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When is it necessary to have cataract surgery?

Answers by Dr. Mitchell Gossman, an ophthalmologist at Eye Associates of Central Minnesota, located in St. Cloud

When is it absolutely necessary to have cataract surgery?


It is never “medically necessary” to have any treatment at all in the medical field, in the sense that a patient is never coerced to undergo a procedure (aside from some uncommon exceptions such as legally protected persons, e.g. those with a legal guardian, or minor children). If a patient declines life-saving or vision-saving treatment for his or her own reasons, that is a right for all patients.

However, there are situations where it is potentially a poor decision to refuse cataract surgery. For example:

1. If your vision has fallen to 20/100 or worse in both eyes, it is unlawful to drive in the State of Minnesota. Therefore, if you have a correctable vision problem, such as cataracts or even a need to wear glasses, you have to decide if you want to have that treatment, or stop driving. No one will force you to have the procedure or glasses – but you will suffer the legal consequences if you drive anyway.

2. If your vision is between 20/50 and 20/90, it is unlawful to drive unless certain restrictions are placed on your license. Again, if you wish to avoid those restrictions, you may choose to take steps to improve your vision with cataract surgery, but it’s not “mandatory” -- you can chose to accept the restrictions, for example no freeway driving or night driving.

3. There is such a thing as cataracts becoming so severe that the surgery becomes riskier. If this occurs, most surgeons will offer surgery, and if the surgery is declined, you may be advised that delaying surgery will make the surgery more difficult and with increasing risks. This is not a common situation in developed countries since most patients have significant problems well before they became a high-risk surgery situation, and they have access to corrective surgery.

4. If a cataract has become so severe that it makes it impossible to conduct a proper eye exam or perform treatments, i.e. the doctor can’t see the back of the eye through the cataract, then cataract surgery may be offered in order to be able to treat other eye conditions, such as retina problems.

5. If a cataract becomes extremely advanced and thick, it can cause the front of the eye to become crowded, which can lead to a form of glaucoma. Surgery can correct this, so you may face a decision between potentially blinding glaucoma and having surgery.

6. If a cataract becomes very advanced, proteins can leak out of it and cause inflammation in the eye. This is a serious, potentially blinding condition, and surgery would be recommended, but in theory you could refuse it and accept permanent loss of vision instead.

The first two reasons are by far the most common cases where you feel your vision is fine for your needs, but you may nevertheless choose to undergo surgery in order to avoid the consequences on your driving privileges. However, by far the most common reason to have surgery is having trouble with visual activities, for example work, hobbies, reading, and driving. If you are having no vision problems, and the DMV vision screening finds your vision to be satisfactory, normally surgery would not be recommended.

Find out more

Dr. Mitchell Gossman is a comprehensive ophthalmologist, along with Dr. Melanie Thares, an optometrist, at Eye Associates of Central Minnesota. The office is located at 628 Roosevelt Road, Suite 101, in St. Cloud. To make an appointment or to learn more, call 320-774-3789 or email

“Ask the Expert” is sponsored content (paid advertising) provided by Eye Associates of Central Minnesota. To learn how your business can promote its products and services like this, contact Sr. Perspective at 320-334-3344.

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