INFO - Medical Myths: The Ripening of Cataracts

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Medical Myths

The 'Ripening' Of Cataracts

July 23, 2001

Last reviewed on July 16, 2004

By H. Shmerling, M.D.

Beth Israel Deaconess Medical Center

The first time I heard my grandmother describe her upcoming cataract

surgery, I was confused by the expression she used. She told me the right

eye was " ready for surgery, but the left eye still needed to ripen. " I have

heard the term so often since then that I long assumed it was a valid

concept, endorsed by ophthalmologists, and that it referred to a process of

maturation that was necessary to make a surgical remedy possible. As it

turns out, the need for a cataract to " ripen " before surgery is a myth.

A cataract is a clouding of the lens that prevents light from passing

through it; because the lens focuses images on the retina (which then

carries visual signals to the brain), it is vital to vision that the lens be

clear.

The condition is common. Of an estimated 30 million persons with blindness

worldwide, cataracts are estimated to account for half. Although the most

common cause of cataract in developed countries is advanced age, the lens

can lose its clarity in a number of other ways, including injury, infection,

inflammation, certain medications, a genetic disorder or radiation (as with

treatment of a tumor). Fortunately, surgical removal of the cloudy lens and

insertion of a plastic or silicone lens has become rather routine and is

generally considered minor surgery with a remarkably high success rate.

But there is no need to wait for the cataract to " ripen " - in fact, cataract

surgery can be successfully performed at any time during the process of

cataract development. As with any other intervention, the timing of surgery

depends on the balancing of risk vs. benefit. For example, if a cataract is

tiny and does not affect vision, the anticipated benefits of surgery are

small or nonexistent, and the operation should be delayed. The cataract may

worsen so slowly that surgery may not be required at all. On the other hand,

proceeding directly to surgery may be appropriate if a cataract

significantly reduces vision, especially if the other eye is not perfect

either. Decisions about surgery are also affected by the person's overall

health, lifestyle and individual preferences. The same degree of cataract

might be well-tolerated by one person and disabling in another.

When cataract surgery was a riskier operation, it was delayed longer, until

symptoms were severe; this waiting period was likened to fruit ripening on

the tree. The notion, as with many myths, likely comes from an incomplete

understanding about the underlying condition and from terminology that is

appealing but inaccurate. With the advent of safer procedures, the concept

is even less appropriate.

In most cases, an early cataract is watched over time, and when it causes

enough problems, surgery is recommended. To think of the cataract as

" ripening " over that waiting period does not usually get in the way of

proper care. But there may be occasions when referral to or follow-up with

an ophthalmologist is delayed because of this mistaken concept - in those

circumstances, it is important to identify the myth for what it is. A lens,

or a cataract within it, has little in common with fruit and does not

ripen - in fact, it only worsens - over time.

H. Shmerling, M.D., H. Shmerling, M.D., is associate physician

at Beth Israel Deaconess Medical Center and associate professor at Harvard

Medical School. He has been a practicing rheumatologist for over 20 years at

Beth Israel Deaconess Medical Center. He is an active teacher in the

Internal Medicine Residency Program, serving as the Firm Chief. He

is also a teacher in the Rheumatology Fellowship Program.

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ntent

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org