Cataract Surgery Lens Implants & Eye Surgeons for Cataracts Blog

Thursday, December 27, 2012

Blurry Film after Cataract Surgery

Question: I had cataract surgery in October and my left eye continues to blur or get a film over it. If I blink hard enough this seems to help. It also hurts at times. Is this normal? Should I visit my eye doctor or cataract surgeon?

Answer: Without a clinical exam to fully understand the range of possible reasons that you have a blurry film after your cataract surgery that clears when you blink, we can only offer the following consideration. What you are describing sounds like an abnormality of the tear film or the eye surface. This is not uncommon at all and occurs in as many as 30% of the patients having cataract surgery. It is often attributed to dry eye or inflammation of the eyelid margins called blepharitis although there could be many other reasons. Your best course of action is to return to your cataractsurgeon and ask him/her to evaluate your situation. In almost all cases there multiple ways to improve the eye surface and tear film depending on the actual cause. Be patient as it does require some trial to find the best therapeutic approach.

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 Diabetic Retinopathy

Question: I have a question about having cataract surgery if I have diabetic retinopathy. I have been diagnosed with diabetic retinopathy and am currently undergoing laser treatment. I am also beginning to develop a cataract and will need cataract surgery for this as well in the future. Are there any restrictions for cataract surgery if you have had laser treatment for diabetic retinopathy?

Answer: Cataract surgery and lens implants for patients with diabetic retinopathy can be performed successfully for the majority of patients but the ultimate results do depend on the overall health ad condition of the retina in terms of the progression and degree of treatment that has been rendered. First, it is critically important that a very careful and meticulous preoperative retinal evaluation confirm the level of vision that should be expected. One of the more common findings in diabetic retinopathy is the presence of Diabetic Macular Edema (DME) which can have a considerable effect of the level of best corrected vision that can be achieved-with or without cataract surgery. It is likely that your eye surgeon rendering the diabetic laser treatments is evaluating you for Diabetic Macular Edema with fluorescein angiography and ocular coherence tomography (OCT) testing. The presence of DME might actually be one of the reasons you are having diabetic laser treatment currently.

Diabetic Macular Edema is often treated with laser and/or vascular endothelial growth factor (VEGF) inhibitor injections such as Lucentis® as well as other medications. One of the concerns that many diabetics have is their susceptibility to slow or poor wound healing and infection. Modern cataract surgery is typically performed using eye drops for anesthesia rather than injections and through a very tiny self sealing incision-often between 2.2 and 3.0 mm. The precision and the architecture of this tiny incision allow it to close and heal without sutures in most cases. So, modern cataract surgery is actually quite “wound healing friendly” and requires no real modification in technique for diabetic patients. Depending on the stage of diabetic retinopathy at the time of your cataract surgery and lens implants, it is possible that your Cataract Surgeon or Retinal Specialist might place a vascular endothelial growth factor (VEGF) inhibitor injection such as Lucentis®, Eyelea® or Avastin® into the vitreous gel as a preventative and/or therapeutic measure. Assuming that you will not have had any retinal or vitreous hemorrhages prior to cataract surgery, and that the vitreous is otherwise healthy, other than these considerations and as long as any presence of macular edema has been accounted for in the setting of expectations for your ultimate vision after the cataract operation-you should have a relatively routine cataract surgery experience.

Thursday, December 13, 2012

Toric Lens Implant Rotation

Question: I had cataract surgery and an astigmatism correcting toric lens implant for a moderate cataract almost 6 months ago. I complained that my vision was way off after cataract surgery and I could see better when I tilted my head a lot. My cataract surgeon found the toric implant to be and said it needed to be corrected, which lead to a second surgery on same eye. I have been complaining for the whole time since then to my eye doctor and my cataract surgeon that my vision became blurry and I am not able to focus both eyes together-my vision is terrible. Now, my Cataract Surgeon tells me the toric lens implant rotated again and he will not reposition it as a thick haze has developed which makes it difficult to read and see with that eye. They recommend I have a laser treatment in the surgeon's office to help get rid of the haze, but once I do that I cannot have the lens repositioned. I am at a loss of what to do, as my vision is so terrible and I can no longer read. I have asked my eye doctor to send me to another eye specialist and surgeon for second opinion and recommendation but he said I have to finish with my current Cataract Surgeon. Help - is there something that can be done to improve my vision since the second time toric lens rotated it is still off.

Answer: Most Cataract Surgeons would not go back yet again and reoperate to correct the rotation of the toric lens implant-too much surgery. A YAG Laser Capsulotomy would BE THE LAST STEP to be taken after all other options for correcting your vision have been explored. There may very well be posterior capsular opacification or a secondary cataract causing the haze-or there may be other problems with the lens capsule causing the haze. It needs to be carefully determined. Also, a very careful refraction and examination of the amount and direction of the astigmatism present on your cornea needs to be observed. Further, a careful and thorough examination of your retina, especially the macula, needs to be performed to be certain that there is no swelling causing the distortion of your vision. One would suspect that the initial toric lens implantation was performed “off axis” as these lenses do not typically rotate excessively as you describe-but it could happen. You should find the best Cataract Surgeon in your area and seek a second opinion.

Retinal Detachment Risk after Cataract Surgery

Question: I am concerned about my risk of retinal detachment after cataract surgery. I am 75 years old, myopic, 75 yrs old and had retinal tears in each eye 13 years ago. What is the chance of retinal detachment after cataract surgery?? I am not ready to have cataract surgery yet but it is causing many sleepless nights

Answer: If it has been 13 years since the repair of your retinal tears-and they were treated with a laser at that time-one would assume that they have been well sealed and the retinas are stable and well attached. To confirm this you should have a consultation with your retinal specialist prior to your cataract surgery who can then clear you for the cataract operation. Once these precautions have been taken, it is likely that with an experienced Cataract Surgeon performing your procedure you will have a safe and predictable outcome.

Secondary Cataract Development Timing

Question: I have a question about the time to develop a secondary cataract. I am a 56 year old woman who had cataract surgery just 3 months ago in my left eye and 2 months ago in my right. My vision was perfect immediately after surgery--20/20 at distance and I could read without glasses pretty well. Now my close up vision is blurry and my intermediate vision in my left eye is also getting blurred. I am told this is due to a secondary cataract. Does this sound right? Do they happen this fast?

Answer: A secondary cataract, which is called posterior capsular opacification or “PCO”, is not an uncommon occurrence after cataract surgery and lens implants. In fact in some reports as many as 30% of patients having cataract surgery actually develop posterior capsular opacification. While the timeframe for the development of PCO can vary widely, it is possible for it to occur in patients a few months after their cataract removal. Depending on the density of the cataract removed, the difficulty of the actual procedure and many other factors can accelerate PCO formation. Fortunately, PCO is readily treatable with a YAG Laser Capsulotomy-a painless, quick and very effective laser treatment that produces almost instant improvement of vision.