Welcome to the Cornea by Kane blog, your trusted source for an honest opinion about your eyes.
Recently, Dr. Kane was asked to write an article in the journal Ophthalmology Management. He was asked to share his views on refractive cataract surgery. What an honor! In this article, Dr. Kane discusses how refractive cataract surgery can still be successful in patients with common corneal conditions. As the article was written for fellow ophthalmologists, here we will provide an overview of the main points of the publication and how this may apply to you. For more information and to see the full print article, be sure to click the link at the bottom of the blog!
What is a Complex Cornea Condition
Many patients have underlying eye disease that can impact the quality of vision. Some of the most common conditions are Anterior Basement Membrane Dystrophy, Fuchs’ Corneal Dystrophy, Radial Keratotomy, and Dry Eye Disease. These conditions are very common reasons why patients may be unhappy after cataract surgery. However, when evaluated and managed prior to cataract surgery, patients with these conditions can still have a great final vision outcome.
Cataract Surgery with Anterior Basement Membrane Dystrophy (ABMD)
ABMD is the most common corneal dystrophy and it causes wrinkling of the skin that covers the cornea. This can have a significant impact on the quality of vision after surgery as it can be like looking through a fingerprint in the middle of your glasses. This can also impact the accuracy of cataract surgery measurements. When detected before surgery, an effective treatment for this condition is to polish off the abnormal wrinkles and give the eye time to heal. Once the cornea is smooth again then you can proceed with cataract surgery measurements. For more information about ABMD from Tailored Eyes please click here.
Cataract Surgery with Fuchs’ Endothelial Corneal Dystrophy
Fuchs’ corneal dystrophy is also extremely common and similar to ABMD may go undiagnosed early on. While ABMD is a problem with the corneal surface, Fuchs’ is a problem with the inside lining of the cornea. Dysfunction and premature death of the specialized pump cells that line the inside of the cornea can lead to poor quality of vision and corneal swelling and haze. Some patients may notice blurring of their vision in the morning that clears up after waking. Patients with Fuchs’ are prone to persistent corneal swelling after surgery. In addition, cataract surgery by itself may not alleviate the quality of vision and glare problems that you may be experiencing. With today’s advances, there are good surgical techniques to minimize the risk of corneal swelling after cataract surgery. There are also good treatment options to remove the dysfunction layer of cells and replace them. There are too many options to discuss at length here but for more information about cataract surgery in patients with Fuchs’ dystrophy please click here to see my other blog post on this topic.
Cataract Surgery with prior Radial Keratotomy, Lasik, or PRK
So you have a history of cornea surgery to be independent of glasses. We call that refractive surgery. Maybe you have enjoyed many years of excellent vision without glasses but now you have a cataract. Now you want to know if you can be glasses free again. The common theme of all of these refractive surgeries is that they change the shape of your cornea to help you be more independent of glasses. What that means for cataract surgery is that our ability to measure the power of your eye will be less accurate. How much will it be off is different in everyone. While we have gotten much better at predicting and hedging toward the correct power, there is still guesswork involved. But fear not! There is now a good option for you to be independent of glasses. The most accurate option today is to use a light adjustable lens implant at the time of cataract surgery. As mentioned above, a light adjustable lens does not depend as much on having accurate measurements. This is because after surgery we are able to adjust the power of the lens a few diopters using ultraviolet light after surgery! This is like getting the golf ball on the putting green and having 3 chances to putt it in the hole rather than just 1 putt. For more information about how the light adjustable lens implant works click here.
Cataract Surgery with Dry Eye
Dry eye can be difficult to manage independent of cataract surgery. If you are struggling with dry eye, it is important to try to maximize how well it is controlled before surgery. The reason it is important to treat dry eye before cataract surgery is because it will get worse after any eye surgery. In addition, dry eye disease can cause an irregular cornea surface which can cause inaccurate measurements and poor quality of vision after surgery. There are many great treatments today from supplements and lubricating tears to eyelid treatments like Lipiflow. Common symptoms of dry eye include blurring of vision after reading or watching TV for a while or a gritty, irritated feeling on the eye. If you think you have these symptoms, then talk to your doctor about starting dry eye treatments before your cataract surgery.
Where can I read more about cataract surgery and complex corneas?
To read the full article on Refractive Cataract Surgery in Patients with Complex Cornea Conditions please click the link to be directed to the November 2022 Ophthalmology Management publication.
Link: Refractive Cataract Surgery in Patients with Complex Corneas.
Summary
If you have a complex cornea, there are still good treatment options. It may still be possible for you to achieve a happy outcome after cataract surgery. Make sure you find a cataract surgeon comfortable managing your condition and understand your options before surgery. If you aren’t sure, then I recommend a consult with a cornea specialist (a doctor like me who has additional training in cornea problems).
I’m Dr. Kane, and that’s my take on it.
At Tailored Eyes, we perform a thorough evaluation of your eyes and together formulate a customized treatment plan to meet your vision needs.
For more information or to book an appointment please call the office at 941-499-1570 or email us at info@tailoredeyes.com.
Steven Kane, MD, FAAO is a Cataract, Cornea, and Refractive Surgery specialist with Tailored Eyes in Sarasota county Florida. He proudly serves the people of Venice, South Venice, Sarasota, Plantation, Osprey, Nokomis, Laurel, Siesta Key, Casey Key, Bradenton, Lakewood Ranch, Anna Maria, Palmetto, Ellenton, St. Petersburg, Englewood, North Port, Punta Gorda, Port Charlotte, Charlotte Harbor, Manasota Key, Arcadia, Fort Myers and Cape Coral.