Cataract Surgery Risks and Benefits

Georgia Eye Institute –

Cataract Operation Risks and Benefits

This letter will review cataract surgery and its risks and benefits. It will focus on the new refractive options that are available because of new len’s designs. Lastly, it will review unexpected benefits with respect to glaucoma.

While cataract surgery in is one of the most successful and predictable eye surgeries in Savannah, risks are still present. To each patient it remains a major surgery as there is the potential for vision loss and rarely actual loss of the eye from infection, bleeding or retinal detachment.

The excitement of cataracts operations come from the refinements in instruments that allow a very small self sealing wound and the precise calculation of a monofocal lens implant that minimizes the need for glasses after surgery. In many cases, the residual refractive error, or need for glasses, is not significant and the patient is content with only reading glasses.

The special lenses are also available to treat most astigmatism. These toric lenses are aligned with your eye to treat the moderate corneal irregular curvature that is not treated by a standard lens. The higher level of premium lens implant is a multifocal lens that is designed to minimize the need for distance and near vision glass. There are multiple brands that utilize different technologies, but the goal is to have some light focused for near and some for far.

This may limit contrast sensitivity and can be associated with glare but for many patients, the benefits far exceed these issues. Not every patient is a candidate for the toric or the multifocal implant and for that reason; Medicare allows an out of pocket charge for the extra evaluation and services. Patients with dry eyes or other surface abnormalities do not tolerate these lenses well, and some consider macular degeneration to be a relative contraindication. Your doctor will take these factors into consideration if you are considering a premium lens implant.

Recent studies have highlighted other benefits of cataract surgery

The Ocular Hypertension Treatment Study reported on the benefits of cataract operation in patients with ocular hypertension in September 2012. The report had a better design and confirmed what other studies had reported, a reduction in postoperative intraocular pressure. There was an average 16.5% reduction in IOP and there was a greater reduction in eyes with the highest preoperative pressure. A lower intraocular pressure limits the potential for glaucoma damage and in some patients may make glaucoma drop therapy no longer necessary. This can be a considerable financial saving given the price of glaucoma medications.

In July 2012, a new study published in The Journal of the American Medical Association examined the incidence of hip fractures in the year after a cataract procedure. The study showed a 16% fewer hip fractures in the year after surgery. Interestingly, the patients between the ages of 65 and 69 had a slightly higher rate of hip fracture but the patients ages 80 to 84 experienced a 28% reduction in hip fractures compared to those Medicare beneficiaries who did not have cataract surgery.

Other studies have shown benefits in mental health and overall quality of life after cataract surgery. It is a very exciting time in ophthalmology and cataracts care. It is amazing to think of the distance we have covered in the last 20 years. While all surgeries carry some risk, there is a lot more to be excited about than feared when you are told, “ You have cataracts and we need to consider a procedure to make you see better.”

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Macular Degeneration, Aspirin and Cataract Surgery

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Macular Degeneration Relationship to Daily Aspirin and Cataract Surgery

Age related Macular degeneration (AMD) is a leading cause of vision loss. It is a major health issue as our population ages and is eager to maintain independence. Preserving central vision allows us to drive and read our mail. Macular degeneration is referred to as dry or wet based on your physicians clinical findings.

Dry macular degeneration is characterized by a progressive thinning and atrophy of the macular region that results in poor central vision. Patients often describe a slow decline of vision with complaints of worsening contrast vision and the need for better lighting. You can think of it as “thread bare “ areas near the central vision that slowly expand leading to larger zones where there is no retina to receive the focused image. This only involves the central retina, or macula, and patients maintain peripheral vision. There is no bleeding or leakage of fluid into the retina.

Wet Age-Related Macular Degeneration

Wet age related macular degeneration, however, does involve bleeding and leakage of fluid into the central retina. This may occur relatively sudden and seemingly without warning. Common symptoms can include: sudden distortion of images or straight lines, a central gray or dark area, or just blurred vision. Early symptoms can be missed as we rarely check each eye individually and one eye may have problems while the other eye allows normal function. The bleeding and leakage of fluid associated with wet macular degeneration is the result of abnormal new vessels growing in the macular region. These new vessels tend to be fragile and may break and bleed without any action on your part.

As we age and become at risk for vascular events, prophylactic aspirin (ASA) has almost become a standard of care. This attempt to prevent clotting and its associated morbidities are obviously at odds with the goals of our wet macular degeneration patients. Many studies have looked at the association between ASA and wet AMDwith respect to causation and prognosis. It is a complex question as vascular disease is more common in patients with macular degeneration and smoking is an independent risk factor for both conditions.

In January 2012 The European Eye (EUREYE) Study reported on the association of ASA and AMD, as determined by questionnaire, within a group of 4700 patients. There was a variable use of ASA and of AMD severity among the participants and they showed that “frequent aspirin use was associated with early and wet late AMD” and the odds were greater with increasing frequency of ASA use. This cross sectional study did not determine causation but only says there may be a link. Obviously, each patients use of ASA or any other supplement must be evaluated on an individual basis but a practical assessment would be that prevention of stroke or heart attack with ASA use will outweigh any concern of ASA causing macular degeneration. The benefit of a healthy diet in green leafy vegetables and smoking cessation far outweigh any concerns associated with aspirin use.

For those patients with newly diagnosed wet AMD and active bleeding, it is reasonable to discuss a change in anticoagulant therapy for the short term. Drugs like Plavix, Coumadin, Pradaxa, and aspirin can exacerbate the bleeding with wet AMD in the short term. Fortunately, the new injection therapies cause regression of the offending new vessels and thereby dramatically reduce the risk of bleeding after a few injections.

Cataract Operation

Another common association and concern is whether a cataract eye operations cause macular degeneration to advance. There are over 3,000,000 cataract surgeries performed each year in the U.S. and many studies have explored this relationship. In November 2009, The Age-Related Eye Disease Study Report No. 27 reviewed 1939 eyes that had cataract surgery while enrolled in the national trial that evaluated antioxidants and minerals in macular degeneration. Each group showed a gain in vision but there was a declining benefit with more advanced pre-existing AMD. The benefit ranged from a gain of more than 8 letters in the group without AMD to only 2 letters gained in the advance AMD group.

In November 2012 the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study reported on the possible association between cataract surgery and the progression of AMD. This study used a fellow eye comparison so that it only included patients who had cataract surgery in one eye and left the other cataract alone for two years. Cataract operations were performed in 1851 patients and 71% had 36 months of follow up. The study showed no increased risk of early AMD or late AMD. There was a slight increase in retinal pigmentary changes in the operated group but the significance is yet to be determined.

Conclusion

Macular degeneration is a complex disease with many contributing factors including genetics, diet, smoking, and exercise patterns. Each study sheds a little more light on the subject but often leaves us with more questions. We believe it is safe to conclude the following:

1. A diet that contains green leafy vegetables and fresh fruits is recommended. Vitamin supplementation with an AREDS approved vitamin is advised for patients with intermediate or advanced macular degeneration in one eye.
2. It is reasonable to use aspirin on a daily basis but the patient’s eye care specialist should be aware of use of any anticoagulants for other medical conditions.
3. Cataract surgery is safe in patients with macular degeneration but it is reasonable to evaluate with a retinal scan or have a retinal consultation before surgery if there is any doubt about the role of AMD in a patient’s vision loss.
4. Tobacco cessation is necessary and cessation counseling should be provided.

 

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Age Related Macular Degeneration

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Age Related Macular Degeneration – Georgia Eye Institute

Age related Macular degeneration (AMD) is a leading cause of vision loss in those over 65. The associated anxiety of losing vision and independence can best be addressed with an understanding of the person at risk, the symptoms, and the treatments that improve the prognosis if the diagnosis is made early.

What is macular degeneration?

Macular degeneration is group of conditions that causes the central part of the retina, the macula, to lose the ability to see. This is an area behind the eye that cannot be easily seen or evaluated unless the eyes are dilated. There are two types of macular degeneration, wet and dry.

Dry macular degeneration is much more common and involves a slow process of aging cells that stop working and lead to blurred or missing areas in the central field of vision. It does not take away side vision.

Wet macular degeneration occurs when the aging retina grows new blood vessels that leak fluid and cause bleeding under the retina. These changes under the retina lead to sudden symptoms of blurred central vision and demand a prompt evaluation and treatment by an Optometrist.

It is much less common than dry AMD but receives more attention because of the potential for sudden severe loss of vision and because treatment is available. Patients are often ill prepared for the effect to lifestyle, hobbies, and work.

Understanding the symptoms

Macular degeneration helps improve the prognosis, but it is very important to understand that early macular degeneration often has no symptoms. Therefore, nothing replaces regular dilated eye exams and the American Academy of Ophthalmology suggests an exam every one to two years after the age of 65.

Patients must remain vigilant by testing each eye alone for more advanced symptoms: blurred vision, distortion, or missing areas in the central vision. The patient may notice it is more difficult to see faces or read, but it is important to remember that with both eyes open, advancing macular degeneration in one eye can be missed.

One can avoid this by checking vision with one eye covered while reading the paper or doing a Sudoku puzzle. Symptoms such as bent/curved lines, or missing letters can be noticed with single corrective eye exam.

Monitoring your vision is good at all ages but from a practical standpoint we can use our personal risk factors to guide our frequency of monitoring for symptoms. While we recognize an increased risk in blue eyed Caucasians of northern European descent, there is three risk factors that demand greater attention: a positive family history, a history of past or present smoking, and advancing age. Every race has an increased risk with advancing age, but a family history can be the most predictive. Genetic testing is not recommended yet but patient with a positive family history of AMD requires earlier and more frequent exams to identify early disease and to allay unnecessary fears if the exam is normal.

While you can’t pick your genetics or stop aging, smoking is the most important risk factor that you can modify. If you are concerned about vision loss from AMD, you must stop smoking. After your dilated macular exam, you and your doctor can tailor a reasonable frequency for exams and home monitoring for advancing AMD.

If monitoring detects new distortion, blurred vision, or areas of missing vision, you should seek prompt consultation with your eye doctor. Early diagnosis is important because it improves prognosis. Diagnostic evaluations may be as simple as a dilated retinal exam with your doctor but could also include an optical coherence tomography (OCT).

This is a retinal scan that can detect small amounts of retinal fluid that may otherwise be missed. More advanced testing with a retina specialist may include an injection of a contrast agent into your arm to perform an angiogram of the retinal vessels to look for abnormal new vessels. These tests determine your potential need for treatment.

Treatment Options

Treatment of wet AMD has seen great strides over the past 10 years. The prognosis has greatly improved with the introduction of injectable medication. Patients who were once certain to become blind have a much better chance of maintaining useful vision.

The importance of early treatment is highlighted by the 90% of people who will maintain or have improved vision if injection treatment is started during early onset of the disease. Regular injections of Eylea, Lucentis, or off- label use of compounded Avastin suppresses leakage and bleeding but unfortunately does not cure the disease. While a few patients can stop therapy, most require regular monitoring and injections indefinitely.

There is no current treatment for dry macular degeneration, but research is looking for ways to stop the degenerative process. Most therapy is supportive in nature with low vision aids to help with reading and daily tasks. Low vision aids can also be of great help to patients with wet AMD.

Vitamin therapy is based on the Age Related Eye Disease Studies that evaluated the role of high dose vitamin therapy at reducing the incidence of AMD and vision loss. In the AREDS II trial, those patients taking the supplements with lutein/zeaxanthin had a 26% reduced risk of developing advanced AMD compared to those not taking the supplement. Most of the participants also took a multivitamin.

Macular degeneration is a complex topic that can cause anxiety because it is poorly understood, and we all fear the loss of vision and independence. With education, routine monitoring, and prompt therapy, the poor vision, and fear of AMD can be minimized.

We stress regular dilated eye exams, not smoking, and a diet in green leafy vegetables and AREDS II vitamin supplements to reduce its effect.

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Georgia Eye Institute Announces Promotion

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Georgia Eye Institute Announces Promotion of Andreia Guthery

8 February 2016 – Savannah, GA – Georgia Eye Institute (GEI) announces the promotion of Andreia Guthery to Satellite Office Coordinator. Guthery Joined GEI 10 years ago, and has held positions in the front office, and billing department.

As Satellite Office Coordinator, Guthery will oversee daily operations in the Vidalia, Glennville, Statesboro, and Richmond Hill offices, ensuring that office policies, procedures and plans are executed in a smooth and expeditious manner, as well as performing financial oversight, office and insurance administration, and personnel management duties.

GEI provides leading edge corrective eye surgery, ophthalmic care, primary eye care and surgical eye care. For more than 20 years the pioneering surgeons and staff at GEI have set new standards for outpatient cataract surgery and lens implantation, advanced retinal care for diabetic eye disease, LASIK laser vision correction, glaucoma management, treatment for macular degeneration, corneal disease, oculoplastic surgery corrective eye surgery,and optometry.

GEI has 13 area offices, including locations in Bluffton, Brunswick, Glennville, Hardeeville, Hinesville, Jesup, Richmond Hill, Rincon, Savannah, Statesboro, and Vidalia. They also provide patients the comfort, safety, convenience and cost savings of a Medicare-approved AAAHC Accredited outpatient surgery center. Georgia Eye Institute Surgery Center (ASC) was built in 2010 to complete the comprehensive care that Georgia Eye Institute provides to our cataract, glaucoma, retinal and corrective eye surgery patients. For more information, visit gaeyeinstitute.com.

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For more information, contact:

Frances Burruss

Joselove-Filson Advertising, Inc.

912.353.7732 x 22 | frances@joselovefilson.com­­­­­­­

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5 Things You Should Know About Laser Eye Surgery

Although laser eye surgery has been around since 1988, there is still a lot to learn about this new technology. Individuals who have vision problems often visit an ophthalmologist to find out what can be done about their vision. Doctors gravitate to the use of laser technology in these settings to get a clean line, making it easy for the patient to heal. However, there are many different facts you may not know about this innovative technology.

LASIK and laser eye surgery can handle a variety of vision impairments, including myopia, hyperopia, and astigmatism. The technology is customizable to each individual, making it easy to modify with each condition. Individuals with astigmatism may require more attention and time, since the eye requires a three-dimensional image to accurately make the incision. Once healed, you will no longer need your contact lenses or glasses. This technique is responsible for over 90% of eye surgeries annually, adding up to over two million patients worldwide every year.

Each person who undergoes laser eye surgery receives the same high-quality service, but this technology allows the doctor to customize the treatment specifically to each patient. Based on your initial examination, your doctor determines if laser eye surgery is right for you and what type of surgery you should have. The specialist will choose between a bladeless approach and wavefront technology to correct your visual impairment. Choosing to have laser eye surgery may be costly now, but you save thousands of dollars on new glasses and boxes of contact lenses for the rest of your life.

The procedure itself is relatively simple. Using laser technology, the ophthalmologist takes a three-dimensional image of the eye, discovering the exact size, and shape to prepare for the surgery. Since laser eye surgery makes no incisions with a blade, the procedure goes by relatively fast, making it easy to return to work only a few hours later. Laser eye surgery is essentially painless and does not even require full sedation or anesthesia. Some physicians offer prescriptions for anxiety prior to the exam to help calm the nerves; however, the surgery itself causes minimal discomfort. To eliminate any potential pain during the surgery, your doctor applies numbing eye drops prior to using the laser technology.

Aside from the speediness of the procedure, the best part about choosing laser eye surgery is the fast recovery time. Since these procedures do not involve the use of a scalpel or other blade, the incision is precise and clean. Though doctors may prescribe eye drops to combat dry eyes, many patients can resume their daily activities quickly. Some individuals even return to work and social engagements within the same day.

If you have additional questions about laser eye surgery, speak with an ophthalmologist. The expertise of a professional can help you decide if you want to correct your vision permanently with little healing time. A vision exam often shows if you are a candidate for corrective eye surgery, helping you to see clearer than through your glasses.

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Laser Eye Surgery

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What is Laser Eye Surgery?

Laser Eye Surgery is designed to correct the vision of an individual with myopia, hyperopia, and astigmatism. An ophthalmologist, reshaping the cornea of the patient for improved vision, always performs this procedure. Some patients fear the thin cutting in the flap of the cornea; however, the days of scalpels and cuts are over. By combining the technology of the Wavelight Allegretto Excimer Laser and the FS200 Femtosecond Laser, the ophthalmologist can achieve greater precision without having to touch the eye at all.

The Wavelight Allegretto Excimer Laser and the FS200 Femtosecond Laser are used as the first laser system that requires no cutting into the eye. Before laser technology became, ophthalmologists would use a microkeratome to open up the cornea. However, the use of a laser gives your specialist the ability to customize the flap to your particular eye shape and ailment. Using Perfect Pulse technology, the Wavelight Allegretto Excimer Laser effectively and safely creates a thin flap in the cornea. Once open, the available ophthalmologist remodels the cornea in a way that perfects the patient’s vision. This approach varies from person to person, making laser technology the best chance at perfect vision.

Upon leaving the ophthalmologist’s office, patient typically receives eye drops or other antibiotics that they need to apply as instructed. The patient receives dark eyeglasses to allow the eyes time to adjust to the new vision without harmful light from the sun.Some Laser Eye Surgery patients decide to use protective goggles instead to reduce dryness and prevent themselves from irritating the surgical site. Follow your surgeon’s directions carefully to make sure your eyes heal properly.

The Laser Eye Surgery process is now safer than ever before, minimizing the margin for error consistently on this already safe procedure. Using lasers for eye surgery gives your ophthalmologist greater control and more predictability when making the changes to your vision. Additionally, surgeons who use lasers for their corrective eye surgeries have better consistency, which means more surgeries that are successful. Since the laser technology is more precise, individuals spend less time healing after the surgery and have a lowered risk of injury post-surgery. The success of this surgical advancement has been studied over the years, concluding that the overall quality of life is improved for patients who previously suffered from vision impairment.

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Glaucoma Awareness Month

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