I’m fortunate to have 20/18 vision. But to get a sense of what it would be like to have a visual acuity of 6/60, I simply have to look at photos taken using the camera of my heavily scratched smartphone; cityscapes are robbed of drama, flowers are stripped of their intricate beauty, and the person I photograph most often – my young son – is rendered totally unrecognizable. It strikes me that the world captured by my weary camera lens is very much like that seen by someone with bilateral mature cataracts. The quality of even simple daily experiences that you and I take for granted would be degraded drastically through such distorted lenses, in fact, I wonder whether it would be possible to live anything approaching an independent life.
The easiest solution for me is a trade-in, but replacement of the scratched lens is at least an option. And for a patient with cataracts, replacement is also a possibility, which gives ophthalmologists nothing short of superpowers (without actually making them superheroes). The capacity to improve vision, not just for patients with cataracts but to an ever-widening number of ocular diseases, has an impact that cannot be understated. The Blue Mountains Study investigators have demonstrated that cataract removal prolongs lives (see page 11). And it’s likely that many other sight-saving interventions will do the same, providing patients not only with the psychological gains of improved vision, but with medical benefits as well. Most patients in the ophthalmology clinic are of retirement age, very often taking prescription drugs for a number of other medical conditions. This polypharmacy presents a considerable challenge to those patients expected to take assorted medicines on complicated regimens. I know my own 84-year-old grandmother struggles to comply, despite having reasonable visual acuity with spectacle use. I shudder to think how she would cope with poorer vision. Extending the life of a patient is powerful; improving the quality of that time is superpowerful. Even in patients with diseases like wet age-related macular degeneration – something that was untreatable just over a decade ago – interventions today slow and stop the decline in vision. That’s precious and personal to the patient, irrespective of the health benefits. Superman often used his laser vision to avert disaster. With cataract removal, lasers are optional; even regular phacoemulsification and aspiration (and skill) can be used to save the day.
Mark Hillen
Editor
