Archive for the ‘Cataracts’ Category
Shocking results of our Vision and Legal Driving Poll. Clue: Scary travels!
06.11.2011Last month, Mary Sweetman, a Certified Ophthalmic Assistant, wrote about the legal requirements for vision when driving. We decided to ask the opinions of our readers how they felt about this prickly issue.
Paul Krawitz, M.D., President and Founder
VisiVite.Com
Elderly Drivers vs. Safe Drivers: Can They Be One And The Same?
05.18.2011
“I can see just fine when I drive”
“I don’t want my license to say I need glasses to drive”
“I only drive to the grocery store. It’s ok, I know my way.”
“I don’t drive at night anymore because I get confused.”
“I passed my eye test at DMV. The girl there let me keep guessing ’til I got it right.”
These statements are just a few examples of comments I hear from my patients on a daily basis. Scary, I know, but telling an elderly person they are no longer legal to drive under the state’s Division of Motor Vehicles guidelines, is never an easy conversation to have.
You would probably be shocked at how lax some states regulations are. Different states define “legal vision” in different ways. In New York State, where I live, legal driving vision requires that a person must have at least 20/40 best-corrected vision in one eye to be able to drive. Unbelievably, only 9 of the 50 states require a vision test upon renewal! New Hampshire and Illinois are the only 2 states that require drivers over the age of 75 to take a vision AND road test upon renewal. Maine, on the other hand, actually requires a road test at renewals beginning at age 40.
I often have to tell patients they have fallen below legal driving limits, but this does not necessarily mean they can no longer drive or have to have their license revoked for good. Bringing them back to legal driving limits may be something as simple as an adjustment to their eyeglass prescription, or possibly the time has come for cataract surgery.
If you have an elderly parent, grandparent or loved one on the road, take a drive with them every so often. While doing so, make careful observations on how they appear to be seeing. If you notice a struggle or a decline, encourage them to see their doctor for an eye exam – for the safety of everyone out there on the road.*
Click here to take my 6-Question survey about vision and driving. here to take survey
Mary Sweetman
Certified Ophthalmic Assistant
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“The issue of good driving vision is not only a legal one. There are also ethical and emotional issues. Elderly drivers who have experienced a decline that makes them unsafe on the road staunchly defend their ability. Yet the same person would be upset if another driver with similar skills were a danger to a grandchild. If a driver is legally blind, there currently are no requirements, and in New York State there are no protections for physicians to report this information. Patients vigorously defend their right to drive because losing that ability means losing independence.”
Dr. Paul Krawitz, President and Founder, VisiVite.com
Cardiovascular risk factors play a role in cataract formation and need for surgery.
01.05.2011Age-related cataracts are often linked with several other conditions. In a recent study, Nemet et. al. found that there is an association between cataracts and the incidence of cardiovascular disease (CVD). 12,894 patients, ages 50 and older, were examined. Each patient was matched by age and gender with two controls who did not undergo cataract surgery. Information regarding the prevalence of various CVD or CV risk factors in each subject was extracted, including carotid artery disease (CAD), diabetes, peripheral vascular disease (PVD), systemic arterial hypertension, chronic renal failure (CRF), ischaemic heart disease (IHD), congestive heart failure (CHF), smoking, alcohol abuse, and hyperlipidaemia.
Dr. Krawitz examining a patient with cataracts during his medical mission in Myanmar
The findings show that CVD and CV risk factors have a higher occurrence rate in patients undergoing cataract surgery compared to the controls. Statistically significant results were obtained for all CVD and CV risk factors except for alcohol abuse. CAD was the most common CVD associated with cataracts. Since the carotid artery supplies blood to the eye, damage to the artery can cause cataracts by reducing ocular circulation. Strong associations of diabetes and smoking with cataracts were also found. Both of these CV risk factors are thought to induce cataracts via oxidative damage of the proteins of the ocular lens. Glycosylation of tissue proteins associated with diabetes may also cause the observed association. Prior evidence additionally suggests that there may be an inflammatory process involved, for elevated levels of CRP and interleukin-6 have been linked with diabetes and cataractogenesis.
One important caveat to this experiment lies with the fact that the controls were designated as those who did not experience cataract removal. It is possible that some of the controls possessed cataracts but chose not to undergo surgery for a variety of reasons. Hence, the prevalence of cataracts may have been underestimated, hindering the strength of the results. Nevertheless, it certainly appears that there is a positive association between cataracts and cardiovascular disease. However, definitive identification of the biological mechanisms behind this association requires further research.
Brian Krawitz
Staff Writer
Does cataract surgery increase the chances of retinal problems?
09.29.2010
Dr. Krawitz prefers the Alcon Infiniti phacoemulsification instrument for performing his cataract surgeries.
Cataract surgery is one of the most important processes with respect to maintaining eye health. With remarkable advances in technology accompanied by an optically demanding aging population, cataract removal has become more frequent and less arduous. However, research has shown that patients with retinal conditions may be prone to postoperative complications following cataract surgery. Cataract removal is vital in these patients because the presence of a clouded lens impedes a physician?s visualization and management of the retina. In a report from Dr. Samer Farah in the 2010 issue of the American Academy of Ophthalmology’s Eyenet Magazine, the associations between preexisting retinal disease and the effects of cataract surgery were examined.
Several retinal conditions and their relationships to cataract surgery were scrutinized. Recent studies have revealed that cataract surgery may exacerbate diabetic retinopathy, a common retinal condition in diabetic patients. Not only did cataract surgery increase the progression rate of the disease in subjects with a preexisting level of retinopathy, but it has also been associated with new occurrences of the condition. Patients with history of retinal vain occlusions (RVOs) are also susceptible to complications resulting from cataract surgery, primarily in the form of postoperative cystoid macular edema (CME). The risk of CME is also prevalent in patients with epiretinal membrane. With respect to age-related macular degeneration (AMD), results have been less conclusive. Due to the diversity of the disease, no accurate relationship has been established between AMD patients and postoperative retinal problems.
The most common cause of retinal complications following cataract surgery is vitreomacular traction caused by movement of the vitreous. However, other mediating factors have been investigated. A particular study showed that patients with a high aqueous humor level of VEGF at the time of surgery were more prone to postoperative macular edema. As a result, anti-VEGF treatment via intravitreal bevacizumab is being used to prevent the onset of this condition. Other options for postoperative retinal care include the use of topical nonsteroidal anti-inflammatory drops (NSAIDS) and AREDS nutritional supplements. For AMD patients, physicians may choose to insert an ultraviolet light-blocking intraocular lens, for UV light is commonly thought to exacerbate AMD. Of course, these patients are also advised to wear sunglasses or hats as further means of protection after the operation.
Certainly, cataract surgery is necessary to improve visual acuity, especially for patients with retinal diseases so that their conditions can be monitored without obstruction.? However, physicians must be wary that certain preexisting retinal diseases can make a patient more prone to complications following cataract removal. Hopefully, understanding the risk factors and employing certain methods of preventative treatment can minimize these postoperative effects.
Brian Krawitz
Staff Writer
Mother Alert – Sun damage not only to skin, but eyes, experts warn.
09.01.2010
While the majority of people are aware of skin damage that can result from unprotected exposure to the sun, very few know about the harmful effects that ultraviolet light can have on the eye. Yet experts agree it is critical to protect the eyes from harmful ultraviolet radiation using hats and sunglasses.
In the short term, UV light can lead to inflammation of the cornea and/or the conjunctiva. While this inflammation usually subsides, long-term UV exposure can lead to cumulative eye damage that is reflected in a number of conditions.
For example, abnormal growth of the conjunctiva, known as pterygium, may develop causing partial blockage of vision by obstructing the cornea. It is also believed that cataract formation is correlated with UV exposure. More severe eye diseases may develop as well, such as cancer and retina damage in the form of macular degeneration. Therefore, it is of utmost importance to wear sunglasses that effectively protect the eyes from ultraviolet rays.
Consumers are advised to purchase glasses that absorb 99 to 100 percent of UV-A and UV-B radiation. Moreover, ultraviolet radiation is not limited to direct sunlight, as reflections from metal, snow, or other surfaces can also inflict eye damage. Sunglasses should be worn at all times in the presence of bright light. *
Brian Krawitz
Staff Writer
