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We all encounter cataracts on a daily basis.
They are mainstay of eyecare today. It's estimated that over 20 million Americans
that are over the age of 40
are affected by cataracts and
this number is estimated to increase to over 29 million by
the year 2020.
We know that cataracts are progressive and, for our patients who are not affected by them,
we want to slow the progression as much as we can.
And for these patients it is important for us to recommend that they stop smoking,
consider supplements,
and increase the use of UV blocking sunwear.
But for our patients who do have cataracts and that they are affecting their vision,
it's time for us to begin the process of cataract surgery.
There are three main areas that need to be considered prior to surgery.
Number 1 is the refractive component.
We will spend more time on this in our next episode (Clinical Insights 12).
Also,
evaluation of the lids and lashes,
and evaluation of the ocular surface.
First, let's touch on the lids and the lashes.
We see blepharitis in one way or another in most of our patients.
Most of us probably don't treat or recommended aggressive treatment in patients with mild cases.
But for patients who are pre-cataract surgery,
we need to treat these patients.
According to studies, blepharitis is thought to be the primary risk factor for Endophthalmitis
and is the number one reason for cancellation of cataract surgery.
We suggest that anyone who is considering surgery start using lid scrubs
several weeks prior to surgery.
And if they have active blepharitis,
they should be treated with the appropriate treatments prior to surgery being scheduled.
Next lets review the ocular surface.
In a multi stage study more than half of all patients undergoing cataract surgery were found to have significant dry eye disease
based on objective testings.
This is definitely worth addressing because a good ocular surface prior to surgery
will aid in the visual and inflammatory outcomes following surgery.
As it stands, every patient that undergoes cataract surgery will have inflammation.
We aim to reduce dry eye and inflammation as much as possible
prior to surgery.
We do this in three ways.
First,
we aim to boost the ocular surface for the patient with mild cases
with a good artificial tear
that they can use throughout their surgical journey.
Next,
with the use of the Cyclosporine BID.
We have colleagues who work in surgery centers and
and when asked when is the right time to put a patient on Cyclosporine pre-operatively,
they answer
NOW!
One study looked at the use of Cyclosporine for one month prior to surgery
and for two months following surgery.
The study group had reduced dry eye signs and improved visual quality after multifocal IOL implantation.
And finally, for patients with significant inflammation,
we will place them on a steroid.
We then monitor their inflammation and attempt to treat the underlying cause prior the surgery.
If the management of the inflammation is a further challenge,
we'll discuss this with the co-managing practitioner at the surgery center
and decide on the next course of action.
Cataract surgery is a milestone in our patients lives and
if we want to improve their quality of life through surgery,
we want to address to their lids, lashes and the ocular surface.
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