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Question:
I have very blurred, severely decreased vision in one eye due to bleeding of a histoplasmosis lesion several years ago which damaged my macula. Recently, I was told that I have a cataract forming in that eye. Since my vision is so low already I am wondering if I need to have the cataract removed. Removing it will not improve my sight—but can it cause any further damage if left untreated?  

Answer:
The macula is the small central area of the retina where fine vision and detail are captured. Approximately 15 million Americans have some degree of macular degeneration. This is a general term that covers the entire spectrum of aging change to the macula. Although in the most advanced cases they may lose central vision, these patients still maintain good peripheral vision. In your case, the macular problem is caused by scarring from the infection.  

If the cataract is advanced enough, patients with a damaged macula can still benefit from having it removed. The surgery should not affect the macular problem—the macula is at the back of the eye, and the cataract is closer to the front of the eye. If you have advanced macular damage, you may not see much improvement in your central vision following cataract surgery, but it may help your peripheral vision and your ability to see in dim lighting. Your doctor will try to determine whether the cataract is significant enough to warrant surgery. Many people who have macular problems undergo cataract surgery to get whatever partial vision improvement they can. Only then will they have the satisfaction of knowing that they've done everything possible to maximize their vision. Finally, cataracts do continue to worsen and a point can be reached when they become much more difficult and complicated to remove. Therefore, if the cataract is getting very advanced, removing it is generally advisable in order to preserve as much peripheral vision as possible.

Answered by: David F. Chang, MD Dr. David F. Chang

Categories: Cataracts; Eye Surgery

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Answered: May 29, 2012

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