Cataract Awareness (cont.)

KNOLLE:
Pain is not normal with cataracts. Some people are more sensitive to glare than others. When we say pain, there's a broad spectrum between pain, discomfort, and annoyance. Pain, per se, is never the result of a cataract. I think you need to be sure you have pain, because it can be very annoying to have glare. There's a big difference between pain and discomfort.

MEMBER QUESTION:
Do all cataracts grow at the same rate?

KNOLLE:
No, all cataracts do not grow at the same rate, and it's impossible to predict the progression of the lens' opacity. It can vary vastly from one eye to the other, even in the same head, and when patients ask me, "How long will it be before I need cataract surgery once the diagnosis is made?" I quickly look at my watch, and they get it. You can't predict when. It's like telling someone how long they're going to live. When patients get really concerned about the fact they may have to have cataract surgery in the future, I tell them I just hope they live long enough to need it, because it's very relative.

MEMBER QUESTION:
Is cataract surgery painful?

KNOLLE:
Cataract surgery is normally not painful, takes less than 20 minutes to do, and results in good vision. If I had not had the confidence in the technology and the procedure, I would not have had surgery just to avoid the use of spectacles. The operation doesn't just work most of the time, it works almost every time. But we're not living in a perfect world, so it cannot work every single time, and each patient has to take some risk for gain.

MEMBER QUESTION:
Is there a greater chance of cataracts in a person who has diabetes than with everyone in general?

KNOLLE:
Probably. That's the simple answer, but I don't know of any huge study that's been done.

MEMBER QUESTION:
My husband had one attempted cataract procedure that could not be completed because his pupil would not dilate enough (he had a stroke that affected the occipital lobe of the brain and he has limited vision) now the doc wants us to go to another facility with more modern technology. My question: Are the risks higher for this than normal cataract surgery?

KNOLLE:
The risk is slightly higher, but I think your doctor is giving you a very good recommendation. There are some centers that can deal with these problems better than others. It's important to seek out these locations for treatment once you realize you have a special problem.

MEMBER QUESTION:
Can anything be done to prevent cataracts or are they an inevitable part of getting old?

KNOLLE:
I tell patients when they ask me what causes cataracts that they're the result of three things: age, hereditary, and bad luck. Almost everyone develops some loss of clarity of the lens as they age, and the metabolic changes of the lens epithelial cells that undergo these opacities are being studied. The visual needs of the patient really dictate when they will require surgery for cataracts

MODERATOR:
Dr. Knolle, before we wrap things up, do you have any final words for us?

KNOLLE:
Another consideration, with respect to clear lensectomy, or lens exchange in the patient without cataracts, is the cornea normally doesn't change as we age, and the axial length of the eye doesn't change unless surgery or injury changes it. So if we replace the lens with a fixed known entity that won't change, the visual acuity should remain basically the same throughout life, because the light that's focused on the retina is the direct result of the corneal curvature, the axial length of the eye, and the power of the lens.

When patients undergo LASIK, the refractive power of the eye is adjusted by changing the shape of the cornea, and this can remain stable for an indefinite period of time, but the lens continues to change as we age, which can again change the refractive power of the eye.

I appreciate the opportunity to answer questions, and I hope I have helped you to understand cataracts and refractive surgery, especially with respect to refractive surgery, because patients that are presbiopic that require reading glasses have a way now to surgically correct this normal aging deficiency in their vision, and at the same time we can correct farsightedness, nearsightedness, and astigmatism.

MODERATOR:
Our thanks to Guy Knolle, MD, for sharing his expertise with us.

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