Michael J Kutryb, MD
Michael J Kutryb, MD
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma
Interests: Ophthalmology
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma
Interests: Ophthalmology
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Feb 08, 2009 - 4 comments
A recent study published in the journal Ophthalmology, revealed that cataract surgery may not increase the risk of progression of advanced age-related macular degeneration (AMD.). The authors used data from the well known Age-Related Eye Disease Study (AREDS.) For many years, cataract surgeons like myself, have cautioned our patients, that we have seem patients that have had worsening of their AMD after cataract surgery but there has never been a direct link. Previous studies have suggested, that the AMD has a propensity to get worse over time with or without cataract surgery. This recent study appears to confirm the general concensus that the AMD needs to followed closely, regardless of whether or not cataract surgery is performed and while some patients may show worsening of the AMD down the road, it statistically not related to cataract surgery as far as we know.
For my part, I always have this discussion with cataract surgery patients who have AMD. I also make sure they are on the appropriate anti-oxidant vitamins, omega 3 fish oil, lutein, and a diet rich in green leafy vegetables like spinach and brocolli. For patients with advanced AMD, I usually use the Acrysof IQ lens which filters UV light and some of the harmful blue light at the very, very end of the visible light spectrum. It is the only IOL that does that and it might have a slightly better protective effect than other IOL's (although no proof yet, long term.) If possible, I also use the very lowest light power on the operation microscope, try to limit the surgery to less than 8-10 minutes. Simple little things with no proven benefit but worth the effort I think.
I have one patient that I think of often who was already at 20/400 vision due to end stage AMD in the right eye and moderate AMD in the left eye with a very cloudy, mature cataract. I have him on AREDS formula vitamins, Lutein and Omega 3 fish oil and a proper diet. It has been about 5 years since we removed the cataract in the left eye and used the Acrysof lens (with the extra chromophore filter) and he maintains 20/20 vision in that eye and often brings in the very heartfelt poetry that he writes and publishes. You see he is a WWII veteran and is a strong patriot. His works of poetry get to me every time and I think the world of him.
Michael Kutryb, MD
For my part, I always have this discussion with cataract surgery patients who have AMD. I also make sure they are on the appropriate anti-oxidant vitamins, omega 3 fish oil, lutein, and a diet rich in green leafy vegetables like spinach and brocolli. For patients with advanced AMD, I usually use the Acrysof IQ lens which filters UV light and some of the harmful blue light at the very, very end of the visible light spectrum. It is the only IOL that does that and it might have a slightly better protective effect than other IOL's (although no proof yet, long term.) If possible, I also use the very lowest light power on the operation microscope, try to limit the surgery to less than 8-10 minutes. Simple little things with no proven benefit but worth the effort I think.
I have one patient that I think of often who was already at 20/400 vision due to end stage AMD in the right eye and moderate AMD in the left eye with a very cloudy, mature cataract. I have him on AREDS formula vitamins, Lutein and Omega 3 fish oil and a proper diet. It has been about 5 years since we removed the cataract in the left eye and used the Acrysof lens (with the extra chromophore filter) and he maintains 20/20 vision in that eye and often brings in the very heartfelt poetry that he writes and publishes. You see he is a WWII veteran and is a strong patriot. His works of poetry get to me every time and I think the world of him.
Michael Kutryb, MD
Thank you, Dr. Kutryb, for posting this information. It certainly makes sense to have the best vision possible for as long as we can, and the study you cited should make those with AMD less fearful about obtaining the benefits of cataract surgery.
Dr. Kutryb,
Have you ever used the blue light-filtering IOLs on anyone who is an artist? I am about to have cat/IOL/DSAEK surgery, and am concerned that this type of IOL might affect color perception as I do artwork. My doc plans to use the Alcon SN60WF. Are there any reports I can read from studies that deal with this issue? Many thanks!
Have you ever used the blue light-filtering IOLs on anyone who is an artist? I am about to have cat/IOL/DSAEK surgery, and am concerned that this type of IOL might affect color perception as I do artwork. My doc plans to use the Alcon SN60WF. Are there any reports I can read from studies that deal with this issue? Many thanks!
All I can tell you is that I have done at least 100 patients with a clear IOL in one eye and the Acrysof Natural IOL in the other eye (SN60WF) and none of the patients ever could tell the difference between the eyes. What you really want is excellent vision and that is what this implant will provide. It is not a tint that you can physically experience in your everyday vision, but rather just enough to reduce some of the harmful wavelengths at the end of the visible light spectrum (in the blue range because any shorter wavelenth and you get ultraviolet light which is invisible to humans.) I like this IOL for another reason because it is extremely easy to work with and ulfolds in an incredible gently manner which is especially important for complex cases.
As a side note we have seen excellent results doing the cataract surgery first, then the DSAEK several weeks later, but different surgeons have different methods. The DSAEK tends to induce unexpected hyperopia or farsightedness of a diopter or a diopter and a half so that needs to be taken into account when picking the IOL power for the surgery. If your surgeon is experienced with this type of surgery he will be well aware.
I would have no hesitation with the SN60WF. We recently did a man who only had one eye. The other eye was lost to trauma and he had a cataract and really, terrible fuch's corneal dystrophy. We waited as long as possible to try to avoid cataract surgery but eventually the vision was so bad that he was ready. I did the cataract surgery with the clear understanding that the DSAEK was already scheduled with the corneal surgeon in about 3 weeks. We knew the corneal swelling would not go away until the DSAEK. He did amazingly well after both surgeries and now can see 20/30 and is very, very happy. Remember that after a DSAEK, no matter how perfect you look, in my experience, you will usually not see better than about 20/40 or 20/40 because the host and graft layers of corneal tissue are sandwiched together and you will forever look through both, with a thickness that is a little more than normal and some subltle changes in the overall curvature and power. THe patients are typically thrilled nontheless. Complete PKP or corneal transplant, which is much more difficult and takes much longer to heal, can in some cases bring back 20/20 vision but the odds of a good result with DSAEK are much better overall (even though usually a 20/30 max) and it is far easier on the eye and the patient. DSAEK is truly a beautiful surgery and the results are a wonder to behold, even for me after being in practice for 15 years.
Michael Kutryb, MD
As a side note we have seen excellent results doing the cataract surgery first, then the DSAEK several weeks later, but different surgeons have different methods. The DSAEK tends to induce unexpected hyperopia or farsightedness of a diopter or a diopter and a half so that needs to be taken into account when picking the IOL power for the surgery. If your surgeon is experienced with this type of surgery he will be well aware.
I would have no hesitation with the SN60WF. We recently did a man who only had one eye. The other eye was lost to trauma and he had a cataract and really, terrible fuch's corneal dystrophy. We waited as long as possible to try to avoid cataract surgery but eventually the vision was so bad that he was ready. I did the cataract surgery with the clear understanding that the DSAEK was already scheduled with the corneal surgeon in about 3 weeks. We knew the corneal swelling would not go away until the DSAEK. He did amazingly well after both surgeries and now can see 20/30 and is very, very happy. Remember that after a DSAEK, no matter how perfect you look, in my experience, you will usually not see better than about 20/40 or 20/40 because the host and graft layers of corneal tissue are sandwiched together and you will forever look through both, with a thickness that is a little more than normal and some subltle changes in the overall curvature and power. THe patients are typically thrilled nontheless. Complete PKP or corneal transplant, which is much more difficult and takes much longer to heal, can in some cases bring back 20/20 vision but the odds of a good result with DSAEK are much better overall (even though usually a 20/30 max) and it is far easier on the eye and the patient. DSAEK is truly a beautiful surgery and the results are a wonder to behold, even for me after being in practice for 15 years.
Michael Kutryb, MD
I should have mentioned, by the way, I have used this implant in about 5000 patients overall with no complants about color perception.
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