LASIK and Cataract Surgery

A cataract is the clouding of your eye’s natural lens and impairs your vision. To correct this problem, your defective lens can be removed and replaced with an implantable intraocular lens (IOL) of a predetermined power.

The measurements that are conducted to achieve this predetermined power are extremely specific. If they are even slightly inaccurate, you may need to undergo laser vision surgery to restore your vision. If you have undergone LASIK surgery, the corneal measurements used to determine the power of your implanted lens have been altered by the reshaping of your cornea. An experienced eye surgeon can accurately estimate these changes by formulas and assessing your eye history. Be sure to tell your eye surgeon if you have undergone LASIK surgery.

At Eyes.com, we are committed to providing thorough and accurate information so you can make an informed decision about your cataract surgery after undergoing LASIK.

Cataract Surgery after LASIK

Most eye surgeries carry the risk of cataracts, and LASIK is no exception. Some ophthalmologists believe that patients with signs of cataracts before LASIK should not have LASIK, since their vision may be corrected with the IOL used in cataract surgery.

Especially since your altered cornea causes inaccurate measurements for IOL placement, patients who have undergone LASIK surgery and develop cataracts might find themselves immediately back in glasses or contacts or having to undergo additional eye surgeries.

If you would like to schedule a consultation, please visit our Eye Doctor Directory to find an experienced eye surgeon in your area.

Study Finds No Link between Asthma Treatment and Risk of Cataracts

New York, NY – According to a recent study, children who take inhaled corticosteroids (ICS) in recommended doses are not at higher risk for developing cataracts as young adults. The study was conducted by a group of researchers led by Dr. Hengameh H. Raissy from the University of New Mexico, Albuquerque. It is the longest study to date regarding the development of cataracts in children taking ICS for extended periods of time.

The study was prompted by initial findings from the Childhood Asthma Management Program (CAMP). In 2000, researchers began evaluating 955 children participating in CAMP. The children were divided into a placebo group and two treatment groups prescribed recommended dosages of ICS medications plus occasional oral prednisone bursts. After following the children for 4-6 years, there were no measurable signs of cataracts on any of the patients.

However, in 2005, three children in the ICS group began displaying “barely measurable” signs of posterior subcapsular cataracts. One of the children required cataract surgery to correct the condition.

As a result, researchers began conducting more thorough cataract examinations on many of the other CAMP subjects.  Out of 232 patients evaluated, 16 exhibited signs of cataracts; 12 of these had posterior cataracts. The proportion of patients evaluated was the same in the control and treatment groups.

The findings did not point to a link between ICS use and an increased risk of cataracts. However, researchers indicated that this study did not rule out the possibility of high daily doses of ICS medications contributing to an increased risk of cataracts. Additional studies would need to be conducted to conclusively rule out such a link.

SSRI, SNRI Use Linked to Increased Risk of Cataracts in Elderly

Vancouver, British Columbia – A recent study has established a potential link between the use of certain selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) and an increased risk of cataracts among people over the age of 65. The study was conducted by Mahyar Etminan at the Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute in Vancouver, British Columbia.

SSRIs and SNRIs are antidepressant drugs. Currently, approximately 10% of the American population takes SSRIs or SNRIs to treat depression and various other psychological conditions. Previous research has indicated that serotonin impacts lens transparency and the development of cataracts. However, this is the first study to document an association between SSRI use and an increased risk of cataracts.

Researchers evaluated a group of patients living in Quebec, Canada who had undergone coronary revascularization between 1995 and 2004. The patients were all over the age of 65. Of the patients involved in the study, 18,784 had been diagnosed with cataracts, while 187,840 were placed in a non-cataract diagnosis control group. Approximately 5.7% of the case study group received an SSRI or the SNRI venlafaxine, while 4.4% of the control group had taken these medications.

The current study demonstrated a 15% increase in the adjusted relative rate of developing cataracts for current users of SSRIs and SNRIs. However, past users of these drugs did not seem to show a similar elevated risk. Interestingly, the increase in the rate of cataract development was strongest with the drugs fluvoxamine and venlafaxine. SSRIs such as citalopram, fluoxetine, and sertraline did not exhibit the same tendencies.

The researchers cited a large sample size, access to detailed prescription drug data, and the ability to assess individual SSRIs as strengths of the study. They also acknowledged an inability to adjust for several potential cataract risk factors as a limitation. Furthermore, the patients in the control group received a relatively short follow-up; therefore, it is possible that some of them may have had undiagnosed cataracts.

While the information from this study is certainly significant and may potentially further our understanding of how SSRIs and SNRIs relate to the development of cataracts, researchers have asserted that additional studies are necessary to conclusively confirm this potential link.

FDA Advisory Panel Recommends Approval for IOP-Lowering Stent

Washington, DC: An advisory panel has voted to recommend approval for a new glaucoma treatment: the iStent Trabecular Micro-Bypass Stent, to be used in combination with cataract surgery. The stent is used to treat primary open angle glaucoma, the most common form of glaucoma.

In primary open angle glaucoma, a rise in intraocular pressure is caused by clogging of the drainage angle. This prevents fluid from leaving the eye and pressure to increase as new fluid is produced. Currently, there are several approved treatment options for glaucoma, including pressure-reducing eye drops, canaloplasty, and filtering microsurgery.

The iStent is essentially a tiny tube, similar to the vascular stents that are used to support arteries during angioplasty. This tiny tube, which is inserted during cataract surgery, allows increased drainage of intraocular fluid, reducing the intraocular pressure.

The FDA advisory panel reviewed research data from studies submitted by the manufacturer and considered whether there was reasonable assurance that the device was safe, effective, and that the benefits of the device likely outweighed its risks. The panel voted 7-1 that there was “reasonable assurance” that the iStent was reasonably safe for use. The panel also voted 6-2 that there was “reasonable assurance” that the stent was effective at reducing IOP. Finally, the panel voted 7-1 that there was “reasonable assurance” that the benefits of the device outweighed its risks. In every case, the recommendations were for placement of the stent during cataract surgery for the treatment of elevated IOP for patients with mild to moderate open angle glaucoma currently being treated with ocular hypotensive medication.

The primary reservation expressed by the committee was that, although the device was safe, its effectiveness seemed to be relatively low. Furthermore, “the panel noted a lack of effectiveness at 24 months and recommended that the indication for use reflect the temporary nature of the device’s effectiveness.” For more information, you can read the advisory panel minutes here.

Since there are currently many treatment options for glaucoma, it is uncertain whether this new treatment would benefit very many people. Currently, many surgeons recommend combined glaucoma / cataract surgery, especially for people with relatively mild glaucoma. For patients with advanced glaucoma, separate surgery is more often recommended.

To learn whether combined glaucoma and cataract surgery might be a good treatment for you, talk to an ophthalmologist in your area.

Possible Increased Risk of Cataracts with Elderly Use of SSRIs and SNRIs

Vancouver, B.C. – Researchers from the Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada have reported that people 65-years-old and older may be at increased risk for cataracts if they are receiving selective serotonin reuptake inhibitors (SSRI) or serotonin and norepinephrine reuptake inhibitors (SNRI).

Both SSRIs and SNRIs are classes of chemicals used as antidepressants to treat depression, personality disorders, and other issues. The authors of the study say this is the first time that SSRIs may be associated with an increased risk of cataracts. However, it is known that serotonin plays an important part in lens transparency, and therefore in the development of cataracts.
The Study

The case-control study focused on residents 65 years old and older from Quebec who had undergone coronary revascularization between 1995 and 2004. Almost 19,000 of these patients (cases) were diagnosed with cataracts. Almost 190,000 patients (controls) were not diagnosed by an ophthalmologist. Nearly six percent of the cases and four and a half percent of the controls were receiving an SSRI or an SNRI.
The SSRIs and SNRIs the patients were receiving include venlafaxine (brand name Effexor) and fluvoxamine (brand name Luvox). According to researchers, when the cases were restricted to outpatient surgical treatment, the same results were found, but paroxetine (brand name Paxil)was an independent predictor for the need for cataract surgery.
A statistically significant increase in the risk of cataracts was not found in:

• Citalopram (Celexa)
• Fluoxetine (Prozac, Prozac Weekly, Sarafem)
• Sertraline (Zoloft)

The risk to patients seems to be confined to current users of SSRIs and SNRIs. The researchers estimate that about ten percent of Americans are currently taking an antidepressant that is an SSRI or an SNRI. Based on these estimates and the results of the study, the researchers suggest that around 22,000 cases of cataracts caused by SSRIs may be avoided each year.