Diabetic Eye Problems in Chinese

One might think that Diabetic Eye Problems such as Diabetic Retinopathy in a Chinese population would be somewhat limited or perhaps considerably lower than American Caucasians given the difference in diet and cultural factors. Researchers reporting in the February 2012 journal Retina-The Journal of Retinal and Vitreous Diseases in an article titled Prevalence and Risk factors for Diabetic Retinopathy:The Beijing Communities Diabetes Study 6 concluded that in the urban population of Beijing studied, prevalence of Diabetic Retinopathy in diabetic patients was 25%. As in whites, increased blood pressure besides elevated plasma glucose concentrations was highly significantly associated with Diabetic Retinopathy in Chinese. It suggests that in Chinese as also in whites, blood pressure control beside control of plasma glucose levels is important to prevent development or progression of Diabetic Retinopathy. Further, just as in a Caucasian population the risk of proliferative Diabetic Retinopathy increases with younger age, longer duration of diabetes, higher concentration of glycosylated hemoglobin (Hemoglobin A1C) and elevated blood urea concentration which is similar to U.S. adults. Thus it would not appear as if the dietary and cultural differences between Chinese populations and U.S. Caucasian populations have a material influence on Diabetic Eye Problem risk.

Statins May Prevent Cataracts

"It would be great news for so many patients if cataracts could be prevented with the statins used for managing cholesterol and lipid problems", stated Fairfield County Cataract Surgeon Leslie Doctor, M.D. of Doctor & Associaates in Connecticut. According to researchers publishing their study in the February 2012 publication American Journal of Ophthalmology, the long term use of statins may have a protective effect against Cataracts, especially for younger patients aged 50 to 64 years. This might be due to the antioxidant properties. Patients taking Lipitor (Atorvastin), Vytorin (Ezetimibe-Simvastatin), Mevacor (Lovastatin), Pravchol (Pravastatin) or Zocor (Simvastatin) for at least 5 years had a protective effect against cataract surgery among patients aged 50 to 64 years but not among patients older than 64 years. In both age groups, shorter-term use of less than 5 years was linked to an increased risk of Cataracts.

"As we do with all new research, we will watch this carefully-it could be a great method of possibly helping patients prevent cataracts if it is found to be true over the long term", commented New Jersey Cataract Surgeon Joel Confino, M.D. of The Eye Care & Surgery Center in Westfield, NJ.

Lens Implants with Pupil Distortion

Question: I had cataract surgery on both eyes in 1968 using whatever procedure was done then and there were no lens implants. My pupil and iris are badly distorted. Is there any way I can have a lens implant now or is it a waste of time?

Answer: It is certainly worthwhile to explore the possibility of having a Lens Implant today-even with the iris and pupil distortion. If the basic anatomy of the anterior chamber of the eye is in reasonable shape-albeit with pupillary distortion, the Vitreous is in some reasonable shape and the Retina and Cornea are otherwise healthy, it is possible that a top Cataract Surgeon who is also trained in reconstruction of the Anterior Segment of the eye, might very well be able to create a positive outcome for you. There are MANY ifs and you do need to find the best Cataract Surgeon in your area and possibly find one who is also a Corneal Specialist as well to schedule a consultation and determine what is possible.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataracts, Astigmatism & Macular Pucker

Question: I have cataracts and a minor macular pucker and astigmatism. Which would be the best choice to correct these? LRI or a Toric IOL? Prescription: OD -2.00-2.00 x 80 20/50, OS-0.75-2.00 x 85 20/30.

Answer: Given that the reduction of vision is at least in part due to the Macular Pucker, in addition to the Cataracts, and if in fact your Cataract Surgeon qualifies you for having an astigmatism correcting Toric Lens Implant, then it would be fair game to use either Limbal Relaxing Incisions (LRI) or a Toric Lens Implant to correct your astigmatism after Cataract Surgery.  With a general preference for the optical quality, stability and no predisposition to cause dry eyes, leading the decision in favor of Toric Lens Implant, as compared to the LRI. Follow the recommendations of your Cataract Surgeon as he or she know your eyes the best.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery with Keratoconus

Question: I have a question about Keratoconus and cataract surgery and not wearing glasses or contact lenses. I am 73 years old and am active outdoors. I have worn rigid contact lenses since 1958 and was diagnosed with Keratoconus in 1970. I have worn contact lenses of decreasing size until recently when we tried a Scleral contact lens for greater vault and pollen protection. They are no longer comfortable. I have cataracts and would like to have the cataracts removed and replaced with a lens implant, that would correct my vision, including astigmatism caused by the Keratoconus and eliminate the need for contacts or glasses. Is this possible? Thanks for the advice.

Answer: Your situation of requiring Cataract Surgery and Lens Implants, when you have Keratoconus for which you are becoming contact lens intolerant, is indeed a complex surgical challenge. The single most important factor is that you have realistic expectations regarding the expected outcome which is NOT likely to eliminate the need for glasses or contact lenses. Here is what you need to know and carefully discuss with a Cataract Surgeon, who is also a Corneal Specialist, who can guide you on the possibility of combined procedure of a Cataract extraction, Lens Implant and Corneal Transplant, if that, in the opinion of the Corneal Surgeon, the best option.

First, anyone who has been wearing rigid contact lenses for as many years as you have, adds significant complexity to the measurement and calculation of the Lens Implant power. Further, anyone who has Keratoconus has UNSTABLE and most likely IRREGULAR astigmatism-BOTH of which markedly decrease the precision and accuracy with which an astigmatism correcting Toric Lens Implant can be calculated if at all.

Finally, you will still require glasses for reading, as it is also unlikely that you are a good candidate for a Multifocal Lens Implant. Now, one remote possibility is that you could find a Cornea Specialist that is performing Corneal Cross Linking for Keratoconus. Corneal Cross Linking might just act to stabilize the Keratoconus enough that it would make the precision and accuracy of the measurements and computations for the Lens Implant considerably better-AND if some level of stable and regular astigmatism could be achieved on the cornea, there is a REMOTE possibility that a Toric Lens Implant MIGHT be of some benefit. This might just eliminate the need for a Corneal Transplant and greatly simplify the ultimate final optical correction that you will require in contacts or glasses. These are all hypothetical considerations dependent on a thorough examination by a Corneal Specialist and Cataract Surgeon.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Halos & Dry Eye after Cataract Surgery

Question: I had cataract surgery on me left eye over a year ago and was experiencing dry eye, foreign object feeling, and night time halos within a few days after surgery. I had the right eye surgery done a few months later after being reassured by my doctors' partner that the chances of having the same problems on the second eye were slim to none. He performed the 2nd surgery and that eye is perfect. I am using Pilocarpine drops on the left eye every time I need to drive at night to reduce the size of the partially dilated pupil to eliminate the halos. I still have dry eye as well. Is there a fix for these problems? Also, what may have caused the problems?

Answer: It is not possible to comment on why your pupil is partially dilated after Cataract Surgery without really examining the eye and also understanding what particular complication or complications occurred during the Cataract procedure. That said, if the Pilocarpine is producing satisfactory results, it would be prudent to continue to follow your Cataract Surgeon's prescription and instructions. Dry Eye symptoms after Cataract Surgery are known to occur in 30% or more of patients, thus what you are experiencing is not terribly uncommon. Depending on the reason for the dry eyes, your Cataract Surgeon has a pretty good "tool box" of treatments to select from, including specific artificial tear eye drops, insertion of tiny tear duct or "punctal" plugs to help retain more tears in your eyes and prescription eye drops called Restasis® to help you actually make more of your own natural tears-or even a combination of these treatments.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Prostate Cancer & Cataract Surgery Recovery

Question: I have a question about recovery from cataract surgery and prostate cancer. I am 78 years old and have prostate cancer for which I take Casodex once a day and Lupron as hormone blockers to keep my cancer in check. I have been taking this for over 10 years. Will these medication affect my recovery from cataract surgery.

Answer: While the actual Cataract Surgery procedure can be complicated by taking a number of selective alpha antagonists or alpha blockers such as Flomax® for an enlarged prostate, the hormonal moderators such as Casodex and Lupron used to actually treat prostate cancer have no affect on either the Cataract Surgery procedure or the recovery from Cataract Surgery. Nonetheless, be sure to tell your Cataract Surgeon about ALL medication that you are taking-both prescription and non prescription as sometimes it is the drug interactions that can cause side effects and problems and not just the medications themselves.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Lens Implants for Traumatic Cataract

Question: I have a question about lens implants for a traumatic cataract. I was the victim of a traumatic eye injury in the late 1960's where I had to have a cataract removed from my right eye. I have been told that the advances in intraocular lens implants have been wonderful and I am interested in having my right eye repaired. In addition, I need a corrective lens in my left eye, as the vision is also impaired. I am wondering if I have my right eye fixed after being blind in it for over 30 years, will the adjustment to having good vision again be difficult?

Answer: We can only offer some limited information for you to consider as we simply do not know enough about the current condition of your eyes and thus having a thorough consultation with the best Cataract Surgeon you can find is really in order.

Now, although you had the Cataract removed in the 60's, we do not know your current age and the age at which you had the surgery. If you were a very young child and then did not have the vision corrected after the surgery, it is entirely possible that the vision is not correctable in that eye-this is testable during an examination.

Next, we do not know if the condition of the Retina was compromised as a result of that eye trauma you had when you got the Cataract. This too can impact the level of correctable vision and the tolerance of the eye to the implantation of a Lens Implant. Again, this most likely can be determined during a consultation. Also, we do not know if there was further damage to the tissue of the eye's "anterior segment" that might require management as part of a Lens Implant procedure. Thus, there is a real need for a consultation for a Lens Implant procedure in that eye.

Regarding the left eye, depending on the health of that eye and the refractive condition of that eye, it is entirely possible that you could have a Lens Implant for vision correction in that eye-again this can be determined at your consultation. Basically, if the right eye is in good condition it might be possible to demonstrate and approximate your vision as corrected with an IOL, by placing a trial contact lens in it for you to experience-all of this would be part of your consultation and answer your basic questions so that you could make a decision on how to proceed.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Double Vision after Cataract Surgery

Question: After cataract surgery in my right eye I have double vision. Objects viewed with ONLY that eye appear about one third larger than the same object viewed with only my left eye. I have seen 5 eye doctors and no one seems to know what is going on.

Answer: While it is impossible to tell much without a thorough examination, there are things to consider as double vision after Cataract Surgery is not typical. First, you do not state whether your left eye requires any type of optical correction. If your left eye has any considerable degree of refractive error, such as nearsightedness and you are attempting to wear eyeglasses, this can cause a problem of unequal image size-called aniseikonia. This would be an obvious and easily detectable problem by the eye doctors that you have seen. You do not state whether there might otherwise be a considerable difference in either the axial lengths or corneal curvatures of the two eyes-this too could possible cause a type of aniseikonia, however it most likely would have been observed well before your Cataract Surgery. Some type of anomaly of the Retina-especially the Macula-in EITHER eye must be ruled out, including pre-retinal membranes and subtle sub-retinal fluid. While it is easy to concentrate on the eye that had the Cataract Surgery, certainly the unoperated eye needs to be carefully examined, as we are sure they would have been, by your Cataract Surgeon. Please consider yet another opinion by scheduling a consultation with a top Cataract Surgeon in your area.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery Evaluation Concern

Question: I feel uncomfortable and rushed in my cataract surgery evaluation. At the first visit with the cataract surgeon, I was seen by the doctor and an assembly line of technicians and given a diagnosis of cataract. At the second visit I was again, given a quick exam by the cataract surgeon and told I could be scheduled for cataract surgery in 2 days. At the surgery center which was in the same building there were only two people who did a medical exam and really only took my blood pressure. They PUSHED for lens implants that cost extra money. I feel uncomfortable & "rushed". Is it me, or is this how things are done today? I am 67 yrs old.

Answer: You are describing the unfortunate reality of an American healthcare system under government siege. Today's Cataract Surgeon-and MOST medical specialists-are under enormous pressure to cut costs of all aspects of the care they provide. Believe it or not, the surgeon's fee paid by Medicare for performing Cataract Surgery-a highly technical, highly complex intraocular surgical procedure that changes lives, is NOT much different than what you pay to get your car exhaust system replaced when you visit Midas® Muffler. Equivalent life value? Hardly!

But the decreasing reimbursements provided to Ophthalmologists has necessitated an acceleration of the "industrialization" of care whereby technicians are engaged to provide more and more of the testing and evaluation of patients. This should not be interpreted to mean that you are getting shortchanged on the quality of care as in most practices these technicians are well trained, highly skilled, certified and under the direct supervision of the Cataract Surgeon who makes the decisions with you about your care. However, stylistically it can very well be impersonal and seemingly disconnected from the Cataract Surgeon. This method of patient care is encouraged and required for physicians to survive under Obamacare-it has cut some $500 million in Medicare funding-this has to come from somewhere.

In addition, Medicare ONLY pays for barest minimum type of Lens Implant for Cataract Surgery and tells the Cataract Surgeon to charge the patient for the Lens Implant that can offer the best vision correction options. So, the Cataract Surgeon can either not bother to present you with the best vision correction option for your Cataract Surgery using advanced technology Lens Implants, or present you the options and get caught "selling" you something.

It is NOT appropriate to PUSH any type of Lens Implant-the choice of Lens Implant is entirely up to the patient-but they should at least hear the choices-albeit there are some practices which may very well "oversell" the Lens Implant options. The reality is that this cannot be a rampant problem, as less than 15% of the Cataract Surgery performed in the U.S. today actually uses advanced technology Lens implants that require private payment by the patient. The decision as to when to have Cataract Surgery is entirely up to the patient, unless there are some associated anatomical or medical issues-such as the potential for Narrow Angle Glaucoma or an inability to assess or treat Diabetic Retinopathy or Macular Degeneration-that make the urgency of scheduling a cataract extraction more acute. It is when the patient feels they are ready that THEY should schedule the Cataract operation.

So, unfortunately this is the state of affairs today in medicine. There are still a few Cataract Surgeons who survive in "high touch" personalized care consultative medical practices-but they are becoming far and few between as their economic survival is challenged. All Cataract Surgeons and Cataract Surgery Centers do their best to deliver high quality care-perhaps NOT the warmest or most patient friendly care-in a challenging environment. The patient has the right to decide if and when to have Cataract Surgery, which practice and Cataract Surgeon to have it with, and whether they wish to have an advanced type of Lens Implant. At the moment choosing the practice style that feels the best to each patient, is still within the patient control and choice, although-unfortunately this will be limited with the ongoing government control of healthcare. This may not be the answer you were looking for but unfortunately it is today's reality.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery & Iris Problem

Question: I have a question about Iris damage after cataract surgery. During cataract surgery how often does the removal of part of, or a thinning of the Iris, occur which then results in the necessity of a contact lens to stop excess light from entering the eye? This was noticed after my cataract surgery. I had Crystalens® lens implants put in. My right eye is perfect, but my left eye is like it has been dilated. I used Pred Forte drops for almost two months, the cataract surgeon thought it may be inflammation, but it is not, there is definitely an area of Iris removed.

Answer: It is really difficult, if not impossible, to know exactly why this happened. However, it is not uncommon to observe small or even larger areas of Iris damage after routine Cataract Surgery presenting as areas of Iris trans-illumination or seeming transparency as well as actual sectors of tissue appearing to be removed. Surgical trauma to the Iris may be noticed after Cataract Surgery to a greater or lesser extent and accompanied by increased glare and light sensitivity, as the eye can no longer effectively control the amount and quality of the light entering the eye. Sometimes just the manipulation and positioning of the Lens Implant as it slides into place, can chafe areas of the Iris during the procedure and sometimes an Iris prolapse can occur, whereby a section of Iris tissue makes its way through the incision, as a result of the large pressure gradients created inside the eye during Cataract Surgery.

Sometimes a patient squeezing their eyes or moving, can change the pressure gradients and cause chafing. Very difficult to say but not that uncommon. Cataract Surgery is very successful BUT it is also VERY complex. It must balance pressure gradients inside the eye, tissue removal, thermal gradients and many other factors that are occurring at the microscopic level.

If you are extremely bothered by this, depending on the exact nature of the Iris defect it may be possible to have a procedure called a "pupiloplasty" which is an advanced method of Iris reconstruction. Your Cataract Surgeon should be able to offer advice as to whether this is worth considering, or even appropriate, in your situation. If you are uncomfortable, or would like a second opinion, this is never unreasonable and you can consider scheduling a consultation with a Cataract Surgeon who has a special interest in anterior segment reconstruction such as a Corneal Specialist.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract, Lens Implant & Cornea Transplant

Question: I require a cornea transplant and lens implant IOL due to blunt trauma to my right eye with loss of a lens and a corneal tear. I have a small cataract in left eye. I have moderate myopia and mild presbyopia in both eyes-corrected with transitional progressive eyeglass lenses. What type of lens implant would be best and should I get the left cataract removed as well.

Answer: Unfortunately, we can only be of limited advice, as we don’t have enough information to give you specific answers. Let’s try, in any event.

First, you do not state and may not actually know the type of corneal transplant that you are having. There are a number of types of corneal transplants and some can actually impact the final refractive error of the eye more than others-thus making really precise Lens Implant calculations somewhat difficult in certain circumstances. Thus, selecting a Lens Implant type that requires a precise set of measurements-such as a Multifocal Lens Implant-is probably not a great idea.

Second, the fact that you have been wearing transitional progressive eyeglass lenses for myopia and presbyopia, is actually a good thing. Regardless of what the refractive outcome ends up being, it would appear that you are able to tolerate these types of eyeglass lenses for correction of the presbyopia. Given that you are moderately myopic, when your Cataract Surgeon calculates the Lens implant power for the right eye, he or she will need to discuss with you whether to approximate the preoperative level of myopia and attempt to match the left eye-or to fully correct it, as close as possible, to not needing any refractive correction and allowing you to function without any correction at distance in the right eye.

If this is chosen you will need to have the left eye Cataract removed to have it rendered clear for seeing distance. In this instance-which is the simplest and most predictable scenario-you would then need to have the transitional progressive eyeglass lenses for a mild distance vision correction and your presbyopia. It may, however, be possible that other options could be employed depending on the overall refractive condition of the left eye and what kinds of activities you wish to engage in, that might be easier or more convenient without eyeglasses. This is really going to depend on the specifics of your eyes and your specific vision needs. The best thing to do is to have these types of discussions with your Corneal Specialist, who we assume is also your Cataract Surgeon and come up with a plan that is likely to give you the best results.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Capsule Rupture with Cataract Surgery

Question: I recently had cataract surgery and experienced a posterior capsular rupture during the procedure. After an initial discussion with my cataract surgeon, whereby he informed me about the rupture, I have subsequently researched what this meant and now have somewhat heightened anxiety (notwithstanding that my surgeon did not seem overly concerned during our discussion). I was ill-prepared to discuss with him at the time, but now have just enough info to be dangerous:-). My question...what are the key questions I should be asking during my next visit with him?

Answer: The complications of Cataract Surgery are generally pretty limited but there are some that can and do occur. A broken or ruptured capsule is one of those complications.

The presence of a break in the capsule can pose anything from no real ramifications to several with some seriousness. First, if the Cataract Surgeon was still able to place the Lens Implant "in the capsular bag" there should be a good result. If not and the surgeon was able to place the Lens Implant in the "sulcus" the result should still be good, with a slightly longer post operative course. If there was any loss of lens material through the rupture, this becomes a little trickier. If the post operative intraocular pressure (IOP) has been easy to control and the cornea is clear without any cloudiness, then this bodes well for a good outcome. If you have not been referred for a Retina consult, this also bodes well for a good outcome. So, generally speaking, if your vision is improving and the surgeon doesn't need to refer for a Retina consultation, then it should all resolve well with perhaps just a longer healing time-maybe a month vs. a week.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cost of Toric Lens Implants

Question: What is the cost of toric lens implants and do I need a pre cataract surgery exam?

Answer: It is important to understand the detail of the cost of Toric Lens Implants for Cataract Surgery as well as the actual cost itself. First, the cost of Toric Lens Implants is set by each individual Cataract Surgeon. The cost of a Toric Lens Implant should include the direct cost of the implant itself, but also all of the additional testing that might be required to obtain the necessary measurements for precise calculations, as well as to make certain that the Toric Lens Implant will produce the best possible results. The additional testing might include corneal topography, a tear film and dry eye evaluation, corneal thickness measurements, aberrometry and additional types of biometry to confirm measurement accuracy. For the additional services that your Cataract Surgeon will provide to render this care and provide the Toric Lens Implant itself, you should expect to pay an additional out of pocket $1,000-$1,500 per eye on average.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Multifocal IOL & Limbal Relaxing Incisions

Question: I recently had cataract surgery with Limbal Relaxing Incisions (LRI) to correct astigmatism and a multifocal IOL inserted. Initially my vision was perfect, but on the 10th day after surgery, there was a marked deterioration in mid to long vision, although my close vision was ok and I can read. My ophthalmologist is unsure what is happening, but seems to be of the opinion that the corneal cuts are healing, thus reinstating my astigmatism - which incidentally is 1.3 diopters. He is not keen to insert toric multifocal lenses, as he feels the only ones available at present are not very good and wants to delay my right eye until a preferred multifocal toric lens is available. I am not happy being left one eyed as my sight is very poor in the right eye. I am looking to get a second opinion but would welome any comments.

Answer: If you have had a regression of the astigmatism correcting effect of the Limbal Relaxing Incisions (LRI) it may be possible to redo them, however, it still may not produce the desired correction in a stable manner. This does happen in some instances. It may be possible to have either PRK or LASIK on this eye to correct the astigmatism and this should produce a predictable and stable astigmatic correction with a relatively low astigmatic correction. If you are in urgent need of Cataract Surgery and Lens Implantation in the other eye with a Multifocal Lens Implant, then you should discuss whether your eye is healthy enough for LASIK in the this eye in order to give you a better correction. Your Cataract Surgeon will of course need to qualify you to have LASIK in either eye based on the health, thickness and curvature of the cornea as well as the quality and quality of the tear film.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular, a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Multifocal Lens Implants & Extreme Nearsightedness

Question: I have extreme nearsightedness and am considering multifocal lens implants. I am 52 year old male and have worn gas permeable contacts since age 15 and monovision for 10 years. I am extremely nearsighted with 18 diopters for right eye and 16 diopters in my left, as well as dry eyes and long eyeballs, from the extreme myopia. I work in an office, fish and hunt. Are multifocal lens implants a viable option? What about monovision? I would love to be able to see at all distances and not have to wear contacts or glasses but I understand that is probably very unrealistic. Given my particulars, what type of lens should I consider?

Answer: Being as nearsighted as you are most likely means that you do in fact have a very axially elongated eye. When this happens, it is not unusual to have some slight degree of retinal thinning and "stretching". When this occurs in the macula or the "center" of vision-even to a slight degree that does not directly impact visual acuity-it can cause a mild decrease in contrast sensitivity.

Multifocal Lens Implant designs are very complex and some may in fact provide a decrease in contrast sensitivity by their very design. Any reduction in contrast sensitivity from a Multifocal Lens Implant could pose a compounding effect and leave you with some annoying visual problems such as difficulty seeing in dim illumination or at dusk or even in inclement weather with cloud cover. While this may sound trivial, it can be pretty annoying. Not all Multifocal Lenses have this effect, but a conservative approach would be to provide the best possible optical Lens Implant solution given the optical complexity of your eyes. That said, the fact that you have been successful with monovision contact lenses could be a strong indication that you could also be successful with Monovision Lens Implants and thus enjoy a "glasses free" state for most activities. 
Creating a monovision correction, using either monofocal spherical, monofocal aspheric or monovision toric IOLs-if you have astigmatism-is potentially a "simpler" solution. One word of caution is that you will need to fully de-adapt from your Rigid Gas Permeable (RGP) contact lenses and will have to achieve stable corneal curvature and thickness, as well as adequate tear film quality and quantity. In some instances the long term wear of RGP contacts can alter the corneal shape and thus impacts the precision of the measurements and computations for the Lens Implants.
Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Airplane Flight, Golf & Cataract Surgery

Question: How long after cataract surgery can I fly on a 3 hour airplane flight and then play golf?

Answer: Modern Cataract Surgery recovery is generally pretty quick. It is important that you follow your Cataract Surgeon's specific instructions in your case as there maybe procedural variations that require modification of your activities. However, typically it is possible to take an airplane flight and play golf within a week after Cataract Surgery. You should, however, be careful when traveling to avoid lifting any heavy objects. And, although most people don't carry their own clubs and golf bag today, please make sure you allow someone else to load, unload and carry your bag and clubs for you. Best of all be safe...have fun!

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monovision with Toric Lens Implant

Question: In August 2011, I had Limbal Relaxing Incisions (LRI) with a multifocal lens implant in my left eye. While the clarity of vision is pretty good, the halos and glare make it truly untenable. My cataract surgeon assured me at the time that he could remove it up to a year later if it didn't work out, which it hasn't. So, his plan is to give me mini-monovision. I've tried mini-mono with contacts and seem to do okay. He plans to explant the multifocal lens in my left eye, a Tecnis® Multifocal, and exchange it with an Alcon AcrySof® ReSTOR® Toric Astigmatism correcting lens implant to deal with the slight astigmatism remaining in that eye post Limbal Relaxing Incisions. The left eye prescription will be -1.75 to give me some nearsightedness. His plan for the right eye is to use an Alcon AcrySof® ReSTOR® Toric Astigmatism correcting lens implant for distance at Plano. My goal is to have as crisp vision as possible with as little glare as possible. I don't know if it makes a difference, but I'm a red-haired, green-eyed woman whose always had some (not huge) sensitivity to light. Also, I have moderate-to-very dry eye.

I don't mind the idea of readers as long as I can read a little with good light if the font's not tiny. My preference would be to have intermediate and distance is sharp.

So, here are my questions:

~ Is this a true mini-monovision corrective package?
~ Would you say these are the best lens choices to achieve crisp vision with as little glare as possible?
~What do you see as the pros and cons re: having the astigmatic lens in my right eye or having Limbal Relaxing Incisions in that eye also?

Answer: What you are describing is a well planned and thought out approach to your vision correction needs and goals. The optical solution of using monovision is sound in light of your intolerance to the complex optical design of the multifocal lens implant. The optical quality and thus the vision results of astigmatism correcting toric lens implants is really quite good and predictable. The level of monovision at 1.75 D selected is pretty much in the "sweet spot" of monovision success and the fact that you have a clinical trial with contact lenses translates into a very high success rate. While LRI's are common and provide good results for many patients they can be a bit unpredictable and unstable and CAN induce dry eye symptoms-thus avoid another LRI would be our suggestion. On that note the only word of caution is absolutely make sure that your tear film is healthy and is of the maximum quantity it can be through whatever dry eye treatments your Cataract Surgeon feels would be most effective.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery, YAG Laser & LASIK

Question: I had Cataract Surgery with a Lens Implant in one eye. I now have a Cataract in the other eye. Will I just need Cataract removal and another Lens Implant or will it require additional Lasik Surgery to get good vision?

Answer: During Cataract Surgery to remove a Cataract it is usual and customary to correct the vision using a Lens Implant. Lens Implants today can correct distance, intermediate and near vision and can also be used to correct astigmatism after Cataract Surgery. LASIK Surgery is a method of vision correction that uses a laser to correct nearsightedness, farsightedness and astigmatism to help people become less dependent or even independent of glasses for seeing at a distance, BUT IS NOT typically part of the Cataract vision correction process, unless there is a significant amount of uncorrected refractive error after the Cataract and Lens Implant Surgery that could not be corrected by a Lens Implant, or perhaps if the patient absolutely did not wish to wear eyeglasses.

SO-to answer your question-it is NOT typical to need LASIK after Cataract Surgery. NOW, what you may be referring to, which is quite a bit more common after Cataract and Lens Implant Surgery, is a YAG Laser Capsulotomy-which is NOT LASIK. When your Cataract Surgeon removes the Cataract, he or she will typically leave the "capsule" of the crystalline lens in place and use it as support for the placement of the Lens Implant. The lens capsule often does become cloudy-referred to as posterior capsular opacification-and needs to be opened by the Cataract Surgeon some time after Cataract Surgery. The procedure of opening the lens capsule is called YAG Laser Capsulotomy and is a quick and effective method of using a laser to create a clear opening in the capsule, so that you get the best possible vision after Cataract Surgery. In general 30-40% of patients who have Cataracts removed will require a YAG Laser Capsulotomy in order to get the best vision.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery Measurements & Medicare

Question: I am interested in knowing more about cataract surgery measurement procedures before the actual surgery. I have been told measurements are not paid for by Medicare.

Answer: You initial Cataract examination and evaluation as well as the minimally necessary measurements to calculate a basic monofocal lens implant prescription are covered by Medicare less any deductibles or co-pays that you might have outstanding. However, should you need the additional measurements necessary for an astigmatism correction with Limbal Relaxing Incisions (LRI) or an astigmatism correcting lens implant such as corneal topography or for a multifocal lens implant which may require a second type of biometry, dry eye testing, ocular coherence tomography (OCT) or other types of testing that fall into a more advanced set of testing protocols, these may be “non covered services” and require you to pay out of pocket. Discuss the testing with your cataract Surgeon and I am sure they will be happy to explain why it is necessary and what might be a non covered service under Medicare. Medicare only covers the basic Cataract Surgery measurements, Lens Implants and overall care rather than the most advanced and complete care.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Blurry Vision after Cataract Surgery

Question: About three weeks ago I had cataract surgery with a toric lens implant to correct astigmatism in my right eye and I see 20/25. I also had cataract surgery with a regular lens implant in my left eye but after two weeks I still see a grayish spot and see some distortion in the center part of my vision. The cataract surgeon also said that he wants to go in with laser after 30 days and do something to the sack where the cataract was removed and the lens implant is in place. Does any of this make sense?

Answer: While we can only make a limited comment based on what you are describing, here are some things you should clarify with your Cataract Surgeon. First, if you are seeing distortion in your central vision you need to make certain that the Retina and especially the Macula are in good health at this time. One would imagine that your Cataract Surgeon confirmed this at your postoperative visit.

Second, it is possible that your blurry and distortion symptoms are related to the integrity of the posterior lens capsule as that is what it seems as if you are describing. If this is the case, a YAG Laser Capsulotomy as your Cataract Surgeon suggests, will improve the vision. In either case, you need to have the information provided by your eye surgeon explained a bit more carefully so that you fully understand what is impacting your vision.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Myopia After Cataract & Lens Implant Operation

Question: I am 66 years old, a fit sailor and had cataract surgery on my left eye 4 weeks ago with a multifocal lens implant. My distance vision is not good and my cataract surgeon says I now have myopia-I didn't before! She doesn't know how it happened but still wants me to go ahead with the second eye, using a monofocal lens implant instead of the multifocal as she said it could happen again! This wasn't what I signed up for. As a keen motor-boater, I wanted clear near and distance sight-very important to me. I had laser eye surgery several years ago and the cataract surgeon knew this. She now thinks the changes to the cornea from the laser eye surgery are to blame for the myopia. I don't-not when she tested me prior to the cataract operation. What can I do now?

Answer: Patients who have had previous Laser Eye Surgery such as LASIK, and now have a Cataract and are contemplating Cataract Surgery need to understand that previous corneal surgery of any type can often make the precision and accuracy of the measurements and calculations for Lens Implants for Cataract Surgery considerably more unpredictable. In order to minimize the likelihood of a "refractive surprise" after Cataract Surgery, it is important for patients to provide the Cataract Surgeon with as complete a set of records as possible from prior to their Laser Eye Surgery, including if possible, a full set of measurements taken as part of the preoperative evaluation, such as corneal curvature measurement, corneal thickness measurements, manifest and cycloplegic refractions and corneal topography data.

With these measurements, along with more sophisticated imaging and measurement instrumentation at the Cataract preoperative evaluation, it is usually possible to mitigate the risk of a "refractive surprise" to a great extent for most-but not all patients. In your case, the measurement errors are further compounded by the need for exquisite precision as you have elected a Multifocal Lens Implant which require absolute accuracy in order to have it perform properly. Now, you have a couple of options to deal with the myopia at this time.

First, you can do nothing and depending on the degree of myopia, you might very well achieve a state of monovision correction after having the Monofocal Lens Implant in the right eye, allowing you to function as you described above.

Second, you can simply wear glasses.

Third, it may be possible to correct the residual myopia with a Laser Eye Surgery procedure like you had before.

Fourth, you could have a Lens Exchange whereby your Cataract Surgeon removes and replaces the Multifocal Lens Implant with the appropriate power to achieve the best distance correction, now that she knows what that actually is. Which of these choices is best, really depends on the degree of myopia, the overall health of the cornea and your eyes in general as well as the risk/benefit analysis of a second surgery on the left eye. Now-if you are at all uncomfortable with the advice and recommendations being provided by your Cataract Surgeon it is NEVER inappropriate to get a second opinion. If you do elect to get a second opinion you should consider someone who is both a Cataract Surgeon as well as a LASIK or Refractive Surgeon and perhaps even a Corneal Specialist, who is accustomed to dealing with both complex refractive and eye surgery measurements and situations.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Eyeglass Changes after Cataract Surgery

Question: A year after I have cataract surgery will I need a new prescription for glasses each year or just after the initial change after surgery?

Answer: For the most part, if you are in good overall health and your eyes are healthy, it would be unusual to have the need to change your eyeglass prescription after Cataract Surgery much beyond the first year. If you take on new activities or hobbies that change your visual demands, this may require a change in prescription. That said, you still need to schedule routine eye exams each year to be sure that no eye problems or conditions such as Glaucoma or Age Related Macular Degeneration (AMD) develop. Maintaining eye health and vision, even if there are no eyeglass prescription changes, is very important and does require a regular eye examination schedule.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Eye Pigment, Colonoscopy & Colon Cancer

Retina Layers

What could the need to have a colonoscopy possibly have to do with eye pigment in the Retina and early detection of colon cancer you ask? The Retinal Pigmented Epithelium (RPE) is a pigmented layer of the Retina which can sometimes be thicker than normal at birth-or “hypertrophic”. When found, areas of Retinal Pigmented Epithelial (RPE) Hypertrophy usually do not cause any vision problems or symptoms and are typically found during routine eye examinations. Congenital Retinal Pigment Epithelial Hypertrophy (CHRPE) is usually found before patients reach 30 years of age and although they may enlarge with time they usually do not lead to malignancies like colon cancer. However, there is an association between people with Gardner's Syndrome-Familial Colonic Polyposes-or polyps of the colon, and CHRPE. If your eye doctor has told you that you have Congenital Retinal Pigment Epithelial Hypertrophy-perhaps called “Bear Tracks” or “Pigment Spots” or “Retina Freckles”, it is important to carefully explore and review your family history with a Gastroenterologist who will likely schedule you for a colonoscopy. CHRPE has a “statistically significant” correlation with hereditary colon polyps known as Familial Adenomatous Polyposis, or FAP. It may be that the freckles are caused by the same genetic mutation that produces the polyps. A study published in 2010 in the American Journal of Gastroenterology concluded that patients with such freckles should be referred for colonoscopies.

Thus-when we are over 50 years of age, the reasons to have yearly eye exams includes not only detecting cataracts, glaucoma, age related macular degeneration (AMD) and other eye diseases, but regular eye examinations may very well be a reminder to be screened via colonoscopy to help detect early risks and potential indicators of colon cancer.