Need Advice! If You Have Severe Dry Eyes Can You Have Cataract Surgery?

[nycdryeyegirl]

Hi,

Last month I saw my eye doctor and he told me that I am not a candidate for cataract surgery and I wish to find out if any of the members on the DEZ have had successful cataract surgery even though they suffer from a dry eye disorder.

In June 2008, I had an acute severe inflammation of my lacrimal and tear glands, caused by my underlying auto-immune condition (lupus) and in a period of twelve to twenty-four hours I was basically left with only twenty to thirty percent of my tear glands functioning.

If I had been given systemic steroids and concurrent immunosuppressant therapy (i.e., cellcept) at the time of this acute attack, I might have been able to reverse the damage done to my tear glands and perhaps stopping the progress of my cataracts.

At my last office visit, I asked my doctor if I should try Durezol (a very strong topical steroid eyedrop) and he agreed that I should try it to see if it would reverse some of the damage done to my tear glands tears. He had also suggested trying cellcept medication to also reverse the damage done to my tear glands and I am still on the fence as to whether I should try this drug because it has some potentially serious side effects.

My vision currently is 20/40 in my right eye and 20/40 to 50 in my left eye and according to my eye doctor some of my visual problems might be due to the cataracts (i.e. not being able to see when the sun is blocking part or all of my vision, glare etc).

I would appreciate hearing from anyone who has had successful cataract surgery after developing a dry eye disorder.

Pam

[irish eyes]

Hi

You have probably done plenty of your own research into this but you might find this of use (although it is nearly 3 years old)

http://webeye.ophth.uiowa.edu/asorn/...eSxCatSurg.pdf

I have a cataract but it doesn't bother me anything like Dry Eye does. I have similar advice i.e. not to do anything with it unless it is absolutely necessary.

[calli66]

The article doesn't say much that's new: basically, screen for dry eyes pre-op, and if found, treat with cyclosporin before and after the operation. This is the same approach advocated for Lasik. There is some mention that cutting corneal nerves disrupts the feedback loop telling the tear glands to produce tears---same info for Lasik.

What I'd like to know is this: Is there any special way that cataract surgery can be performed for dry eye patients that can mitigate the damage to the corneal nerves, and prevent the dry eye from worsening after the surgery? I get the impression that the surgeons just do it the same way for everybody, regardless of whether they have pre-existing dry eye.

I want to hear about techniques for dry eye patients that are different from the regular surgery----ways that minimize the damage. At the least, I would prefer a surgeon who is aware of my dry eye and is "extra careful" (whatever that might be) when doing the surgery.

Pre and post treatment with cyclosporin (Restasis) is not an option that would work for me----been there, tried that, made things worse.

C

[ringo]

new non surgical treatment that removes cataracts and helps dry eye as well

http://www.antiaging-systems.com/extract/babizhayev.htm

article about a breakthrough medication that eradicates cataracts with photos of pre- and post-treatment corneas; serious cataracts are compeltely resolved after 2 to 6 months treatment with n-acetyl-carnosine drops, also used to treat other ocular diseases like ocular inflammatory disease (one of which is dry eye)

note: these are new drops different from n-acetyl-cysteine drops which many dry eye patients use.

[irish eyes]

I think the drops are marketed in the UK as Can-C or Bright Eyes.


http://www.youtube.com/watch?v=Tg5jcl27eF4

http://www.youtube.com/watch?v=T97z3...eature=related

[Moonraker]

A few days ago, I started a thread asking if anyone had had experience of Bright Eyes but no replies have been posted yet. The article mentioned above seems quite convincing, though I would be interested to see an independent assessment. I'm fairly sure that the drops have yet to be approved by the UK authorities. What about in the US?

Incidentally, my doctor didn't seem bothered about my dry eye when she removed the cataract and never mentioned any potential problems (over and above those normally associated with cataract surgery). But then my dryness only needed treating with Lacrilube at night and Viscotears during the day.


Moonraker

[ringo]

Hi Moonraker,

I have missed your thread- but I am fairly certain that if a drug is on the market it must have been approved by the authorities. I researched a bit on the internet-- seems that this medication is well advertised. My mum was diagnosed with dry eye and cataracts recently, so I have advised her to ask her doctor about this.what are ur resevations towards these drops? may be you could also consult a doctor about them?

My mum also has inflammation, so doctor put her on treatment to resolve it, as he said that he cannot operate with active inflammation. May be you had a case of moderate dry eye, so your doctor did not see it as a problem? as far as i know any surgery should be avoided with dry eye, just to be on the safe side. A surgery could make things so much worse. How are you after the operation? any change in your dry eye condition?

[irish eyes]

Statement from Royal College of Opthalmologists UK

Taken from http://www.rcophth.ac.uk/about/press/
Updated 1st October 2009


Statement on N-acetyl-carnosine Eye Drops

"The evidence for the effectiveness of N-acetyl-carnosine eye drops is based on experience on a small number of cases carried out by a Russian research team. To date, the research has not been corroborated and the results replicated by others. The long-term effect is unknown. We do not feel the evidence base for the safety is in any way sufficient to recommend its us. More research is needed."

Mr David Wong, Chairman, Scientific Committee



"Bright Eyes"

Bright Eyes is not and may not be sold as a cure for cataracts. Bright Eyes is not licensed in Britain for use as a medicinal product but is sold as lubricating eye-drops to relieve tired and sore eyes.


Page updated 1st October 2009 (SAD)

[ringo]

Thank you for this update Irish eyes.

I find it weird though that these drops are licensed in the UK as lubricating drops, and at the same time their long-term safety is questionable according to the quoted statement.

If they are licensed as lubricating drops, and I had a cataract, I would give them a try. I just read today that they are extensively used for resolving cataracts in pets, and they work for hundred percent clearance of the cataracts.The evidence from the human trials is also compelling. If I had a cataract with the horrible dryness I would definitely give them a try before deciding on a surgery. To me the prospect of eyes getting worse after the surgery is more scary than any drops...especially "lubricating" ones.

But, thanks God, I do not have such a decision to make. Anyhow, it is always good to be aware of multiple options...

[Moonraker]

Hi Ringo

Irish Eyes has answered your query for me (thanks) and his quotes sum up my reservations. At £30 or so for a small phial they would be very expensive lubricating drops! The major importer in Britain markets a number of "alternative" preparations for various conditions. I became aware of the drops because of an article in the Daily Mail, which prompted a lot of public interest. People were invited to set themselves up as agents selling the drops, which didn't help their image as a genuine medical preparation.

If ones' eyes are otherwise normal, I would say that surgical removal of cataracts is the best option, especially if one already wears glasses, as the artificial lenses can greatly improve one's vision. My short sight went from 8 and 4.5 dioptres to 2 ( now 1.5) and 0.5. But I recognise that if there are complications it's worth considering alternative treatments.

I would like to see reports from people who have tried Bright Eyes on whether or not these helped their condition. Ringo says: "The evidence from the human trials is also compelling", but I'm unclear as to how independent these were.

Compared with many on this Forum, my dry eye condition is moderate, The surgeon did advise that after the op I should use a brand new tube of Lacrilube to guard against infection. The op made no difference to my dry eye.

[irish eyes]

Remaining on this topic, Can-C drops are available from an on-site store that I have done business with. You will see that they make this claim:

This latest anti-ageing breakthrough is a special form of Carnosine, called N-acetylcarnosine, a natural antioxidant, that has achieved remarkable results in clinical trials

Can-C eye-drops are sold as an eye-lubricant, but are being used in parts of the world for other eye problems as well. They are safe to be used by most people, including those with cataracts

http://www.dry-eyes.co.uk/acatalog/CanC_Eye_Drops.html

If you look, there are 3 customer reviews - only giving 3 stars out of 5.

Note that they say they are safe to be used by people with cataracts and not for cataracts.

Two 5ml bottles cost £27.

Bright Eyes is a bit more confusing because the Swiss company (ETHOS)claimed that they are not available in Europe - although I did find them renamed and marketed as Re-Vital Eyes (Bright Eyes) by Ethos from £45.00.

(How would you know whether or not they were really working....? Regular doctors' check ups?)

[calli66]

I remember reading an article somewhere about the difficulty medical researchers have in finding any compound that will actually penetrate to the interior of the eyeball. This contradicts the Can-C claim that the active ingredient goes into the vitreous and works on the clouded lens that way. My other doubt, gleaned from their website and others selling the same product under a different name, is that they use the exact same (limited) images of before and after treatment----I believe it's one or two images of a human eye, and one very blurry black and white one of a canine eye.

As someone said, "More study is needed." I do wish it worked, as I would like to "dissolve" my mild (at this point) cataracts instead of having surgery.

Question for Moonraker: Did you have a choice of powers in the replacement lenses you got? Could you have been corrected fully, instead of correction to -2.00 D and .50 D? I am curious---being at -8.50 D myself, I would like correction, but am not sure I could deal with the full amount. I've become accustomed to being undercorrected in glasses by about -1.00 D---I don't like the harsh crispness of 20/20 for daytime.

Calli

[Moonraker]

Question for Moonraker: Did you have a choice of powers in the replacement lenses you got? Could you have been corrected fully, instead of correction to -2.00 D and .50 D? I am curious---being at -8.50 D myself, I would like correction, but am not sure I could deal with the full amount. I've become accustomed to being undercorrected in glasses by about -1.00 D---I don't like the harsh crispness of 20/20 for daytime.

Calli

I understood from reading up the subject that some surgeons like to aim for -1 in one eye and plano (perfect vision) in the other. I recall that -1 was what the surgeon had planned for, but it came out at -2. The poorest eye was treated some years before the other one, and I recall that the surgeon recommended going for -1.

For a year or so after the -4.5 had had the cataract removed, I wasn't sure whether the sight in that eye was better with or without my new glasses. (I gather some slight instability in vision can be expected.) It often depended on how moist the eye was. Now it's developed Posterior Capsule Opacification (which I understand is more a side effect than a complication and is quite common and easily treated), so I'm getting slightly fuzzier vision.

Overall, my new "eyesight" is quite acceptable. I can shop at supermarkets and browse in libraries without distance or reading specs, though for reading books and newspapers I do use reading glasses. I could manage without distance specs outdoors (except obviously for driving) but for the need to protect the dry eye.

I had no trouble with the big improvement, though I gather my vision was/is monocular, which I understand means each eye works independently. (No doubt someone will come up with a better definition!)

[calli66]

Thanks for the info, MR!

C

[Lucy]

I've had cataract surgery on one eye. I don't believe taking drops or any supplements will make the cataract go away. Just my personal opinion.
I have extremely dry eyes due to Lasik surgery and later Sjogrens.

I had very little trouble with this. The incision they make is very tiny. I also had the opaque capsule blasted. I have a cataract in my other eye, but I'm afraid of having it done. I just had my eyes tested and my vision in that eye has really declined. I won't be able to put it off much longer.

Because I had lasik, the doc had trouble guessing my correct RX on the implant and I ended up at -4.5. If you haven't had Lasik, this would not apply to you at all.