If you have been here (to this part of my web-site) before, then you know that this used to say NO. Well, earlier this year (2001) the FDA did approve one machine for laser removal of cataracts, but it hasn't caught on with cataract surgeons, and it isn't really what you would expect. The beauty of lasers is that they promise surgery without an incision. However, with the currently available laser technology, incisions must still be made, and from what I understand, the laser is not as versatile as the now standard ultrasound based methods (phacoemulsification). In my opinion, the current laser cataract removal technology is nothing more than a gimmick that allows people to claim that they remove cataracts with a laser. Research continues in this area, but with very very few exceptions, lasers are not currently used for removing cataracts. Modern small incision cataract surgery utilizes ultrasound to liquefy (emulsify) the cataract.
Actually, the only possible advantage that lasers hold in cataract removal is that they may eventually allow even smaller incisions to be used. Currently I use an incision of slightly less than 3 millimeters, which is pretty darn small. In fact, I can't use a significantly smaller incision, because if I did, then I wouldn't be able to implant an artificial lens at the end of the case. I predict that new lens implant technology that allows lenses to fit through even smaller incisions will need to proceed the acceptance of lasers as a method to remove cataracts
A cataract once removed, can not grow back. However, during cataract surgery the "posterior capsule", a very thin, clear membrane which wraps around the back side of the cataract is left intact, and eventually this becomes cloudy. This so called "secondary cataract" can be treated with a YAG laser. This is a painless office procedure which restores vision in a matter of minutes to patients with "secondary cataracts".
Over time the vitreous slowly liquefies, and one day, without warning, that little condensation (the optic nerve is only 1.5 millimeters in diameter here) peels off, or "detaches" from the optic nerve, and starts floating inside the vitreous cavity. Now the little sucker, which is often shaped like a ring, or a bug, casts a shadow on the retina, and we see something floating around. Most of the time we don't notice it, but when looking at a bright, homogenous background, there it is, annoying us. These types of floaters never go away, but after a couple of weeks, our brains just ignore them (most of the time).
Unfortunately, floaters can also arise from retinal detachments, bleeding inside the eye, infections, or inflammation inside the eye, so if you have a new floater, please see an Ophthalmologist.
Now close your right eye, and put your nose on the computer screen and make a smudge on your monitor, right between the "X" and the "O". (actually, just bring your head within 4 or 5 inches of the monitor, but line your nose up between the "X" and "O".
STARE at the "O" and SLOWLY pull your head away from the screen (make certain you are not being watched).
As soon as the "X" enters your blind spot, it "disappears". As you continue to pull back, it reappears.
[Note: the distance between the "X" and "O" will depend on your screen size, and your web browser. If the "X and "O" are about 6 inches apart, then the blind spot will "appear" when your head is about 22 inches away from the screen].
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The left eye has a blind spot about 15 degrees to the left of central vision (fixation) and the right eye has a blind spot about 15 degrees to the right of fixation. We don't perceive our blind spots because the visual fields of the two eyes overlap, and because our brains fill in the blind spot automatically. When the "X" sits in the area of your blind spot, your brain "fills in" the area with the white background of the rest of the page. This ability of our brains to automatically "fill-in" gaps in the peripheral vision may account for why so many people with peripheral visual loss (e.g. Glaucoma) do not perceive any change in their vision, until they have lost so much peripheral vision that they are literally tripping over the furniture. Now go clean off your monitor.
What is a cycloplegic refraction?
"Refraction" is the process for determining your optimal lens (glasses) prescription. When you press your face against that cold black thing, trying to decide if "one" is better than "two," then your are having a refraction. Obviously it isn't always apparent which one is better, and as it turns out, most people tend to make errors towards the minus side (so called "over-minused"). Thus it is possible, and in fact rather common, that if you are nearsighted your prescription has too much minus, or if you are far-sighted, not enough plus. The reason people tend to "over-minus" is because of accommodation. If you were accommodating during your eye exam (and who isn't), then you may be over-minused. One very effective way to prevent you from accommodating during the exam is to temporarily paralyze or cycloplege the muscles of accommodation using specialized eye drops. We call it cycloplegia because, well, lets face it, who would want to come in for temporary paralysis?
Many refractive surgeons, myself included, insist on a cycloplegic refraction before performing refractive surgery.
No.
The cornea has no blood vessels, and neither does the lens. As long as cataract surgery is done using topical anesthesia, and a clear-corneal incision, there is no need to stop taking blood thinners. Even so, it is safer, as far as your eye is concerned, to stop blood thinners prior to cataract surgery just as you would for any other type of surgery.
I always check with a patient's general physician or cardiologist before making a decision about whether or not to discontinue blood thinners prior to cataract surgery. Although modern techniques in cataract surgery have introduced new risks and complications, overall they have substantially decreased the risks involved, both to your eye, and to your overall health. If stopping your blood thinners would be dangerous to your health, then it is comforting to know that using modern surgical techniques, you do not have to stop taking them in order to have cataract surgery.
First of all, the term "MonoVision" is a bit misleading, but the idea is that one eye naturally focuses best for distance vision, and the other eye focuses best for near vision. Optimists say that one eye is always clear, and pessimists feel that one eye is always blurry. Actually I believe that most, if not all people can adjust to this as long as the difference between the eyes is not too great, and if they way long enough for their brain to adapt. I use this quite often with cataract and refractive surgery patients.
In fact, if you are between the ages of 35 and 50 years of age, and you have only mild nearsightedness with little or no astigmatism (less than 2.5 diopters), you would be foolish not to at least try monovision before having both eyes corrected for distance. For patients who meet all of these criteria I usually make an oral agreement NOT to treat the second eye for at least 3 months. There are many advantages to this approach, and actually it isn't a bad way to go even if you are going to have both eyes corrected, because it lets us see how the first eye reacts to surgery before touching the second eye..... Anyway, in addition to this your costs will be cut in half, your surgical risk will be cut in half, and the chances that you will have years of vision without using glasses are greatly improved. Years of vision without using any sort of glasses. Isn't that why you really want LASIK surgery in the first place?
One of the hot "new" procedures you may
be hearing about is Clear Lens Extraction. Don't get me wrong, this
is a great alternative to Laser Vision Correction for many people, especially
those who are 65 years of age, or older, or those with very high corrections.
The thing is however, that this is not even remotely "new".... its just
cataract surgery given a different name. Actually, this is my refractive
procedure of choice in most people over the age of 65, and in my opinion,
elderly people should NOT have LASIK or PRK (see Hidden
Dangers of LASIK for more info on this topic).
Until today (10/21/01) I have bee fairly "luke-warm" about this issue, because there has not been any solid evidence that vitamins prevent or treat any eye disease. Now there appears to be evidence that vitamins actually do help to PREVENT the more severe forms of Macular Degeneration.
In a nutshell, the Age-Related Eye Disease Study by the National Institutes of Health has recently shown that high dose antioxidants slowed the progression of Macular Degeneration in patients with moderate to severe forms of the disease.
The study also showed that patients with mild forms of the disease had no benefit from vitamin therapy. Furthermore, the study showed that the rate of progression of cataracts was not affected by vitamin therapy.
Specifically, patients consumed a brew
of vitamins that included
vitamin C (500 mg),
vitamin E (400 IU),
beta-carotene (15 mg),
zinc oxide (80 mg), and
cupric oxide (2mg)
and soon this will be available as "Ocuvite PreserVision"
Click
here for more details, and a link to more links....
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