Re: Myopia & Retinal problems

Posted By Mike on June 13, 1999 at 15:40:10
In general, what is the length of the eyeball when a person should consider themselves at greater risk for retinal tears or detachments.  For example, are there studies that show that people at 27 mm or above are at what ?% greater risk than people at 25 mm? Is the degree of diopter deficiency a better measurement for determining risk?
If a person has minus 6 diopter myopia & over 40, should that person have their retinas examined once a year by an ophthalmologist even thought they have no other health problems?
Is there some risk when the eye doctor shines the light through the slit lamp onto the retina?  Is ultrasound more useful for detecting smaller retinal tears?

[HFHS MD JL]

Posted By HFHS M.D.-JL on June 13, 1999 at 18:15:44
Most studies use the diopters when studying levels of myopia and the assoc risk of retinal detachment.  There is a correlation between the length of an eye and the dioptric power.  A rough guide is that a high myope (greater than 5) has a lifetime risk of retinal tear/detachment of 5%.  This number is greatly influenced by other factors such as lattice degeneration or other ocular conditions.  Certainly, those more myopic are at greater risk.  I would recommend that high myopes have their retinas examined every year, certainly after age 40.  The gold standard for retina examination is using the binocular indirect (bright light).  Ultrasound would not be as sensitive or practical.  There is essentially no risk to the retina when using a bright light for evaluation, but it is possible if the light is used for an extended period.
This information was provided for educational purposes only.
HFHS M.D.-JL

[Mike-Walsh]

Posted By Mike Walsh on June 13, 1999 at 19:50:06
In general, by how much would no stitch cataract surgery add to that 5% lifetime risk.  If the YAG laser should happen to be needed later, how much would that again increase the risk in your opinion based on perfectly healthy 47 year old eyes other than the -6 diopter & upcoming bilateral cataract surgery situation. The reason I am struggling with this issue is because if I thought there was too great of a chance of the cataract surgery & potential YAG to cause retinal problems I would consider having the cataract surgery done on only one eye & waited until I was possibly much older to have it done on the eye that doesn't have quite as bad of a cataract.  Someone told me that I should have both cataracts taken care of shortly after each other because I would probably heal better before I have other health problems that could come with older age. Would there be a greater reason to go with an Acrylic lens vs most current generation Silicone lens based on the -6 diopter eyes?  Both my eye doctor & myself feel that I will be able to adapt to the new multifocal Array but are still waiting for the diopters to include the range for my minus 6 eyes.  My eye doctor says that when I get one eye done I will tend to realize how bad my other eye should be done too....but that could be a short term gain if the surgery would cause retinal problems.  Another way of looking at it would be that if I did start having a tiny retinal tear on an undone eye.....could the cloudy lens prevent the eye doctor from seeing quite as clearly through the slit lamp technique that you described in your post.  I would really appreciate a thorough well thought out answer to this current post of mine even if it means a slightly delayed reply from you or one of your other experienced eye surgeons.
One final note, you are close to the Canadian border, I would consider having my eyes done there because they are using the expanded diopter Array in Canada already from what I have been told. If your EYE CLINIC could do it as a clinical trial it would be possibly even better here in the USA because of my Blue Cross & Blue Shield coverage.  I am from a more rural area(North Dakota) & you might have better expertise & equipment etc.  I have been to the Detroit area before...but it does seem like getting on plane right after surgery wouldn't be ideal either.  Thanks

[HFHS MD JL]

Posted By HFHS M.D.-JL on June 14, 1999 at 08:53:21
First, I would recommend surgery close to home if possible.  The exact percentages you are asking for are not available because a study such as you are describing would be difficult.  I would say that if the surgery is uneventful, the increased risk of retinal detachment is not that much.  Also, I have noticed a much lower rate of capsular opacification using an acrylic lens.  This would mean you would likely not need a YAG done which would slightly increase the risk of retinal detachment.  You will likely want both eyes done to improve binocularity.  You may consider seeing a retinal specialist to further evaluate your retinal periphery to look for any weak areas.  In general, people do real well after cataract surgery with far fewer complications than we experienced in the past.  Good luck.
This information was provided for educational purposes only.
HFHS M.D.-JL

[Mike__0__0]

Posted By Mike on June 14, 1999 at 19:53:17
It is very important to me to have the multifocal but I do not want my decision to cause a retinal problem later on. Isn't there some other advantages to using the silicone lens?  Are you sure it isn't the square edge effect that makes it appear like there might be less PCO?  I kind of trust Dr. David Apple's recent survey.  I sure don't want to rely on a casual or biased observation!










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