cataract surgery while on prednisolone

[Sorop]

I am currently on 25mg of prednisolone after reducing from 60mg over nearly 2 years but have now developed rapid onset cataracts in both eyes. I am waiting for an appointment with an ophthalmologist after an urgent referral by the optician but she said it is possible than they would not operate while I am on this level of steroids. I would appreciate any comments from this wonderful forum which I have found so helpful and follow all the time. I live in the UK. Thank you in anticipation.

[DorsetLady PMRGCAuk volunteer]

Hi Sorop,

My cataract started declining when I was on about 12mg of Pred, almost 2 years after starting drug (80mg) so similar timings to you, but at a much lower dose. Have you had problems with flares to still be at 25mg? Yes can see you have, just looked at your previous posts!

Mine was monitored by eye clinic on a 3 monthly basis, and a couple of changes of lenses, until about 8 months later, by when I was down to 6.5mg a day.

The surgeon really didn’t want to operate then as he didn’t consider it bad enough - but I argued my case -

a. I only had one eye (right lost pre- diagnosis), and needed to be able to drive to get out for my own well-being (lost hubby over previous year), and

b. I was off to NZ within 2 months and didn’t appreciate that I’d paid a lot of money and wouldn’t be able to see it! So he reluctantly agreed to operate.

He didn’t have a problem with the Pred, but as yours is higher there may be a bit more discussion, but I’m sure others have had operation a high doses without problem. It’s only a 20-30 min procedure and local anesthetic.

If your waiting lists are anything like Dorset’s then it’s not going to be done ASAP, so don’t worry and just see what eye clinic say.

[Sorop in reply to DorsetLady]

Hi DorsetLady. Thank you for your helpful and prompt reply. Yes as you kindly discovered I had a big flare at 15mg / 12.5 after doing so well. I as folloing my rheumy's plan but it was it appears too fast. However thanks to members of this forum particularly you and PMRpro I am now a tortoise not a hare as I have downloaded the DSNS steroidtaper plan and am now on the second month of it. I will wait to see what the consultant says re cataracts but wanted some ammunition to take with me. Best wishes

[Heather270240 in reply to DorsetLady]

Hi DorsetLady. I lost the sight of my left eye due to GCA and have a cataract on my right eye. However optometrist will not refer me to have it removed as he said it was too risky. I was interested to read that you are having your cataract removed. Perhaps I should have a second opinion.

[DorsetLady PMRGCAuk volunteer in reply to Heather270240]

Hi Heather,

I actually had it done in 2014!

There was never any mention of it being too risky. If you don’t have it done all that is likely to happen is that the cataract may affect your “good” eye to the extent that you cannot see out of that one either.

However, not all cataracts deteriorate to the same degree, some manage without the op, but I think you need a second opinion from a surgeon. He won’t operate if it’s not necessary, but at least then it can be monitored by the eye hospital.

[Heather270240 in reply to DorsetLady]

Hi Thanks for your reply. I agree with you about the cataract getting to such a stage that it will affect my good eye and will not be able to see. That horrifies me so I have made a private appointment to see a Mr Chris Jenkins who is an Opthalmic Surgeon and works mainly out of Moorfields but I am seeing him here at Somerfield Hospital Maidstone. Incidentally, do you have any side affects like lightheadedness and very sensitive to light and sunshine since loosing your sight, or are these symptoms conneted to the cataract?

[DorsetLady PMRGCAuk volunteer in reply to Heather270240]

Hi again,

It took me some time to get brain working correctly after sight loss. Because light is still coming into “lost” eye, the brain is still trying to process the perceived information received. That gave me a sort of headachy feeling for quite a long time. If you haven’t already read it, have a look at my post - and then let me know if your eye is similar, would be interested to know how others have been affected -

healthunlocked.com/pmrgcauk....

I think the sensitivity to light/sunshine is Pred related as well - although once you’ve had cataract done, you are told to be more aware of both, sunshine in particular.

Good luck with your appointment and please let me know outcome.

[Heather270240 in reply to DorsetLady]

Thanks for your reply. Mine is an almost identical story. Mis-diagnosis by GP. Wouldn't believe me when I told him what I thought I had with severe claudication of the jaw. He told me to go off and enjoy my holiday in the sun and we would discuss it on my return. I was in week 1 of a two month visit of Spain when I woke and found I was blind in my left eye. Luckily I was a short distance from Cordoba Hospital where the treatment was excellent and with swift action they saved my right eye. My symptoms of dealing with everyday tasks are similar to yours, although for the first six months I hardly knew anything was wrong and then when I reduced to 20 mg everything went crazy, lightheadedness etc, but like you I feel blessed that I have a remaining good eye. I will certainly let you know how I get on with my appointment.

[DorsetLady PMRGCAuk volunteer in reply to Heather270240]

Good job you were in Spain - they seem to be one of the countries “up” on GCA/PMR. I know there are others, but not many!

[tazzi]

Hi Sorop, I also required cataract surgery in both eyes last year 1st in May whilst on 11mg pred and the 2nd in july whilst on 10mg. Only local anaethestic via drops is given and op only lasts approx. 20mins.Absolutely no problems! Being on pred was not even mentioned as an issue for the op so I wouldn't worry, although mine were like yours ie pred induced and rapid onset. The world will be a brighter place Ipromise - good luck.

GCA since nov 2015 started on 60mg now on 7 1/2mg.

Tazzi.

[Cally55]

I have a similar history, GCA feb 2016, 40 mg now tapered to 14 after digression to 19 because coated pred doesn't work for me. Developed rapid cataracts in September got referral to hosp and operation on right eye at beginning of December, after 5 weeks wait. However still not had follow-up, got an appt at end of month after I saw gp. So went to optician because i have been experiencing balance issues. Both he and GP think it is probably because one eye is so different from the other. I was short sighted and new lens is long sighted, new glasses have helped. No problems riding but have to concentrate hard to walk straight sometimes. It is getting better. The eye dept had no problems with an apparent dose of 19mg pred and said should have 2nd eye asap, this was before current hiatus in NHS.

The operation is magic! It was a great relief to come out of the fog.

[bribaz in reply to Cally55]

Hi Cally55.

I have lost sight in my left eye due to pre-GCA diagnosis, and I have noticed that I, too, have balance issues. If I try to stand on one foot I can't keep my balance like I used to be able to - just did this out of curiosity when I noticed my balance issues. Like you, I also find it difficult sometimes to walk in a straight line.

I have noticed when I am in a situation where someone is walking towards me, that it is sometimes not clear between us who is going to go to which side when we pass, and often end up going the same way and nearly bump into each other. The eyes must co-ordinate similar to the ears where balance is concerned.

I am just finding all this out now, as GCA only started for me in mid-October 2017. I am finding this site very useful, as I am sure you will, for people to share their problems and experiences, and for the good advice that fellow-sufferers are able to offer.

[GCA1947]

Dear All

This site is an absolute godsend because of the knowledge that is available that none of my Doctors possess. If I had a £10.00 for every Doctor whose said oh your G.C.A. will be over in 2 years, 2.5 years or 3.0 years and they were all wrong I'd be a rich man. Well quite well off then. 5 years 1 month and counting. Got two very mild cataracts and currently reducing down from my first flare in July 2017 and am on 8.0 mg a day reducing half a milligram a month .

Regards

Colin

[Robinre]

Hi, I had to have cataract surgery. Possibly because of age (79) and not from PMR. However, I did not heal well. I still had swelling many months later and had to be under of the care of a retina specialist. Finally, one year after surgery and one more surgery to "clean up" from that surgery, I was released from the specalist's care. Now I am hesitant to have the other one done since I amstill on Pred (4 mg). I think I will wait until I am down to 1 mg (I was actually on 3 when I had the surgery but had a flare since surgery. My regular Opthalmalogist said I did not heal well.