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Your questions and comments about any aspect of your eye health not covered in this website are most welcome. To submit your question or comment, please click here.

October 2019

Pauline from Milton Keynes, United Kingdom, asks:
months ago, I had consecutive lens replacement with cataract surgery to correct long distance vision. My post op distance prescription for my left eye is +1.25, and my right eye is +0.75. Is this the best I could have expected?  I am worried about my left eye as I can see a white 'cloud' at the top, centre of my eye. No one can give me an explanation that I understand. Also my eyes have been red rimmed from just after the 2nd op. My GP says It's not blepharitis. Both eyes look as if I have red eye shadows surrounding them. I would be grateful for any comments. Thank you.

Brian replies:
Dear Pauline, thank you for your queries which I will answer in turn.

1. Is a post op distance prescription of +1.25 in the left eye and +0.75 in the right eye the best that you could have expected? This is difficult to answer without knowing the condition of your eye beforehand. Generally speaking, I aim for my patients undergoing cataract surgery to have a post op distance prescription of between -0.10 to -0.50, so your current post op prescription is not the most ideal.

2. A white 'cloud' could be due to posterior capsular opacification (cloudiness behind the intraocular lens implant) or posterior vitreous detachment.Posterior capsular opacification can easily be treated in 5 minutes with an office-based procedure called laser capsulotomy. Usually, no treatment is indicated for posterior vitreous detachment. However if the symptoms are very bothersome, this can be treated with an operation called vitrectomy, which is similar to surgery to repair a detached retina.

3. There are many causes for eyes to be red. Some of the common reasons include dry eye, blepharitis, and irritation to eye drops. Unfortunately it is not possible to say what your red eyes are due to without examination at the slit lamp.

I hope this helps, and good luck!

July 2019

Judy from Melbourne, Australia, asks:
Hello Brian, my husband has a cataract on the eye that sustained a blunt impact injury 20 years ago. He has seen an ophthalmologist who has diagnosed zonular dialysis. The report is scary actually. Can you please explain this condition in layman’s language? The specialist he saw did not fully explain the risks involved removing the cataract with this prevailing injury. Many thanks.

Brian replies:
Dear Judy, thank you for your query. A cataract is the natural lens that has become cloudy. Cataracts mostly develop with age, but can also develop as a result of trauma.

In the normal eye, the natural lens is held in place inside the eyeball by zonules. Think of the zonules as cobwebs, supporting the lens in the middle. The zonules (cobwebs) keep the lens suspended in the correct position within the eye.

Following trauma, the zonules can be damaged just as cobwebs can. When this happens, this is called zonular dialysis or zonular dehiscence. If too many zonules are damaged, there won't be enough zonules to support the lens in the correct position.

In normal cataract surgery, intact zonules are needed for the  intraocular lens implant to be implanted successfully in the ideal position (this is called "in-the-bag implantation"). The lack of zonules in your husband's case means less support for the lens during surgery, thus making the operation more tricky and time-consuming to perform.

There is a risk that a second operation may be required to fix any problems caused by the zonular dehiscence. This may include a vitrectomy procedure, when the lens/cataract loses all zonular support and drops to the back of the eye instead of being suspended in the eyeball. This may also include a secondary lens implant, when the intraocular lens implant has to be stabilized using a technique that does not require support from the zonules (this is called "out-of-the-bag implantation").

I hope this helps. Good luck and all the best.

April 2018

Sandy from Masaryktown, United States of America, asks:
My husband had retina surgery going on two years ago in his right eye. He is now seeing like an oil spot. He had the gas surgery.Is this normal?

Brian replies:
Dear Sandy, thank you for your query. I wonder if your husband may have developed a visual field defect following retinal detachment surgery. This is a well-recognized phenomenon, although it is not common. Unfortunately, how and why this happens is unclear and therefore, no treatment is available.

Another possibility is that your husband is developing (or has developed) a cataract following surgery. This can be easily corrected with cataract surgery.

Your husband will need a visual field test and a full dilated fundus examination by an ophthalmologist to determine what the issue is. Good luck!

Kishorbhai from Vadodara, India, asks:
My wife has undergone cataract operation in both the eyes. But in the right eye, she felt a flash after the operation. Then it was difficult to fix the number for spectacles. Her vision is very weak that she could not see beyond 10 feet. As per doctor she has no problem with the operation. Can you guide me for further treatment?

Brian replies:
Dear Kishorbhai, thank you for your query. I wonder if your wife may have developed a retinal detachment or cystoid macular edema. Your wife will need a full dilated fundus examination and OCT scan of the macula by an ophthalmologist to confirm the diagnosis.

February 2018

Casey from Great Falls, United States of America, asks:
Hi, I have a question: Does iritis happen all at once or is it detected before by an eye exam? Mainly I am wondering if you had your eyes examined 6 months before the iritis, would it have been seen? Because I come to find out I have adhesions, and my pupil is mis-shaped, and as far as I know my iris is connected to my lens. So I am wondering if this would have been seen 6 months ago, because that's when I had my last eye exam?

Brian replies:
Dear Casey, thank you for your query. To diagnose uveitis (or anterior uveitis), you need to see cells in the anterior chamber indicating the presence of inflammation. Sometimes the inflammation and cells can be so mild that the iritis may be missed. An adhesion of the iris to the lens is a sign that iritis has occurred, either currently or at some point in the past. It is not possible to determine whether or not iritis occurred 6 months previously on this basis alone.

January 2018

Margaret from Elk Mound, United States of America, asks:
I had cataract surgery on both eyes. From the start, I had issues with right eye. I called about a week later, as the inside of my eyelid was egg yoke yellow. Nurse said, no problem. Then, it was gone. Light problems, still cannot see properly and I have a bubbly film on the inside of my eye. The film is getting thicker and I am losing some sight. I'm 66 and live in rather small city. Saw another doctor and he had to do a YAG treatment. Can you please tell me what is going on? Why is this film growing and growing? Do I need surgery again? Thank you.

Brian replies:
Dear Margaret, thank you for your query. From what you have described, your left eye developed posterior capsular opacification after cataract surgery. This is when some scar tissue grows behind the lens implant that was inserted into your eye during surgery. Posterior capsular opacification is relatively common after cataract surgery. Treatment is with laser capsulotomy. This is a 5-minute procedure which is safe, effective, and is performed in the office setting. You may need repeat laser at some stage in the future, particularly if the scar tissue grows again. However, it is very unlikely that you will require further surgery to treat this.

Frank from Ten Mile, United States of America, asks:
What is the surgery called that is done for lens dislocation and what is the success rate along with the recovery time?

Brian replies:
Dear Frank, thank you for your query. By lens dislocation, I presume that the natural crystalline lens or intraocular lens implant has dislocated into the vitreous cavity at the back of the eye. The surgical procedure to correct this is called a vitrectomy with lens repositioning or explantation. The success rate is quite high, and the recovery time ranges from 1 to 3 weeks.

Disclaimer: Replies to your questions are only general in nature, and in no way are to be considered as replacement for a proper ophthalmology consultation and examination. If you require a more specific evaluation, please consult your ophthalmologist for a full eye examination.

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