneration, you can consult with Dr Gordon-Bennet via her Top Doctors profile.