By Dr. Allen Douma
Tribune Media Services
Q: I had a cataract operation with an implant five months ago and have had vision problems ever since. After three visits to ophthalmologists for fine lines and floaters in my vision and not being able to focus well, I asked the doctor if I had gotten the wrong implant. He said if you don't trust me, then why did you come to me? My granddaughter says I ought to get a second opinion. What do you think? -- P.C., Illinois
A: The short answer to your question is yes, I absolutely agree with your granddaughter. And I hope the doctor you select for a second opinion not only has the proper training and experience, but also better communications skills, and can show more empathy for your concerns.
Let me briefly discuss cataracts and floaters. There are several different types of cataracts, but the basic problem is that the lens of one or both eyes becomes cloudy or hazy. This commonly results in difficulty with distant vision, blurred vision and, especially, poor vision at night.
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Everyone is at risk of getting cataracts and that risk climbs rapidly after the age of 65. In addition, people with diabetes, a strong family history of cataracts and those who take corticosteroids for a long time all have an even greater risk as they get older.
As you know, the treatment for cataracts is surgery. The best way to decide on the time for cataract surgery is to determine how much your ability to function and enjoy life is limited by the changes in your eyesight.
With modern microsurgical techniques, cataract surgery risks are greatly diminished and the results are almost always excellent. But a full understanding of the expected benefits and risks should occur before making the decision.
Complications can indeed occur as the result of surgery, and include swelling of the eye itself, infections and floaters. Do you or did you have swelling or infection?
Spots before the eyes -- "floaters" -- can certainly be annoying, as they appear to move across the field of sight, interfering with vision. Did you see floaters for the first time after the surgery or were they present before but became more noticeable?
These opaque specks seem to be in front of the eye, but they are in fact floating inside, in the vitreous, which is a clear, gel-like substance that fills the inside of the eyeball.
They are "seen" because of shadows cast on the retina, the light-sensitive nerve layer in the back of the eye that receives visual images and transmits them to the brain.
Floaters can affect people of every age, but they are often associated with changes in the vitreous gel inside the eye as we become older. Formation of floaters in this way is not usually an indication of more serious problems and they will often go away by themselves.
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Floaters can also be caused by a detachment of a portion of the retina in the back of the eye. A sudden onset of floaters, especially accompanied by flashing lights (photopsia), may be symptoms of this more serious problem and should be evaluated by an ophthalmologist.
Also, some of the material in the interior of the eye could be blood or matter from an inflammation of the back of the eye called uveitis. This can also be serious and should be checked out. Surgery could also result in material in the vitreous.
If you have the common form of floaters, they cannot be prevented or treated. Also, for many people, the eye and brain gradually become accustomed to them and, after a while, they are hardly noticed. This is similar to ignoring windshield wipers when you're driving in the rain.
It does take time for the eye to recover from the surgery. Let us hope by now your vision problems have improved. If you get proper follow-up care and monitoring, they can be treated effectively.
Dr. Allen J. Douma writes a daily column on a variety of medical and health issues. Write to him in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, IL 60611; or contact him at DRFamily@aol.com.
