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.

Related Topics:

• WebMD Video: Crystalens instead of Cataract Surgery
• Eyedrops: An Ocean of Uses

SPOOKY: Do Ghosts Really Perform Surgery?

Ever heard the phrase 'ghost surgery'? It can be a very scary topic.

Ghost surgery exists whenever an individual performing an operation is not the same person that the patient expected to be wielding the scapel.

In some busy practices the patient is led to believe (let's simply say 'underinformed') that their hotshot superstar surgeon will perform the procedure. Hotshots often charge more than what is covered by insurance and patients are willing to pay the difference in order to benefit from Dr. Hotshot's advanced skills and experience. Sadly, Dr. Nobody may actually operate on the unknowing (asleep) patient. This is a deeply unethical medical practice.

Ghost surgery can also arise in the training environment. Young surgeons in need of experience sometimes develop their techniques on unsuspecting patients who believed that the attending staff surgeon was in charge. This, too, is unethical. It does not involve reimbursement revenues but it corrodes the trust patients put in their doctors.

Now, let's be realistic. Residents have to learn how to perform surgery somewhere, right?!? A well-structured clinical residency program is the ideal environment for senior surgeons to train their successors. Standing side-by-side the staff and resident surgeons collaborate to get the best results for their patients. If portions of a case are too precarious or too unfamiliar to the young protegé the more experienced attending surgeon typically takes over. The patient is protected every step of the way.

It is the responsibility of the attending surgeon to approach the patient and ask this important question. If a patient declines to have a surgeon-in-training scrub-in the choice needs to be respected. Fortunately, this is a rare occurrence.

Here's a neat secret: If you are ever brought to the hospital in the middle of the night needing surgery, and they offer you two options: Surgery Chief Resident (cub) or Chief of Surgery (lion) go with the Chief Resident! As a general rule, that young doctor has recently performed an enormous volume of surgical procedures and knows the latest and greatest ways to fix you up. The Chief of Surgery spends a lot of time going to meetings and performs far less surgery.

So, how do most folks feel about a resident serving as primary surgeon with staff supervision? A recently published study collected patients' feelings on the subject with the use of an anonymous survey distributed to 106 preoperative patients needing cataract surgery. Here's what they found:

• 96% felt that they should always be asked (no ghost surgery)


• 83% claimed that they would agree to let the resident assist the attending surgeon perform the eye operation


• 55% felt that the standard pre-op consent form was adequate disclosure (who reads those anyway?!?)


• 49% claimed that they would allow the resident to be the primary surgeon

If you or a loved one is anticipating surgery make sure you clearly understand all options. Make sure that ghost surgery is not tolerated in your hospital. Specifically ask who will serve as primary surgeon and their level of proficiency. Do not abdicate that decision to anyone!

REFERENCE: Archives of Ophthalmology, September 2008, pages 1235-1239.

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• Sizing Up Surgery
• LASIK Eye Surgery Overview

Activity After Eye Surgery

During the preoperative counseling sessions with my surgery patients one of the most frequently asked questions has been, "Doctor, after my eye operation when can I resume normal activity?"

My traditional answer is, "Well, first we have to understand what is normal for you!"

For example, there are seniors who spend all day sitting in their recliner watching cable TV. I'd advise them, "Go for it!" The same advice does not apply to factory laborers.

See, there are no universal boilerplate rules - everyone is different. Experienced surgeons apply this rule both to available options regarding the most effective surgical approach for an individual patient as well as the recommended length of convalescence.

Times are tough. Many patients insist on returning to work on the day following eye surgery. A simple desk job may be acceptable.

Unbeknownst to me I've had patients rope cattle the day after surgery. That's a double dare: genuine risks exist for both postop trauma and wound contamination. They probably should've waited a full week or longer.

One very satisfied patient organized an impromptu cocktail party to celebrate her beautiful outcome. Yes, she drank too much, fell, and ended up back in the hospital. Fortunately for her she experienced an equally smooth recovery from her repeat operation - not everyone is so lucky.

Here's a generalization: Compared to a generation ago (when I trained in ophthalmology) patients now heal much faster and regain function much sooner. Advanced techniques and technology get the credit. Few folks get an eyepatch anymore, and far fewer stay overnight in the hospital. By all means, lay low at least until your first postoperative visit with your surgeon. No bending, straining, heavy lifting or drinking.

Today's blog carries an important lesson. Make sure you clearly understand all postoperative restrictions/limitations before you consent to any surgery. It's wiser to postpone elective surgery than to jeopardize the outcome, right? Planning an overseas cruise? Make sure it does not conflict with the doctor's plans for your recovery. Bon Voyage!

Related Topics:

• WebMD Video: Laser Eye Surgery Helps More People See Better
• WebMD Video: Computerized Scalpel for Steadier Eye Surgery

Technorati Tags: eye surgery, vision, health-and-wellness

Web Victory for Dissatisfied Patients

It took over 5 years but one dissatisfied, legally-blind LASIK patient has successfully defended his right to host a website that publicizes his plight and identifies his surgeon.

Remember, Lady Justice is blindfolded!

Legal wonks can savor the full court decision.

Back in 2002 the surgeons claimed the website was defamatory and they threatened legal action. The host initially sanitized the website but subsequently reloaded it with clear documentation of the patient's claims. The doctors filed suit claiming that the initial removal of the website criticisms to avoid suit constituted an agreement never to mention their names on the Internet.

The Pennsylvania Superior Court in Philadelphia disagreed. According to the advocacy group Public Citizen:

Companies routinely threaten consumers and Internet hosting companies with libel, defamation or trademark infringement litigation in response to legitimate criticism. With a short deadline for compliance, consumers are often pressured into removing criticism from Web sites and censoring their speech to avoid costly and time-consuming litigation.

"This is another victory for consumers who use the Internet to criticize companies," said Paul Levy, the Public Citizen attorney who filed the appeal. "Free speech and consumer rights would be seriously endangered if the temporary removal of criticisms from a Web site could be construed as an 'agreement' not to say anything about the company in the future."

Caveat emptor? From now on the sign should read "Let both the Buyer and Seller Beware!"

Related Topics:

• WebMD Video: Laser Eye Surgery Helps More People See Better
• WebMD Video: Computerized Scalpel for Steadier Eye Surgery

Technorati Tags: eye surgery, LASIK, vision, health-and-wellness

Project ORBIS: Spring Break in China

Is it spring break yet in your area?

This year my wife and daughter are doing something different for spring break, something very different.

You may not know it but my spouse is also an ophthalmologist. She specializes in pediatric ophthalmology. She has been invited to participate in Project ORBIS a nonprofit humanitarian organization. ORBIS strives to eliminate avoidable blindness and restore sight in the developing world. ORBIS works closely with local communities, governments and hospitals to design programs that increase local skills, improve health care facilities and foster awareness of eye health. Enormously successful, this year ORBIS celebrates its 25th anniversary.

There are many wonderful medical charities. What's really different about ORBIS is that, unlike most other international medical organizations, ORBIS does not arrive, perform 500 operations, and fly away. ORBIS is actually a flying eye hospital (a converted DC-10 with operating rooms and classrooms). At each faraway destination ORBIS' volunteer eye surgeons teach clinical and surgical skills to the local doctors. This is an enduring gift that persists long after the two-week visit concludes.

This weekend my wife and older daughter travel to the Peoples Republic of China with ORBIS to share knowledge and experiences regarding the care of pediatric eye surgery patients. I am extremely proud of both of them for choosing to make a positive difference in the world.

My spring break? I get to stay home and finish preparing our taxes!

Learn more about Project ORBIS.

Related Topics:

• WebMD Video: Treating Cataracts in Children
• WebMD Video: Preemies: Early Eye Surgery May Prevent Blindness

Technorati Tags: pediatric eye surgery, spring break, Project ORBIS, health-and-wellness

LASIK versus LASEK

Every year millions of Americans undergo laser refractive surgery. The two most commonly performed procedures are LASIK and LASEK. These are acronyms for some outrageously complicated medical terms. Just to satisfy your curiosity, the 'K' stands for keratomileusis!

LASIK requires a surgical incision to create a flap of clear cornea underneath which the laser energy is applied. That flap never really heals -- it can always be dislodged or lost...yikes!

LASEK only lifts the superficial corneal epithelium and heals permanently within days.

Technical differences, but are the outcomes similar?

Surgeons from the University of Illinois at Chicago reviewed 122 pairs of patients. They were matched by age, refractive error and many other criteria. These folks all had less than 8 diopters of myopia.

After all of the patients recovered from their surgery it was determined that both techniques were safe and effective. Six months later the postoperative uncorrected visual acuity was similar in both groups as was the rare incidence of complications.

Given that these operations are felt to be equivalent, the authors of the study acknowledge that LASEK offers the additional advantage of no flap-related complications as occurs with LASIK.

Thinking about laser refractive surgery? Ask your eye surgeon with which procedure she feels more comfortable and more experienced. Because this is elective surgery you do not want to be someone else's guinea pig, right?

SOURCE: American Journal of Ophthalmology, Dec 2006

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• WebMD Video: LASEK for Eyes
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Technorati Tags: LASEK, LASIK, eye surgery