We might never find out, which came first, the chicken or the egg, but we will help to find the strategy when the cataract was first, then glaucoma joined. Here you will find answers to "non-paper" letters from our readers about those unexpected eyespots, complications after Lasik, and other actual topics.
Raindrops, floaters, and OTHER THINGS
Readers in our time write paper letters less and less, but on the new Benjamin Eye Institute website the questions are increasingly coming in. Today, Arthur Benjamin answered these by telephone while overseas. And by the way, he is returning soon, so now is the time to make your appointments.
“I have recently been getting eyespots. Is there some radical way of dealing with them? I can’t find anything on the internet”.
Yes, there is vitrectomy, with which you can remove all kinds of spots, but this operation is difficult, expensive, and risky. There are also particular doctors that will split larger spots into hundreds of smaller ones, but the YAG laser microblasts cause shocks that can lead to retinal detachment and glaucoma. Among serious ophthalmologists, these doctors don’t have the best reputation.
“What triggers the appearance of spots?”
Most often this happens gradually and spontaneously. The eye has the fastest muscles in the body, so when fragments of the vitreous substance peel off they flounder about, not keeping up with the movements of the eye. More and more exfoliates and conglomerates, and the shadows of these formations are perceived as spots.
“I have cataracts, and recently discovered I have glaucoma, as well. Where do I start?”
Modern ophthalmology has something new for this – the iStent or tribecular microshunt. Remember, the main problem of glaucoma is increased intraocular pressure, since the outflow of intraocular fluid isn’t working. The best treatment option allows for its production and irrigation of the eye, but also its ability to drain. This is very difficult because it’s always a struggle – pressure is too high or too low. So a new method has appeared, this iStent, a microshunt made of titanium that’s kind of like an underwater tube connecting drainage with the front part of the eye. The introduction of the microshunt adds 1-2 minutes to a cataract operation, without any postoperative complications that are usually associated with pressure being too low. The part of the eye where the shunt is inserted is simply not visible, so it’s necessary to use a special lens with mirrors, and this requires surgical skill. If it is done correctly, though, it is not only safe but extremely useful.
“A question from me – so this shunt probably needs very little maintenance?”
At BEI, practically every other patient has glaucoma, and after the operation the patient’s eye pressure stays normal for about 7 years.
“I read somewhere that after Lasik, patients suffer from dry eyes. Is this true?”
Yes, but it is a temporary phenomenon. Younger people have quicker recovery, and in 20-somethings there is no dryness after a week or two. I was 40 years old at the time of operation, and I had to use drops for a couple of months. But if the candidate for Lasik has very dry eyes, the operation cannot be done.
“Are there complications after Lasik?”
With an experienced surgeon using the best technology, it is extremely rare.
“I am 40 years old. I was going to get Lasik, but I was told that sooner or later I’d get cataracts or farsightedness, and the operation would have to be done again under already difficult conditions.”
Farsightedness and cataracts occur independently of Lasik, which gives a stable effect. Sometimes a person says, “I got Lasik but it stopped working, and I need to do it again,” when in fact they just need to remove the cataract. If the Lasik was done a long time ago and patient data is lost, we can make measurements using a special machine not available in many offices. After removing the cataracts, the machine scans the eye and reports the data, which I use to give you the most accurate lens.
“Another question from me. Several years ago, when I returned to your office after an operation, you already had better equipment than anywhere else, but you still continue to buy new technology, and use the newest lenses and most amazing implants, in particular the “raindrop”. Are you driven by a competitive spirit?”
We haven’t thought about our competitors in a long time. We guarantee our results, so in order to do this we have to keep up with the times. Nowadays, “getting your cataracts done” can be found on every corner, but in order to achieve better results the surgeon must be skilled and have the most powerful diagnostic equipment. What is the point of introducing a lens, which can correct corneal astigmatism, if you don’t know what side effects it may have, and then be unable to handle them? Do you tell the patient, “Well, you’ve got an unfortunate set of eyes”? The operation begins not with the removal of cataracts, but in the days and weeks before. It is necessary to make an accurate diagnosis, find out what kind of cataracts they are, make sure that the retina allows for the procedure, understand what’s happening with the cornea, see whether the patient had Lasik before (which changes everything), if the patient has dry eyes, etc.
“And what is this new Raindrop implant, which can relieve presbyopia? Is it put in both eyes at once?”
to be continued