All About Cataracts

In the past, some have thought that Alzheimer’s patients would have difficulty in coping with cataract surgery and the resulting vision changes. But cognitive ability, mood and sleep patterns improved in cataract surgery patients with mild Alzheimer’s disease in a recent study.

The 38 subjects all had mild dementia and an average age of 85. They had advanced cataract in at least one eye and underwent a cataract removal operation that included implantation of artificial intraocular lenses. All but one of the patients experienced dramatic vision improvement at both near and far distances.

The ability to notice, understand and respond appropriately to their environments improved in 25 percent of the patients; also, many experienced relief from depression. Most of the patients showed improvement in sleep patterns and nighttime behavioral issues.

Brigitte Girard, MD, the lead researcher of the study, presented the findings at the annual meeting of the American Academy of Ophthalmology in late October.

The specialized equipment required for modern cataract surgery can be prohibitively expensive for small rural hospitals, especially those with low patient volumes. Often this means rural residents must travel long distances to a metropolitan health care facility to have their cataracts removed.

Surgical outsourcing allows eye surgeons to provide modern cataract surgery at small rural hospitals.

Cataract surgeon Jamie M. Monroe, MD, has found a solution: surgical outsourcing. For the past eight years, Dr. Monroe, who is surgical director and owner of Cataract & LASIK Center of Utah in Orem, Utah, has been using the services of a surgical outsourcing company called Sightpath Medical to help her provide state-of-the-art cataract surgery in small rural hospitals.

In the October 1, 2010 issue of Ophthalmology Times, Dr. Monroe describes how the outsourcing company allows her to choose her preferred surgical equipment, instruments, supplies and intraocular lenses (IOLs), and the company brings it all to the rural hospital on designated days. The hospital pays for the outsourcing services on a per-case basis without having to make a large capital investment in its own cataract surgery equipment.

The outsourcing service also provides certified technicians and surgical staff to assist the cataract surgeon during the procedures.

Dr. Monroe co-manages the pre-operative and post-operative care of her remote cataract patients with their local optometrist.

According to Dr. Monroe, she now performs cataract surgery at rural hospitals ranging from 100 to 300 miles from Orem, and patients are extremely appreciative to have access to high quality cataract surgery close to home with no need for extensive travel.

A new Veterans Health Administration study confirms the safety of cataract surgery, finding a low mortality rate 90 days after the procedure, even among high-risk patients.

Researchers at the VA Medical Center and at Warren Alpert Medical School of Brown University (both in Providence, Rhode Island) evaluated 45,082 patients in the National Patient Care Database who had significant cataracts and who underwent outpatient cataract surgery at VA hospitals between October 2005 and September 2007. Mean patient age was 71.8 years, 97.6 percent of patients were men and the postoperative follow-up period was 90 days.

The most frequent systemic health problems among the patients in the study were diabetes (40.6 percent), chronic pulmonary disease (21.2 percent), cancer (12.5 percent) and congestive heart failure (9.5 percent).

The study data revealed the mortality rate within 90 days after cataract surgery was 7.1 per 1,000 patients (0.7 percent).

Independent risk factors for mortality within the 90-day follow-up period were patient age of 80 years or greater, one or more hospitalizations within the past year, chronic pulmonary disease, cirrhosis, multiple myeloma, leukemia and metastatic solid tumor.

The study authors concluded the risk of mortality within 90 days after cataract surgery is low, even for high-risk patients such as the elderly and those with significant preoperative systemic diseases.

A full report of the study appears in this month’s issue of Ophthalmology.

August is Cataract Awareness Month, and to mark the occasion the American Academy of Ophthalmology (AAO) recently issued the following tips to help consumers maintain healthy vision and make the right choices when cataracts develop:

When cataracts interfere with daily activities, it's time to consider surgery.

• Have an eye exam if you are over age 40. Advancing age is a risk factor for cataracts and other eye problems. Based on the findings of your exam, your eye doctor will advise you how often you should have your eyes examined in the future.

• Know the risk factors for cataracts. In addition to advancing age, risk factors for cataracts include smoking, extensive exposure to the sun’s harmful UV rays, a history of a serious eye injury or inflammation, having diabetes, prolonged used of steroid medications and a family history of cataracts.

• Know how to reduce your cataract risk. A healthy diet, exercise, maintaining control of your blood sugar if you have diabetes, avoiding smoking and protecting your eyes from the sun’s harmful rays with UV-blocking sunglasses and a wide-brimmed hat may help reduce your risk of cataracts.

• Evaluate how cataracts affect your life. If you have cataracts, the decision when to have cataract surgery should be based on your daily activities and how much interference your cataracts are causing. If you are noticing blurred vision, glare, halos, reduced color perception or other cataract-related problems when driving or performing other daily activities, it’s time to consider surgery.

The AAO offers additional information about cataracts and cataract surgery at its EyeSmart consumer website.