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Medical Forum / General / Vision / November 2007Reduce risk of retinal detachment in cataract surgery by not inserting lens?
I am fairly nearsighted and need cataract surgery in both eyes. My surgery is scheduled for next Wednesday. My last prescription for glasses was around 5-6 diopters in both eyes. I'm wondering if it would significantly reduce the risk of retinal detachment by asking my eye doctor to not insert a replacement lens but instead correct my vision completely with glasses? Any comments or suggestions would be appreciated. Thanks in advance! >I am fairly nearsighted and need cataract surgery in both eyes. My > surgery is scheduled for next Wednesday. My last prescription for [quoted text clipped - 3 lines] > vision completely with glasses? Any comments or suggestions would be > appreciated. Thanks in advance! No it would not. If your retina is at risk, it's because your eye grew long and created stretch in the retina. Removing the lens doesn't make your eye shorter. Not all -5/-6 retinas show signs of stretch, so it may not be much of an issue. In any case, you'll want an implant. Without _any_ implant you'll need +14.00 contacts or glasses. The implant can be chosen to eliminate the need for distance correction, or to leave you a little nearsighted, whatever you and your doctor decide. -MT, OD > No it would not. If your retina is at risk, it's because your eye grew long > and created stretch in the retina. Removing the lens doesn't make your eye > shorter. I was thinking that the less manipulation and jerking that my eye undergoes, the more likely my retina will remain intact. Will the new lens add any additional fluid pressure or shock waves on the retina that could make it come loose? Also, without implanting a plastic lens, I wouldn't have to worry about alergic reaction to the material. > Not all -5/-6 retinas show signs of stretch, so it may not be much of an > issue. [quoted text clipped - 3 lines] > for distance correction, or to leave you a little nearsighted, whatever you > and your doctor decide. -14 must be really thick glasses. I was thinking that my idea would probably not be practical because the old lens capsule would not have a well defined shape or a constantly changing shape that would affect my vision. > -MT, OD > I was thinking that the less manipulation and jerking that my eye > undergoes, the more likely my retina will remain intact. Will the new > lens add any additional fluid pressure or shock waves on the retina > that could make it come loose? Those pressures are negligible. The only way it would cause detachment is if you have a big retinal tear just waiting to detach, and that's ruled out by a dilated examination before the surgery. > Also, without implanting a plastic > lens, I wouldn't have to worry about alergic reaction to the material. That might be possible but I've never seen or heard of it. I'm sure there are newer materials but classically implants are made of PMMA (plexiglas) and humans just don't react to PMMA. > I was thinking that my idea would > probably not be practical because the old lens capsule would not have > a well defined shape or a constantly changing shape that would affect > my vision. The capsule is normally transparent so that wouldn't be much of a factor. The main thing is you're removing a lens with +15 or +20D of power and it must be replaced by _something._ In your case, just subtract 6 diopters and you come out "plano" with clear distance vision. -MT Dear Mark, Any operation on the eye entails risk. At the point they must remove the "cataract" lens, the risk is probably not changed to insert a replacement lens at that point. You should ask you MOD about this issue. But the GREAT thing about that replaced internal lens is that you get your distant vision BACK. You will have a choice of very-sharp distant vision, and some loss of near vision, or an "intermediate" refractive state, of prehaps -1 diopter. Best, Otis > I am fairly nearsighted and need cataract surgery in both eyes. My > surgery is scheduled for next Wednesday. My last prescription for [quoted text clipped - 3 lines] > vision completely with glasses? Any comments or suggestions would be > appreciated. Thanks in advance! On 11/1/07 8:05 AM, in article 1193929550.844885.260880@z9g2000hsf.googlegroups.com, "Mark" <mkhuebner@gmail.com> wrote: > I am fairly nearsighted and need cataract surgery in both eyes. My > surgery is scheduled for next Wednesday. My last prescription for [quoted text clipped - 3 lines] > vision completely with glasses? Any comments or suggestions would be > appreciated. Thanks in advance! Actually, NOT implanting a lens probably INCREASES risk of a retinal detachment. The lens in place stabilizes the iris diaphragm, and reduces forward movement of the vitreous, which is the factor thought to induce retinal detachments by a tractional mechanism. In addition, the implant reduces incidence of contracture and opacification of the capsular bag, which would become more hazy and require a discission of to open it, again increasing vitreous forward movement, and increasing risk. The iplant you need might be very low power, even plano, or in some cases being a negative power. These lenses are made in such powers for situations like this. I will be operating on a -18 eye that is about 32 mm long soon - haven't decided on the IOL power yet. David Robins, MD Board certified Ophthalmologist Pediatric ophthalmology and adult strabismus subspecialty |
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