What You Need To Know About Cataract Surgery

When you schedule a cataract operation, your surgeon may require that you have a medical workup first. Since these operations are now commonly performed in an outpatient setting, your general practitioner can order the necessary tests. The whole operation procedure, either cataract surgery alone or a combined cataract and filtering operation, can take ninety minutes to perform if the case is uncomplicated. Depending on your condition and the surgeon's preference, you may stay overnight in the hospital or you may go home after the operation.

During the operation, if you are having local anesthesia, your surgeon will inject the anesthetic around your eye. It may hurt, but the discomfort will last for only a few seconds. The surgeon will then perform the cataract surgery. If you are having glaucoma surgery at the same time, that will be done immediately after the intraocular lens implant has been put in place.

After the operation, your eye will be bandaged overnight. In the morning, your eye will be checked by your surgeon and your IOP measured. You will most likely be advised to take an assortment of drops, including antibiotics to prevent infection and steroids to reduce inflammation. You will also be given an eye shield, a perforated plastic oval to fit over your eye, to protect your eye when you sleep, and you will be advised not to bend your head, lift anything heavy, or strain during bowel movements (a stool softener can be used if necessary to prevent this problem). Otherwise, you can assume your daily activities. Some surgeons say you can shower; others advise against it.

Within four to five weeks, depending on how quickly your eye stabilizes, you may then be fitted with glasses. Many ophthalmologists prefer to implant lenses that make the eye slightly myopic and then correct distance vision with eyeglasses or contact lenses, especially with patients who are already nearsighted. They have found that people who are accustomed to viewing the world myopically don't adapt well if their vision is fully corrected.

The decision as to what strength lens implant to use is based on a combination of measurements, including the curvature of the cornea, the depth of the anterior chamber, and the dimensions of the eye itself. You have something to say about the strength of the intraocular lens as well. You are entitled to discuss in advance with your doctor what you feel will be most comfortable for you.

At this stage, unfortunately, bifocal intraocular lenses are not available, so you may decide on a reading-strength intraocular lens with additional correction (glasses or contact lenses) for distance. This combination feels familiar to most nearsighted people. Some doctors and patients have opted to have one eye fitted with a reading-strength lens and the other with a distance lens. While this arrangement is convenient and eliminates the need for glasses, it makes it impossible for the eyes to converge and work together properly, which is important for close work and depth perception.

As with any type of surgery, complications can arise with cataract removal, and people with glaucoma may be more likely than others to experience some problems. Pupillary block is uncommon, but it may occur as a complication of cataract surgery. In this condition, the aqueous fluid is unable to squeeze through the space between the lens and the iris, and pressure builds up, pushing the iris forward to block the drainage channel. This can cause a dramatic increase in intraocular pressure. Pupillary block can be corrected with an iridectomy or iridotomy. Studies indicate that there are fewer cases of pupillary block if extracapsular extraction is used.

Another difficulty may occur if the intraocular pressure decreases to a critical stage. While people who have glaucoma want to have low intraocular pressures, too-low pressure may result if the aqueous fluid passes from the anterior chamber too rapidly, causing the chamber to flatten. When the chamber is flat, parts of the eye like the iris and cornea, which are normally kept apart by the fluid, can touch and stick together - and that is a decidedly undesirable event. An IOP under 5 mm Hg may be an indication that this is happening.

Bleeding may also be a problem. Any intervention into your eye (or any other part of your body, for that matter) can cause the disruption of blood vessels. Most often these bleeding vessels can be cauterized or will seal themselves, but in some cases it may take a day or so for such a situation to resolve. In most cases it does resolve, but until the blood clears away your vision will be blurry.

If you have a fragile cornea, something called corneal decompensation may occur. In this condition, the cornea begins to lose cells and is unable to regain its former shape and consistency. This problem occurs if your cornea has a scarcity of cells, which may result from laser treatment or the use of medication. Glaucoma patients are more prone to this effect.

Your eye may also react to the implanted lens material by forming adhesions at the lens's points of contact. If the lens is improperly positioned, chronic iritis (inflammation of the iris) may result. If there is recurrent bleeding, neovascularization may develop, promoting a condition similar to the neovascular glaucomas. In some cases, a Cataract operation can also precipitate an attack of narrow-angle glaucoma, for with this operation there can be a slight shifting of the parts in the eye, and these - the pupil, the ciliary body, or even trapped air - can block the angle through which the aqueous fluid flows.

What Is Making My Eyes Dry?

There are two basic problems that can be causing your eyes to become dry and lack the usual tears: either you're not making enough tears, or the tears you're making aren't as good as they used to be. Occasionally dry eyes may be caused by a third problem: the eye itself can't get the tears where they need to go.

Perhaps your eyes don't make enough tears. This condition, called KCS (for keratoconjunctivitis sicca), usually occurs in both eyes but can be worse in one eye than the other. One of the most common causes of tearing deficiency is simply age. Like skin and hair, our tears tend to "dry up" slightly as we get older; we just make fewer tears. For most of us this decrease isn't terribly noticeable, but for some people tear production can drop off significantly - enough to produce the classic dry-eye symptoms of irritation, redness, grittiness, burning, or eye fatigue. (KCS is also more common in older women than in other
groups, probably because of the hormonal changes that occur with age.)

Other health problems can hamper tear production. One of these is injury to the lacrimal glands, from infection or trauma; the effect of the injury may be temporary or permanent. Another is Bell's palsy, a condition that affects the facial nerves; its effects too may be either temporary or permanent. People with this ailment are often unable to close one eye or blink on one side of the face, and that eye also produces fewer tears. As you may imagine, the combination of not being able to blink and making fewer tears causes major problems with dryness.

Autoimmune disorders can impede tear production. Sjogren's syndrome is the miserable trio of symptoms - dry eyes, dry mouth, and joint pain - that may be associated with other autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma. (The term secondary Sjogren's syndrome is used to describe dry eyes associated with any other disease.) Other systemic ("whole body") diseases, such as sarcoidosis, leukemia, lymphoma, and chronic thyroid problems, often diminish tear production, as well.

Occasionally medications decrease the tear-making ability in some people. For instance, as you may already know too well, antihistamines and decongestants for allergies and colds dry out everything - eyes in addition to sinuses. Diuretics, taken to lower blood pressure and ease water retention, may decrease tear production. Hormone replacement therapy and even birth control pills also can lead to dry eyes. Other potentially eye-drying medications include certain eye dilators, motion sickness inhibitors, antidepressants, oral acne medications, and opiate-based pain medications.

Even if your tear production is just fine, your eyes can still be dry if the quality of tears is poor. Remember the ingredients in each tear; they're all important, and when the balance of them is off, your tears (and your eyes) may suffer as a result. Diseases in the eye or body can cause a drop in either the mucin or the lipid portion of tears.

What Is Glaucoma & Where Did It Originate From?

Glaucoma is now believed to be the end product of a number of distinct structural and systemic diseases characterized by high pressure inside the eye and optic nerve damage. This pressure can damage and even kill the sensitive nerve cells in the back of the eye, causing loss of sight. Glaucoma is not a new disease. The ancient Greeks gave us the term glaucoma, which they used to describe all eye diseases leading to blindness. In the first several centuries A.D., cataracts, which are amenable to treatment, began to be distinguished from glaucoma, which could not be treated. The association of glaucoma with increased pressure in the eye is often attributed to Richard Banister, an English oculist and author of the first book on ophthalmology in English, who made this observation in 1622 . Banister noted that if you felt an eye with glaucoma by rubbing on the eyelids, the eye felt more hard and solid than normal.

Today, a diagnosis of glaucoma is based on three factors: intraocular pressure (IOF), the pressure within the eye, which is typically elevated; characteristic changes in the visual field, specifically a loss of peripheral vision; and signs of damage to the optic nerve. Very often the first indication that glaucoma may be present is an increase in IOP. Since the 1930s, eye doctors have distinguished between two primary forms of the disease: open-angle and narrow-angle glaucoma. These determinations were based on the width of the angle formed by the meeting of the iris and the cornea. Grades I and II glaucoma (glaucoma in the presence of 10-degree and 20-degree angles, respectively) were designated narrow-angle glaucoma; grades III and IV glaucoma (glaucoma in the presence of 30-degree and 40-degree angles, respectively) were termed open- angle glaucoma.

Angle-closure glaucoma - glaucoma caused by a narrow angle and/or close proximity of structures within the eye to each other - may be considered a structural problem. Open-angle glaucoma is divided into a number of different varieties. The most common type of glaucoma is primary open-angle glaucoma. The other glaucomas that make up the open-angle family are variously called structural or secondary, or glaucoma as an end product of a disease.

Today, researchers have recorded more than a dozen distinct forms of glaucoma, and there may be more. Some scientists claim that they can differentiate between as many as forty different types of glaucoma. Although primary open-angle glaucoma accounts for the majority of cases of glaucoma, many people do have other forms. As the differences among glaucomas become clearer, and the root causes are better identified, researchers may be able to develop specific treatments for controlling each individual type of glaucoma.