November 1, 2016
Cataracts on a Post-Lasik Generation

Cataracts are most likely to change vision during aging.  More than 60% of Americans have had cataract surgery or have a cataract after age 80, a total of 24.4 million people according to the National Institutes of Health’s National Eye Institute.  At first, vision is easily correctable with glasses, but once the ability to participate in desired activities is inhibited and glasses can no longer correct the problem, cataract surgery becomes necessary. As part of cataract surgery, an intraocular lens is implanted, where a lens is placed inside the eye. While there is no extra risk for the procedure itself post refractive surgery, a problem arises in level of correctability. Refractive surgery changes the shape of the cornea. The equipment used to measure the cornea for cataract surgery does not take into account its new post-refractive surgery shape, and therefore presents a standard error in results. This calculation error may cause the patient to require glasses, or there is an option of getting a touch-up refractive surgery procedure afterward. A “common misunderstanding is that Lasik can fix everything. Refractive surgery can only do what glasses and contacts can do for a patient, so if that doesn’t correct the issue, then it won’t correct with Lasik either” says Michael Savetsky M.D., an Ophthalmologist practiced in New York and Los Angeles. If a patient does choose to get a repeat refractive procedure after cataract surgery, Savetsky recommends photorefractive keratectomy (PRK), instead of Lasik because it is less invasive and works on the surface of the eye instead of lifting up the corneal flap.

 

It is important for a nursing staff to be able to recognize the signs of correctable vision loss, like cataracts, and how it distinguishes from irreversible vision loss. While cataracts are eventual to form, recognition is often difficult at early stages and detection is key. Many elderly patients ignore declining vision and interpret the signs as inevitable aging. They often don’t report it or ask for help, so consistent monitoring is increasingly necessary. A good indicator to look for is frustration with reading. An all too common occurrence are patients who claim their vision is fine, but they just cannot read. Patients often also request brighter lights, notice glare or bump into things. Nurses need to recognize the need to refer patients to an ophthalmologist. Staff training programs are available through The Braille Institute and Lighthouse for the Blind. The training provides nursing staff with the proper tools and confidence to provide patients with top quality care.

 

Once vision loss is properly diagnosed by an ophthalmologist, management of the patient’s care can be altered. For reversible vision loss, proper improvement interventions can be chosen, while with irreversible vision loss, tools can be used to enhance the patient’s remaining vision. In the early stages of cataract development, the assumption is that the patient’s vision still allows them to do what they choose.  Patients awaiting cataract surgery need to be treated with similar accommodations to those with irreversible vision loss. They can no longer participate in things they want to do, and require nursing staff to maximize their comfort level and safety as much as possible. Recommendations include providing an easily navigable and open space, increased lighting in rooms, a magnifier, and routine placement of items to increase accessibility. Some patients may need a referral to a low vision specialist.

 

Pull quote box 1:

 

“common misunderstanding is that Lasik can fix everything”

 

Pull quote box 2:

 

Recommendations include providing:

  • an easily navigable and open space
  • increased lighting in rooms
  • a magnifier
  • routine placement of items to increase accessibility

 

Dos and Don’ts of Cataract Surgery:

 

Dos:

 

  • Ask questions and address your concerns
  • Know the available options for lens implants and surgical technique
  • Take prescribed eye drops prior to surgery, as instructed
  • Take it easy during the recovery period

Donts: