EYES ON THE FACTS

The Guardian (Charlottetown) - - THE ISLAND - Dr. Gif­ford Jones

Cataract surgery is pos­si­bly the safest surgery per­formed, says colum­nist, but it’s still im­por­tant to be in­formed

Do you re­mem­ber the Hol­i­day Inn ad?

It stated, “There Are No Sur­prises at the Hol­i­day Inn.”

But, un­like Hol­i­day Inns, there’s no such thing as sur­prise-free or risk-free surgery. To get an up­date about Cataract surgery I in­ter­viewed Dr. Ray­mond Stein, med­i­cal director of the Bochner Eye In­sti­tute, and as­so­ciate pro­fes­sor of oph­thal­mol­ogy at the Univer­sity of Toronto.

To­day, by age 80, half of North Amer­i­cans have de­vel­oped cataracts. The only good treat­ment when vis­ual loss fi­nally af­fects qual­ity of life is to have a foggy lens re­moved and re­placed with an­other one. To­day, due to im­proved sur­gi­cal ad­vances, it’s pos­si­bly the safest surgery per­formed.

But I also re­ceive re­ports from peo­ple who are not pleased with their al­tered vi­sion. Some wish the cataract surgery had never been done. So I asked Stein what can go wrong, so pa­tients won’t have sur­prises.

Stein says that in­fec­tion is al­ways a con­cern. But now eye in­ci­sions are only a few mil­lime­ters long so in­fec­tions are rare. For­tu­nately, when they oc­cur, the ma­jor­ity can be treated with an­tibi­otics. But, on rare oc­ca­sions, an eye is lost.

This is why one should al­ways re­mem­ber this fact of life. There may be only one chance in thou­sands of los­ing an eye, but if the Gods say it’s go­ing to hap­pen to you, it be­comes a 100 per cent hit. You might con­clude it would have been pru­dent to de­lay surgery. But de­lay­ing surgery is also risky. Foggy vi­sion can re­sult in fall­ing, frac­tured hips and death.

Stein says that reti­nal de­tach­ment is an­other se­ri­ous com­pli­ca­tion. But, luck­ily, it’s also a rare one. The retina, the back part of the eye, trans­mits im­ages to the brain. So if the retina be­comes de­tached, vi­sion is im­paired and it can lead to blind­ness. If this com­pli­ca­tion hap­pens the retina can be re-at­tached by gas in­jec­tion, laser ther­apy or by other in­traoc­u­lar surgery.

Stein lists yet an­other com­pli­ca­tion — dis­place­ment of the lens. The new lens is nor­mally held in place by what’s called, the pos­te­rior cap­sule. But just as joints can be­come dis­lo­cated so can the lens. This may hap­pen many months later and re­quire an­other oper­a­tion.

Some­times these prob­lems are an act of God and could not have been pre­vented. But, as I’ve stressed for years, it’s pru­dent to al­ways go to surgery with a first class ticket. Why? Be­cause it’s been aptly said that, “prac­tise makes per­fect”. This is true whether you’re a plumber or cataract sur­geon. So I asked Stein how many cataracts he had per­formed. His an­swer? 50,000 over the last 30 years! That’s a lot of prac­tice!

You say that, as a lay per­son, it’s eas­ier said than done to find a first-class sur­geon. I agree it’s never easy. But here’s a med­i­cal tip. If you’re for­tu­nate enough to know a scrub nurse who hands doc­tors in­stru­ments day af­ter day, ask her. You will never find a more re­li­able source.

Since pre­ven­tion of cataracts is bet­ter than cure, wear sun­glasses to de­crease the ef­fects of sun­light. Liv­ing close to the equa­tor in­creases risk of cataracts. So does high al­ti­tude. The peo­ple of Ti­bet have the high­est rates of cataracts in the world. And be sure to use pro­tec­tive glasses for tennis and other sports.

What about the use of vi­ta­mins? The cornea and lens have the high­est con­cen­tra­tion of vi­ta­min C in the body. In one study those with low lev­els of C had 11 times greater risk of de­vel­op­ing a cataract. So for years I’ve taken daily high doses of vi­ta­min C pow­der, partly for eye pro­tec­tion.

Dur­ing the in­ter­view, Stein men­tioned an in­ter­est­ing point. He said, that “pa­tients at the Bochner Eye In­sti­tute are of­fered a choice of ei­ther the tra­di­tional cataract oper­a­tion or the new laser surgery.”

I asked him the log­i­cal ques­tion, “What type would you choose?” His quick re­ply, “Laser surgery!”. He added, “I’ve also used the laser pro­ce­dure on the last 25 oph­thal­mol­o­gists.” I quickly con­cluded what’s best for oph­thal­mol­o­gists is also good for the rest of us. That’s med­i­cal tip No. 2.

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