Qualifying Vision for Cataract Surgery

We've mentioned many times that routine cataract surgery is scheduled when there is documented visual impairment related to the cloudy lens: difficulty driving, trouble reading, etc. That is to say, cataract surgery is performed when the patient (not the surgeon) decides the time is right.

That doesn't always mean that patients with 20/20 eyesight can have cataract surgery just because there is a little glare when driving at night. To prevent abuse some states have established minimum standards that qualify the procedure for insurance reimbursement. Yes, there are always waivers and exceptions for unusual circumstances, but the following states require best-corrected preoperative vision at or below these levels:

20/40 or worse: DE, DC, MD, PA, TX, VA

20/50 or worse: GA, ID, IN, KY, MT, NC, OH, SC, TN, WV

Don't worry! Your surgeon's staff will not schedule your cataract operation unless the procedure is already pre-authorized by the insurer.

Related Topics: WebMD Video: Focus on DSAEK Eye Surgery, Eye Health Center

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Bug Bites and Blurry Vision

Hooray! Summer is almost here!

In our 'neck of the woods' the weather pattern vacillates but more and more days are sunny and warm. This sounds like a perfect opportunity to remind everyone about generous use of sunblocks as well as use of protective clothing and UV sunglasses.

Maybe so, but there's a different outdoor threat to your vision you need to know about - insect bites!

How could a mosquito sting on your arm alter your eyesight?

What's the connection between a tick bite and double vision?

The danger is not so much the bite itself, rather it is the exchange of infected fluids when an insect's saliva or blood meal enters your own circulation. The specific threats are West Nile (a virus, blame mosquitoes) and Lyme Disease (a bacterium, blame deer ticks).

Serious infections by West Nile virus are rare but real! The entire central nervous system can be involved and this includes the brain, optic nerve, and retina. Case reports have already appeared in the medical literature. There is no specific medical treatment, supportive care only. Most survivors eventually recover good vision.

Lyme Disease has been around longer. It is caused by a spirochete (a tiny spiral-shaped bacterium called Bartonella). The circular rash from the tick bite is a valuable warning. Serious neurologic complications can develop. Permanent vision loss is caused by inflammation of the retina and optic nerve. Aggressive antibiotic therapy offers the best chance for complete recovery.

These infections have been confirmed in all 50 states. The risk of infection begins the moment you step outside the door of your house.

• Clear your property of all standing water.
  
• Use DEET insect repellants.
  
• Wear long-sleeve shirts and trousers when walking through brush and forests.
  
• Inspect your body and scalp for freeloading critters.
  
• Finally, don't forget to protect your pets from summer insect bites.

Now, aren't you already longing for the return of cooler weather?

Related Topics: Summer Skin Makeover, Summer Safety for Kids

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Blindness After Viagra: Premature Conclusions?

Last year there was great interest concerning reports of blindness in older men after having taken Viagra (Sildenafil citrate, Pfizer). Like most health stories in the news there were a few days of buzz and then the issue dropped off the radar in favor of some other, scarier headline.

Eye doctors theorized that Viagra compromised bloodflow to the optic nerve, causing a serious eye problem called Nonarteritic Anterior Ischemic Optic Neuropathy (NAION). NAION has been around a long time, long before Viagra, and it typically befalls older adults with high blood pressure.

A new report in this month's Archives of Ophthalmology analyzes claims that Viagra caused these men to lose eyesight. To date 86 cases of sudden vision loss after Viagra use have been reported. Several cases were disqualified and rediagnosed. Nearly half recovered vision after the attack - a much higher recovery rate than usually encountered with NAION. 43 cases had insufficient followup data. Bottom line: nothing conclusive, not even 'kinda conclusive'.

At best, there is a 'possible' connection between Viagra and NAION. Having said that, no definitive scientific explanation exists to explain how Viagra could cause NAION. Millions of Viagra tablets have been prescribed to millions of hypertensive older males. Why so few cases? Equally important, if erectile dysfunction drugs were to blame why didn't the problem affect both eyes?

The authors of this retrospective review recommend that only men with documented prior attacks of NAION should avoid use of erectile dysfunction drugs like Viagra, Levitra, and Cialis.

As always, talk to your personal physician for specific advice as it pertains to your individual circumstances.

Related Topics: Routine Maintenance for Men, Diet, Lifestyle May Affect Eye Health

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Retinal Detachment after Cataract Surgery

Cataract surgery with intraocular lens implantation is the most common surgical procedure performed in America. One of the most devastating postoperative complications following cataract surgery is a retinal detachment (RD). It can occur weeks or months following uncomplicated cataract removal. Severe vision loss persists unless the retina is promptly reattached.

Years ago the risk of RD was in the 2-5% range. Contemporary advances in surgical technique have greatly reduced the its incidence. Theory has it that the surgical procedure led to traction by the clear vitreous gel which, in turn, tugged on the retina to form a tiny hole. Eventually liquid vitreous would enter the hole and elevate the retina (think water underneath the carpet - lots of water!)

A recently published study examined 45,000 cataract procedures that led to 845 RDs; that's about 1.8%.

The greatest risk factor identified was a tear in the lens capsule at the time of surgery. It alone contributed to 37% of RDs. Other troublemakers include larger than average eyes (greater than 23mm axial length), rupture of tiny lens zonules before or during surgery, and a history for previous RD in the fellow eye.

Age, type of surgical technique, and choice of anesthesia were not statistically significant.

What can you do with this information? If someone you know is having cataract surgery you can quickly assess the potential risk for a retinal detachment by asking the surgeon if there were any complications during the procedure. Don't be satisfied with "Everything went fine!" That could mean "There were problems but we fixed them!" Specifically ask if the posterior capsule remains intact, if there was any vitreous loss, and if there was any damage to the lens zonules. Don't be intimidated if the surgeon seems put-off - you are empowered with information like never before!

Related Links: Cataracts and Your Eyes, Fact of Fiction: Myths About Your Eyes

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Permanent Recall of Contact Lens Solution

This update is adapted from information released by the American Academy of Ophthalmology:

Bausch & Lomb has told the U.S. Food and Drug Administration (FDA) that based on scientific and epidemiological data, unique characteristics of the formulation of ReNu with MoistureLoc in certain unusual circumstances can increase the risk of Fusarium infection.

Bausch & Lomb's other ReNu products, including MultiPlus and Multi-Purpose, are not included in the recall. To date, data available do not indicate a problem with these products or generic brands of this contact lens cleaning solution.

Saying it's the "right thing to do," Bausch & Lomb Chairman and CEO Ron Zarrella today issued the worldwide recall. He said his company will not reintroduce the product.

In a letter to consumers, Zarrella wrote: "After thousands of tests, there is no evidence of MoistureLoc contamination, tampering or counterfeiting. That leads us to conclude that there may be some aspect of the MoistureLoc formula, when combined with certain environmental factors, lens wear and care practices, and other factors, that might increase the risk of Fusarium infection in rare circumstances."

Baush & Lomb implicates alexidine, a disinfecting agent added to MoistureLoc. The company claims that alexidine is safe and effective, but under certain extreme conditions - such as when the solution is allowed to evaporate, when the solution is not regularly replaced in the lens case, when the bottle is kept open in between uses, or when the case is not cleaned properly or changed regularly the solution is more likely to be contaminated with Fusarium in the environment.

The FDA today said it supported Bausch & Lomb's global recall, and planned to issue findings "imminently" from an inspection of Bausch & Lomb facilities in Greenville, S.C. The U.S. Centers for Disease Control and Prevention has received reports of more than 120 confirmed cases of Fusariuim keratitis as of May 12. An additional 60 cases are under investigation, and 15 are listed as "possible."

Related Topics: Contact Lens Solution, Eye Fungus Risk, New Contact Lenses, Old Infection Risk

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Tracking Which Freckles Become Tumors

Not infrequently a worried WebMD community member writes about findings made during a routine eye examination. Often it is the presence of a flat, pigmented mole in the back of the eye. The patient is beset with the news and the doctor departs without giving a complete explanation. (Perhaps the doctor gave a thorough explanation but the fretful patient was unable to process the information.)

There are several pigmented moles inside the eye but a choroidal nevus is the one that demands the most scrutiny. Choroidal locates the freckle to a layer of tissue underneath the retina - nevus means a benign growth of pigmented cells. Most choroidal nevi are safe and are managed with periodic exams. A small percentage of these nevi, however, can grow and become a choroidal malignant melanoma.

Eye specialists have recently published clinical data in the British Journal of Ophthalmology that describe long-term followup of patients with choroidal nevi. This study ran for 20 years and evalauted 659 patients. This is a select group. Most patients with choroidal nevi are never seen by an eye doctor because they have no symptoms or nobody looked. These 659 were referred for ongoing evaluation, making it a skewed population.

Painless ultrasound imaging was very effective in predicting which choroidal nevi would misbehave. It ended up that 17 (2.9%) within this study group developed choroidal melanoma at the site of previous nevi. 2.9%! Remember, it's a skewed population! The ultrasound device measured both the size of the moles and their internal composition. A minimum of eighteen months' followup was necessary before any nevus exhibited changes sufficient to call the lesion melanoma.

What does this new information mean? Most choroidal nevi remain benign in the vast majority of cases and expert ultrasound studies can help identify the earliest changes before any trouble starts.

Related Topics: Melanoma Skin Cancer Strikes Again, Summer Buyer's Guide: Sunglasses

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Mother's Day Rapidly Approaching

Just a few days remain before Mother's Day. Cards, flowers and phone calls will get things started. Looking for a few special surprises for your Mom?

How about a quality pair of wraparound 100% UVA/UVB sunglasses? Protect your mother from hazardous rays that contribute to wrinkles, cataracts and macular degeneration. Does your Mom like Sinatra or hip-hop? You can even get shades with built-in MP3 players.

Neat magnifiers can be found in many optical shops. There are illuminated clip-on devices to help with bedtime reading as well as those slim credit card style magnifiers for squinting Moms on the go.

At first glance this may seem silly, but what about a supply of quality vitamins? The good ones are pretty expensive. (See my earlier post on Vitamins and Vision ) Choose a balanced multivitamin with added antioxidants like beta carotene, selenium, and lutein. Most brands of 'eye vitamins' are meant to taken in addition to the daily multivitamin...simplify life with one quality product.

Take good care of your Mother - you wouldn't be here without her!

Related Topics: How to Pick Good Sunglasses, Stressed Out Mom? Get Relief, Naturally

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Bird Flu: Don't Panic, Prepare!

Remember the panic over West Nile Virus?

• Less than 1:100 infected stings caused infections
• Less than 1:100 infected people got sick
• Less than 1:100 who got sick went to the hospital
• Less than 1:100 hospitalized with WNV died from the disease!

Can you feel the Avian Flu tension building?

There needs to be a reality check. Perhaps there have been 40-100 worldwide human deaths, but nobody knows the total number of human Avian Flu infections. It is likely six or seven digits.

Like any flu outbreak, only the very sick seek medical assistance. The rest get better on their own.

Avian Flu is not Ebola! Its strain is very similar to this winter's seasonal influenza outbreak (which has also killed hundreds across the country, mostly older and susceptible folks). Many previous flu strains were originally tracked in other animals.

To summarize, nobody at HHS/CDC is talking Armageddon. We need to protect those at greatest risk. The rest of us will just deal with it.

Related Topics: Bird Flu FAQ, Flu Pandemic Guide: Stock Up on Basics

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UPDATE: Fungal Corneal Ulcers in Contact Lens Wearers

A few weeks back there was lots of media coverage regarding a serious eye infection that were felt to be caused by fungal-contaminated contact lens solutions (Fusarium).

Having recently attended a conference of eye pathologists, I conducted an informal survey and discovered the actual number of infections is likely much higher than originally reported.

According to the most recent data from the CDC:

• 86 cases of Fusarium keratitis are confirmed, 9 cases are listed as "possible," and 96 remain under investigation.
• Complete data are available on only 58 cases, due to a lag in reporting. Of those 58, 56 were listed as a contact lens user.
• The products used by those 56:
• 32 - Bausch & Lomb ReNu with MoistureLoc
• 15 - Bausch & Lomb ReNu MultiPlus
• 7 - Bausch & Lomb ReNu (unspecified)
• 3 - Advanced Medical Optics (AMO) products
• 3 - Alcon products

Note: The numbers add up to more than 56 because some people may have used more than one product.

The CDC did not issue any other information related to the underlying cause of the fungal infections. Investigations continue by the CDC and the U.S. Food and Drug Administration (FDA).

The American Academy of Ophthalmology recommends that all contact lens wearers stop using Bausch & Lomb ReNu with MoistureLoc and switch to another solution. Other solutions may have been mentioned in connection with these infections, but there is no confirmed link yet.

Whatever solution you use, be aware of the symptoms of infection, and contact an ophthalmologist immediately if you experience any of these:

• Sudden blurred vision
• Unusual redness
• Pain in your eye
• Excessive tearing or discharge from your eye
• Increased light sensitivity

This story is not going to go away anytime soon!

Related Topics: FDA Updates Contact Lens Advice, Caring for Your Contact Lenses

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