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ARTICLE 1 OF 2
Understanding Cataracts
by Tracy Ravin, MD
Cataracts are a leading cause of curable blindness worldwide. In the , no one should go blind from cataracts with proper care of an ophthalmologist. Formation of a cataract is a normal aging process of the lens inside the eye. The lens is the part of the eye that helps focus light rays on the retina (the back layer of the eye). Early in life, the lens is transparent and lets the light pass through; with time the lens becomes cloudy and then is called a cataract. When the cataract gets cloudy enough to interfere with a persons’ vision, cataract surgery should be considered. This article will address common questions people have about cataracts.
What Causes Cataracts?
In most cases, the answer is age. Cataracts form slowly and cause no pain. Rarely, babies can be born with a cloudy lens called a congenital cataract. Some things that speed the development of cataracts include: long-term use of corticosteroids, alcoholism, diabetes mellitus, eye injury, smoking, and long-time exposure to ultra-violet (UV) light.
How Will I Know If I Have a Cataract?
Many people have cataracts without knowing it. This is because in the early stages the cataract does not interfere with vision. As the lens gets thicker, it has more power within the eye which can actually improve reading vision, sometimes called “second sight.” With time, the lens becomes cloudier and may cause a gradual blurring of vision. This is often noticed as a difficulty reading road signs when driving. Night driving can also be affected. Haloes around lights are often seen. Sensitivity to bright light or decreased vision in bright light are common complaints. Ability to distinguish or perceive colors may be impaired.
How Are Cataracts Treated?
For early stage cataract, changing glasses prescription may improve vision. There are no medications or eye-drops that will help. When cataracts are interfering with normal activities of daily living, surgery should be considered.
Florida Eye Associates’ surgeons usually remove cataracts under local anesthesia in our ambulatory surgery center. The surgeon makes a tiny incision and the clouded lens is removed through "phacoemulsification," a process that uses ultrasound power to liquefy the lens so it can be withdrawn. A clear lens implant is then placed in the sac that used to hold the cataract.
The power of the lens implant is adjusted according to measurements taken before surgery. With the proper lens implant, sometimes the need for glasses can be eliminated. A common misconception that lasers are used in cataract surgery is not true, although laser treatment may be done at some point after cataract surgery. Cataract surgery is covered by insurance and Medicare.
How Long Is Recovery from Surgery?
Patients go home the same day after cataract surgery. Most patients have no pain, only a scratchy or sandy feeling in the eye. Most people return to their normal activities within a day or two after surgery. Eye drops are used after surgery and avoiding heavy lifting or rubbing of the operated eye are recommended. Other instructions depend on the physician's preferences.
Can Cataracts Come Back?
No. Once removed, cataracts cannot grow back. Sometimes a film can grow behind the lens implant and cause cloudy vision to return. This membrane can be removed with a laser and does not grow back.
Tracy Ravin, MD is a comprehensive ophthalmologist with Florida Eye Associates. She is accepting new patients at her offices in Melbourne and Cocoa Beach and can be reached at 727-2020.
ARTICLE 2 OF 2
Diabetic Retinopathy – An Overview
by Ralph Paylor, MD
Diabetic retinopathy is an ocular complication of diabetes. It affects about one half of the Americans diagnosed with diabetes and can lead to blindness if undetected or untreated. Because diabetic retinopathy can damage your sight without obvious symptoms, diabetics should have a dilated eye examination at least once a year.
Diabetes can cause damage to tiny blood vessels including those of the retina, the light-sensitive tissue at the back of the eye. While retinal blood vessels are being damaged, most people do not notice any changes in their eye or their vision. Sometimes, the blood vessels leak fluids onto the macula which is the portion of the retina responsible for seeing fine detail. When this happens, the fluid makes the macula swell, resulting in blurred vision.
As the disease progresses, new blood vessels grow along the retina and in the vitreous gel of the eye. Without treatment, these blood vessels can swell, bleed and ultimately destroy the retina.
A dilated eye examination allows your doctor to look at the back of the eye and check your retina for early signs of the disease, such as: changes in blood vessels; retinal swelling, such as macular edema; pale, fatty deposits on the retina; or damaged nerve tissue.
If your doctor suspects that you need treatment for macular edema, he or she may ask you to have a test called fluorescein angiography. Dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows your doctor to locate the leaking blood vessels.
There are two treatments for diabetic retinopathy. They are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged. It is important to note that although treatment is very successful, there is no cure for diabetic retinopathy.
Laser photocoagulation is performed in a doctor's office or eye clinic. Before the surgery, your ophthalmologist will dilate your pupil and apply numbing drops. The doctor also may numb the area behind the eye to prevent any discomfort.
The lights will be dim. As you sit facing the laser, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. For the rest of the day, your vision will probably be a little blurry.
Instead of laser surgery, you may need an operation called a vitrectomy to restore your sight. A vitrectomy is performed if you have a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a salt solution. Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous.
Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.
Vitrectomy is often done under local anesthesia. This means that you will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye. It removes the vitreous and inserts the salt solution into the eye.
Diabetes is a serious threat to sight and should be taken very seriously. Early detection and treatment is critical to ocular health, but good management of diabetes is the best prevention. Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise also play important roles in the overall health of those with diabetes.
Florida Eye Associates, founded in 1967 is the area’s leading provider of ophthalmology services. For information and appointments, call 727-2020. |
