Cataracts at age 43

One of the most common causes of cataract at a “young” age is chronic corticosteroid exposure. Posterior subcapsular cataract is perhaps the most common type of cataract seen in younger people, and symptoms may develop rather quickly. Measurements for determination of intraocular lens power are notoriously more difficult following LASIK or other refractive surgery. This is especially important to know if a multifocal lens is contemplated. It is desirable to have a surgeon who has an IOL-Master device for measurement of the eye preoperatively. Contact lenses are not used for correction of cataract, but may be used for monovision correction of presbyopia or for correction of irregular astigmatism following refractive surgery. Be aware that a LASIK surgeon may not be the one to see for cataract surgery.

Both immersion ultrasound biometry and IOL-Master are excellent ways to perform biometry. Sometimes IOL-Master cannot be used, as in the case of very opaque posterior subcapsular cataract. On the other hand, especially in higher myopes with long eyes, some of whom may have had refractive surgery, the axial length as measured by ultrasound may differ from the measurement obtainable by IOL-master. This is because the fovea is not necessarily located at the longest axial point of the eye. I have used both extensively and prefer the IOL Master when available, especially with long or short eyes. Who set the “gold standard”? Timoptic has been the gold standard for FDA glaucoma medication trials, but that does not mean most ophthalmologists prefer it as first-line therapy anymore. Then again, it probably offers the most value for the dollar per dose of any first-line therapy, so maybe it should be preferred in consideration of our economic problems.