Judy is an experienced consultant who frequently travels to business meetings. She got here to me because she felt her contact lenses were uncomfortable and wanted to explore other options – especially surgical alternatives.
One option was to replace the lens with an implant. This surgery is similar to cataract surgery, but is offered to patients who do not have the disease. However, it is not without risk.
As an optometrist specializing in touch lenses, dry eye treatment, and pre- and post-operative management of eye surgery, I had the experience required to help Judy.
Dry eyes
I began with Judy’s clinical assessment. When she got here to see me, she was about to turn 53 and had myopia (cannot see far), astigmatism (images stretched to near and much), and presbyopia (low vision at near) due to age.
She hated glasses and didn’t want to wear them in front of clients, so she had undergone laser surgery to correct myopia 15 years earlier.
At the age of 45, when presbyopia developed, Judy had to wear contact lenses again. Around the time of menopause, on the age of 51, she developed dry eye symptoms, which had turn out to be more severe within the months preceding her visit to me.
Changes in lens materials, care products, or wearing style (sooner or later) had little effect. The dry environment (automotive interiors, airplanes, processed office air) to which she was frequently exposed contributed to her symptoms. She also spent a variety of hours in front of the pc screen, so she blinked less often, which in turn increased her visual discomfort.
Clinical examination revealed that she did indeed suffer from dry eyes. She had a reduced amount of tears, side effect of laser surgery. Her cornea was dry and discolored, which we attributed to incomplete closure of the eyelids during sleep, undoubtedly induced by cosmetic eyelid surgery she had undergone three years earlier. And then got here the results of her medications: some antidepressants dry eye effect.
Step by step approach
Judy’s vision problems were compounded by poor eye health.
All dry eyes affect the standard of vision, whatever the correction method used. The very first thing that needed to be done was to restore balance and cure her dry eyes.
The past surgery has left a mark and there is no going back. So what should we do in this example?
As for the eyes, yes first step is to provide intensive lubrication (fully artificial tears, without chemical preservatives). The ointment also needs to be applied at bedtime to protect the cornea while you sleep. For this reason, topical use of cyclosporine must be considered its effect on tear stability.
Additionally, soft contact lenses may worsen dry eyes. Fortunately, there are other alternatives. Scleral lenses these are large, stiff lenses that create a tear reservoir, which helps reduce dry eye symptoms. Despite their large diameter, these lenses are very comfortable because they rest on the white of the attention (sclera) without touching the cornea. Visually, they will compensate for myopia, astigmatism and presbyopia.
I suggested these lenses to Judy. However, I understood from her response that she was searching for a surgical alternative as a substitute.
(Michaud Oil), Provided by the writer
Lens substitute, clear crystal lenses optional
Laser amplification is out of the query when the cornea becomes too thin.
However, for several years now, surgery has been possible to replace the crystalline lens, the natural lens contained in the eye, with an implant. Similarly to cataract surgery, this procedure is performed within the absence of the sort of pathology, in often younger (50-65 years) and healthy patients. And it’s quite popular today.
The advantage is that this implant can correct most vision defects – unlike Lasik. In Judy’s case, it could be a multifocal lens (for distance and near vision) and a toric lens (astigmatism).
Judy was immediately fascinated about this selection. She assumed that thanks to this operation she could be permanently free from the necessity to wear contact lenses or glasses.
A procedure that carries potential risks
Every surgery carries risks. In the case of a disease or pathology, the ophthalmologist’s decision to operate should theoretically be based on a rigorous assessment of the extent of risk compared to the expected advantages.
When replacing a transparent lens within the absence of any pathology, the risks and advantages have to be weighed in a different way. Basically, we’re talking about non-essential and non-urgent cosmetic surgery. The risks remain, but the advantages are less obvious and more related to personal patient satisfaction, which might vary greatly depending on our own perspective.
Although cataract surgery is considered a protected procedure, the identical cannot all the time be said replacing clear lenses. The younger the patient, the greater the chance of complications. Other patient-specific aspects it can even affect your weight. The patient’s condition must be fastidiously assessed before proceeding.
The retina of each myopic person is susceptible to tearing. This is a possible complication of cataract and lens surgery this could not be taken flippantly. The highly myopic retina is also stretched and may worsen after 60like a movie screen that breaks. Vision mechanically deteriorates.
A multifocal implant requires an ideal retina to provide good vision. Because Judy was very nearsighted, her lifelong vision could not be guaranteed after clear lens substitute.
Not to mention that, like her mother and grandmother, she could sooner or later develop macular degeneration. Also on this case the vision of the multifocal implant will likely be significantly impaired.
Multifocal implants are sometimes related to the perception of halos and glare, especially within the evening. Although most patients tolerate these unintended effects after surgery, they will turn out to be very concerning in the long run persist over time. Dry eyes may be the worst. Moreover, the procedure is not completely reversible – removing the implants could have serious consequences.
So replacing Judy’s lens didn’t seem to be the perfect option, a minimum of for now. In the meantime, she decided to consider scleral lenses and optimize her dry eye treatment.
She left satisfied after exploring her options with the one who knew her eyes best – her optometrist!