Because cataracts tend to grow gradually, one of the most important treatment issues is determining when they degrade vision to the point that the patient is at an increased risk of falls or accidents, or that their quality of life has been significantly undermined. (An August 2002, study reported in the Journal of the American Medical Association found that cataract patients who had surgery to treat the condition had 50 percent fewer car accidents than those patients who did not.)
Medicare and most insurance programs will pay the cost of cataract removal once a patient's vision has deteriorated to 20/50 or less when reading the standard (Snellen) eye chart, which was developed about 100 years ago. By contrast, states typically require at least 20/40 vision for driving without glasses.
Cataract patients often complain of glare, double vision, a shift in colors, and other problems. "There have been innumerable articles and textbook chapters noting that the Snellen test does not document the visual deficits experienced by cataract patients," said Samuel Masket, MD, chair of the Eye Surgery Education Council. While some insurance companies will cover the cost of cataract surgery based on additional testing, there is no widely accepted test that can corroborate patient's vision complaints.
"Patients are often in the position of having to curtail night driving because cataracts have made it dangerous or they have to cut back participation in other activities that enrich their lives
Contact: Samuel Masket, MD
American Society of Cataract and Refractive Surgery