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.

Scratched Cornea after Cataract Surgery

Question: I had cataract surgery in my right eye 7 weeks and afterward I had a scratch on my cornea from the bandage and went right back to the cataract surgeon. He said it was improperly bandaged. I am still dealing with a severe astigmatism (+5) due to the swelling. He ruled out corneal disease with topography and am now taking Acular. How long will I have to wait for the swelling to decrease and vision to get better? It concerns me because around light it looks like a lighted up partial cob web.

Answer: You are correct in questioning why the recovery from a scratched cornea and the associated corneal edema has persisted for many weeks. Certainly residual corneal edema can result in astigmatism but as you suggest this is an awfully long time to manifest corneal edema unless there is some other underlying cause. While it is possible, it does beg the question of whether some other corneal problem is causing the swelling and astigmatism to persist. Your description of a “partial cob web” is also curious. If in fact other types of corneal disease such as corneal dystrophies have been ruled out it might be worth exploring the possibility that the initial appearance of a scratched cornea was possibly due to a corneal infection such as Herpes Simplex Keratitis and not really simply a scratched cornea. While only a remote possibility, it should be explored along with other possibilities. A simple scratched cornea and the associated corneal edema should have healed by now and thus further examination might be important. If there is any doubt then you may want to consider scheduling a consultation with 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.

Eye Surgery Stress & Dog Therapy

“Any type of surgery-especially eye surgery such as cataract surgery can be stressful for patients,” commented Connecticut Cataract Surgeon Leslie Doctor, M.D. “Our staff and facility at the Wilton Surgery Center are really excellent at making cataract surgery patients feel relaxed and comfortable. Nonetheless I found a recent article in the journal Pain Medicine regarding how dog therapy can decrease emotional stress and promote a sense of well being pretty intriguing.”


Dog therapy and petting your dog before your cataract surgery might just find its way into the preoperative counseling given to cataract patients before their eye surgery, if recent reports from the 6th World Congress of the World Institute of Pain and published in Pain Medicine are any indication. By interacting with a dog and petting a dog there is actually a decrease in a whole host of biochemical markers including stress hormones along with increases in endorphin levels-both of which are long lasting after you have left the dog’s company.

“I know that the advanced cataract surgery procedures we use for our patients is geared to getting the best clinical results, as well as to help our cataract patients from all over Maine have an easy, quick and comfortable recovery from their cataract surgery,” noted Maine Cataract Surgeon Bruce Cassidy, M.D. of Eyecare Medical Group in Portland. “We are very attentive to making sure our preoperative medications really help cataract patients to be calm and relaxed. As a dog lover myself, I do appreciate the calming effect petting my dog has after a long day of cataract surgery.”