Talent Mash

As an eye surgeon this is a question I am frequently asked by patients. (I am
often tempted to reply “Yes – as long as you think your pectoral muscles are
up to it, and you don’t get into too much of a flap”.) However the more
sensible answer is that in most cases there are no restrictions on flying
after cataract surgery. It is usually quite safe to do so, even relatively
soon after the procedure. It is though always wise to ask your own eye
specialist before doing so, and to have their reassurances. Only they will
know the specific details and requirements of your case.

The air conditioning within an aircraft may make the eye feel a little dry
and irritable but this is not harmful. If this occurs using some artificial
tear lubricant drops may be helpful, along with the normal post-operative
eye drops prescribed by your surgeon. Avoid rubbing the eye if it is
irritable. Instead closing the eye gently may be helpful as this reduces
evaporation from the eye surface and the eyelids offer natural protection.

Do not fly away from post-operative supervision until your ophthalmic team
is happy that the eye has sufficiently recovered from surgery. If you need
to travel out of reach of their care during the post-operative recovery
period check that you are in a location where an eye specialist is
available, in case problems arise. The specialist who has performed the
surgery may be able to recommend a colleague at the new location. It does no
harm to ask.

The only situation where flying may be dangerous after eye surgery is when a
bubble of gas has been placed within the eye. This is not done during normal
cataract surgery. It is sometimes done for operations on the retina, e.g.
retinal detachment repair. Gas within the eye will expand if a plane flies
at high altitude and this can be harmful to the eye and vision.

Like any surgery, cataract surgery creates risks, like bleeding and infection. Before cataract removal, the physician may advise the patient to stop temporarily taking medications which increase the danger of bleeding at the time of surgical operation. After surgery, he/she must keep his/her eyes clean, do not touch the eye without cleaning the hands and use recommended medications to aid in minimizing the dangers of infection. Serious infection may cause vision loss.

Cataract surgery increases slightly, the danger of retinal detachment. Some eye disorder, like high myopia(nearsightedness), may further add to the risk of retinal detachment after removal of cataract. The most common sign of retinal detachment is abrupt increase in floaters or flashes. Floaters are small “cobwebs” or spots that appear to hang in the field of vision. Retinal detachment has to be given attention right away because of its medical urgency. If you observe rapid increase in flashes or floaters, see an eye specialist right away. Your eye should be examined by an eye surgeon as needed. Retinal detachment does not cause any pain. Early medication of this eye illness can prevent eternal loss of vision. The sooner the treatment is, the better is the chance to regain good eye sight.

Cataract removal is the most ordinary operations done in the U. S. It is the most effective and safest type of surgery. Almost 90% of people who had cataract surgery had better visions afterward.
Preparations done before surgery.

Two weeks prior to surgery, some tests will be done to the patient. These tests will include the measurement of the curvature of the cornea, the size and shape of the eye. These facts will help the doctor to choose the exact type of IOL. The patient is advised not to drink or eat anything twelve hours prior to surgery.

You may be asked not to eat or drink anything 12 hours before your surgery.

During surgery, drops will be placed into the eye so that the pupil will dilate. The areas around the eye will be cleansed and washed. The operation normally lasts less than 1 hour and almost painless. Plenty of people prefer to remain awake at the time of surgery. Others are put to a sleep for a short duration of time. When awake, the patient will be given anesthetic to numb nerves in and around the eye.

After operation, a patch can be placed over the eye. The patient is allowed to relax for a short period of time for observation of any problem, like bleeding. Plenty of people who were operated on cataract were discharged on the same day

Usually mild discomfort and itching are common after cataract operation. Some fluid discharges are also regular. The eye can be sensitive to touch and light. Discomfort may occur, but after a day or two, moderate discomfort would disappear. Few days after surgery, the doctor will suggest the patient to make use of eye drops to help in healing and reduce the risks of infection. It is necessary to wear eyeglasses or eye shield to protect the eye. Refrain from pressing or rubbing the eye.

When at home, avoid bending from waist to pick up some objects. Do not raise heavy objects. You may walk, climb the stairs and do some light household tasks. Healing is completed within 8 weeks.
Problems can develop after surgery. These problems include bleeding, infection, inflammation, vision loss, double vision and low or high eye pressure. These problems can be resolved with prompt medical attention and may be successfully treated, so when problems appear try to consult your doctor.

Cataract surgery is the removal of a natural lens with opacification problem and the implantation of an artificial intraocular lens with good condition. The surgery has gone through a dramatic improvement since first invented and is considered the most effective way to cure the eye cataract problem.

Cataract surgery includes the procedures of cataract extraction and intraocular lens implantation. The types of cataract extraction vary differently from each other, but the most preferred one is the Phacoemulsification (Phaco) technology. This method uses a machine with titanium or steel tip and an instrument called chopper. The tip vibrates in the eyes at ultrasonic frequency to emulsify the lens material, and the chopper cracks the nucleus into smaller pieces to accelerate the emulsification process. There is usually a small incision or an enlarged incision for the insertion of the intraocular lens. This is not an easy job, though 90% of the operations are successful in restoring good vision. There are some complications following with and corneal edema (swelling of cornea) is such a serious potential complication. Furthermore, the likelihood of phaco technology is greater in the cornea edema complication because of the long time vibration in the eye.

There are some conditions which can result in greater probability to undergo the cornea edema. A very dense cataract, a shallow anterior chamber and a bad cornea disorder are all the reasons for serious swelling in the eye. For example, a dense cataract requires more time to vibrate to completely emulsify the lens material; a decreased distance allows more shock wave to reach the back layer of the cornea. They are all bad symptoms for potential cornea edema. Meanwhile, the clogging up of the drainage areas in the eyes caused by the viscoelastic fluid will lead to a higher post surgical intraocular pressure, which in turn causes the cornea swelling state.

However, for some situations, an experienced surgeon can minimize the side effects. A good pre-surgical evaluation and a careful post-surgical care are necessary for a successful operation. So, you do not need to worry about the complications of the surgery. Since you know a lot of notice items about the cataract surgery, you can expect an accurate operation and a wonderful post-surgical vision.

Sometimes in the months and years following a cataract operation the vision within the eye can gradually diminish. For the patient the effect can be rather like the original cataract recurring. One common cause for this is a phenomena called “Posterior Capsule Opacity”. It is also sometimes referred to as “after cataract”. What is it?

This can be explained by thinking of the eye as a camera. Like a camera the eye contains a lens. This is positioned within the eye just behind the pupil. This natural lens of the eye has the shape of a tiny discus, similar in size to a “smartie” or “M & M” sweet. A cataract occurs when this lens becomes hazy and obscures vision. To remove a cataract the surgeon must therefore remove the lens from the eye.

The lens of the eye has a thin membranous outer layer. This is called the lens capsule. As with a discus there are two main surfaces to the lens capsule. The front surface is called the anterior capsule and the rear surface the posterior capsule. During modern cataract surgery a small piece of the anterior capsule is removed in order to gain access to the cloudy interior of the lens. The art of cataract surgery is to remove this cloudy inner lens material whilst preserving the posterior capsule that lies behind it.

Returning to the “smartie” or “M & M” analogy a cataract operation is a bit like removing a tiny piece of the sugar coating from one surface so as to remove the chocolate within; but leaving behind the rest of the sugar coating intact! The effect is to create a little empty sac with a hole in its front surface. In the eye this is called the capsular bag. A replacement artificial lens (called the lens implant) is then inserted into this bag. The posterior capsule lies behind this lens implant and partially supports it.

The posterior capsule is extremely thin and delicate. Its centre is thinner than a single red blood cell! Eye surgeons make every effort to preserve the posterior capsule intact during surgery. It helps maintain the natural compartments within the eye. It separates the fluid filled space at the front of the eye from the jelly (called the vitreous) that fills the main rear cavity of the eye. It also stops the vitreous from moving forwards and interfering with the operation.

At the end of surgery the posterior capsule is clear and transparent. In some patients it may become hazy or opaque during the following months and years. This is “Posterior Capsular Opacity”. Eye surgeons refer to it as “PCO”. If this happens and it impairs vision significantly it can be treated using a laser. This is a quick simple painless outpatient procedure taking just a few minutes to perform. This treatment is called a “YAG laser posterior capsulotomy”. The aim is to create a small opening at the centre of the posterior capsule and thus clear the line of vision. If there is nothing else wrong with the eye this treatment should restore vision to that first achieved after the original cataract operation.

The information within this article is for general interest only. These are the personal views of Consultant Ophthalmologist Mr C J Heaven. If you have a problem with your vision then always seek the advice of your own eye specialist.

The evolution of cataract surgery has changed significantly over the years. It began with simply opening a large wound to remove the cataract, and then closing the hole leaving a void where the natural lens was. The only way a patient could then see was with the aid of very thick post surgical eye glasses. Eventually, contact lenses were developed that would correct the high power required to permit these folks to see well after surgery.

With the invention of the post cataract implant, these thick eye glasses and contact lenses became obsolete. Intraocular implants were initially developed with the goal of correcting distance vision, but still required eyeglasses to permit near vision. As time passed, an implant was needed that would permit both distance and near vision without the need for reading glasses. The first multi focal implant attempts were very poor, and were quickly discarded as useless appliances.

With almost 3 million cataract surgeries being performed annually, and that number expected to double in the next 5-10 years, better alternatives needed to be introduced. A very promising implant that permits both distance and near vision is the Crystalens by Bausch and Lomb. Unlike standard multifocal implants, the Crystalens is an accommodating lens that changes focus as the individual needs to see up close, or far away. It works on the premise that best simulates the natural lens’ ability to accommodate when reading is attempted. That is to say, the lens flexes forward when reading, and backward when viewing in the distance. This implant does however have its limitations. Most surgeons are happy when the implant achieves 20/30 in the distance, and some clarity at near.

This ability for the Crystalens to change focus is accomplished with the aid of the eye’s cilliary body; which pulled on the eye’s natural lens prior to its extraction resulting in its change in thickness. The cilliary body muscle continues to function throughout life and has even demonstrated greater contractile force after cataract surgery. The Crystalens is attached surgically to this muscle to assist in its function.

As this muscle contracts and rotates, the implant flexes and it alters the anterior chamber depth which results in the internal gel of the eye (vitreous) moving forward. Current research has shown that a 1 mm anterior movement will result in an increase of 1.3 diopters in accommodative ability. The Crystalens implant has hinges which allow the implant greater flexibility to move for accommodation.

The Crystalens AT- 45 had a 4.5 mm optic zone, while the Crystalens 5.0 has a 5 mm optic zone. These implants do work quite well, but still received patient complaints of poor near and night vision. The latest development is the Crystalens HD which supports a 5.0 OZ and increases the center thickness to 1.5 mm in the central zone of the lens. This increase in thickness permits a greater arching of the lens and thus better near focusing. The results have been outstanding according to Dr Thierry Hufnagel, a New York eye surgeon at the Stahl Eye Center. This increase in accommodative arching appears to be the answer to better near vision with these post cataract patients.

The FDA’s trial of this lens implant has demonstrated at least 2.OO diopters of accommodation in most patients (enough to read at arm’s length), and as much as 4.00 diopters of accommodation in some of these patients. An additional benefit of this new lens is a decrease in poor night vision as well.

After the cataract surgery you can return home stay quietly for two to three days. Do not lift any heavy objects. Do not bend down. You can watch TV and resume your normal diet.

It is better to wear dark glasses for a week to protect your eyes, even when you sleep. You should never rub your eyes. You should completely prevent your eyes from coming into contact with water and soap. You should never go for a swim or take showers, till the incision heals.

You can return to your office for desk work. You should take extensive precaution to see that your eyes do not come into contact with any dust or dirt. Completely avoid any dusty atmosphere. Avoid driving for at least one week after the surgery.

Post operative care involves the application of medications like the eye drops and ointment prescribed by the doctor, regularly. Wash your hands clean before you apply any medication. You should always use sterilized strips to wipe the drops of medicine that comes out of your eye. Alternately get surgical cotton and cut it into small square pieces. Put in the pressure cooker for ten minutes after the pressure develops. Then this cotton would be sterilized. Store it carefully and use it.

You may experience watery eyes a for few days after surgery. After the cataract surgery our eyes could turn red. You will be asked to meet your doctor the day after your surgery. You will be told to contact the doctor immediately if

o You experience severe pain of the eyes.

o Your vision becomes suddenly blurred

o If you see sudden flashes of light.

o If you see things floating across