CATARACT & DIABETIC RETINOPATHY

[PKRNK]

Hi,

My father is 65 years old and has been diabetic for the past 16 years and recently was diagnosed with a clot in his leg and hence has been on blood thinners and statins.

Last month he woke up one morning with no vision in his left eye. He can just see a little silhoutte from the corner of his left eye. The eye doctor said he has diabetic retinopathy and has severe blood leakage. It was so much that he couldn't check whether the retina was damaged or not, according to him i should wait for 2 to 3 months hoping that the blood would dry, enabling him to see what actually is the problem

He checked the right (good) eye for damage and said some blood leaking has already begun in the right eye as well and we need to get laser therapy done so that atleast one eye can be saved. The problem is that the cataract in his right eye is very thick and hence is not letting the doctor perform the laser therapy and he wants to get the cataract taken care of first, as per the doctor in diabetic patients & ofcourse who have diabetic retinopathy it is always advisable to do the laser therapy first & then after a couple of months perform the cataract surgery but since he is unable to see anything due to the thick cataract he says he will have to perform the cataract surgery first.

I am really worried that if anything goes wrong with his right eye he might not be able to see at all. I had the following questions:

1. Should I listen to the doctor & go ahead with the cataract operation in the right eye,inspite of his warning that under normal circumstances laser therapy should be performed first Or should I wait for 2 or 3 months to see the outcome of his left eye
If I do agree do go ahead with the cataract surgery are there any chances of his
Losing complete vision from his right (good) eyes, if this occurs he will be totally
Blind.
2. since he suddenly loss  vision in left eye due to heavy bleeding, what are
The chances of heavy bleeding to start in the right eye in such cases?
3. Does diabetic retinopathy make the cataract surgery more vulnerable to complications and is it worth taking that risk on his good eye?
4. Also will cataract on the other hand make the retinopathy worse in his good eye?

5. Are there any chances he would get back vision back in his bad (left) eye?
Is it advisable to wait for 2 or 3 months? Will waiting for 2 or 3 months make
The case more complicated

I would really appreciate any experiences or insights.

Thanks

[John C Hagan III, MD, FACS, FAAO]

1. The cataract is not the problem, the problem is the diabetic retinoapthy. No one can give you "odds" on the surgery.

2. The blacked out of his vision are problem where the bleeding is. The blood is in the retina.

Go to Google IMAGES and type in the term  proliferative diabetic retinopathy.  Look at the pictures it will help you understand the mess diabetes does not the back of the eye.

3. Diabetic retinopathy is a function of how long a person has the diabetes, after 15-20 years everyone has some, also the diabetic control, where ther person smokes, has high blood pressure, high cholesterol, how obese they are, whether they exercise and luck.

You will need to get "risks" from the surgeon that has actually seen your dad's problem. He has big problems and even with proper treatment the risks are high but much higher to do nothing.

JCH III MD

[PKRNK]

Thanks for your prompt reply.

I have a few more questions

1) can a cataract surgery on the right eye in such cases lead to total blindness in the right eye?
What is the percentage chances of him losing complete vision in the right eye following the cataract
surgery?
2) it is generally said if there is bleeding the person sees some black dots or dark areas but incase
of my fathers right good eye, he can see everything without the black dots or dark areas but he cannot read small letter like letters in newspaper & magazines, he sees everything blurred (not part of the picture or sides blurred but the entire blurred vision), does this in some way prove that the bleeding is not too much or the retinopathy is not reached the last stage (proliferative or advanced proliferative) & blurred vision is mainly due to the thick cataract.

3) What can be the exact cause of sudden loss of vision in the left eye? can it be due to heavy bleeding or due to damage done to the retina due to heavy bleeding? the doctor told me that if diabetes is kept under good control then there is a good chance that the blood will dry up & he might gain back his lost vision in the left eye, what do you think is the chance of the blood drying & he gaining is vision back in the left eye.
if the blood will not dry up by itself then the doctor said he will have to perform vitrectomy surgery &
retina detachment surgery incase if the retina is damaged? what is the sucess rate if both the above surgery needs to be performed in such a case & do you think the retina will have been damaged
as the doctor has said there is severe bleeding in the left eye.
if the blood does not dry up & if vitrectomy surgery is delayed will it cause further damage to the retina?

thanks

[John C Hagan III, MD, FACS, FAAO]

1. Concentrate on saving what's left of the right eye. It is better to do laser first then cataract surgery but the cataract can prevent laser being done first. Such is your father's case. Do the cataract first. You father is at risk of blindness no matter what's done to him. It's a shame that he let himself get in such an advanced state. Diabetics should have their eyes checked yearly by an Eye MD to prevent advanced disease.

2. The bleeding is much more likely going to be due to diabetes than cataract eye surgery. If nothing is done the likelihood is that the right eye will experience a severe problem like the left.

3. Yes and Yes

4. At his stage its a moot point. This is more of an issue in very small cataract and very early diabetic eye disease.

5. Waiting will not increase the risk since he's been evaluated. The prognosis for the left eye is very guarded.

JCH III MD