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Dr. Lloyd's blog has now been retired. We appreciate all the wisdom and support Dr. Lloyd has brought to the WebMD community throughout the years.

Tuesday, October 7, 2008

One Eyedrop Worth Asking For

Most folks with healthy eyes who undergo cataract surgery usually sail through the procedure. Within weeks the patient enjoys crisp, colorful vision that they haven’t experienced in years.

However, some folks have a more rocky course. One big boulder along the road to full vision recovery is something called cystoid macular edema (CME). This is a leading cause of delayed vision recovery after cataract surgery and, for a minority of patients, permanent vision loss. It is very frustrating to the patient and surgeon because the cataract surgery and the intraocular lens implantation may have been flawless yet the patient still can’t see well enough to drive safely.

The macula is that small region of the retina used for reading and precise focusing. How small, you ask? It’s a circular area approximately one-third inch in diameter… roughly the diameter of the eraser at the end of a new pencil. Any changes to the macula can have profound visual changes: trauma, bleeding, inflammation, swelling (edema).

Here’s what happens during CME: Leaky retinal capillaries in the vicinity of the macula lead to pockets of accumulated fluid that cause the macula to thicken – just like a recently sprained ankle. It can be quickly diagnosed with the doctor’s ophthalmoscope and confirmed with a simple OCT scan performed in the clinic.

Lots of factors contribute to the development of CME after cataract surgery and many are preventable. Ophthalmologists know it is far better for the eye to prevent CME than have to treat CME.

New clinical research offers evidence that the daily application of nonsteroidal eyedrops for 3 days prior to cataract surgery significantly reduces the incidence of CME. Now, here’s the good part. Nearly every cataract surgery patient will be taking those identical eyedrops after surgery anyway, so it won’t cost any extra money. Simply begin taking the nonsteroidal eyedrops before the operation.

If you know someone anticipating cataract surgery be sure to pass along this valuable nugget: Ask the surgeon about using the post-op nonsteroidal eyedrops prior to surgery. Get a head start on CME; it could make all the difference in the world!

REFERENCE: American Journal of Ophthalmology, October 2008, pages: 554-560.

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Posted by: Bill Lloyd MD at 4:16 pm

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