Lasers May Make Cataract Surgery Safer

According to data presented at the annual American Academy of Ophthalmology meeting, pretreatment of cataracts with a laser could make the procedure safer. Two studies considered the use of lasers to soften cataracts before cataract surgery and suggest that this could make cataract surgery safer.

In the past, cataract patients were asked to let their cataracts “ripen,” meaning the proteins would congeal to the point that the crystalline lens was firmer and easier to remove. Now, though, in most cases the lens in broken up in ultrasonic phacoemulsification and then suctioned out, which does not require the lens to be firm. In fact, it is easier to emulsify the lens if it is less firm.

To accomplish a less firm lens, a femtosecond laser (the same one used to create a flap in some LASIK procedures) is used to deliver near-infrared light that fragments the lens so ultrasound is less necessary or even unnecessary. The femtosecond laser procedure has been FDA-approved, but is not widely used because its benefits are not well understood.

In one study, 29 patients all had the femtosecond laser procedure in one eye and standard cataract surgery in the other eye. The femtosecond laser was used to etch cross-hatch patterns in the surface, essentially scoring the lens for fragmentation. These lenses required 45% less ultrasound energy to fragment, and surgeons made 45% fewer movements.

The second study looked at the incidence of cell damage caused by laser cataract surgery vs. conventional surgery. In 225 eyes where laser lens fragmentation was preserved, no endothelial cells were lost from the cornea. In eyes receiving standard cataract surgery treatment, 1-7% of endothelial cells were lost. Endothelial cells represent the innermost layer of the cornea and are a useful gauge of eye health because they do not regenerate.

Lasers can also be used to perform precise, accurate, and repeatable incisions for cataract surgery, unlike manual surgery, which is more variable.

It is unknown whether laser cataract surgery will take off in the future, but it does seem to have significant advantages. To learn which procedure is right for you, please contact a local ophthalmologist.

Cataract Surgery Improves Mood, Sleep in Alzheimer’s Patients

According to findings presented at the annual meeting of the American Academy of Ophthalmology, cataract surgery can improve the mood and sleep patterns of Alzheimer’s patients. Although some advocates had feared that cataract surgery may worsen dementia and other mental health symptoms, cataract surgery actually created a marked improvement in two key indicators for patients.

The relatively small study looked at 38 Alzheimer’s patients with an average age of 86, the majority of whom were women. They were evaluated before surgery and three months after surgery. By three months, most patients have stable vision and are considered to have achieved final results from cataract surgery.

Seven of these patients had been rated as “depressed” before surgery. Six of them showed improvement, while the other remained about the same. Three out of four patients showed improved or unchanged scores in mood, memory, and their ability to function independently. Researchers pointed out that cataract surgery might help improve “sun-downing” behavior in which Alzheimer’s patients experience decreased memory and depression when the sun goes down. By improving night vision, cataract surgery might help Alzheimer’s patients to use visual clues to context themselves.

The survey also evaluated the benefits for caregivers. Although fewer experienced significant benefits, one in four caregivers reported that caring for their loved one was easier. Unfortunately, about the same amount reported that it was harder, most commonly because of increased agitation.

One of the main limitations of the study was that there was no control group. However, this is a worthwhile study because it dispels the myth that Alzheimer’s patients will not benefit from cataract surgery. This paves the way for more Alzheimer’s patients to get cataract surgery in the future as well as future studies that will demonstrate the benefits of the surgery for this demographic.

To learn more about the benefits of cataract surgery or to schedule a cataract surgery for yourself or a loved one, please contact a local ophthalmologist today.

Smoking and Vision Damage

It is common knowledge that smoking poses serious health risks. Most notably, smoking dramatically increases your risk of respiratory conditions such as lung cancer, asthma, and emphysema. But did you also know that there is a strong link between smoking and vision damage?

When you smoke, you are introducing thousands of chemicals into your bloodstream. Many of these chemicals are harmful and can potentially damage your eyes. In fact, smoking increases your risk of two common age-related vision conditions: cataracts and macular degeneration.

Cataracts are a condition occurring when your eye’s lens becomes clouded. Studies have found that people who smoke more than 15 cigarettes a day face a three times greater risk of developing cataracts than nonsmokers. This is due to the fact that cigarette smoke increases the oxidative stress in your eye’s lens, which increases the likelihood of cataracts.

Age-related macular degeneration (AMD) is the leading cause of blindness for people over the age of 65. Smoking is the leading preventable risk factor for this condition. Cigarette smoke affects your macula, the component of your retina which provides you with sharp vision. A recent study found that approximately 25% of AMD cases were directly related to smoking.

If you smoke cigarettes, it is important to go for regular vision checkups with your ophthalmologist as you get older to make sure you catch these conditions in their early stages. The longer you wait, the greater your chances of suffering serious vision loss.

Please contact eyes.com today to find an experienced ophthalmologist in your area.

Cataract Patients May Experience Increased Pain with Second Cataract Surgery

Tuscon, AZ – A study shows that patients who need to undergo a second cataract surgery may have an increased level o f post-operative pain. It is believed this is the result of decreased anxiety before their procedure, and is likely psychological. That is to say, they never saw it coming.
The authors of the study state, “Having enjoyed a successful first cataract extraction, a portion of patients may subsequently approach their second cataract extraction with less trepidation but also an expectation of less pain. Any pain they experience is then perceived as significant.”
The recommendation for these patients is preoperative counseling. Although the patient may know quite a bit about the cataract procedure from their first surgical experience, doctors should not assume they know a lot about it. The authors say surgeons should take some extra time to discuss with patients that they may experience more discomfort than the first time because they will be more aware of what is going on.
It is believed that this is the first study of increased pain in a second procedure for eye surgery patients, although the phenomenon has been looked at before.
The Study
The study looked at four different perioperative surveys of 65 patients who underwent bilateral sequential clear corneal extraction using a topical anesthesia for phacoemulsification. The pain and anxiety levels included the administered State-Trait Anxiety Scale and Amsterdam Preoperative Anxiety and Information Scale that were given to the group prior to their surgery, just after surgery, and then on the first day post-surgery. They were given a scale to put down their level of pain, evaluating on a visual analog scale of 0 to 10. This was done to evaluate objective and subjective pain indicators.
Around 40 percent of patients who took the survey reported a higher visual analog pain score after their second cataract surgery. On average, the patients’ anxiety level dropped from their first to their second surgery.
If you would like to discuss any concerns about pain during cataract surgery, please find an experienced ophthalmologist in your area through www.eyes.com today.

Decentration of IOLs in Cataract Surgery

In order to give you the best results after cataract surgery, it is crucial that your new lens be properly centered in your eye. Failure to properly center your lens may result in visual defects, such as blurriness, glare, and halos. There have been a number of innovations that have significantly reduced the tendency for intraocular lenses to be decentered following cataract surgery.

Several different placements are used for lens placements. Intraocular lenses were placed either inside the capsule that contains the natural lens, in the sulcus of the ciliary muscles that surrounds the lens, or in a combination of both places. In most cases, placement in the bag is preferred because the bag helps to center and stabilize the lens.

Another aspect that can impact the centration of the intraocular lens is the type of incision used on the capsular bag. The first incision used to remove the lens from the capsule and insert the new intraocular lens was the can opener technique, which made a series of tiny cuts around the capsule to create a circular hole. Then it became more normal to use what was known as an “envelope” incision to remove the lens from the capsule. However, this technique is now known to be associated with a greater incidence of decentration of the intraocular lens. Now more surgeons prefer to use what is known as continuous curvilinear capsulorhexis, which involves the creation of a triangular segment in the capsule bag for removal of the natural lens and placement of the intraocular lens.

Finally, the improvement of lens design has significantly reduced the incidence of decentration of IOLs in cataract surgery. New, foldable lenses make it easier for cataract surgeons to get the lens properly centered in the capsule.

And innovations continue. Recently, a study has shown that the use of a femtosecond laser may further reduce the incidence of decentration of lenses in cataract surgery. Whether this eventually becomes the standard practice or not remains to be seen.

The success of cataract surgery and the quality of results you see depends significantly on the techniques and technology used by your surgeon. To talk to a local ophthalmologist who uses the most advanced cataract surgery techniques, use our surgeon locator tool.

Keeping Your Eyes Healthy with Proper Nutrition

When most people think about eye health, they probably aren’t worrying about improving their diet. However, the truth is that what you eat affects your entire body – your eyes included. Patients who are careful to eat a diet rich in certain vitamins and nutrients can effectively reduce their risk of many different eye diseases, keeping their vision healthy for years to come.

Some important vitamins and minerals you should include in your diet are:

  • Vitamin C – Contains antioxidants that rid your body of harmful free radicals, reducing your risk of cataracts and age-related macular degeneration (AMD). Good sources of Vitamin C: strawberries, citrus fruit, broccoli, and green peppers.
  • Vitamin A – Keeps your retina functioning properly, and also reduces the risk of night blindness by helping your eyes adjust to variations in light and dark. Good sources of Vitamin A: carrots, eggs, and spinach.
  • Vitamin E – Prevents cataracts from forming and/or delays their growth. Good sources of Vitamin E: nuts, green vegetables, fortified cereal.
  • Minerals – Selenium and zinc help your body better absorb antioxidants (i.e., from Vitamin C). Both zinc and selenium can be found in yogurt, red meat, cheese, macaroni and cheese, and enriched rice and breads.

If you have more questions about nutrition for your eyes, contact an experienced ophthalmologist in your area today to schedule a consultation.

Displacement of Nuclear Fragments during Cataract Surgery

Most cataract surgery performed these days is performed using the technique known as phacoemulsification. Phacoemulsification is when the lens is mixed in with the fluid inside the lens capsule, then is vacuumed out. Sometimes, though the lens is cut up into small pieces and removed manually through the incision in the lens capsule.

Whatever method is used, there is a risk that not all lens fragments will be removed from the eye. Sometimes pieces of the lens can become concealed by the iris or may become lodged in the drainage angle. These pieces may remain concealed for years, causing compounding vision problems including eye irritation, swelling, and visual loss. In many cases vision loss may cause you to have vision that is equivalent to or worse than your vision prior to cataract surgery.

Estimates of the incidence of retained lens fragments after cataract surgery range from 0.3% to 1.1%. The lower estimates are more likely to be accurate because they are derived from much larger sample sizes. It seems that the incidence of retained fragments varies widely from practice to practice, with less-experienced surgeons and lower-volume practices experiencing higher rates. Other variables that have been identified as increasing your risk of retained lens fragments include:

  • Advanced age
  • Posterior synechia (when the iris sticks to the lens capsule)
  • Incomplete pupil dilation
  • Psuedoexfoliation (an accumulation of whitish-grey protein in the eye)
  • Previous vitrectomy (removal of eye fluids)

Fortunately, when patients experience this complication, they can still achieve good vision results with additional treatment. Some patients actually need no additional treatment to get good results, but if vision loss is occurring, vitrectomy is the preferred treatment. Vitrectomy gives good results, with up to 68% of patients regaining vision of 20/40 or better.

If you have cataracts and are selecting your cataract surgeon, make sure to talk to your surgeon about the possibility of displaced nuclear fragments and his or her incidence of this complication. Since rates vary widely among surgeons and can dramatically impact your quality of results, this is a question that can make all the difference in your cataract surgery outcome.

Please contact a local ophthalmologist to talk about your cataract surgery today.

Cataract Surgery is Possible for Patients in Their 90s

Providence, RI – Results published in the March issue of Ophthalmology allay concerns eye surgeons may have about performing cataract surgery on some of their oldest patients. According to the study, patients who are in their 90s are no more likely to suffer complications than patients in their 80s.

Dr. Paul B. Greenberg, clinical associate professor of ophthalmology, Alpert Medical School, Brown University, who recently helped author a paper about this, believes that eye surgeons will see more patients in this age group. “We wanted to find out whether being 90 or older increased the risk of having complications relative to being 80 and older.”

The national study included 554 nonagenarian patients and 11,407 octogenarians who had undergone cataract surgery at the Veterans Health Administration between October 2005 and September 2007.

There were the expected complications in the age groups, including posterior capsular tear and retained lens fragments. One interesting thing investigators found when looking at the different age groups is that older patients had lower systemic comorbidities than those in the 80-89 bracket. There were higher incidence of COPD, diabetes, and malignant neoplasms. The 90 and above group had higher cases of dementia, which is simply related to age.

One theory behind the results is that the nanogenarians selected for the study were healthier ones. The study does not tell practitioners how to select someone who is 90 or older for cataract surgery, but it does open the possibility of looking at some of the oldest patients who can be treated and makes doctors more aware. The next step is to look at nanogenarians outside the VA to see how they compare with patients within the study.

If you are interested in learning more about cataracts, please find an experienced eye doctor in your area through www.eyes.com today.