Glaucoma and Cataracts
OPHTHALMOLOGY
With the right level of expertise, patients suffering from multiple eye conditions such as cataracts and glaucoma can gain significant improvement…sometimes during a single procedure.
 “Glaucoma is a condition in which people have high intraocular pressure,” says board-certified ophthalmologist Robert E. Edelman, MD. “That pressure pushes on the optic nerve and damages fibers in the nerve, eventually leading to loss of vision.”
This disease is commonly referred to as the “silent thief of sight” because patients develop the condition without being aware of it at first.
“Glaucoma sufferers lose vision in a particular way, from the periphery in,” explains Dr. Edelman, “so they don’t always notice it right away. Fortunately, we have sensitive tests that enable us to detect it early rather than waiting until people come in complaining of vision loss because by then it’s too late.”
When approaching a patient who has both cataracts and glaucoma, the first thing Dr. Edelman decides is the severity of their glaucoma. “If they have mild to moderate glaucoma, I will usually just do a cataract surgery because modern cataract surgery has a treatment component for glaucoma in it anyway: it lowers the pressure a little in most patients.
“For patients with moderate glaucoma, sometimes before cataract surgery I will perform a selective laser trabeculoplasty, a laser treatment which helps lower intraocular pressure and maybe even get the patient off of one of their eye drop medications.”
In patients with severe glaucoma, explains Dr. Edelman, he performs cataract surgery with a trabeculectomy; in other words, a combined cataract and glaucoma procedure.
“Severe glaucoma patients are those who are on three or more medications, have significant visual field loss, and significant optic nerve damage,” he clarifies. “People who have severe glaucoma are more likely to have their eye pressure get worse after cataract surgery, so it is in these patients that we do both cataract surgery and trabeculectomy to avoid pressure problems.”
Premium lenses
The primary goal in treatment of cataracts in patients with glaucoma is to improve the patient’s vision while reducing their need for eye drop medications wherever possible. To that end, Dr. Edelman frequently recommends a particular type of lens for cataract patients, depending upon his patient’s particular needs and eye conditions.
“This is the era of premium lenses, and I really like the Toric® lens to correct for astigmatism. I think this is a very good lens to be incorporated for select glaucoma patients,” he adds.
“Multifocal lenses are not contraindicated in glaucoma patients, but I am much more hesitant to consider them,” he reflects. “The reason is that with the multifocal lenses, patients may experience a loss of contrast sensitivity after surgery, where objects are not contrasted sharply. People who have glaucoma or macular degeneration or diabetic eye disease may already have some degree of reduced vision, and we want to be cautious about reducing their contrast sensitivity more.
“The Crystalens® is a lens that does not affect contrast sensitivity. It’s an accommodating lens that helps people see larger print or the computer, and can be considered in glaucoma patients. However, I strongly lean toward using the Toric lens for glaucoma patients who also have astigmatism.
“Ultimately, if I can perform a cataract surgery and that lowers their pressure by itself, and we avoid a glaucoma surgery, that’s wonderful,” concludes Dr. Edelman. “However, for patients who have more severe glaucoma, we offer a variety of options. We always work to customize a course of treatment for each patient’s condition and personal preferences.”
Patients speak
 Floyd Culbreath and Fred Wagner are both patients who have benefited from Dr. Edelman’s expertise in cataract treatment.
“I’ve been a diabetic for many years,” says Fred, “so I went to Manatee Sarasota Eye Clinic to get established with some doctors for the eye problems that I might develop. I have gone there for quite a few years.”
When Fred’s vision began to change as the result of both cataracts and glaucoma, Dr. Edelman was there for him.
“I was really happy with how Dr. Edelman laid things out for me and told me what the chances are that things are going to be better,” recalls Fred.
For Floyd, a cataract in just his left eye alone caused difficulty with his vision.
“I was having problems reading and problems seeing at night, especially when driving,” he explains. “It just kept getting worse, and I finally decided I couldn’t put up with it any longer.”
Both patients had cataract surgery, and, in Fred’s case, an additional procedure for his severe glaucoma was performed at the time of his cataract procedure.
“Fred was using three different glaucoma medications in his right eye,” explains Dr. Edelman, “and his vision had decreased to 20/70. Because he had significant glaucoma and was using a lot of eye drops, I performed cataract surgery together with the glaucoma procedure called trabeculectomy. He turned out correctable to 20/30 with no glaucoma drops.
“Floyd’s cataract surgery turned out very well, too, and he rarely uses any type of eyeglasses now,” adds the doctor. “I was pleased to be able to provide results like these for Fred and Floyd.”
Naturally, both patients are thoroughly pleased as well.
“I went from where I couldn’t read without reading glasses to where I can read a newspaper with no glasses. I’m not using glasses at all, except when I read something real fine or am trying to thread a needle,” assures Floyd.
“It’s helped my golf game a lot!” he continues. “I can stand off from about two hundred yards and see a golf ball on the green.”
“My vision was 20/70 and now it’s 20/30,” confirms Fred. “My vision is probably as good now as it was fifteen years ago, so it’s been really successful as far as I’m concerned.” FHCN – Michael J. Sahno
|
| FOR MORE INFORMATION |
Manatee-Sarasota Eye Clinic
Murray L. Friedberg, MD
Robert E. Edelman, MD
Scott E. Silverman, MD
Eric L. Berman, MD
Robert P. Sambursky, MD
Pooja Khator, MD
Allison V. Menezes, MD
Jeffrey M. Davis, MD
217 Manatee Ave., E.
Bradenton, FL 34208
(941) 748-1818
Blake Medical Arts Building
2010 59th St. W., Ste. 3800
Bradenton, FL 34208
(941) 748-1818
8947 U.S. Hwy. 301 North
Parrish, FL 34219
Sarasota Eye Clinic & Laser Center
1427 S. Tamiami Trail
Sarasota, FL 34239
(941) 366-4777
2020 Cattlemen Rd., Suite 500
Sarasota, FL 34232
Lakewood Ranch
8340 Lakewood Ranch Blvd, Medical Office Building 1, Suite 280
Bradenton, FL 34202
1515 Sun City Center Plz.
Sun City Center, FL 33573
(813) 633-3065
www.youreyedoctors.com
|
|