I am a GCA patient since AUG 22. I started on 60 MG Prednisone and have tapered to 5.5 mg since then using DSNS. I have had vision problems almost from the start -- blurry vision mostly, but now I have significant cataracts -- AND I've had to change my prescription 4 times since AUG 22.
My cataracts are significant enough that surgery is being considered. I have been told that a new lens will be inserted into my eye to replace the lens that is clouded by the cataract.
Here are my questions:
1. My ophthalmologist told me that increasingly bad cataracts will cause the need for prescription changes. If this is true, then perhaps I ought to have this surgery to avoid the need for frequent prescription changes. Have any of you been told this, or have had to deal with this?
2. I have long read that prednisone, in itself, can cause vision problems. But the more I read, the more I understand that yes, it can cause fuzziness, cataracts, glaucoma, and other problems but nowhere do I read that it will directly cause the need for a prescription change. This is important to be, because IF prednisone in itself (without considering cataracts) can cause the need for a prescription change then perhaps I ought to wait until I'm at a lower dose (or zero dose if possible) before I get the surgery so that the new, replacement lens will be inserted into a more "stable" eye. Does this make sense?
Thanks
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montebello
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my feeling is go for the cataract surgery as soon as you can as it will make so much difference to your sight. I have macular oedema and was referred through the eye clinic there and it was wonderful. Pred can make your eyes dry but drops help with that. The new lens will need a prescription change as it will improve your sight so much.
Three of my friends in the last month have had cataract operations. One had both eyes done at the same time. My next door neighbour dropped in the other day and said he had had one eye done the previous afternoon. I would not have known. He was on his way out for lunch with friends. The whole thing seems to take an incredibly short space of time.
Hello, I recognise that issue with the ever changing optical prescription. My optician suggested getting to very low doses of Pred before changing my prescription, if it was safe to do so, as I could spend a fortune on new glasses. The eye is worked by muscles and Pred affects muscles. Sure enough they kept changing and it was a pain. I even found that they were affected if I ate too much salt too, probably because Pred causes fluid retention also. My Pred induced cataracts developed from nowhere over a 6 month period but then didn’t get worse after that. They are not worth doing apparently even though night driving is not pleasant.
I can’t comment on the surgery as I don’t know how it works.
I had one cataract replaced in 2014 when I was at 9mg... [other not required as sight loss pre to diagnosis].
As only one eye involved the lens was a monofocal which is the most typical lens type implanted. It only has one focusing distance, hence the name monofocal.
Depending on what you need, it can be set to focus on things close up, in the middle, or far away. You could set it for clear-distance vision, as most people do, which is ideal for walking, running, driving, and seeing people far away.
Sometimes glasses are needed to read or do close work, but you can discuss exactly want you need with surgeon at pre-op appointment.
I required spectacles for close work pre Pred [varifocal], and now 10 years on, almost 8 without Pred the prescription has not altered.
Go for the operation, it's quick and painless - just make sure you do as told re eye drops etc afterwards.
I don't think it does make sense. If the prescription changes are solely due to the advancing cataracts, the cataracts will just continue to thicken and make your vision cloudier and they will have to give you ever stronger prescriptions to be able to see anything. Eventually they won't be able to work miracles. Snazzy and I needed changing prescriptions for other reasons due to the PMR and/or pred effect on muscles.
In the past they made patients wait until the cataract was what they called "ripe" before they were removed - that was because of the technique they used. Modern techniques mean they can do the op far sooner, before your vision is so bad you can't see anything.
I agree with all above. Mine were done with corrected implants some years ago; I elected to retain my vatifocal glasses to avoid having to faff around with reading glasses but with a much less myopic prescription. I do notice that my eyes are fuzzy on my present 25mgs, but I expect that will improve once I am able to get the dose down. The glaucoma pressures have also gone up a bit due to the higher dose. Best of luck with it.
I'd like to thank you and all the others for their advice and experience.
My ophthalmologist actually suggested that I go ahead and fulfil the latest prescription -- and that if it helps my vision then perhaps wait to see if the cataracts worsen. Since I'm entering a low dose of prednisone, I might be able to avoid the surgery.
I got the new lenses yesterday, and I can see with perfect focus -- although a bit foggy due to the cataracts.
The ophthalmologist did say that all surgery, including cataract surgery, has risks associated with it and should only be done if absolutely necessary.
My questions were more an attempt to understand the mechanics of the rapid need for new lenses. One of you suggested that the eye muscles are affected by prednisone -- that comment helped a lot. The other contributor (and a more likely contributor) are the cataracts themselves. But if my cataracts do not worsen, I can certainly live with my present situation.
I agree, there are risks to with any surgery. I had a problem with my first cataract op, some fragments slipped behind my eye. And they couldn’t put the new lens in at that time. A week later it was sorted and the new lens put in, I still say it was worth it and the second eye had no problem. I love my new lenses! I know many people who have had cataract ops with no problems and I think mine may have been due to the fact that I have injections in that eye for macular oedema.
I have glaucoma, and had both my cataracts done 3 years ago. I have got 3 stents in my right eye, and 2 stents in my left eye for help with drainage of my eyes, and to help with the pressures in both eyes. I had varifocal lenses in both eyes, and now at the age of 80 my eyes are so good and my pressures are really good, and I can see to read and drive without glasses, so very happy with the results.
Here in France glasses and lenses are eye-wateringly expensive 🤣, so most folks go for cataract surgery to stabilise things out as an economic imperative.
Blimey - not quite that here in Italy and I thought here was pricey!!! I got 2 pairs for a bit more than that last time and I have to admit, the frames were a bit eye-watering!!!!!
Even so, book me an ✈️!!. Varifocal Lenses hereare at least 600e each, and I have excluded the pittance the state and my top up insurance contribute. Full top up optician insurance isn't économique unless one gets yearly new glasses. One can go with ones insurers agreed optician at lower cost but ones choice of frames and lenses is limited and the opticians are not always as skilled as in the independent sector.
The cornea, which is clouding, is an extension of the sclera which has muscles attached which pull the eye around. It is normally clear and not , as far as I know, a focusing medium. That is the function of the lens. All that is happening is that clarity is deteriorating as the cornea gradually clouds. The new cornea is a replacement clear cup with no focusing which could be given a focusing facility I suppose. Then your conversation on the focal prescription would be valid. Your focusing is affected by the muscles which stretch or contract the lens. Your cornea is made more sensitive to UV light by prednisone thus causing the cataract, which is why you are advised to wear sunglasses in bright light. Failure of your eye to focus properly is corrected by glasses or contact lenses. The changing prescription whilst on pred. is because the muscles controlling the lens are affected by the steroid. the lower the dose the less the effect. Zero is obviously the preferred state.
Cataracts are clouding of the LENS not the cornea. If it were the cornea. vast numbers of corneal transplants would be required - rather than the artificial LENS
My bad. thanks for the info. That must be clever surgery as the lens is adjusted by the muscle to achieve focus. I'm very interested now especially as they say it is a simple op. and very successful. Will look into this more.
Forgive me, Cycli ,but the cloudy cataract is in the lens not the cornea . A cloudy cornea has altogether other causes and treatments, unless I have misunderstood what you are saying?
A lens implant is not adjusted by the muscle at all. It is a corrective lens like a glasses lens, put in the old lens capsule, at a fixed power and focus, that is why one might need reading glasses cos the eye cannot accommodate for close work once it is put in. The preexisting lens with its other abnormalities if present, ie astigmatism, myopia etc is removed. Its not quite as clever as you assume!
Just goes to prove how great this forum is. My left eye has developed a cataract. I also has astigmatism and needs a prescription. Not bad enough yet for op so will wait till off pred. and it's negative effects before I decide. Don't like the dea of a fixed lens but seems the best alternative since I need specs anyway.
I suppose because the muscle no longer does what it should. However, since the eye isn't working as well as when young I reckon it's the right thing to do. Still, probably sensible to wait till pred very low or zero.
I have bi lateral fixed lens .I only need glasses to read or for any close work.I can drive and live the rest of time glasses free.It seems a great bonus to me.
FwIw, had my high myopia partially corrected to 3D and my high astigmatism totally corrected with the implants when I had the cataracts done. I wear varifocal glasses, much weaker than prev, all the time. There are quite a few variations possible. Some folks choose to go for perfect distance vision, and just use reading glasses .
Hello...You have gotten some great replies. I would for sure get rid of the cataracts; I did, and it was such a welcome change. What I did was buy what I call 'readers' until I felt I wanted to get a prescription lens. My opthalmologist agreed. I started my pred journey with GCA in August 2019 and just got my first prescription lens about a month ago. I took the script he gave me and went to Walmart for my frames; they send the lenses out like anyone. I do still use my readers for painting and the computer....I just got down to 3mg plus Actemra. I wish you the best....cataract surgery is really a breeze. I thought they were wheeling me in ....they were wheeling me out. 💞
have them done, I had short short sight since the age of 11, I hated wearing glasses at that age. When I’d been on pred for some time my eyesight started to get worse, I had a new prescription made up and within a couple of months I needed to get a stronger prescription, I also kept getting dry eyes, also eye infections. When I went to the eye hospital they said I needed cataracts surgery, she said she had a cancellation the next day, I was booked in after getting the correct prescription and health check the same day and about 6 weeks later I had the other eye done. I no longer have to wear glasses and only on the odd occasion do I need glasses for very close work, eg threading a needle, or if sometimes the writing is very small.
Eleven years ago (way before PMR) I had recently had new varifocals. 9 months on, I realised that I couldn't read roadsigns properly. I had a new eye test and sure enough the prescription I needed had chanhed. The Optometrist said my cateracts had got significantly worse since the last test and referred me (privately - I had insurance then) to have the cataracts removed. I was a very simple and painless operation, no worse than having a tooth filled. I had both eyes done, 2 weeks apart. I opted for single vision lenses. I have been waring glasses since the age of 9 so was quite happy to have to use glasses for reading. I also use fixed focus glasses when using the computer. Cost of the op then was about £5,000.
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