Cataract FAQs
What is a cataract?
A cataract is a clouding of the eye’s internal lens, which can interfere with the ability to see clearly.
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Are cataracts found only in older people?
The majority of cataracts are a result of aging, which can cause proteins in the lens to clump and cloud the lens. The age at which a cataract affects vision can vary, from as early as the fifties to as late as the seventies and beyond. In rare cases, infants can have congenital cataracts. These are usually related to the mother being afflicted with German measles, chickenpox, or another infectious disease during pregnancy, but sometimes they are inherited. Diabetic patients, as well as others affected by a systemic metabolic disease, may develop a cataract at a younger age than the average patient. Pharmaceutical compounds, like corticosteroids, may also cause a cataract to form early.
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When should cataracts be removed?
Cataracts start small and virtually unnoticeable, but get larger and cloudier, and obscure vision more over time. It is generally best to wait until the cataract interferes with a patient’s vision and lifestyle before performing surgery. A surgeon, architect, or designer may need early cataract surgery in order to fully accomplish their routine duties. An older patient suffering from other more severe systemic diseases or with dramatically reduced personal activities may be able to temporarily delay cataract surgery.
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How are cataracts removed?
A small incision is initially made in the eye, near to the cornea, and the surgeon introduces an ultrasound probe to break up the cataract and simultaneously remove its fragments. Normally, an intraocular artificial lens, or IOL, is inserted at the end of surgery in order to replace the natural cloudy lens and refocus the images coming from outside onto the retinal surface.
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Is the procedure serious?
Like any surgery, cataract surgery involves a certain degree of risk. However, cataract surgery is one of the most commonly performed types of surgery, and choosing a highly trained and experienced surgeon will consistently reduce the risk of complications.
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Retinal Detachment Questions
What is the retina?
The retina is the light-sensitive tissue that lines the back wall of the eye. Like film in a camera, the retina is responsible for creating the images that we see.
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What is retinal detachment?
Retinal detachment is what happens when the retina separates from the back wall of the eye.
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Are there different types of retinal detachment?
Yes, there are three types. Rhegmatogenous is the most common, and describes a tear or break in the retina that allows fluid to get under the neurosensory retina and separate it from the underlying retinal pigment epithelium (RPE), the pigmented layer of cells that nourishes the retina.
Tractional detachment describes the detachment that occurs when scar tissue on the retina’s surface contracts and causes the retina to separate from the RPE.
An exudative detachment is frequently caused by retinal diseases, including inflammatory disorders and/or trauma to the eye. In this form of detachment, fluid leaks into the area underneath the retina, but there are no tears in the retina.
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What are some of the risk factors for retinal detachment?
Retinal detachment is more likely to occur in people who:
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What types of reattachment procedures could be offered?
Pneumatic retinopexy uses an intraocular injection of expandable gases followed by application of cryotherapy in order to close a preexisting retinal tear or hole located in one of the upper retinal quadrants. This surgery can be performed on an outpatient basis and requires careful positioning of a patient’s head in the first postoperative days.
Scleral buckle surgery uses a flexible band to pull the retina to the back wall of the eye; the doctor often drains off the fluid that is trapped under the retina. The buckle is usually a piece of silicone sponge or solid silicone. Often, scleral buckle surgery can be performed with local anaesthetic and on an outpatient basis. This procedure has been used successfully for more than 40 years.
Vitrectomy is a slightly newer procedure that involves removing the vitreous gel and replacing it with a gas bubble, which the body’s fluids will gradually replace. It is most commonly used for traction retinal detachments, but is also used for rhegmatogenous detachments. It can usually be done as same day surgery and with local anaesthesia. Mild sedation, in order to decrease psychological stress, may be beneficial for anxious patients.
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Macular Hole Questions
What is a macular hole?
A macular hole is a small break in the macula, the centre part of the retina responsible for all sharp, detailed vision. Generally a macular hole occurs in the very centre of the macular area, known as the fovea.
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What’s the difference between a macular hole and age-related macular degeneration?
Although both conditions are more common in people 60 and over, macular holes and age-related macular degeneration are two separate and distinct conditions. In fact, macular degeneration is a real degenerative process that includes structural, metabolical and microvascular changes as causative factors rather than mechanical ones.
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What causes macular holes?
As we age, the vitreous, the gel-like substance that fills about 80% of the eye and helps it maintain a round shape, slowly shrinks and pulls away from the retinal surface. If the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole. Macular holes can also occur as a result of high myopia, macular pucker, persistent cystoid macular edema and eye diseases such as diabetic retinopathy and Best’s disease.
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How do I know if I have a macular hole?
In the early stage of a macular hole, you might notice slight distortion or blurriness in your straight-ahead vision. Straight lines and objects can begin to look bent or wavy. You may also experience progressive difficulties in reading.
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What are the stages of a macular hole?
Stage I is known as foveal detachment. Without treatment, approximately half of stage I macular holes will progress. Stage II is characterized by partial-thickness holes. Without treatment, about 70% of stage II holes will progress. A full-thickness hole is described as Stage III. Most central and detailed vision can be lost when a Stage III macular hole develops.
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How is a macular hole treated?
Although some macular holes will seal themselves and require no treatment, in many cases, a surgical procedure known as a “pars plana vitrectomy” is necessary. In the surgery, the vitreous gel is removed to prevent it from tugging on the retina and replaced with a bubble of air and gas. The bubble acts as an internal bandage that holds the edge of the macular hole in place until it heals. In order to optimize postoperative anatomical results and visual outcome, adequate “face down” positioning may be required for one week or more after surgery.
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How much can the surgery help?
Results can vary. The less time a patient has had a macular hole, the better his or her chances for successfully recovering vision. Dr. Cusumano can discuss your risks and expectations during the consultation. When surgery is not delayed and patients are careful to remain “face down” after surgery, it is possible for them to completely regain pre-existing visual acuity.
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PRK versus LASIK
What is the difference between LASIK and PRK?
In both LASIK and PRK, an ultraviolet laser beam is used for reshape the anterior curvature of the cornea. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is partially vaporized with the laser. In PRK, the top layer of the cornea, the epithelium, is gently removed, exposing the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and is then folded back after laser surgery. PRK requires the postoperative application of a “bandage” contact lens for 4-5 days, in order to reduce patient’s discomfort during the reepithelialization process. The LASIK procedure does not require the transitory application of a contact lens, permitting patients to obtain satisfactory visual rehabilitation immediately after surgery, but is characterised by a higher rate of complications than PRK. When considering safety the absolute priority, PRK is without any doubt the procedure to be recommended. The moderate discomfort following PRK during the first 3-4 days after surgery could be easily controlled by means of locally applied eye-drops or administration of mild anti-pain tablets.
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Prof. Dr. med. Andrea Cusumano
Via Donatello 37
Rome, Italy 00196
Phone: +39 06 320 0369
Fax: +39 06 322 7607