(February 10, 2009 - Insidermedicine) Dr. Sherif El-Defrawy, MD, PhD, FRCSC, the immediate past President of the Canadian Ophthalmology Society, discusses what he would do if he had blurry vision that could possibly be a cataract. Dr. El-Defrawy is Associate Professor and Head of the Department of Ophthalmology at Queen’s University, Kingston, Ontario.
We recently caught up with Dr. Sherif El-Defrawy, associate professor and head of the department of ophthalmology at queen’s university in kingston ontario. Dr. El-Defrawy is the former president of the Canadian Ophthalmology Society.
If I had blurry vision that could be a cataract…
Dr. El-Defrawy: There are several primary eye care providers that can assess for blurred vision. Most often patients will be detected in either their family doctor’s office on a general examination, when their vision is tested (the doctor might note that vision is down), or at their optometrist’s office - many patients regularly see an optometrist, whether for glasses or regular checkups, and often decreased vision will be picked up there. There are also many people who have regular visits with an ophthalmologist, and certainly an ophthalmologist will detect a reduction in vision and go from there.
There are many causes of decreased vision. Because you have blurred vision does not automatically mean you have cataract, and in fact one of the very important steps that an ophthalmologist will take is to ascertain that it is not many of the diseases that can lead to decreased vision that is taking place in your eyes. For example: going form front to back, people can have corneal diseases that could five rise to blurriness, you can have inflammations within the eye that can give rise to blurriness; there are a variety of problems that can occur in the back of the eye, inflammations in the back, or effect the retina of the eye (the retina is akin to the photographic film that sees the picture and sends it to the brain); there are a variety of vascular causes, and many other causes that can give you blurred vision.
An ophthalmologist will go through and ensure that this is not what is causing the blurriness and they might arrive at the conclusion that it is a cataract. A cataract is the opacification, or the lack of clarity occurring in the natural lens of the eye. There are a variety of causes for this: we know that it can be related to drugs; it can be related to certain diseases within the body; the most common cause of cataracts that we see today is the aging process, we know that the largest group of cataracts we call senile cataracts; we know that genetics play a role; we know that exposure to UV radiation plays a role; we know that the diet that we eat plays a role in whether we form cataracts or not, or rather, how soon we form cataracts in life. If you take any human being, if they live long enough, they will develop a cataract, or an opacification of their lens.
What are the steps involved in cataract surgery?
Dr. El-Defrawy: The cataract surgery starts when we make an incision into the eye, to allow us access to the front part of the eye. After that incision we make an opening in the capsule that contains the lens and then use a phacoemulsification probe to take out the cataract. This probe uses ultrasonic energy to break up the cataract into a fine dust. And then basically vacuums it out of the eye. There are remaining fibrils of tissue and we can just aspirate these out of the eye. After all that is removed from the capsule, we then put in a folding lens that is going to focus the light back into the eye. It sits within that capsule and never has to come out and be cleaned or anything else. And that’s basically the surgery.
Dr. El-Defrawy: If I had blurry vision and I thought I had a cataract, the first thing I would do is make an appointment with my eye care provider and I would see my ophthalmologist or optometrist to ensure that I did indeed have blurry vision. It would be very important to see an ophthalmologist to ensure that blurry vision was related to cataract and not any of the other diseases that can cause blurry vision.
Once that is determined it would be very important to know what my visual acuity is. Because if I don’t meet the level required for driving, then I know that I would want surgery much sooner than if I did meet it. So that would probably be my first criteria. If I did meet the level of vision required for driving, then the next thing I would be thinking about was what I use my visual system for. Am I still able to paint he way that I like? Am I still able to read the books that I like? Or do I find that I fatigue very quickly after about twenty minutes of reading, and I stop reading because of that. Am I still able to do the work that I do every day using my eyes the way that I do? If I am able to still do all of those things, then I am in no rush to get the surgery, and I would probably defer. If I find that any of those things are compromised, then I would definitely look to getting the surgery. And of course, the last thing is that I would put value on my ophthalmologist’s opinion. I know that, as an ophthalmologist, he or she has seen many cataracts, and can comment on how dense this cataract is, and what they think as far as surgical timing.