All About Cataracts

A popular medicine taken by men for benign prostatic hyperplasia, commonly known as BPH or an enlarged prostate gland, is associated with increased risk for serious complications after cataract surgery, according to a study published in the May 20, 2009 issue of the Journal of the American Medical Association (JAMA). 

Flomax (tamsulosin HCl, Boehringer Ingelheim Pharmaceuticals) is a popular prescription medication to treat male urinary symptoms due to BPH. Symptoms include the need to urinate often, waking up several times during the night to go, a weak urinary stream and frequently feeling an urgent need to urinate.

BPH is common among older men: It is estimated that more than 50 percent of men over age 60 and almost all men over age 80 have symptoms of an enlarged prostate. The condition can also affect men in their 40s and 50s.

Tamsulosin HCl, the active ingredient in Flomax, belongs to a category of drugs called alpha blockers. Alpha blockers relax certain muscles and help small blood vessels remain open. In addition to treating BPH, alpha blockers are used to treat high blood pressure.

Researchers in Canada recently conducted a retrospective study of over 96,000 men age 66 years or older who had cataract surgery between 2002 and 2007. Of these patients, 3,550 (3.7 percent) had taken tamsulosin within two weeks of their cataract procedure and 7,426 (7.7 percent) others had taken other alpha blockers within two weeks of surgery.

Adverse events following cataract surgery were significantly more common among patients with recent tamsulosin exposure (7.5 percent) than among controls (2.7 percent) matched for age, surgeon and date of cataract surgery. There was no significant increase in the risk of adverse events following cataract surgery from recent use of other alpha blockers for treatment of BPH or high blood pressure.

Serious cataract surgery complications associated with recent Flomax use include retinal detachment, dislocation of the intraocular lens and endophthalmitis (inflammation of the interior of the eye, usually caused by infection).

Take Home Message: If you are currently taking Flomax for BPH symptoms, be sure to discuss this with your cataract surgeon prior to surgery. He or she may recommend you temporarily discontinue BPH treatment or switch to a different alpha blocker for a period of time before and after your cataract procedure to reduce your risk of medication-related surgical complications.

Source:  Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. May 20, 2009.

Crystalens HD, the latest generation accommodating IOL produced by Bausch & Lomb, improves vision at all distances compared to the company’s previous model, the Crystalens Five-O, according to a new study.

Speaking at the recent annual meeting of the American Society of Cataract and Refractive Surgery, Jay S. Pepose, MD, PhD, presented the results of a study of 67 eyes implanted with the Crystalens HD intraocular lens during cataract surgery. At one month after surgery, monocular testing of uncorrected visual acuity (UCVA) revealed:

• 79 percent of the eyes were 20/30 or better for distance vision
• 97 percent of the eyes were 20/30 or better for intermediate vision (approximately 32 inches)
• 85 percent of the eyes were 20/30 or better for near vision (approximately 16 inches)

Best-corrected visual acuity (BCVA) with eyeglasses for distance vision was 20/20 or better in 96 percent of eyes and 20/30 or better in 100 percent.

Compared with data from cataract surgery using the earlier Crystalens accommodating IOL, the new Crystalens HD provides better vision at all distances. Forty-two percent of eyes receiving the Crystalens HD IOL attained uncorrected distance vision of 20/20 or better, which is 50 percent higher than the percentage of eyes attaining the same level of UCVA after surgery with the Crystalens Five-O, said Dr. Pepose.

The Crystalens HD also surpassed the UCVA performance of a leading brand of multifocal IOL (AcrySof ReSTOR, Alcon) for distance and intermediate vision:

• 57 percent of eyes with Crystalens HD were 20/25 or better at distance
• 45 percent of eyes with the multifocal IOL were 20/25 or better at distance
• 91 percent of eyes with the Crystalens HD were 20/25 or better at intermediate
• 35 percent of eyes with the multifocal IOL were 20/25 or better at intermediate

The AcrySof ReSTOR multifocal IOL, on the other hand, performed better than the Crystalens HD accommodating IOL when comparing uncorrected near vision. Twice as many eyes receiving the multifocal lens attained 20/20 or better UCVA at near than eyes receiving the Crystalens HD. But the percentage of eyes attaining 20/30 or better UCVA at near was roughly the same for both groups (85 percent).

Accommodating IOLs are single vision intraocular lenses that move slightly in the eye in response to focusing effort to provide a full range of vision. Multifocal IOLs maintain a fixed position within the eye but have an optical portion that contains several lens powers to provide a full range of vision. Both types of IOLs can decrease the need for reading glasses and computer glasses after cataract surgery.

Accommodating IOLs and multifocal IOLs are premium intraocular lenses that cost more than traditional monofocal IOLs used in cataract surgery. Therefore, choosing these lenses will increase your cataract surgery cost. For details, consult a cataract surgeon near you.

Disclosure:  Dr. Pepose, director of Pepose Vision Institute (Chesterfield, MO) and professor of clinical ophthalmology, School of Medicine, Washington University (St. Louis, MO), is a paid a consultant to Bausch & Lomb.

AllAboutVision.com (AAV) announced this month the launch of its new Cataract Surgeon Directory.

The directory will allow AAV visitors to find an experienced cataract surgeon in their area and schedule a consultation to learn more about cataracts, cataract surgery and the latest premium IOLs (intraocular lens implants) used to correct vision in modern cataract surgery.

The new cataract surgeon directory lists prominent eye surgeons located in cities and major metropolitan areas throughout the United States and Canada, and includes detailed information about each doctor, directions to their practice, contact information and a link to their websites.

AllAboutVision.com’s cataract surgeon directory is free and no registration is required.

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AllAboutVision.com was established in January 2000 and provides consumers independent, trustworthy information about eye health, eyecare and vision correction options. All health-related articles appearing at AllAboutVision.com are developed with input from AAV’s Advisory Board of prominent eye doctors. In 2008, more than 7.8 million unique visitors accessed AllAboutVision.com for information about eye care and eyewear, including contact lenses and vision surgery.