Early Cataracts: Vision Loss Associated with MS But Not Caused By It

Like you, I’ve read a lot about medical conditions I could develop on that long, lonesome highway to the ash heap. Just when I thought I’d heard everything, I learned about one more.

Annual appointment with the ophthalmologist

In November, I attended my annual appointment with the ophthalmologist. He checked the health of my optic nerves, retinas, intraocular pressure, and refractory issues, and all remained unchanged. I got off easy with MS-related vision problems: one old lesion in the left optic nerve that didn’t affect my vision at all— and no changes or worsening since the attack in 2009 that brought it on. My vision is 20/20 with corrective lenses in a well-lit room and a bit worse in a darkened one. I didn’t understand the significance of that until he dropped a mini-bomb on me.

Cataract progression with MS

After last year’s exam, I read his notes online that mentioned early-stage cataracts. I was surprised but not worried. It was at such an early stage that he hadn’t even mentioned it during the exam. I chalked it up to aging, though I hadn’t heard people complaining of cataracts who were as young as I was. What surprised me during this latest exam was that he said my cataracts had progressed from +1 to +2 in just one year.

Steroids and cataracts

Doc went on to say that steroids can bring on early cataracts and hasten their worsening. I’ve taken steroids a total of four times in the past 19 years: Two were three-week courses of oral prednisone; one was with Solumedrol followed by a four-week course of oral prednisone; and one was a ten-day course of oral prednisone. I’m guessing that is a pretty light history of steroid use compared to other MS patients, but research shows that both prolonged and intermittent high-dose steroid use can cause early cataracts.

Research has also yielded some interesting facts about the kind of cataract that can be medication-induced1.

  • Corticosteroids can cause subcapsular cataracts.
  • Subcapsular cataracts form behind the lens sac, or capsule. It causes a halo effect around lights and trouble reading in low light. By contrast, nuclear sclerotic cataracts form in the center of the lens. They’re the most common kind and are caused by aging.

In addition, the following risk factors could influence your chances of developing cataracts2:

  • Ultraviolet radiationfrom sunlight and other sources
  • Diabetes
  • Hypertension
  • Obesity
  • Smoking
  • Prolonged use of corticosteroid medications
  • Statin medicines used to reduce cholesterol
  • Previous eye injury or inflammation
  • Previous eye surgery
  • Hormone replacement therapy
  • Significant alcohol consumption
  • High myopia
  • Family history

It is a more likely scenario that people possess several risk factors for early development of cataracts. My own medical history includes:

  • Hypertension
  • Smoking
  • Corticosteroids
  • Statin therapy for high cholesterol
  • Hormone replacement therapy

Options for cataract surgery

Because of the rapid progression of my cataracts, the ophthalmologist described the options available for cataract surgery down the road. In traditional cataract surgery, the lens is removed and replaced by a plastic intraocular lens (IOL). This corrects distance vision but not mid-range and reading vision. Wearing corrective lenses is still necessary.

Recent advances

Recent advances give me the option of multi-focal IOLs that will correct distance vision, mid-range and reading vision. Since I also have astigmatism, a toric multi-focal IOL is also available and which completely eliminates the need for any corrective lenses after the surgery. Although Medicare will cover my surgery, the multi-focal IOLs would cost me approximately $2000 per eye. I’m not sure that $4000 would pay for itself in eyeglass expenses saved, but taking on the debt might very well be worth the complete freedom from having to pay for and wear corrective lenses for the remainder of my life. Fortunately I have time to think about it.

Have you developed early cataracts? If so, did your doctor explain what factors might have brought them on?

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