FAQ

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Diabetic Retinopathy And Cataract

Yes , one can have a cataract and also co existing diseases like diabetic retinopathy and also glaucoma. One should undergo a comprehensive evaluation of the  eye before cataract surgery.

NO. It is always advisable to undergo retinal evaluation before cataract surgery.

It is always advisable to  get the retinal assessment done before surgery and stage the retinopathy, take treatment for diabetic retinopathy if necessary before cataract surgery. Sometimes the cataract may be too dense to thoroughly assess and treat a retinal condition. Only in such cases cataract surgery can be done prior to retinal treatment.

Retina specialist after evaluation and relevant investigations can decide if the retinopathy requires treatment before cataract surgery. Its advisable to have a consultation with a retina specialist before cataract surgery if there is retinopathy.

Unless the cataract is very dense or a mature cataract with absolutely no view of the fundus , in most of the other cases one can assess  the retina and stage the diabetic retinopathy fairly accurately even in the presence of cataract.

Indirect ophthalmoscopy, slit lamp biomicroscopy, Optical coherence Tomography (OCT), fluorescein angiography, OCT angiography. They are done and interpreted by retina specialists.

Cataract surgery may lead to progression of the diabetic retinopathy and may even worsen a pre-existing macular edema (swelling of the central part of the eye due to diabetes). Therefore where possible its always advisable to treat diabetic retinopathy first.

Depending on  the stage of retinopathy, the retina Specialist may advise retinal laser or intravitreal injection. In case the diabetic retinopathy has progressed to a tractional retinal detachment or a non clearing vitreous hemorrhage (bleeding inside the eye), a combined cataract and retina surgery is advised. Neoretina is a centre for excellence for such advanced surgeries.

In diabetics the cataract progresses faster and hence cataracts are more dense than those in patients without diabetes. In some cases the pupil fails to dilate adequately. Since patients are at risk of diabetic retinopathy, early cataract surgery is advisable in diabetics so that their retinal evaluation is not hampered by the cataract and can be done adequately.

Fasting blood sugar of less than 140 and post prandial of less than 200 is recommended. This reduces the chance of infection and helps in better healing.

Not all cases of diabetic retinopathy need treatment. Few cases wherein one has accumulation of fluid within the retinal layers(diabetic maculopathy), injections are advised.

Yes. Early stages of retinopathy do not warrant any treatment unless there is accumulation of fluid. Observation with strict control of sugars is what is needed. Fluid in the retinal layers that is not encroaching the centre of one’s retina or is away from the retinal centre can be observed or in severe cases can be managed with laser treatment.

In cases where the fluid accumulates at the center causing increase in retinal thickness and with visual disturbances.

Injections help to reduce the fluid and also cause regression of new(abnormal) blood vessels that develop on the surface of the retina.

No. The role of injections is to reduce the fluid level. In the initial treatment phase one would need frequent injections. However one should also focus on controlling the metabolic parameters like hypertension, diabetes, cholesterol levels and any kidney disease(creatinine levels). Once a stable point is reached in the eye, one can avoid injections. However a lifelong retina check up is mandatory to follow up the condition and get treated as and when required based on the eye condition.

The number of injections one would need varies from individual to individual. Several factors are to be taken into consideration like how our retina responds to the injection, maintaining stable blood sugars and other factors like hypertension, cholesterol and kidney disease.

Yes. Monthly injections are mandatory until the retinal reaches a stable point. Usually the next injection is to be planned prior to the weaning off effect of the previous injection.

Though this varies, it usually ranges around 8-12 over a period of first two years.

Sometimes one’s retina does not respond to one type of drug. Ideally non response to injections has been defined as no reduction or minimal response to the drug only after 6 injections. However with the availability of newer drugs one might consider shifting you to a different drug early.

Injections prior to diabetic vitrectomies are given only in advanced cases wherein one’s retina has higher chances to bleed. Injections are given in these cases to reduce the risk of severe bleeding during surgery. However one must be cautious as the surgery has to be planned within 5 days from the date of injection. Sometimes one might prefer giving injection during the surgery.

No procedure would ever come free of side effects. One needs to assess the risks and benefits before opting for any treatment. Side effects of injections are usually related to the eye like infection(sometimes vision threatening), cataract, increase in the intraocular pressure and rarely retinal detachment. Absorption of the minute amounts of drug given into the eye into the blood happens rarely that can cause systemic side effects like stroke, worsening of already compromised kidney function.

Overall there are two classes of injection: anti-VEGFs(anti- vascular endothelial growth factors) and steroids.

Depending on your retinal condition, the amount of fluid, chronicity(since when the fluid is persisting), any systemic limitation your doctor would advise the injection which is appropriate to your eye.

Glaucoma

Glaucoma is a slowly progressing problem. On an average, untreated Glaucoma takes around 10-15 years to advance from early damage to total blindness. With an IOP (Intraocular Pressure) of 21-25 mmHg it takes 15 yrs to progress, an IOP of 25-30 mmHg around seven years and pressure more than 30 mmHg takes three years. Glaucoma can also occur at normal eye pressure; progression to blindness is even slower in this variant.

Glaucoma is the name of a group of eye diseases that leads to vision impairment or total blindness if left untreated as it is a disease of the nerve (optic nerve) that gives us all forms of the night – vision, colour vision, and side vision.

Glaucoma is not curable but it is controllable, like diabetes and hypertension. To prevent or slow down further damage, regular eye examination, eye drops, laser procedures, pills or surgical operations as determined by your doctor can help. To detect advancement and to restrict further side vision loss, regular eye examinations are effective.

Blindness can be prevented if it is recognised in the initial stage. Medications can slow down the progression of glaucoma by reducing elevated intraocular pressure (IOP) as this restricts further damage to the optic nerve.

Most types of glaucoma have no symptoms. However, there is an acute variety that can cause severe eye pain, blurred vision, headache, nausea, and vomiting; this preceded halos around lights.

There are no specific vitamin supplements that prevent glaucoma. In this case, one needs to incorporate supplements like B-complex, Calcium, Zinc, Magnesium, Vitamin A, C and E in the diet.

There are no studies that prove the role of stress as a contributing factor in causing glaucoma

This will be determined by your doctor, taking into account your age, your general health and how much damage already exists for a given eye pressure.

This will be determined by your doctor, taking into account your age, your general health and how much damage already exists for a given eye pressure.

No food item has been specifically implicated in the causation of glaucoma. Healthcare professionals cite restriction in consumption of certain foods. Such foods contain saturated fatty acids and Trans fats; excessive alcohol and coffee should also be avoided.

Glaucoma can occur irrespective of age-group, but the risk increases with advancing age. Usually, open-angle glaucoma affects people aged above 40; primary congenital glaucoma affects 1 in 10,000, juvenile, open-angle glaucoma affects 1 in 50,000.

Preventing glaucoma from getting worse is not difficult. Regular eye examinations and being regular with treatment (if prescribed) are important.

Glaucoma occurs when the optic nerve is damaged; this damage is permanent and irreversible and can result in blindness either partially or entirely. However early diagnosis might save your eye from losing vision.

Yes, certain eye drops can cause heart problem, they have the potential to reduce heartbeat and alter blood pressure. If you inform your doctor of your general health, such a drug will not be prescribed.

Normal pressure in the eye ranges from 6-21 mmHg. Glaucomatous damage of nerve can take place in normal pressures also

The imbalance between the production of eye fluid called aqueous and its drainage can lead to an increase in eye pressure.

Being fit is always good. The consistent aerobic program is essential to maintain the normal pressure of the eye.

No glaucoma is not a life-threatening disease. However in advanced disease, due to extreme constriction of side vision, patients may experience the greater number of falls and accidents, if not careful.

Certain types of glaucoma are commoner in females, like angle closure glaucoma and normal pressure glaucoma

Right treatment at the right time might help you control further damage to the eye. Lowering eye pressure can stop glaucoma progression.

There is no absolute conclusion about the research but yes a good hot cup of green tea might lower the risk of eye diseases. Catechins in green tea reduce harmful oxidative stress in the eye.

Only acute angle closure has symptoms like vomiting, blurred vision, extreme head, and eye pain, nausea and sudden sight loss. Otherwise, most glaucomas are symptomless in the early stages.

Vitamins like A, B found in green leafy vegetables etc.can be of greater advantage if consumed abundantly. Even vitamin C and E can also be added to the diet to prevent glaucoma.

Cataract

If you have had cataract surgery, it usually requires 3 weeks to heal completely. If you are asked to wear glasses, you cannot wear it until the eye has completely healed.

Not all cataracts need to be removed. But if you experience lack of clarity in vision during everyday tasks like driving, playing etc, it is time you consider getting it removed.

If the cataract is left untreated, it impacts your routine life leading to danger of falls due to poor vision. In worst conditions, the cataract can leave you blind if ignored for a long time.

It takes around 3 weeks to recuperate from cataract surgery.

Cataract surgery is the safest surgery of all surgeries being performed in the world. The success rate of a Cataract surgery is 98%. However, every surgery entails risks and cataract surgery is no exception. Endophthalmitis is the only complication that can cause permanent vision loss. Its incidence is less than 0.04% to 0.2% in individuals at risk. The incidence is further less in patients without any risk factors.

After cataract surgery, it is advisable to avoid sleeping on the side of the operated eye for 24 hrs. Rubbing your eye or even water can aggravate the chances of infection. Post surgery, you should be careful for at least 2 weeks.

The blurriness (if any) after cataract surgery generally goes away within a week. If it still persists you must consult your doctor.

The average age of cataract surgery depends on whether you’re residing in a tropical or a cold climate and the amount of sun exposure. People living in tropical climates like India tend to cataracts at an earlier age. Having said that, the average age for cataract surgery would be 65. A US-based survey in 2004 cited the age group somewhere around 73-75.

Once removed, cataracts never grow back. The posterior capsule, which is the support for the implanted intraocular lens (artificial lens) might opacify in some individuals after months to years after cataract surgery. This opacification of the capsule can be treated with a LASER procedure (Nd: YAG capsulotomy) in the outpatient department. Once done, the capsule never opacifies again.

No, cataract surgery is not a painful procedure. It is always done under local (anesthetic injected near the eye) or topical (anesthesia with eye drops). Pressure sensation may persist after anesthesia, but patients do not generally experience any pain.

The risks involved in cataract surgery are retinal detachment, glaucoma, dislocation of artificial lens, inflammation, bleeding and infection.

There are no side effects of cataract surgery. There might be late complications like swelling of the macula (central portion of the retina), inflammation or opacification of the posterior capsule where the artificial lens is placed. These complications can be treated and vision restored.

You can take a shower after cataract surgery but water shouldn’t enter your eye, which means you cannot take a head bath for at least a week after cataract surgery.

Protective glasses are prescribed after cataract surgery. But for the purpose of reading, you can use your old glasses for up to 3 weeks until the refractive power of the operated eye stabilises, after which your doctor will prescribe new glasses.