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Medical Forum / General / Vision / March 2007info on cataract surgery
hello, I am a 49 year old woman. When I was 29, i suffered a retinal detachment in my left eye. This was repaired with a silicon buckle. Two years later, \i had a detachment in my right eye, once again it was repaired witha buckle. Two years after that, \i develolped an allergy to silicon and had to have both buckles removed. \luckily, the car tissue has held everything in place since. About 10 years ago, i developed macular degeneration (wet form) in my left eye and am bacically blind in that eye. \now, i have started to get cataracts in both eyes. Aside from the fact that this all seems totally unfair for one person, I am wondering if there ia anyone else out there who has had so much eye problems!! The idea of more surguery is frightening as every surgery seems to take away a bit more of my precious little bit of vision. \i would appreciate any input from anyone who has experienced anything close to this. You are right, this doesn't seem fair to have suffered so many problems with your eyes. My father-in-law is a retinal specialist and I asked him about your problem. He said it isn't that uncommon to see this combination of problems - he has several patients who have similar medical histories. He combines the surgery with medicinal treatments. He's based in Italy and developed Phototrop, which is an omega-3 based formula that improves the healing of the retina, plus an anti-inflammatory composition. Unfortunately, Phototrop is currently unavailable in the States. I myself am trying to get his formula on the U.S. market along with his new anti-inflammatory product, but that won't be until the Fall of this year, so I don't have an immediate solution for you. I hope you can use some of this information to help your doctor provide you with the best treatment. What's really surprising is that you got wet mac degen at age 39. I would think that is very uncommon and would recommend you do everything possible to keep yourself healthy (careful diet, regular exercize, etc). The early cataracts may have resulted from the other surgeries, but are relatively easy to fix. I would make sure the retinas are firmly "down" before going in (maybe a second retinologist opinion), but the surgery for cataracts is pretty simple and safe. Don't let them talk you into any kind of multifocal or "focusing" IOL. As bad luck as you've had, it's not the worst. Consider my patient, about your age, who went in for lower back surgery a couple of years ago. She had 20/20 vision both eyes. Came out of surgery totally blind in both eyes (4+ hours face down under general anesthesia apparently cause extremely low blood pressure that killed her optic nerves). Now she has a guide dog and is learning braille, but at least her house was paid for by the settlement. There's always someone in worse straits. w.stacy, o.d. >hello, > [quoted text clipped - 14 lines] > > > I would make sure the retinas are > firmly "down" before going in (maybe a second retinologist opinion), but > the surgery for cataracts is pretty simple and safe. Don't let them > talk you into any kind of multifocal or "focusing" IOL. The cataract consent form that I am looking at has the following statement, "The doctor has explained to me that there is even a possibility of some other complication occuring, which has not been specifically listed in this consent. In addition, as in any operation there is the rare possibility of drug reactions, serious bodily harm, or even death". It is nice to know the operation is "pretty simple and safe", otherwise. Don W. > The cataract consent form that I am looking at has the following > statement, "The doctor has explained to me that there is even a [quoted text clipped - 5 lines] > It is nice to know the operation is "pretty simple and safe", > otherwise. It is usually safe but they will cover themselves with disclaimers. And after all it is surgery. That is why you don't want to have it unless your quality of life is affected, like for example you can't drive.  SignatureCharles > It is usually safe but they will cover themselves with disclaimers. And > after all it is surgery. That is why you don't want to have it unless > your quality of life is affected, like for example you can't drive. > > -- > Charles Yup, Death would affect my (as they say) QoL. Don W. > > I would make sure the retinas are > > firmly "down" before going in (maybe a second retinologist opinion), but [quoted text clipped - 10 lines] > It is nice to know the operation is "pretty simple and safe", > otherwise. Crossing the street is simple and safe. Still, people die. Cataract surgery is pretty minor, but the consent form isn't. > > otherwise. > > Crossing the street is simple and safe. Still, people die. Cataract > surgery is pretty minor, but the consent form isn't. Cataract surgery is known to accelerate the onset of macular degeneration. Or make a present MD shituation worse. The operation may be simple but the surrounding conditions may make it unsafe. Don W. >Cataract surgery is known to accelerate the onset of macular >degeneration. Or make a present MD shituation worse. The operation [quoted text clipped - 3 lines] > > Those are strong words. I don't think it's been established that cat. surg. accelerates the onset; in fact how would that be proven? It would have to be quite a study. And most MD patients end up with better vision post cataract surgery. The last sentence may be true for some special conditions, but the procedure remains very safe in good hands, and pretty risky in bad hands. You might be jumping to some conclusions, as you could say the incidence of death among cataract surgery recipients is higher than the incidence of death in the general population. That would be a true but meaningless statement, due to the age gradient. What would also be true but perhaps more meaningful is that people with cataracts live longer if they have IOLs installed than if they don't. w.stacy, o.d. > Those are strong words. I don't think it's been established that cat. > surg. accelerates the onset; in fact how would that be proven? It > would have to be quite a study. And most MD patients end up with better > vision post cataract surgery. In some of the references relating cataract surgery and MD, there is a split as to their relationship. In one reference Dr. Wong (Ref 1), says, "The relationship between cataract surgery and ARMD has been inconsistent". And he cites the Beaver Dam Eye Study where they found a 5 year progression of MD (after cataract surgery). Then he cites studies where no associations have been found. Lundstrom (Ref 2) in his study concluded that subjects in various stages of dry MD improved their visual function. Ambrecht (Ref 3) said QoL (Quality of Life) was maintained (Like "Do no harm"!) after cataract removal in mild and moderate ARMD group and no increase in rate of progression of MD. However, there is one paper by Kaiserman (Ophthalmology 2007; 114: 278-282) titled "Cataract Surgery Is Associated with a Higher Rate of Photodynamic Therapy for Macular Degeneration"). He argues that the increased rate of PDT (due to increased rate of MD) is associated with the onset of cataract surgery and compares this between matched groups. That is, one group has cataract surgery and has a certain rate of PDT, and the other matched group does not have the surgery and has a lesser rate of PDT. The conclusion in all of this, it seems for me, is that if the cataract is minor and the MD is mild or moderate, you can expect improvement. But, if the cataract is not minor, and the MD non- minor , then cataract surgery my not be beneficial, and possibly do harm. Don W. Ref 1. Wong, Editorial. "Cataract surgery in patients with cataract and age related macular degeneration: do the benefits outweigh the risks"? Br J Ophthal 2000; 84 Ref. 2. Lundstrom, "Cataract surgery and quality of life in patients with age related macular degeneration". B J Ophthal 2002; 86 Ref 3. Armbrecht, J Cataract Refract Surg 2003; 29 > > > otherwise. > > [quoted text clipped - 4 lines] > degeneration. Or make a present MD shituation worse. The operation > may be simple but the surrounding conditions may make it unsafe. Then again, as the cataract progresses, the patient goes blind. How fun is that? > > > otherwise. > [quoted text clipped - 6 lines] > > Don W. I hadn't heard that cataract surgery accelerates MD. Both the wet and the dry? I had cataract surgery in my left eye a couple of years ago although I didn't see any difference in my vision after the surgery. I have the same prescription now as I had as a teenager. I had been told that I had 3 or 4 medium size drusen. Now they seem concerned about these drusen but they never told me that they could be made worse by surgery. >>>>otherwise. >> [quoted text clipped - 14 lines] > these drusen but they never told me that they could be made worse by > surgery. I think the above was a gross exaggeration. There is some speculation that cataract surgery may affect the evolution of mac. degen, but to my knowledge it's never been pinned down very well scientifically. Most people with both mac. degen. and cataracts have their cataracts and do far better than if they just leave the cataracts alone... > hello, > [quoted text clipped - 12 lines] > bit of vision. \i would appreciate any input from anyone who has > experienced anything close to this. Been there and done that. I've had retinal detachments in both eyes. The buckle in my right eye is fine, although, there is astigmatism that isn't correctable. I've had cataract surgery in both eyes. I didn't get a buckle in my left eye, since it would worsen my vision. I see well. A good surgeon will not take away from your vision. |
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