 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Glaucoma / February 2004Cataract Questions, & Glaucoma Starting new thread for earlier question
Rick Cohn, M.D. wrote: > TNARTLADY@webtv.net (\( TN Artist, trish,tn \)) wrote in message news:<10816-400B1980-124@storefull-3251.bay.webtv.net>... >> I would like to know what the symptoms are when a person needs >> cataract--surgery --My Opthamalogist said mine may be ready around >> August --I have noticed my parking leaves a lot to be desired lately.; ) >> & My eyes are Real sensitive to the sun .Lately they feel like they are >> full of fluid -unusual since I have dry eyes . > > Not sure why you posted this under the "Diamox" topic, but I'd be > happy to answer your question. The most common symptom of cataracts > is glare, especially while driving at night Oncoming headlights often > appear like starbursts (I don't mean those chewy fruit candies) and > bright sunlight can be disturbing as well. It becomes hard to read > street signs, and reading books may become somewhat difficult. A > shift towards increased nearsightedness may cause a change in eyeglass > prescriptions. Vision very gradually takes a yellowish tint, making > it hard to distinguish certain colors easily (for instance black from > navy blue). Many patients won't notice the color change as it occurs > quite gradually. After the first cataract is removed, then the > patient becomes very aware of the change when comparing the vision in > the surgical eye with the eye that still has a cataract. I get > comments from my patients like, "Wow, I didn't realize how dim things > had become!" or "The colors are fantastic!" For the average patient, > cataract surgery is a breeze...it should take between 5 and 30 minutes > depending on the surgeons experience and the difficulty of the > cataract (on average it takes me 8 minutes to remove one). Dryness of > tearing has little to do with cataracts. Hope that answered some > questions. > --Rick Cohn, MD > Glaucoma Specialist Dr, Rick. I was just told by my glaucoma specialist (Ihave ocular hypertension) that I have a cataract that is hindering my vision," though not yet "ready for removal. So, your answer abovw was very timely & helpful. I'm not sure what kind of cataract it is. It's in my good reading left eye. I have a kind of monovision, as the left eye is nearsighted and the right is farsighted. I am 60. What type of urgery do you prefer? Do you use "PE" ultrasound to remove the cataract pieces? Do you use any stitches? Any pros and cons re the different surgery procedures? Do you prefer acrylic or silicon IOLs? Thanks! Carolyn  SignatureA contented malcontent. http://www.equalizers.org > What type of urgery do you prefer? Do you use "PE" ultrasound to remove > the cataract pieces? Do you use any stitches? Any pros and cons re the > different surgery procedures? Do you prefer acrylic or silicon IOLs? > Thanks! > Carolyn I perform an 8 - 10 minute phacoemulsification surgery (using ultrasound to break up the cloudy lens) through a clear-corneal microscopic incision with topical anesthesia. That means no long needles to numb the eye (just drops), but I do use some mild I.V. sedation to help you relax. My tiny incision is self-sealing, so no stitches are used. Patients go home with a clear shield and no patch...they take the shield off at home and can immediately use the eye. I use both silicone and acrylic lenses depending on which surgery center I operate at (some centers use silicone more often because these lenses are much cheaper...both work great, though). Phacoemulsification is the best technique available. Some have experimented with the use of lasers to remove cataracts, but no advantages were found over ultrasound, and laser is certainly riskier as it is a flammable heat source. Extracapsular techniques involve a larger incision with 5-8 sutures needed to close the eye. This surgery was very popular before phacoemulsification, but it is only used today by older surgeons (those who didn't train in the days of phaco) or on extremely dense cataracts. If your surgeon doesn't do phaco...try another surgeon!!! Typically I will do between 10 and 15 cataract surgeries between 7 AM and 11:30 AM on a Tuesday morning...as I said, it's a pretty quick procedure if the right person is doing it. You might ask the surgeon how long the procedure takes...if he/she says 20 minutes or longer, also find another surgeon. Hope that answers some questions. Good luck to you. --Rick Cohn, MD Glaucoma Specialist Winter Park, FL > I perform an 8 - 10 minute phacoemulsification surgery (using > ultrasound to break up the cloudy lens) through a clear-corneal [quoted text clipped - 24 lines] > Glaucoma Specialist > Winter Park, FL Dr. Rick, Once again, a very thorough, reassuring response. I wish I lived in Florida, sigh...You also answered my important unasked questions: re if my surgeon doesn't do phaco, takes longer... and what about laser.Thanks!! Carolyn SignatureA contented malcontent. http://www.equalizers.org Carolyn I agree --wish I lived in Fla --these posts have been so helpful to me - I'm sitting here taking notes . AND it is SO good to see a lot of genuine posts here !!!!! Question -do most patients toss their glasses after catarct surgery , DR. C ??? I have astigmatism --doubting that I would not still use my Bi focals . > Carolyn I agree --wish I lived in Fla --these posts have been so helpful > to me - I'm sitting here taking notes . AND it is SO good to see a lot > of genuine posts here !!!!! Question -do most patients toss their > glasses after catarct surgery , DR. C ??? I have astigmatism > --doubting that I would not still use my Bi focals . Most patients still need some glasses after cataract surgery, mostly for reading, occasionally for both reading and distance. Patients with preoperative astigmatism are more likely to need glasses after cataract surgery. --Dr. C This was the answer I expected . thanks ! I called MY Opthamalogist 's nurse and asked her what procedure he used to remove cataracts --this is what she said --He does a micro-incision with a topical antisceptic , when I asked is this with a lazer she said a Phaco --faco ? machine -well duh --hopefully this means -your procedure Phacoemulsification ????? > This was the answer I expected . thanks ! I called MY Opthamalogist 's > nurse and asked her what procedure he used to remove cataracts --this is > what she said --He does a micro-incision with a topical antisceptic , > when I asked is this with a lazer she said a Phaco --faco ? machine > -well duh --hopefully this means -your procedure Phacoemulsification > ????? Yes, a phaco machine means phacoemulsification, ultrasound energy. Topical anesthetic (not antisceptic) is what numbs the cornea so you don't feel the micro-incision. No laser is involved. --Dr. C. > I perform an 8 - 10 minute phacoemulsification surgery (using > ultrasound to break up the cloudy lens) through a clear-corneal > microscopic incision with topical anesthesia. <snip> You might ask the surgeon > how long the procedure takes...if he/she says 20 minutes or longer, > also find another surgeon. Hope that answers some questions. Good > luck to you. > --Rick Cohn, MD > Glaucoma Specialist > Winter Park, FL Dr. Rick, Ii did ask my glaucom specialist, and he said 20-30 minutes re phaco. When I mentioned the shorter time preference, he said that those who do it that quickly have more problems and do not stay with the patient as long,leaving it to others. He said he is careful, so it takes longer. Are you counting just the actual surgery time? Also, I have seen recommendations for using NSAIDs for three days before surgery to reduce inflammation, and steroids after. Do cou concur? Thanks, Carolyn SignatureA contented malcontent. http://www.equalizers.org > Dr. Rick, > Ii did ask my glaucom specialist, and he said 20-30 minutes re phaco. > When I mentioned the shorter time preference, he said that those who do > it that quickly have more problems and do not stay with the patient as > long,leaving it to others. I'm in the room with the patient for 20 minutes but the surgery takes me 10. I don't "leave anything to others." I start the case and finish the case and talk with the patient afterwards in the O.R. He said he is careful, so it takes longer. >Maybe so...that doesn't mean he's a bad surgeon. You need to assess your level of comfort with him. > Are you counting just the actual surgery time? (for me, yes) > > Also, I have seen recommendations for using NSAIDs for three days before > surgery to reduce inflammation, and steroids after. Do cou concur? Some use one, the other, or both. I only use NSAIDs in patients more likely to develop increased inflammation or swelling in the retina...particularly diabetics or patients with very dark brown eyes (African Americans). Otherwise I use Pred Forte 1% 4 times a day for a week along with Zymar, an antibiotic drop. I stop the Zymar at 1 week and taper off the Pred Forte over 1 month. --Dr. C >>Dr. Rick, >>Ii did ask my glaucom specialist, and he said 20-30 minutes re phaco. [quoted text clipped - 24 lines] > week and taper off the Pred Forte over 1 month. > --Dr. C Dr, Rick, Once again, a very helpful reply. I suspect that you and my Dr. actually agree, e.g., 20 min. total time; 10 actual surgery time. I'll check that out with him. Thanks! Sorry, but one more question. The Wills site also suggested steroids after. 9ince rhey can raise IOPs for some time after, you (and they must consider the benefit worth the risk in this case? Thank you for being here!! Carolyn SignatureA contented malcontent. http://www.equalizers.org >>> Dr. Rick, >>> Ii did ask my glaucom specialist, and he said 20-30 minutes re phaco. [quoted text clipped - 37 lines] > Thank you for being here!! > Carolyn Dr. Rick, Eek. A sheet on Pred Forte notes that "If you have had cataract surgery, this medication can delay healing." Any thoughts/advice? This gets more and more complicated, I guess medicine does that. Thanks again, Carolyn A contented malcontent. http://www.equalizers.org > > Sorry, but one more question. The Wills site also suggested steroids > > after. 9ince rhey can raise IOPs for some time after, you (and they must [quoted text clipped - 7 lines] > > Any thoughts/advice? Yes...1) you worry too much (I don't hold that against you...I come from a long line of worry-warts) and 2) you should never EVER read package inserts on medications. I use Pred Forte on EVERY postop cataract...without it the eye will be quite red and sore for up to two weeks, and inflammation can lead to swelling in the retina and permanently blurred vision. I'd risk a little pressure elevation (which I virtually never see, even in my glaucoma patients) for the comfort. --Dr. Cohn >>>Sorry, but one more question. The Wills site also suggested steroids >>>after. 9ince rhey can raise IOPs for some time after, you (and they must [quoted text clipped - 18 lines] > comfort. > --Dr. Cohn Dr. Rick, Haha, I guess you put it in perspective. My husband kids my sister and me about our "nedical network," since as a school psychologist and a psychiatric social worker we do a lot of research of medical issues. :-) (And both of our fathers died prematurely due to medical errors.) Thanks for the reassurance, once again. It's just that as a constant reader who loves to drive, I'd hate to jeopardize the precious vision. With gratitude, Carolyn Worry Wart no 2 here again ; ) I worry about Prednisone and glaucoma --since I am occasionally on a "burst " for COPD. I hav e read that Pred can Cause glaucoma ???? another question --how soon after Cataract can one safely resume exercise ?.I am going to a re-hab for copd where I use the Bike and the Row machine while on o² . > Worry Wart no 2 here again ; ) I worry about Prednisone and glaucoma > --since I am occasionally on a "burst " for COPD. I hav e read that Pred > can Cause glaucoma ???? another question --how soon after Cataract > can one safely resume exercise ?.I am going to a re-hab for copd where I > use the Bike and the Row machine while on o=B2 . While oral Prednisone can raise IOP, it is quite uncommon...It is rare compared to the use of topical prednisolone acetate drops used to fight ocular inflammation. If you're concerned, simply get your IOP checked next time your are pulsed with steroids. Regarding the exercise, that's up to your surgeon. Ask him or her. I let patients do aerobic exercise (tread mill, cycling, stairmaster) the day after surgery and golf or tennis is okay two or three days later. No swimming for at least a week, and no weight lifting also. Better ask your doc for his/her preferences, you worry wart. --Dr. C > I let patients do aerobic exercise (tread mill, cycling, > stairmaster) the day after surgery and golf or tennis is okay two or > three days later. No swimming for at least a week, and no weight > lifting also. Better ask your doc for his/her preferences, you worry > wart. What are your thouhts about isometric exercise in general? I've come across some references that say it can raise blood pressure, but nothing about IOP. > > I let patients do aerobic exercise (tread mill, cycling, > > stairmaster) the day after surgery and golf or tennis is okay two or [quoted text clipped - 5 lines] > across some references that say it can raise blood pressure, but nothing > about IOP. Never seen any studies on this...personally I don't have a problem with any type of exercise in glaucoma patients. Hanging in an inverted postition is not recommended though. --Dr. Cohn LOL are there any Bats Here ? > Never seen any studies on this...personally I don't have a problem > with any type of exercise in glaucoma patients. Hanging in an > inverted postition is not recommended though. What, not even for sex? ;-) MC <copeSPA@MZAPca.inter.net> wrote in news:copeSPA- 3EBB3B.03525901022004@mail.inter.net: >> Never seen any studies on this...personally I don't have a problem >> with any type of exercise in glaucoma patients. Hanging in an [quoted text clipped - 3 lines] > > ;-) Only for no longer than 10 seconds <g>. Sherry > MC <copeSPA@MZAPca.inter.net> wrote in news:copeSPA- > 3EBB3B.03525901022004@mail.inter.net: [quoted text clipped - 8 lines] > > Only for no longer than 10 seconds <g>. I'm a guy, so that's not going to be a problem... ;-) Hmmm --I like your advice best concerning exercise --maybe I will ask my Dr . and maybe ------ Hi Dr. Rick, Your response to the cataract question certainly stirred a lot of interest. I have one more question. I've noticed in recent years that people who have had cataract surgery in both eyes several years apart end up with one eye that looks normal from the outside, but the newer implant has a sparkling, artificial, weird look. Evidently the type of lens is different. This is particularly non-cosmetic when only one eye is involved, and is still undesirable at best with both eyes. If there is no other alternative, I would be inclined to delay surgery as long as possible. How would you respond to this? > Hi Dr. Rick, > [quoted text clipped - 10 lines] > > How would you respond to this? You have made a very good observation...the reflection you are talking about comes off of acrylic implants...it is not particularly visible off of silicone implants. Since both types are very well tolerated (except only in patients with chronic or recurrent uveitis, or in those with significant diabetic retinopathy, in which case acrylic might be preferable), simply ask your surgeon if he/she uses silicone (if the reflection is particularly bothersome to you. Hope that helps --Rick Cohn, MD Now, that's a helpful interchange, re something I'd never considered or heard of. Thanks! >>Hi Dr. Rick, >> [quoted text clipped - 19 lines] > (if the reflection is particularly bothersome to you. Hope that helps > --Rick Cohn, MD SignatureA contented malcontent. http://www.equalizers.org Dr. Cohn , What are the chances of the cataracts coming back after surgery ? I ask because some of my meds for copd -can cause cartaracts. Also Lately I have noticed I have a problem judgeing distance -much to the shagrin of a lady in Wally Marts recently as I bumped her twice with a cart --!!!!! LOL was I imbarrased !! would this relate to cataracts ? > Dr. Cohn , What are the chances of the cataracts coming back after > surgery ? I ask because some of my meds for copd -can cause cartaracts. > Also Lately I have noticed I have a problem judgeing distance -much to > the shagrin of a lady in Wally Marts recently as I bumped her twice > with a cart --!!!!! LOL was I imbarrased !! would this relate to > cataracts ? Cataracts can never come back...once they're gone, they're gone for good. All that we leave behind when a cataract is removed is the back membrane (posterior lens capsule) of the natural lens, against which we place the lens implant inside the eye. In 30 - 60% of patients who have cataract surgery, that membrane will become hazy anywhere from 3 months to 5 years after surgery (avg. about 1.5 years). Then a YAG laser can be easily used in a 1 minute painless procedure to pop a small hole in the membrane to allow the patient to see better. This is the one and only time that laser is used in regard to cataracts in the eye (remember that cataracts are broken up with ultrasound, not laser). Some call this hazy membrane a "secondary cataract" but I don't like that term because it sounds like the cataract is growing back, which it isn't. Regarding you bumping the same lady twice, we call that being a klutz! LOL. Sigmund Freud used to say that there's no such thing as a mistake. If you bumper her twice, you subconsciously WANTED to bump her...maybe she looked like an old enemy from your youth...hmm? Take care, Rick Cohn, MD LOL --I wanted to BUMP that nice lady ? klutz fits -and I like that better-er ! Better to be a Klutz than just plain mean ; ) I HOPE I don't have to deal with a Yag Lazer -sounds grosse , but thanks for warning me ; ) |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.