Q. I have had chronic migraine for 17 years after getting a complete hysterectomy. I have a hyper-excitable nervous system with two main triggers. One is environmental (such as air flow, wind, cold, heat, humidity, etc.) and the other is certain visual stimuli (such as attempting to wear prescription eyeglasses or contacts, using a magnifying glass, watching a flat-screen TV, using a computer screen, etc.). I have natural monovision and diminishing vision in each eye due to aging. Plus, I now have cataracts in each eye.
Is cataract surgery feasible for a person with a hyperexcitable nervous system and visual triggers? Looking through prescription glasses, contacts or a magnifying glass—for literally only minutes—causes a migraine, so I am afraid having a permanent unclouded lens implanted will also trigger a migraine. And since this lens is permanent, I am afraid the migraine will be 24/7 with no way to stop it. My ophthalmologist says my brain might adjust after surgery, but there is no guarantee, and the surgery is permanent. My neurologist and neuro-opthalmologist are aware of my problem but don’t have a solution. Do you have any recommendations regarding the feasibility of cataract surgery or other options for a patient such as myself? – Maureen B.
A. The response to surgery is completely unpredictable. If vision is well corrected, surgery might give you less visual strain. At the same time, change in anything, including vision, can trigger attacks. Your best bet is to get optimal migraine treatment, and then get the vision corrected if you need it to see better, not for headaches.
Mark Green, MD, Mount Sinai School of Medicine, New York City
