Re: CANNOT SEE TO READ

On May 27, 12:03 pm, ray <spamm...@xxxxxxxxxxxxxxxx> wrote:
On Mon, 26 May 2008 16:44:30 -0500, "Mike Tyner"



<mty...@xxxxxxxxxxxxxx> wrote:

<p.clar...@xxxxxxxxx> wrote

are simple refractive changes, cataracts, and potential retinal
problems (diabetic retinopathy, macular degeneration, etc.) And such
an examination is directly in line with the skills and scope of
practice of optometrists, as well as ophthalmologists, both groups who
have "medical" training regarding the eye.

I think the first doctor (an optometrist) had it right. He described
yellowing and vacuoles. He blamed the diplopia on vacuoles ("little lenses")
and while that was hogwash, it was closer than anyone else got.

Our OP (ray) said, early on, that his only symptom was monocular polyopia
OU. There just aren't that many things that cause monocular polyplopia OU at
age 67.

Fuch's isn't on the list, short of fresh central erosions. Fuch's is a red
herring, when it comes to explaining the symptoms.

Ray described one LED looking like six, each in focus. He's got refractile
wedges and medicare won't pay until he degrades to 20/40.

I appreciate your input, and value your opinion. I am still very
confused. The polyopia came on overnight. After about a month it is
not nearly as bad. Now there a bunch of images close together and
seem to be more smeared than in good focus. The vision gets better
and worse. The Muro drops seems to clear it up sometimes. I put up a
home eye chart and my vision goes from 20/20 to about 20/50.

I didn't think early Fuch's was such a barrier to surgery, and I suspect
another surgeon might not be so put off.

The cataract surgeon measured corneal thickness of 645 and guttata of
3+. He said the Fuchs is fairly well advanced. How is it determined
how far advanced it is? I am going for a cell count next month. Does
that shed any more light on the subject? He said he has seen too many
people with Fuchs that had bad results with cataract surgery that he
does not recommend operating. John Hopkins says that it is usually OK
for corneal thickness below 640. When I get motivated I will shop for
a cornea surgeon. Do you have any recommendation for a good one in
the pacific northwest? Or would you recommend a different cataract
surgeon?

From the John Hopkins site:

http://www.hopkinsmedicine.org/wilmer/conditions/fuchs/treatment/fuch...

Fuchs Endothelial Corneal Dystrophy (FECD) and Cataracts

Some people with cataracts also have Fuchs Endothelial Corneal
Dystrophy (FECD). If a Fuchs patient undergoes cataract surgery, the
fragile endothelial cells of the cornea may be damaged. (The
endothelial cells are those cells at the very back of the cornea. The
endothelial cells deteriorate in patients with FECD.) The loss of too
many of these cells can lead to edema (swelling) of the cornea. This
edema can then sometimes lead to painful corneal bullae (blisters),
deterioration of vision, and eventually, the need for a corneal
transplant.

In summary, in a patient with FECD, a cataract surgery may hasten the
need for a corneal transplant. Because of this risk, the corneas of
FECD patients are examined carefully before cataract surgery.
Sometimes, the eye doctor will decide that the patient should have
both cataract surgery and a corneal transplant at the same time. By
doing this, two separate surgeries are combined into one procedure,
and recovery time is greatly reduced.

Recent research has helped doctors figure out when a Fuchs patient can
have simple cataract surgery and when a Fuchs patient should have a
combined surgery (cataract surgery plus corneal transplant). These
researchers showed that many Fuchs patients with corneas thinner than
640 microns can usually have simple cataract surgery. (A micron is a
very tiny unit of measurement. Each micron is 0.00004 inches long.)

Whenever a person with FECD has cataract surgery, the surgeon uses
special jelly-like material called viscoelastic gel. Viscoelastic gel
is put inside the eye to protect the back of the cornea during the
surgery. The viscoelastic gel is then taken out again at the end of
the surgery. This gel has been shown to greatly decrease endothelial
cell loss during cataract surgery.

Ophthalmologic researchers are trying to figure out if there is a
minimum number of endothelial cells that everyone has to have in order
to see properly. Preliminary research, however, indicates that no
absolute number exists for this threshold value. Instead, it seems to
vary from patient to patient.

But waiting for 20/40 seems ill advised.

-MT

Fuch's is commonplace. 1% of the population is quite a lot of
people. I see people with various stages of Fuch's in my practice on
a weekly basis.

Cataract surgeons are particularly alert to endothelial cell problems
like Fuch's since those patients tend to have a higher rate of
complications than people with healthy endothelial cells.

In its final stages, Fuch's can cause reduced vision, fluctuating
vision, and pain. However, according to my training and experience,
moderate Fuch's such as you seem to have is not a significant
contributer to reduced vision. Perhaps you have cataracts, and the
Fuch's has got the attention of your surgeon simply because it could
impact the success of your surgery. If so, then cataracts is the
primary problem and Fuch's is simply an aggravating circumstance that
complicates your surgery.

Why are you planning on seeing a corneal surgeon? A corneal
transplant (aka penetrating keratoplasty) is an appropriate treatment
for end-stage Fuch's where the cornea is becoming opaque and acuity is
significantly compromised. Is that what your doctor is telling you?
Believe me, you don't want a corneal transplant unless its absolutely
necessary because even a successful outcome is generally not very good.
.

Relevant Pages

  • Re: CANNOT SEE TO READ
    ... If a Fuchs patient undergoes cataract surgery, ... fragile endothelial cells of the cornea may be damaged. ... endothelial cells are those cells at the very back of the cornea. ... In summary, in a patient with FECD, a cataract surgery may hasten the ...
    (sci.med.vision)
  • Corneal-surgery
    ... method depends on the patient. ... from the surface of the cornea. ... cornea and the tissue is put back into place.The procedure is usually ... painless and the improvement in vision is usually immediate. ...
    (misc.health.alternative)
  • Re: Cataracts and astigmatism
    ... Astigmatism can come from the cornea or the crystalline lens, and the two are additive optically, so that depending on the axis of the cyl. ... The cataract surgery always eliminates the lenticular astigmatism, but the IOL can have some astigmatism, either on purpose or accidentally. ...
    (sci.med.vision)
  • Re: Cataracts and astigmatism
    ... Astigmatism can come from the cornea or the crystalline lens, and the two are additive optically, so that depending on the axis of the cyl. ... The cataract surgery always eliminates the lenticular astigmatism, but the IOL can have some astigmatism, either on purpose or accidentally. ...
    (sci.med.vision)