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Cataracts

Online Health Chat with Dr. Roger H.S. Langston

May 27, 2011


Introduction

Cleveland_Clinic_Host: The eye’s lens (behind the iris) is typically clear and functions to focus light as it passes to the back of the eye. Cataract is a condition characterized by clouding of the natural lens, usually as a result of normal changes due to aging.

Dr. Roger H.S. Langston is a Staff Physician in the Department of Ophthalmology at the Cole Eye Institute at Cleveland Clinic. He joined Cleveland Clinic in 1974 after completing a fellowship in cornea and external diseases. Dr. Langston's secondary appointment is in the Transplantation Center at the Cole Eye Institute.

Dr. Langston is a Diplomate of the National Board of Medical Examiners and the American Board of Ophthalmology. He is also a Fellow in the American College of Surgeons. His areas of specialty include cornea transplantation and cataract surgery. Dr. Langston has personally performed several thousand cataract operations.

Dr. Langston earned a medical degree from McGill University in Montreal, Canada. After a rotating internship at Pennsylvania Hospital in Philadelphia, he did an ophthalmology residency at Georgetown University in Washington D.C. and then moved to Boston to complete a fellowship at the Massachusetts Eye & Ear Infirmary, a teaching partner of Harvard Medical School. He was board-certified by the American Board of Ophthalmology in 1974.

Cleveland Clinic’s Cole Eye Institute is ranked among the top 10 ophthalmology programs in the country by U.S. News & World Report, making it the top-ranked program in Ohio. We are among an elite group of dedicated, comprehensive eye institutes. Our fully integrated model helps us provide patients with quick and easy access to specialty and sub-specialty care for a wide spectrum of eye conditions -- from the routine to the complex. Cole Eye Institute has extended its quality ophthalmic care to several locations throughout Northeast Ohio, allowing patient access to ophthalmologists closer to their homes.

To make an appointment with Dr. Langston or any of the specialists at the Cole Eye Institute, please call 216.444.2020 or call toll-free at 800.223.2273, ext. 42020. You can also visit us online at www.clevelandclinic.org/eye.


Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Roger H.S. Langston. We are thrilled to have him here today for this chat. Let’s begin with some of your questions.

jolie: What are the various types of cataracts?

Dr__Roger_Langston: The major types of cataracts are nuclear sclerosis, cortical, and posterior subcapsular.

julliard: Do both eyes generally progress at the same rate?

Dr__Roger_Langston: Generally they do, but it varies a lot from person to person.

clear_view: Do cataracts cause long-term problems?

Dr__Roger_Langston: Ordinarily, the only issue is progressively diminished vision. Occasionally a surgeon may recommend cataract surgery in order to decrease problems with glaucoma or corneal dystrophies.

wake_up: When would you recommend having your cataracts removed?

Dr__Roger_Langston: Cataract surgery is appropriate when your lifestyle is significantly compromised by your vision.

nystrom: Can cataracts be prevented?

Dr__Roger_Langston: Not really. Most cataracts are due to normal aging. Some cataracts are associated with diabetes, so blood sugar control may be preventive. Some cataracts are associated with corticosteroid use. Decreasing the dose, if medically possible, might help. Exposure to bright sunlight, especially reflected light -- as off the water -- should be avoided. A healthy diet including anti-oxidants could also be useful.


Cataract surgery

jbo: When is cataract surgery not recommended? For example, if you have cataract in one eye only and 30 percent vision in other eye.

Dr__Roger_Langston: Cataract is a normal aging change. It is not damaging to have a cataract in the eye. Within reason, the results of surgery are the same whether it is done early or late. The patient can decide if and when to have surgery based on how he or she is functioning and knowing the risks involved in the surgery. Occasionally, the surgeon will recommend surgery because the cataract is becoming so dense that it would be technically difficult to perform the surgery if you were to wait.

In a normal eye, the chances of getting a good result with surgery approaches 99 percent. There is a 1 percent risk of having surgery where vision is 'good enough to get around,’ but not reliable enough for reading and driving. There is a roughly 1:1000 chance of losing all vision in the operated eye.

Cataract surgery is a very successful operation as a rule; however, surgeons would usually not recommend surgery unless the patient's life is compromised and the surgery would provide a chance to meet the individual's needs.

If the patient has significant age-related macular degeneration (AMD), cataract surgery may not improve the patient's lifestyle.

clara: I have been told that I might benefit by having cataract surgery. I only want to do distance seeing. Can a person only do one eye? What are the dangers of cataract surgery? I have been told (not by a medical person) that the retina can detach more easily.

Dr__Roger_Langston: Yes. You can have only one eye done. Many patients only have cataract surgery in one eye. Years ago, when cataract surgery was more invasive, there was a distinct increase in risk of retinal detachment associated with the operation. Nowadays, if the retina is otherwise normal, the risk is minimal.

eleven: How do you predict refraction in cataract surgery?

Dr__Roger_Langston: The calculations are based on measurements of the corneal curvature and the length of the eye.

robp09: If an eye has had bad cataract surgery, can the other eye have a newer lens for near and far?

Dr__Roger_Langston: I would recommend against that as there are more complications with the near and far lens implant. I would recommend a conventional mono-focal lens in the second eye.

close_outs: As I get older, it takes longer for my eyes to focus from near to far or far to near. Does this situation improve with cataract surgery?

Dr__Roger_Langston: No. Cataract surgery does not improve this. You will likely require bifocal or reading glasses.


After surgery

clara: What is the recovery after cataract surgery?

Dr__Roger_Langston: This depends on the surgical technique. In general, the patient is up and about immediately after surgery with normal activities that are not strenuous. The patient cannot drive on the day of surgery because of sedation. By the next day the patient can read, drive, and engage in most routine activities.

go_go_go: After cataract surgery, how often does one need to be checked?

Dr__Roger_Langston: Surgeons have different protocols and preferences. Ordinarily the day after surgery and one month post-surgery. It is also important that you have a way to contact your surgeon at any time of the day should you have problems.

hey_guys: Is it normal for some people to have trouble reading after cataract surgery?

Dr__Roger_Langston: No. With appropriate glasses, reading should not be a problem if the eye is otherwise healthy.

back_up: What can or should be done about the bright glare after cataract surgery?

Dr__Roger_Langston: Most patients have fewer problems with glare after cataract surgery, especially if the lens implant is mono-focal. Sometimes glare may be due to scar tissue forming around the lens implant in which case laser surgery may help.

katie93: Are headaches and/or dizziness normal after surgery or would this indicate a problem?

Dr__Roger_Langston: Headaches and/or dizziness are not usual, and in my experience they are likely to be unrelated to the surgery.

hot_days: What are the signs or symptoms that would indicate a problem after surgery?

Dr__Roger_Langston: Pain, redness, discharge, and blurred vision.


Glasses and Contact Lenses

how_to: Can you continue to wear contact lenses after cataract surgery?

Dr__Roger_Langston: Yes you can. In some cases, when cataract surgery is performed, the focusing power of the eye can be changed, making contact lenses unnecessary.

jackop: Can some of the symptoms of cataracts be corrected with eye glasses?

Dr__Roger_Langston: Yes, temporarily. It is common for cataracts to change the focusing power of the eye, and often glasses will improve distance vision or near vision, or both.

Over time, it may be that the glasses are so strong that they become uncomfortable to wear. That is the time that surgery may become necessary.

nemvi: My mother had cataract surgery about three years ago and no longer needed her glasses. She now once again needs reading glasses. Is this normal? How long does the effect of surgery usually last?

Dr__Roger_Langston: This is not uncommon. The shape of the eye continues to changes throughout one's lifetime.


Lens Replacement

flrp: Is there more than one type of lens that is used for cataract surgery? If so what are they and is one better than another? What are the advantages of one type of lens over another?

Dr__Roger_Langston: There are three major kinds of lens implants used for cataract surgery. The standard approach is a mono-focal lens. This gives good vision at either distance or near, but not both. Glasses probably will be needed after the surgery.

Toric lens implants may be able to correct for astigmatism and reduce dependence on glasses. They generally are not fully covered by insurance.

The third major type of lens is multi-focal or accommodating. These may give both distance and near vision at the same time. They are not always successful, and patients will often experience glares and halos from light sources and difficulty in low light circumstances, such as driving at dusk.

halle: If I change my mind about the type of replacement lens after cataract surgery, can it be replaced?

Dr__Roger_Langston: Yes, but it is not always easy and it is far better to make the right choice first.

ptp455: Can a replacement lens cloud up?

Dr__Roger_Langston: The lens itself does not cloud up; but in approximately 15 percent of patients, the membrane behind the implant does. If this happens, it is generally treatable with a YAG laser. This is a procedure done in the office with excellent results.

luba: I had the Restor implant in the eye about a week ago and have my right eye scheduled for three weeks from now. My distance vision is great! However, my near to mid vision did not improve so well. Could this be from the type of implant (lens) or is this normal? Will the other eye be for close/mid-range vision perhaps?

Dr__Roger_Langston: What you are telling me is not uncommon. It is important for your surgeon to know this, as it may change the lens selection in the second eye. Frequently, patients with Restor lenses do much better after surgery on the second eye.

harley3: How does one make the best informed decision as to the correct lens?

Dr__Roger_Langston: The best way to do this is a conversation with your ophthalmologist. It is important to have the give-and-take of conversation rather than using written material.

because: You mentioned long or short vision lenses for cataract surgery. Do you need to choose one over the other? How about a golfer who reads?

Dr__Roger_Langston: You have to choose. Some patients will choose to have one eye corrected for distance and the other eye for near. This may, however, not be a good choice for a golfer who might desire more balanced vision. On the other hand, it may be a good excuse for a missed putt!


Cataracts and other eye disorders

harper2: Can you please touch on cataract surgery with Fuchs dystrophy?

Dr__Roger_Langston: Fuchs’ dystrophy of the cornea makes the cornea more susceptible to damage with routine cataract surgery, even in the best of hands. It may even lead to the need for a corneal transplant.

If you have Fuchs’ dystrophy, I would recommend that you be evaluated by a corneal specialist prior to surgery.

brothers: What is the increased risk in cataract surgery with pseudoexfoliation? If you are diagnosed with glaucoma and have been suspect-base line tested with no progression for eight years, is it reasonable to assume you have a congenital large cup?

Dr__Roger_Langston: In pseudoexfoliation, the attachments of the cataractous lens (zonules) can be fragile, leading to technical difficulties in accomplishing the surgery and an increased risk of subsequent dislocation of the implant lens.

good_times: Can you have cataract surgery if you have glaucoma and or macular degeneration?

Dr__Roger_Langston: Yes.

ever_green: I had a detached retina with my first cataract surgery 10 years ago. Is that likely to happen with my second cataract surgery in the near future?

Dr__Roger_Langston: You probably are at an increased risk for retinal detachment in the second eye.


General Questions

Peppy: I have read that having cataract surgery if you have a drug eluting stent may place you at high risk of a stent thrombosis. What are your recommendations to such a patient to prevent this catastrophic event?

Dr__Roger_Langston: I am unaware of this problem and would recommend that you discuss this with your cardiologist.

jj89: Are cataract surgery and cosmetic surgery compatible?

Dr__Roger_Langston: Yes. They should be done in separate procedures.

shuboo: I had cataract surgery (both eyes) in 2007. When I come in from the outdoors, I have difficulty seeing for several minutes. Is this common?

Dr__Roger_Langston: It is fairly common since more light gets into the eyes than prior to cataract surgery. You should mention this to your ophthalmologist during your routine eye exams.

panamble: Explain how broken cataracts develop and how to deal with them. I am 59 going on 60. Does this have something to do with it?

Dr__Roger_Langston: I am not familiar with the term 'broken cataracts.'

pretending: Use of n-alpha-acetylcarnosine drops for cataracts.

Dr__Roger_Langston: I am not aware of any reputable studies that show they work.

i_promise: I had cataract surgery and laser. Will seeing closely with bright light affect my eyes?

Dr__Roger_Langston: No.

hahaho: Can untreated cataracts eventually lead to untreatable blindness?

Dr__Roger_Langston: As a direct cause, this would be extremely unlikely. However, if the cataracts are dense enough, they may prevent adequate examination of the retina. For example, this could lead to a lost opportunity to diagnose and treat retinal disease such as macular degeneration


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Roger H.S. Langston is now over. Thank you again Dr. Langston for taking the time to answer our questions today about cataracts.

Dr__Roger_Langston: You are welcome. Thank you.


More Information

To make an appointment with Dr. Langston or any of the specialists at the Cole Eye Institute, please call 216.444.2020 or call toll-free at 800.223.2273, ext. 42020. You can also visit us online at www.clevelandclinic.org/eye.

A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit www.eclevelandclinic.org/myConsult.

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

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This chat occurred on May 27, 2011

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. ©Copyright 1995-2011 The Cleveland Clinic Foundation. All rights reserved.