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My ophthalmologist and I don't see eye-to-eye on this
I have cataracts in both eyes, and as they have grown worse, I notice a touch of imbalance has come into my life.
I asked my GP if there was any association between the two. He said no. I asked my ophthalmologist also. He said no.
I say yes.
Is Vertigo and Dizziness Related To My Cataracts?
You've seen the questions on Google:
I asked my GP these questions more than a year before I had cataract surgery, and he assured me that the answer was no. I asked my ophthalmologist at my first appointment to set up my surgery, and he also said no.
After surgery to remove cataracts in both my eyes I used my new clear vision to do some research. I respect the professionals, but I came to a different conclusion. It is quite likely that cataracts can produce vertigo, and nausea, and tiredness.
What is dizziness?
Maybe it depends on what they call dizziness. My idea of dizziness is the sensation of the room spinning, feeling faint or as if you've lost your balance, or the floor is moving slightly beneath you.
My kind is the latter.
It is not uncommon to experience vertigo or dizziness as you get into your 70s, like me. And mine is not independent of aging. But I am convinced that cataracts exacerbate the age-related factors.
Let's run through a few.
Loss of sensory perception is the overall cause
Firstly we have to appreciate that maintaining the position of our head in perfect balance, and in perfect anticipation of our next vector of movement, is an astonishing feat.
We witness this when one-year-olds are learning to walk. If they lose control of their head, then its momentum, whether over or under-anticipating their movement, brings them crashing over.
Balance in walking and standing is dependent on a huge number of sensors feeding the brain so that it can anticipate our movement and direction and position our head and limbs to match.
This balance requires reliable sensory input from our eyes, our vestibular system (the balance system of the inner ear), and proprioceptors in all of our joints and muscles. Proprioceptors are the key - these are sensors of position and movement in all of our joints but in particular in the neck, hips, knees ankles and feet.
Ever twisted your ankle?
I say proprioceptors are the key because as we age, the proprioceptors in our joints lose their sensitivity. They either die off naturally like our taste buds, or they degenerate due to a weakening blood supply, or they are damaged from use.
Ever twisted your ankle? Have you noticed, to your frustration, that same ankle continues to be the one that gets twisted or injured? That's because the proprioceptors in the inner workings of your ankle joint are damaged and your brain doesn't know how to correctly place your foot.
As we age, the sensitivity of the proprioceptors in our lower limbs degenerates most, and in our neck. The loss of sensitivity in our neck is especially related to dizziness, or the sensation of floating.
What do cataracts have to do with it?
Vision provides enormous sensory input to our brain to enable it to keep us upright and balanced. Between half and two-thirds of the brain is used for visual processing.
When our eyes are open, two-thirds of the electrical activity of the brain is devoted to determining our current and future position and how to stand still or to move in balance.
The sensors in our neck have to be sending the same message to the brain as our eyes if the brain is to determine what we should do next precisely. But when we are older, our neck sensors struggle to determine the position of our head accurately.
Misalignment between our visual and neck inputs
We aren't aware of it, but when we move our head, our eyes counter-rotate. Otherwise, we would not be able to see clearly when our head is moving. Think of our eyes as gyroscopes. But the eyes can only counter-rotate successfully if they have accurate information about the movement of our head.
As our neck sensors dull, the vertical and horizontal alignment that the brain determines from the eyes cannot be validated with the positional inputs from the neck.
This misalignment, combined with blurry vision resulting from cataracts, throws the brain into overload, and it struggles to anticipate our next step, literally. We sway as we take that step.
It's brain overload trying to match poor visual and joint references
That, folks, is the connection between cataracts and dizziness. Our eyes are sending blurry signals to our brain, our neck is sending lagging and poor quality signals to our brain, and our ankles are sending few signals. We drift a little.
Also, take into consideration that cataracts don't grow evenly in each eye, and they don't necessarily grow in the same place.
So the two-thirds of the brain used to process vision now has to process and interpret mismatched sensory information from each eye and select appropriate balance strategies. As we age, brain processing can slow down, which results in slower balance responses.
My high body awareness clued me in to what is happening
I know something that my earnest doctor and ophthalmologist don't know. I know my body. After more than 20 years of regular, intense, exercise of many types my body awareness is very high. This awareness is one reason that I can manage to run 5km every day without injury.
I can perceive this connection between my deteriorating vision and dizziness.
Oddly enough, it does not happen when I run.
That is because my cataracts are in the centre of my eyes. When I run I look down through the edge of my eyes at the trail - about 2m ahead. I can't see the faces of people coming towards me clearly, but I can see the track clearly, and can avoid the tree roots and rocks with agility. As I run I feel completely steady.
That tells me that when my vision is most blurred, such as reading and when writing this, is when my brain struggles.
What does science say, that the doctors don't?
What doctors say about after cataract surgery
It is common for patients to experience dizziness after cataract surgery. Sometimes it lasts because of distortion in the vision and differences in the signals each eye is sending to the brain. Mostly it disappears after a few days.
A 2015 study found that "A new study found that after routine cataract surgery, the improved vision led to patients experiencing significantly less dizziness".
Those two studies may seem contradictory, but they aren't. They both show that vision problems, including cataracts, are associated with dizziness.
What doctors say about before cataract surgery
Binocular Vision Dysfunction refers to the inability of the eyes to work together as a team. The eyes need to aim together and focus accurately at a point in space and be able to change focus between closer and further objects quickly. A symptom of BVD is dizziness.
Cataracts impede the ability of the eyes to work together as a team.
This 2016 meta-study concluded, "This review suggests that dizziness (is linked with poor vision". Cataracts cause poor vision.
Conclusion - check out your dizziness, it may just be your eyes
What does all this mean?
If you are developing cataracts, then you may find the floor moving a little or wobble a little on your first step away from the sink. It is very likely to be your cataracts, despite what your doctor tells you.
That's important to know, because vertigo or dizziness can be a sign of more serious issues, such as a brain tumour. Get all the other things checked out. I did - even a brain scan.
I will give the last word to the American Academy of Opthalmology, who say (Jan, 2020) "It is very unusual for any eye problem to aggravate dizziness."
You have both sides, decide for yourself.
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