Reason for the research: Danger of a Cataract Operation

More and more from eye diseases suffering people report to us about a partly dramatic decrease of vision after a cataract operation of many do not recover. Here we talk mainly about patients who had suffered already at a retina disease or macular degeneration but also about patients who had not had a retina disease before the cataract operation. This to us seemingly conspicuous accumulation of a decrease in vision in connection with macular degeneration and a cataract operation is the reason for our research.

Cataract: Is an operation dangerous when a macular degeneration is progressing at the same time?

Many patients have answered this question to us with a definite „yes“. An operation of the cataract was dangerous. We wanted to know this in more depth and have started to research and came to the following conclusion:

According to patients a cataract operation can accelerate an already progressing macular degeneration / retina weakness. It could probably even trigger a macular degeneration.

An in November 2009 published press release declares the contrary was the case. A study is appointed in which it is said that fears that a cataract operation would trigger a macular degeneration or even worse were unfounded. In fact the contrary was the case. Basically the five year lasting study should find out how vitamins and minerals have an effect on a cataract and macular degeneration. Yet due to the possible connection between cataract and macular degeneration the data of 1,244 patients were assessed especially in connection with the macular degeneration. Further it is said that an improvement of the visionary acuity could be seen, regardless whether it was a dry or wet macular degeneration. One year later 865 operated eyes were once more examined. The press release says that even after this one year a in statistical significant extent improved visionary acuity could be verified. Despite that we would like to point out that from the pre publication it could not be seen how exactly the cataract operation had an impact on a macular degeneration.

Source: www.medicalnewstoday.com/articles/169541.php

Cataract and Macular Degeneration: Conclusion

Despite this in November 2009 released study there cannot be made an exact connection between macular degeneration and a cataract operation. Many macular degeneration or cataract patients applied to us in letters or by phone call and reported an extreme deterioration of their macular degeneration after a cataract operation. Further studies or more detailed information about macular degeneration in connection with a cataract operation are not known to us right now. Yet we recommend patients with a macular degeneration to caution in case a cataract operation is due.
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Here are some results of our research about the risks of a cataract operation

1. General Risk of complications through a cataract operation lies at 0.4 to 4.2 %.
2. Cataract OP Risk: (Strong) retina bleeding. Worst case up to getting blind
3. Cataract OP Risk: Enlargement of the tissue membrane at macular degeneration
4. Cataract OP Risk: Macular edema / macular degeneration
5. Cataract OP Risk: Retina removal (1% to 2 % of Ops)
6. Cataract OP Risk: instance of vitreous body, inflammation, clouding of the corenea, post cataract
7. Rates of complications, kind and extent of the possible complications were not sufficiently known to most of the patients before the operation.
8. The to expected visionary acuity after a cataract operation could, unless there are complications, fairly be assessed. There is an examination method for that.

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Cataract is worldwide the most abundant reason for blindness

In Germany alone there have been 400,000 cataract operations at a minimum per year since 2005. For the year 2009 experts expect up to 800,000 operations to implant artificial lenses. Many of those cataract operations are done to the patients’ fullest satisfaction but not all. There are complications with small to strong forms. At the above mentioned number of cataract operations the average researched complication rate of 2% would already lead to 12,000 complication cases a year and this alone in Germany. In connection with the macular degeneration if any even more.
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Cataract Operation: Is it an extreme strain for the eye?

From the above mentioned complications arises that due to cataract operations regular and substantial strain takes part on the retina. How big has the danger for the retina respectively the eye which is already weakened by a macular degeneration? The risk will absolutely be higher since the functions and thus the resistance of a degenerative retina is generally worse than the one of a healthy retina. The more the macular degeneration has progressed the higher the risk for losing vision because the macular is more and more unable to withstand the strain of the cataract operation. Thus the danger of worsening the macular degeneration is heightened. We found out that the connection between cataract and macular degeneration has already been discussed for years among experts.
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Our comment to the risks of a cataract operation at macular degeneration

According to this result about macular degeneration it does not surprise that many statements about the complications at cataract operations are received by us. These are mostly patients who were diagnosed already before the operation with retina degeneration, macular degeneration or diabetic retina disease; but also patients who were diagnosed with macular degeneration shortly after the operation for the first time. For details look at Cataract and macular degeneration: Conclusion
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Cataract: Our recommendation regarding an operation

1. Ask your doctor to explain as much as possible the individual chances for success and the risks of a cataract operation. Do not accept the standard explanation sheet. Have courage and ask your questions! Also with macular degeneration.
2. Ask for an examination (for example with a laser retinometer) to find out how high the gain in visionary acuity (by removing the clouded lens and implanting a clear one) the doctor expects to be. Then assess whether the eye operation on base of the assessed visionary acuity gain and the probable risks of a cataract operation are worth it at the moment, especially if you have already a disease such as macular degeneration.
3. Discuss with your ophthalmologist whether before a cataract surgery an examination of your retina is useful. With this examination it usually can be determined whether your eyes are already strained by a degenerative process or even macular degeneration and thus you may have a heightened risk through the cataract operation.
4. Assess with your ophthalmologist carefully the prospects and risks of a cataract operation (also in connection with macular degeneration). A medical necessity to operate on the cataract is only seldom given! The patient has to decide for himself how and whether he wants to get his eye disease treated. He needs to give a written consent and has to carry the consequences himself.
5. Ask your ophthalmologist whether he can even assess the risk of a cataract operation in your case. Sometimes a cataract has progressed so far that the ophthalmologist is not able to recognize an already damaged retina or macular degeneration. The risk to lose visionary acuity can be low but also be very high, especially in connection with macular degeneration.
6. If the risk is too high or seems not to be calculable you should consider whether the cataract operation should be done or in order to avoid risks, decide rather to live with the lessened visionary acuity and do not do the operation. You should also consider whether first more riskless treatments of the eye disease within the alternative area of medicine (also see macular degeneration) should be used. This could take place with the goal to delay the progression of the cataract or even to prevent it. We have heard of such successes also in connection with macular degeneration. In some cases there is a medical necessity to operate on the cataract.

Remark: We research further in this case and ask you to send us your experience you have made with cataract or macular degeneration treatments.
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Cataract Definition:

Cataract is a clouding over of an original clear eye lens. Cataract is worldwide the most reason for blindness. Thereby the so called age-related cataract is meant which occurs in most cases from the 60th birthday onwards. A cataract can also be the consequence of an eye injury, an eye operation, electric shock or side effects of medication. The original meaning of cataract is “Waterfall”, which gives a conclusion on the look of the cataract when it has reached a certain stage. Cataract patients whose disease has progressed very far a gray colour can be seen behind the pupil. Cataract leads to the patient looking through a milky glass and that the visionary acuity decreases more and more. Further typical symptoms of cataract are: The usual therapy for cataract is an operation under local anesthesia.
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Cataract: Classification

The cataract is basically classified by the location of the clouding. Cataracta conticalis means a clouding of the lens cortex. Cataracta subcapsicularis posterior means a clouding of the layer underneath the rear lens capsula. Cataracta nuclearis means a so called nuclear cataract.
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Cataract: Causes

The most noticeable criteria of a cataract as well as macular degeneration ist he age. Cause in this sense is a change of the metabolism in the lens of the eye. The consequence is the typical cataract characteristic of the clouding of the eye lens.

Principally the cataract but also the macular degeneration can occur at any stage of life. Cataract can also be found aside of older people, in newly born or teenagers. Cataract can be inheritable and stay for many generations. Is the cataract of non inheritable cause a clouding of the eye lens is assumed to be already founded by a virus infection in the uterus. Mostly German measles or mumps infections during the time of pregnancy are mentioned here.

Cataract is not necessarily in every case the consequence of a changing metabolism during aging. The eye disease can also be caused through numerous damages of the eye lens. UV-rays can damage the eye lens and also numerous diseases, medication, such as cortisone. Also blood sugar disease diabetes mellitus or dialysis patients can cause a cataract. Further possibilities to get a cataract are injuries in the eye, x-rays or infrared rays or even lightning impact. Even the mentioned macular degeneration can lead to an added deterioration of viewing at cataract.
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Cataract: Frequency

A cataract is found nearly at every over 65 years old person (also a frequent age at macular degeneration), at least a starting which probably has not been discovered. At the age between 65 and 75 100% of the population have a cataract whereas 50% notice viewing disturbances when the 75 age is reached.
(Source: University clinic Greifswald (Topic Cataract))
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Cataract: When should be operated?

The right time for a cataract operation should be discussed with the ophthalmologist. For this question it is among others crucial what visionary acuity they eye still possess and how well the patient can cope with the reduced viewing performance on a daily base. The same is valid for macular degeneration.

As long as the cataract is only light it is often possible to gain visionary acuity through a new pair of glasses. In a further stadium of the cataract a new pair of glasses is of no use and it has to be determined whether the viewing disturbance is high enough to undertake a cataract operation or not. The more the viewing is impaired the higher is the acceptance to undergo an operation.

Also the nervousness of the patient regarding the cataract operation plays an important role, after all it is an operation on the eye which is subjectively seen as the most sensible organ of the body. The fear of the cataract operation or macular degeneration is sometimes very high, especially if a cataract patient has learnt from friends that there were complications after the operation or the viewing hasn’t improved or even worse were worse than before.

An improvement of viewing after a cataract operation is maybe not given if another eye disease is existing which reduces the visionary acuity such as macular degeneration, a diabetic retina disease, a glaucoma, a viewing nerve inflammation or circulatory disorder or a functional change in the viewing centre of the brain such as after a stroke.

The recommendation is to assess the possible benefit against the risk in every single case, at cataract as well as macular degeneration. Especially if only one eye is still working or another existing disease such as macular degeneration this assessment is curcial. If only one eye can see and an occurring risk would damage the “last” eye the entire viewing would be reduced. As a cataract patient you should ask precisely and also know that every operation, cataract as well as macular degeneration contains a risk and one cannot automatically assume to be able to see better after a cataract operation.
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Cataract: Symptoms

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Cataract: How is it diagnosed?

The diagnosis cataract is a daily routine for the ophthalmologist. Basically the viewing performance of the eye is measured after the optimal correction of a possible defective vision through the cataract has been done with measurement glasses. Should the viewing performance be under normal a so called slit lamp, an examination microscope, is used to examine the lens. The split lamp generates an optical cut through the lens and the ophthalmologist can recognize clouding (for example as with the cataract) very well. Similar examination processes are also used at a macular degeneration. A further progressed cataract can often be seen with the eye.
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Cataract: What chances does an operation have?

Cataract operations are usually successful; meaning usually the removal of the lens is successful. Cataract operations are not usually successful if you ask whether the patient will be able to see better after the operation. Ca. 90 – 95% of the operated can see better after the operation. In other cases the same visionary acuity is given or worst case scenario even deterioration can be seen after a cataract operation. Especially when at the same time a macular degeneration is existent or other unhealthy changes of the retina occur you should be careful. Also see above under the topic Cataract & Macular Degeneration.
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Cataract: How do I need to prepare for the operation?

In advance of a cataract operation the general health situation is assessed because if it should be worse than normal there could be a heightened risk for the viewing ability after the cataract operation. Especially if there are other diseases present such as macular degeneration you should be cautious. Also see Cataract and Macular Degeneration Conclusion

Usually only one eye is operated on, after that, after a certain break, the other. This approach is probably done to see whether the operation of the first eye went well.

Due of the short operation time of approximately 15 to 20 minutes it is usually done under a local anesthesia. Usually a light tranquilizer is given and of course blood circulation, puls etc. are watched during the operation.
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Implanting artificial lenses

Why is an artificial lens implanted during the cataract operation? Goal is to replace the former diffractive impact of the transparent natural eye lens. If there would not be an artificial lens implanted the eye would be farsighted by ca. 15 dioptres and would need as a consequence a correction of this size. In former times it was common to wear a so called cataract pair of glasses, a very strong pair of glasses for cataract patients.

With the artificial lens a former defective vision of the patient can be corrected at the same time with the operation. This is not always precisely possible yet the resulting defective vision is most of the times lower than before the cataract operation.
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Cataract: multi focal lenses

Such a lens has two main focal points, one for far sighting and one for close sighting. The incoming light is differently distributed and spread across several focal points. Often, this is optimal for cataract patients. This enables a sharp viewing in almost all distances. Yet through the distribution of light a loss of contrast is generated. This leads to viewing light sources mainly in the twilight somewhat distorted.
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Cataract: How is the operation run?

According to today’s medical standard the extra capsular operation technique is mainly used during a cataract operation.

At this method of a cataract operation the Phacoemulsification procedure is mainly used. At this today most modern kind of cataract operation the lens capsule is opened at the front in layers. This only a few millimeters large cut enables the access. Afterwards the inner, harder lens core is scaled down with the help of ultrasonic rays, liquefied and exhausted with the softer so called lens cortex. For the now empty lens capsule pocket there are 2 methods. Either the existing cut is slightly enlarged and a harder Plexiglas lens is implanted or a soft folded artificial lens is inserted either in front of or behind the pupil, depending on the method, unfolded and fixated. The lens remains there for the rest of the life. Basically note: Should both eyes be affected by the cataract, only one eye is usually operated on first. The second cataract operation is done some time later.
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Cataract: After the operation?

The cataract operation does not take longer than 15 to 20 minutes in most cases. Both at the cataract and the macular degeneration the patient should avoid the following in the following week of the operation: A complete healing can be expected most of the times in ca. four to six weeks after the eye operation.
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Cataract: What can you do?

No matter how harmless an operation against cataract or macular degeneration may seem, it is always an impact into the human system and often weakens the strength of the eye in a not to be underestimated extent, sometimes more sometimes less. When in doubt, talk to your ophthalmologist about the cataract operation.

Also be careful at the daily body care such as showering or washing the hair in the time directly after the cataract operation. You should also take extra precautions against sunlight after the operation. Also see macular degeneration.
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Cataract: Does the viewing capacity change after the cataract operation?

In most cases you will note an improvement of your viewing capacity only a few days after the cataract operation.

Yet you need still a pair of glasses for near sighting respectively far sighting.

Often deterioration can occur after weeks or months. This so called post cataract develops through a clouding of the rear lens capsule.
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Cataract: Complications

The following complications are known: Rarer: Regarding the artificial lens: Note:This section is only part of the most known risks, side effects and possible complications. We do not claim them to be complete and recommend always a discussion with your ophthalmologist.
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Cataract: The Post Cataract

As post cataract the newly clouding of the in the eye remained rear capsule of the lens is meant. The viewing capacity is decreased again. According to reports it takes ca 3 to 5 years until between 10 and 50 % of all cataract operated will face a post cataract. This can also happen after a few months. Especially in teenagers the post cataract rate (up to 95 %) is very high. The definition post cataract varies extremely hence the variations. Up to now the exact context between cataract, macular degeneration and numerous stadiums of a post cataract is not known. This so called post cataract (Cataracta secundaria) can be treated with laser or an operation. The following treatments can be used: At the first mentioned procedure a so called laser split lamp is inserted against the lens rear capsule (so called membrane) under local anesthesia which will open it leading to a distinct improvement of the visus (Rise of visionary acuity). An operation does work almost in the same way.

Alternatively it was tried to minimize the post cataract problematic in different ways. Among others it was tried to improve the quality of the artificial lenses (intraocular lenses (IOL)) that are used at a cataract operation.

(1) Source: http://www.katarakt.net/html/pco.htm
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Cataract: Procedure at an existing astigmatism

The main problem of astigmatism lies in the deforming surface of the cornea. The incoming light is refracted unevenly which leads to a distorted viewing. In combination with a cataract or macular degeneration the viewed image is additionally distorted. Depending on the symptoms the astigmatism can be corrected in some cases with the cataract operation.

Alternatively it can be done at a later time through an ambulant operation but only after ca. 2 to 3 months after the last cataract operation.

There are 2 operation methods used: The Cost:

Many of the statutory health insurances carry only the cost for a normal operation. The cost of a treatment of astigmatism (ca 300 Euro per eye) has to be paid by the patient himself. It is best to get in touch with your health insurer since the regulations can be quite different regarding cataract and / or macular degeneration.
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Cataract: Are there any late risks?

Already since ca. 1978 artificial lenses are inserted during a cataract operation and carried by the patients for the rest of their lives.
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Cataract: Does one feel the artificial lens?

During the first time after the operation there may be a feeling of an alien element for example when touching the eye. But usually the lens is not felt by the patient at all.
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Cataract: Studies

We were asked in the past whether an ambulant cataract operation with the possibility to be at home after only a few hours would not be a heightened risk and could be negative on an also progressing macular degeneration.

Scientists of the international research network Cochrane Collaboration have assembled existing studies and evaluated.

The result: Four months after the cataract operation the patients had a similar visionary acuity but independent of whether they had been treated ambulatory or stationary at a hospital. At the ambulatory operated patients temporary complications occurred somewhat more but did not take any influence on the overall operation success.

It has to be noted that these results are only built upon a limited study and thus may vary in reality strongly.
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Antioxidants with cataract and macular degeneration

Other studies have alarming results regarding cataract compounds. So it is said: "Studies of the last years prove: They do more damage than they are useful."

"Also the propagated usefulness of highly dosed beta carotenes, vitamin A, C and E alone or in combination to improve various eye diseases was researched by the same team. Conclusion: The named vitamins do not protect but can even cause a deterioration of the viewing capacity at cataract. An age-related progressing loss of viewing (macular degeneration) or the degenerative retina damage (Retinitis Pigmentosa) cannot be stopped the publishers say. [1]."
(Source: http://www.heilpflanzen-welt.de/news/200908-Mythos-Antioxidantien.htm)
[1] NN: Vitamine A,C,E und Betacarotin: Wie nützlich sind Antioxidantien? (2), arznei-telegramm, 12/2003; 34: 111-3
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Cataract and Smoking:

A further study from the 90ies proves the connection between consuming tobacco and cataract. Quotation: The American study lets assume that smoking leads to a change of the lens which is only able to rebuild itself in part. Anti smoking campaigns are of utmost value also with regards to cataract. 1.35 million cataract operations are performed in the US alone per year causing a cost of 3.5 Billion US $.

Similar research is done for macular degeneration.
(Source: Blauer Dunst, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg)
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