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Q.

"Is it normal to schedule a laser cataract surgery with lens implant on one eye, then schedule the second eye ONLY two days later? My husband is a Type 2 Diabetic and this is how they have scheduled his two laser cataract procedures, with only one day between them. Is this common to schedule these procedures so close together?"



A. Different surgeons have different approaches to how far apart they do cataract surgery. Some surgeons actually do them at the same time, but use separate instruments for both eyes to minimize any contamination affecting both eyes. Most surgeons wait two to four weeks between cataract surgeries. I generally wait three or four weeks between surgeries for my own patients. The reason to wait is primarily to make sure there are no complications such as an infection or inflammation which should be treated before proceeding to the other eye. In patients with very strong prescriptions, the surgeries are generally closer together so that patients do not have to deal with the imbalance between the eyes for as long. Laser cataract surgery is a new type of cataract surgery where the cataract is broken up with a laser rather than the previous technique of an ultrasound machine breaking up the cataract. Ellis Hospital has just ordered this laser and it should be operational in a few months. I will begin using this laser as soon as it is in place.



Q.

"What is scleral buckle surgery?"



A. Scleral buckle surgery is one of the surgical techniques for repairing a retinal detachment. The retina is the inside layer of the eyeball, and if a tear develops in the retina, fluid can accumulate behind the retina and cause it to detach. Scleral buckle surgery involves placing a small silicone band around the outside of the eyeball to reattach the outside of the eye to the inner retina. The band is far behind the front of the eye and not able to be seen. The surgery is often combined with either a freezing procedure called cryotherapy, or laser surgery to repair any retinal tears.



Q.

"I had an eye pressure reading of 68 in my left eye for 26 hours. Now I have been told I have a pale optic nerve. I could see well before but now am almost totally blind in one eye. Did the high pressure cause the pale optic nerve?"



A. Normal eye pressure is up to 21, and pressures as high as you report for a day may have resulted in a pale optic nerve. It may also be the cause of your drop in vision. To help determine this, your ophthalmologist has to determine the cause for the high eye pressure. There are multiple causes for this including acute glaucoma, bleeding, trauma, as well as others. The cause would then determine whether any treatment would be beneficial.



Q.

"Does cataract surgery increase the risk of exudative age-related macular degeneration?"



A. Cataract and Age Related Macular Degeneration are two fairly common eye conditions; both of which become more prevalent with age. Studies looking at large populations of patients with macular degeneration and cataracts have not shown any evidence of cataract surgery increasing the risk of macular degeneration (either the exudative “wet” form, or the non-exudative “dry” form). However, cataract surgery will not prevent progression of macular degeneration if it is already present. Additionally, you may develop macular degeneration after you have cataract surgery. In this case, the macular degeneration is not caused by the cataract surgery. Instead, it is a result of a fairly common eye condition that would have developed with the aging of the eye, with or without cataract surgery.



Q.

"I have had a serious bout with dry eyes. I could barely open my eyes due to the severe pain. I was given Lotemax and also artificial tears. It has been three days and I still have blurred vision and dry eyes. How long does this last before there is significant improvement."



A. Dry eye is an extremely common condition I see in my office everyday. It ranges from mildly annoying irritation and burning to severe limitation of daily activities due to inability to open the eyes or focus clearly. The wintertime is generally the most symptomatic due to the lack of humidity indoors and vents blowing across the eyes while in the car. There are multiple treatments available, from over the counter artificial tears, to prescription steroid drops (ie. Lotemax) or prescription drops to promote additional tear production, such as Restasis. Just as the condition typically worsens over several days to weeks, the improvement will take time, and may require adjustment to the treatment regimen. With the severity you describe in the question, it may take several weeks for the eyes to return to normal, and you may need to increase the frequency of the tear drops. You should check with your eye doctor before adjusting any of his recommendations.



Q.

"How long does it take for cataract surgery to heal?"



A. The recovery after cataract surgery varies from individual to individual. For many patients the vision improves within a few days to a week; however, patients may note fluctuations in the vision for up to a month after surgery. For this reason, I typically do not prescribe new glasses for my patients until one month after surgery. If there are any difficulties during the surgery, there are other underlying eye conditions, or the cataract is very advanced the recovery may be longer, possibly several months. Regarding activities after cataract surgery, I ask my patients to refrain from heavy lifting or strenuous exertion for one week after surgery. I additionally have my patients wear a protective shield over the eye while sleeping for the first week to prevent any accidental injury to the eye. By the second week, most of my patients are able to resume all of their normal activities.



Q.

"Hi I am a 22 year old female and my doctor thinks I may have glaucoma. On my first visit I was told that my cup to disc ratio was large, at this date my pressures were fine. I had a visual field test and was told that the results were normal. However on my second visit my pressures had soared to 25. I had a cornea thickness test done which was normal as well. My doctor therefore thinks I have glaucoma and has put me on Xalatan although I have no nerve damage. My question is, will I eventually go blind or lose my vision? My grandfather suffers from glaucoma and has lost his sight."



A. Glaucoma is a serious condition that unfortunately does not have symptoms until the disease is very advanced. This is why diagnosing glaucoma early is important, especially in someone who has a family history. In your specific case, since you are young and have a normal visual field there is unlikely any significant optic nerve damage from the glaucoma. At this point, the most important thing is keeping the eye pressure under control with the eye drops your doctor has prescribed. For some glaucoma patients eye drops alone do not control the eye pressure and either a laser surgery or operation is required. For the vast majority of patients, as long as the pressure is controlled, and follow-up appointments are kept, the vision can be preserved.



Q.

"How is the condition for “Lazy Eye” treated?"



A. “Lazy Eye” is a general term that can either mean an eye that turns in or out, or that has poor vision. The most important aspect of treating a lazy eye is making the diagnosis as early as possible. If it is diagnosed before eight years old, patching the better seeing eye for several hours a day may help. Glasses may also be required. Finally, if the eye turns in or out, it may require surgery on the eye muscles to straighten the eye.



Q.

"I had cataract surgery 6 weeks ago. My eye waters and hurts in the right bottom side of my eye. Is there anything i can do?"



A. Although there have been many advancements in cataract surgery over the past several years, it is still surgery and there is a recovery period. Most of the improvement is over the first few weeks, but there can be some final healing especially around the incision site for up to several months. Likely what you are experiencing is discomfort and irritation around the incision site. At this time you are likely finished with your prescription eye drops, and a lubricating tear drop would be a good choice to relieve some of the discomfort. Alternatively, some surgeons use sutures during cataract surgery, and it is possible a suture is irritating the eye; if this is a new symptom since you last saw your ophthalmologist another visit can rule this out.



Q.

"What is astigmatism and how is it treated?"



A. Astigmatism is one of the different types of Refractive Errors that can affect the eye. The other types are nearsightedness and farsightedness. Astigmatism means that the cornea or lens of the eye is not curved equally in both directions like a baseball. Instead, it has differing curves more like a football or an egg. There are several treatment options for astigmatism. This simplest treatment is glasses. For those wishing to avoid glasses, contact lenses or LASIK surgery can be an option for treating astigmatism. Glasses, contact lenses, and LASIK can treat near-sightedness or far-sightedness in addition to astigmatism. Finally, for patients undergoing cataract surgery who have astigmatism, a lens implant can be used which corrects for the astigmatism as well.



Q.

"I have extreme dry eye - I have tried over the counter medications nothing seems to help. What would be the best treatment for this condition?"



A. Dry Eye Syndrome is a very common condition, and typically is more prevalent in the winter months with more time spent indoors with dry furnace air. The initial treatment of choice is what you have tried - over the counter tear or lubricant drops. For patients who do not respond to this treatment a medication to help the body produce more tears can be prescribed by an ophthalmologist. Alternatively, a minor office procedure can be performed to occlude the tear duct and allow your tears to stay on the eye longer.



Q.

"How often can laser surgery be performed on the eye to lower ocular pressure due to glaucoma? Is this repeated procedure dangerous to the eye?"



A. Argon laser trabeculoplasty (ALT) is done to lower intra-ocular pressure in those patients with open angle glaucoma who are not adequately controlled on maximum tolerated medical therapy. This may be performed in one or two stages in which half of the drainage system is treated at a time. Repeat ALT is generally not effective for long-term intra-ocular pressure control. Only about 20% of patients have a second pressure lowering response lasting at least one year.



Q.

"How long is the average recovery period for cataract surgery?"



A. The length of the recovery period following cataract surgery is dependent on the size of the surgical incision. Using modern techniques, incisions should be self-sealing and are one-eighth inch long. This allows the implantation of a foldable intra-ocular lens. No stitches are used. When this procedure is performed, there are very few limitations in activity post-operatively. Full activity may be resumed with no restrictions in one week. New eye glasses may be prescribed in two weeks.



Q.

"I had sudden double vision in 1995. I am told the only thing that can help me is prisms in my glasses. I have had them made stronger 4 times. Can anything be done before there is no help?"



A. Double vision due to a muscle imbalance in an adult is usually corrected with prisms in eyeglasses. If this does not correct the problem though, surgical correction may be indicated, depending on the cause of the muscle problem.



Q.

"Can a cataract be removed by laser surgery?"



A. No. It is a widespread, almost universal, misconception that modern cataract surgery is performed using a laser. Today’s cataract extraction involves forming a small (about 1/8 inch) incision into the eye. Through this opening, the cataract is broken into pieces and aspirated (phacoemulcification). An intra-ocular lens is then folded in half and inserted into the eye. No stitched are required.



Q.

"I had cataract surgery 4 weeks ago and my vision is still blurred. Should I be concerned?"



A. Little or no improvement following cataract surgery is always a concern. There are many reasons for this outcome, ranging from pre-existing conditions to complications at the time of, or after, the surgery. Your prognosis will depend on the cause. Your surgeon is most likely aware of the cause and should be willing to discuss the situation with you.



Q.

"I was recently told I had early cataracts forming with “spokes” forming in both eyes. How long before my vision will be impaired?"



A. It is impossible to exactly predict the progression of most types of cataracts, since they are caused by the aging process of the lens. However, some types of cataracts which are caused by other factors, such as medication, may progress rapidly unless the causative factor is removed.



Q.

"Cataracts, what are they, why and what can I do to help sight?"



A. A cataract is an opacification of the crystalline lens of the eye. When the transparency of the lens decreases enough to disturb vision, a clinically significant cataract exists. At this point, surgical removal of the cataract is necessary to restore visual acuity.



Q.

"How long does it take an eye to heal after cataract surgery?"



A. There are numerous factors which affect the healing time following cataract surgery. They include: The type of procedure and intra-operative complications. However, assuming that a small incision procedure is performed and there are no significant complications, useful vision may be achieved when the eye dressing is removed on the day after surgery. Vision usually stabilizes in one to three weeks, at which time an eyeglass prescription may be required. Also, by this time, there is usually no need for further medication.



Q.

"I have Ischemic Optic Neuropathy in one eye. What are the chances of this condition developing in my other eye? Will taking one aspirin a day help prevent that outcome?"



A. Ischemic optic neuropathy results from the death of the optic nerve fibers which are within the eye. This is caused by occlusion of arteries that supply these fibers. The most common cause of this is arteriosclerosis. Two less frequent causes are giant-cell arteries and clots from coronary by-pass surgery. There is no therapy for anterior ischemic optic neuropathy when the cause is arteriosclerosis. Also, there is about a 50% chance that it may occur in the second eye. Aspirin may prevent clot formation and is your best hedge against this.



Q.

"What is the difference between “open-angle” and “closed angle” glaucoma?"



A. An “angle” is formed where the iris (colored circle of the eye) attaches to the sclera (white of the eye). This is where intra-ocular fluid is drained from the eye. In “open angle glaucoma”, this drainage system is not visibly blocked and appears normal (“open”). In “closed angle glaucoma”, the iris blocks this drainage system just as a floppy rubber disc blocks a sink drain. In either type of glaucoma, the result is a rise in eye pressure because of the blockage.



Q.

"What is optic nerve atrophy?"



A. The optic nerve connects the eye to the brain. There are multiple diseases that can cause atrophy of this nerve and reduce vision in that eye. There are several causes that exist at birth but may not affect vision until older. More commonly however, optic nerve atrophy is caused by an acquired disease. Glaucoma is one of the most likely causes of optic nerve atrophy, and becomes more prevalent with age. Other causes include inflammation of the optic nerve such as optic neuritis, or decreased blood supply to the optic nerve as in a condition called Ischemic Optic Neuropathy. These conditions can be initially evaluated with a complete dilated eye exam, and occasionally further testing is required.



Q.

"What is vitreous detachment and how is it treated?"



A. The vitreous is a gel-like substance inside the eye. Over time, that gel begins to liquefy creating an interface where the gel-like vitreous meets the liquid vitreous. This creates a shadow that is transmitted to the retina and seen as a “floater.” Often, as the vitreous is liquefying, there is traction, or pulling, on the retina which can cause the sensation of “fl ashes” of light. A vitreous detachment is part of the normal aging process of the eye, and the floaters and fl ashes associated with it usually subside over time. The biggest risk associated with vitreous detachment, is that while the vitreous is separating from the retina, the traction is too great, and a retinal tear or detachment occurs. This is much more serious, and requires a laser or surgical procedure for repair. This is why, anyone with the new onset of fl ashes or floaters should be seen for a complete dilated eye exam.


This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

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