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Michael J Kutryb, MD  
Male

Specialties: Ophthalmology, Cataract Surgery, glaucoma

Interests: Ophthalmology

Kutryb Eye Institute - Titusville
321-267-2020
Titusville, FL
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Cataract Surgery MonoVision Tips

Nov 27, 2008 - 164 comments

I've seen several posts in recent weeks about desired monovision after cataract surgery.  Since this is a subject near and dear to my heart that I deal with every day at the office, I wanted to give you some tips on how I deal with this very tricky situation.

1.  Monovision is not for everyone, especially if you are into athletics or want clean crisp distance vision.  In general, it seems to appeal to people that don't like the look or feel of glasses on their face and are higly motivated and willing to make sacrifices in vision quality to achieve that.

2. You seriously need to have tried it successfully with contact lenses before considering monovision after cataract surgery.  The intraocular lens implants used with cataract surgery are basically permanant and not easily replaced, so changing your mind after the fact is something to be avoided at all costs.

3.  Decide what your vision priority first and try to get that accomplished before going for priority number two.  You're not allowed to say "I just want to see at all distances without glasses" here.  That would be a wonderful result and something to shoot for but being realistic, you need to decide if I had to choose, what would I most desire, the ability to see near or far without glasses.  In my practice, I find out the main priority and shoot for that first and if I can achieve it in the first eye then the second eye has some wiggle room for me to add some near or distance vision as desired.  It is more of a DISTANCE plus some near added in or NEAR with a little distance added in.  This is a little of a mental game but my goal is to set expectations in a reasonable way and avoid giving in to the "I want it all, I want it now mentality" that has become more common, especially in the baby boomers.

4.  Mini-Monovision is a very desirable result for many patients and usually provides excellent distance vision and some useful near vision for computer work, and light reading like price tags and menus.  It is my favorite technique.  For example, after determining the dominant, I would aim for 20/20 distance vision (as close as possible) in that eye and then aim for something like 20/50 in the non-dominant eye with about -1.25 of myopia or nearsightedness in that eye - just enough to support a small to medium amount of intermediate and near vision.  It is such a small difference between the eyes that a great many patients can adjust to it quite well. These patients already can see almost perfectly for distance with one eye so that the non-dominant eye is freed up somewhat to be a little less sharp for distance and a little better up close.  There is one caveat with this technique and that is that it is crucial to get the first or distance eye as clear as possible for distance.  It it is a little off for distance, then I am occasionally forced to make the second eye for distance as well since these patients usually have distance vision as the main priority.

Keep these ideas in mind when considering cataract surgery, and I welcome your comments and questions.  I really enjoy communicating with my surgery patients and getting to know what they want out of cataract surgery.  I get to be the "Vision MatchMaker" every day and it's a responsibility I take very seriously.

Michael Kutryb, MD
Kutryb Eye Institute
www.kutrybeye.com

Topamax and Another Acute Glaucoma Attack - Almost.

Aug 09, 2008 - 95 comments
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Topamax

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topamaz

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topiramate

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glaucoma

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blindness

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acute glaucoma

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narrow angle glaucoma

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flomax

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flomax urgency frequency

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tamsulosin

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kutryb

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seizures

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myopic shift

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drug side effects

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adverse reaction

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vision

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vision loss

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Migraines



I hope anyone who uses Topamax for any reason is fully aware of the serious risk of acute narrow angle glaucoma.  I had read several articles about it but saw it firsthand last week.  As usual on my quiet weekend off I got the dreaded call from the emergency room, again.  This time about a woman on Topamax for 7 days who seemed to have lost almost all her vision 12  hours after increasing her dose per her doctor's instructions.  Some quick thinking sparked me to ask if she could see up close and lo and behold while she was blind as a bat in the distance, she could see the tiniest print about 6 inches in front of her nose.  She had developed an acute myopic shift from a choroidal effusion which pushed the lens/iris diaphram forward.  Fortunately, God was on  her side because she was smart enough to stop the Topamax and go to the emergency room before she developed an attack of acute narrow angle glaucoma (symptoms severe eye pain, headache, nausea, vomiting, almost complete vision loss.)  Her ocular pressure was actually only slightly elevated and with cessation of the Topamax, her pressure returned to normal in a day, while it took over a week for her vison to return to normal.  It was extremely impressive the way the lens moved forward initially.  After a week, the lens moved back to normal position and the eye looked completely different as if from another person.  It was really something I will never forget.  She could have gone blind if she hadn't stopped the drug and gone to the  emergency room.

So, if you are taking Topamax or getting ready to increase you dose or considering starting it - please, please take my advice and remember that it can cause sudden worsening of your vision, and if an attack of narrow angle glaucoma starts, you can develop severe eye  pain, extreme headache, nausea, vomiting and nearly complete loss of vision.
Next on my list of least favorite drugs - Flomax - the only drug I know of that actually caused it's own completely new syndrome - the formidable "Floppy Iris Syndrome" nemesis of cataract surgeons everywhere.

Michael Kutryb, MD

Paintball Guns = Recipe For Blindness

Jul 26, 2008 - 17 comments
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paintball gun

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eye protection

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blindness



It's my weekend off to relax, but unfortunately I had to go the emergency room to see another young man with a severe paintball gun injury.  He has lost almost all his vision in the left eye.  His eye, fortunately didn't burst like the last one -so I didn't need to spend 2 hours in the operating room piecing him back together.  This is the 6th young man I have seen with nearly total loss of vision in an eye due to a senseless paintball injury. One had to give up his dream of being an Air Force pilot.  One could no longer play football which was his passion.  The tragedy of it all is that they were just trying to have fun, and it was usually one of their best friends that pulled the trigger.  These paintball guns are so much more dangerous than BB guns because the whole idea is to shoot to kill another person (in a simulation, of course, of a real gunfight.) You're aiming at other people, not at a soda can or a target like you might with a BB gun.

Please take my advice.  If you ever get the crazy idea to play paintball, NEVER, EVER TAKE OFF YOUR EYE PROTECTION because that is exactly when you will get hit in the eye.  Remember Murphy's Law.  Whatever can go wrong, will go wrong.

Next time... my other biggest pet peave - weed wackers.

Michael Kutryb, MD