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RAF482: Cataracts · Running: A FEVER

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I was reading Sherlock Holmes from the late
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19th century and Dr. Watson was talking about
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a Cataract procedure. I couldn't believe that this
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problem has been corrected with surgery
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for a really long time.
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Running: A FEVER Episode 482 Cataracts.
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Welcome to Running: A FEVER.
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My name is Michael Davis and this is
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a show about fitness, diet and medicine.
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My goal
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is to live a long, healthy, happy, active
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life right up to the very end.
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And it's all
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about livin' long and lovin' life.
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This episode is about Cataracts, what they are,
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why they
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happen, how doctors find them and what surgery
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actually does. I'm going to give you the
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background first and Then I'll talk about my
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own Cataract surgery which just happened
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recently. Quick disclaimer up front, this is education
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and my experience, not medical advice.
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A Cataract is a cloudy area in the
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lens of your eye. The lens sits behind
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the colored
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part of the iris and its job is
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to bend light so it focuses on the
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retina. When the lens
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is clear, light gets through cleanly.
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When protein in the lens clumps and the
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lens clouds,
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the picture gets blurry, hazy, washed out, like
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looking through a foggy windshield sometimes.
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Now in my case, I had a cornea
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transplant in my right eye and since then
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I've been
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prescribed a steroid, prednisolone, that's a drop that
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goes in daily. Now a while back
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it was up to two drops a day.
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Over the years I've had some minor complications
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and the
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steroids help prevent that. The downside is that
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the steroid also encourages protein
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growth. So this year I had a rapid
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degradation of the vision in my right eye.
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It happened
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very fast. Cataracts are extremely common with age.
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The National Eye Institute notes
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that more than half of Americans, 80 or
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older, either have Cataracts or have already had
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the
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surgery to remove them. You can get them
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earlier too for reasons that we'll cover.
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Now Early on you might not notice much.
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As the Cataract grows, typical symptoms include
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Cloudy or blurry vision, colors that look faded
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or yellowish, Trouble seeing at night, Glare
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from lamps, sunlight or headlights that just feel
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too bright, halos around lights, double
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vision in one eye sometimes, needing new glasses
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or contact prescriptions more often
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than usual. These symptoms can also come from
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other eye problems so an exam matters.
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Doctors often describe Cataracts by where the clouding
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sits in the lens. So there are several
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different TYPES here. There's a Nuclear Cataract in
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the center of the lens.
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Distance vision
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often suffers first in this case and some
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people get a temporary second sight where
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near vision seems better for a while because
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the lens is focusing power shifts.
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The lens
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can be yellow or brown over time which
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messes with your color sensation.
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Cortical Cataracts are in the outer layers of
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the lens, often in spoke-like or wedge
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shaped patterns. Glare and bright light trouble are
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common. Then there is posterior subcapsular cataracts
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toward the back of the lens just in
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front of the capsule that holds it.
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These can progress
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faster and you can have Glare, halos or
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trouble with near work or bright light.
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This type shows
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up more often with steroids, diabetes, inflammation or
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radiation exposure. People often have more
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than one of these patterns at once.
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There are also traumatic Cataracts after injury, radiation
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related Cataracts and rare Cataracts in kids congenital
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or from childhood disease. After Cataract surgery some
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people later get cloudy visions again from scar
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tissue in the capsule that holds the new
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lens. That. That's often called a secondary Cataract
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or posterior capsule opacification. It isn't the old
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Cataract coming back, it's a common treatable after
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effect, often cleared with a quick laser procedure
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called the wide
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YAG capsulotomy. RISK FACTORS. Age is the big
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one. You know I don't think you should
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really be worried about Cataracts because you know
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if you live long enough it's one of
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those things that pretty much everybody gets.
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Age is the big one.
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So Beyond that risk goes up with smoking,
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heavy alcohol use, diabetes or high blood sugar
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over time, long-term steroid medicines like the
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UV exposure from sunlight, that's why you need
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to protect your eyes, family history, prior eye
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injury, eye disease or eye surgery like the
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cornea transplant that I had, Obesity which is
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listed among risks and major clinical summaries.
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You don't need a dramatic risk factor.
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Plenty of people get age related Cataracts with
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nothing exotic on the list.
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Now, how is it
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diagnosed? An eye doctor, an optometrist or an
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ophthalmologist checks for Cataracts as part of a
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comprehensive eye exam. That usually includes dilating drops
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so the pupils open wide, then looking at
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the lens and the back of the eye
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with a slit lamp and related tools.
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They're also looking for glaucoma, retinal problems and
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optic nerve issues because those change the plan.
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One little side note here
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I've spent a lot of time with eye
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doctors obviously. I've had transplants and such and
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so I'm for the rest of my life
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going to be seeing an ophthalmologist on a
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regular basis. I used to think that the
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dilation was really bad because they tell you
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not to drive but of course you're going
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to drive, right? I can still see a
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stop sign so why shouldn't I drive?
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Anyway, I found out that one of the
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things was they usually have me take out
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my contacts, right? And previously I didn't bother
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to put them back in.
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Well, if I put the contacts back in,
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I see a lot better which makes sense.
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So it's not just the dilation but it's
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the removal of the contacts.
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So now, when I'm at the ophthalmologist, I
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always at the end put my contacts back
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in before I go out
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driving and that's much better and much easier
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and much safer for me and the rest
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of the world. All right, so surgery is
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not an emergency for most people.
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Stronger glasses, better lighting and magnifiers can help
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early on. So you can wait generally.
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Now in my case, there was rapid, I
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still have my left eye, but there was
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rapid degeneration in my right eye so that
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I was practically blind in my right eye.
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It was so blurry that I really couldn't
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see much of anything. But for most people,
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it's not an emergency. You don't have to
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hurry in and get it done.
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The decision operates usually about whether the Cataract
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is getting in the way of life.
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Reading, driving, work, hobbies, trail running, whatever you
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actually need your eyes for.
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TREATMENT. Surgery is the only way to remove
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a Cataract. In modern practice, and I found
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out, you know, I was reading Sherlock Holmes
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from the late 19th century
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and Dr. Watson was talking about a Cataract
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procedure. I couldn't believe that that that this,
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you know, problem has been corrected with surgery
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for a really long time.
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I think my ophthalmologist told me it goes
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back to like Egyptian times and something and
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they did something
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like a long, long ways.
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So this this is nothing new.
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But what is new is that currently the
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surgery almost always means taking out the cloudy
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natural lens and putting in a clear artificial
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lens called an intraocular lens or IOL.
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Now the cool thing about this is you're
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not going to get Cataracts twice.
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I mean, you may have that scar problem
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on the capsule thing, but once you had
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this surgery, you've got a non organic lens
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in there that's not going but clouded up
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by protein. and so once you have done,
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-you know that's it.
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You never have to have it done again.
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The common technique in the United States is
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a small incision phacoemulsification ultrasound energy breaks up
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the Cloudy Lens. It's removed in a foldable
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IOL
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goes in through a small incision usually as
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an outpatient procedure. You're typically awake with the
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eye numbed. If both eyes need surgery, doctors
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usually do one eye, let it heal, then
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do the other. That makes a lot of
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sense to me. Even though it's a super
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common procedure with almost, I asked the surgeon
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what their success rate is.
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He said virtually a hundred percent.
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But still, it's always, you know, good practice
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to do it one or the other.
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There's also a laser assisted option but the
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American Academy of Ophthalmologies take in plain terms
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is studies have not clearly shown fewer complications
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or better outcomes than skilled traditional phaco.
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Surgeon skill matters more than the marking.
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Now someday, in the near future, I believe
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all surgeons are going to be replaced by,
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robots because they a more.
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Will be more reliable and like I said
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you know, have a success rate because they
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don't have all of this.
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It's kind of a side topic.
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Surgeon skill. A skilled surgeon, it's fine.
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So the laser assisted option necessarily makes things
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better.
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IOL options at a high level.
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Now this is a conversation you have to
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have with your surgeon and not a product
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pitch, but there are several TYPES.
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Monofocal is one main focus distance, often set
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for distance. Reading glasses you'll still need.
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This is a workhorse lens and the one
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insurance most often covers. It's also the one
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I had, which was recommended due to my
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transplant. So it's not like I could have
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had a better lens and not had
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to use reading glasses ever again because of
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my situation. And again, this is why this
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is something that you go over with your
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doctor. It's not something that's just, well, I
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want the best lens available.
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You can't always get exactly what you want,
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but the other kinds are Toric, which is
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built to help corneal astigmatism, multifocal or other
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presbyopia correcting designs aimed for more than one
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distance. It's basically like a bifocal
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bifocal.
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night driving and how much you hate glasses
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all matter Medicare and typical insurance usually
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cover a standard
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I
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often attachment
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Your surgeon should walk you through your personal
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risk picture
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I had none of these adverse effects on
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MY SURGERY
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Recovery
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Many people noticed better vision within days.
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My case was immediate.
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It was often on the order of several
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weeks.
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I drops to prevent infection and reduce inflammation
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are standard.
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They gave me a combo drop bottle Cost
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$25.
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They gave me right there at the ophthalmologist
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and I had to use that for basically
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a week
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afterwards and I didn't use my normal steroids
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during that time and it started off at
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like
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four per day then it went down to
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actually it went for four weeks four per
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day the first
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week three per day the second week and
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two and then one and when it got
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down to one since
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I'm doing two steroid drops I did that
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but I didn't have to do the series
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because that's
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included in the combo drops and I lost
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that bottle so I can't tell you exactly
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what
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it's called but anyway that made it easier
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I didn't have to put multiple drops in
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full
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healing is often in the order of several
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weeks I drops to prevent infection and reduce
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inflammation are standard Avoid rubbing the eye ask
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your surgeon about lifting swimming
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eye makeup and when you can get back
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to harder workouts don't take timing advice from
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me
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like a lot of surgery you know they
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tell you not to lift heavy objects for
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a while
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so I guess that can affect your healing
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process so can you delay Cataract surgery
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You can't stop aging lenses with any kind
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of supplement.
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Or anything a Cochrane review of randomized trials
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found no evidence that antioxidant
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vitamins supplements beta carotene vitamin C vitamin E
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prevent or slow age related Cataracts
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it's just going to happen when it happens
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What you can do is chip at modifiable
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risks
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that we they mentioned before don't smoke control
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your blood sugar if you're a diabetic go
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wheeze you and heavy drinking protect your eyes
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from UV with sunglasses that block 99 to
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100 percent of UVA and UVB wear a
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bremed hat The World Health Organization has long
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flagged UV as a contributor to Cataract burden
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Those steps are about lowering risk
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and delay not guaranteeing you'll never need surgery
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now I've started wearing a hundred
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percent UV a B sunglasses they're not expensive
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and there are plenty of style options as
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well it's just that you need to look
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for that 100 percent UV just search for
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100 percent
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UV production in the description of the product
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the ones I have are by Ozark Trail
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which
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is Walmart's store brand they are wraparound so
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they provide a little more protection at
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the expense of not quite folding flat because
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they're curved want to hit your fitness goals
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faster it all starts with protein but tracking
16:30
how much you need can be a total
16:32
headache
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that's why we made it simple head over
16:36
to runningafever .com resources and download your
16:40
protein cheat sheet today fuel your body right
16:43
fitness how does this affect your fitness clear
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vision matters for running and trail work footing
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traffic night miles reading a watch or a
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map If Glare and night vision are falling
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apart that's a safety issue not vanity exercise
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itself does not make a Cataract worse but
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bad vision can make training unsafe after
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surgery follow your ophthalmologist timeline the American Academy
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of ophthalmologies general Recovery
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guidance for many patients includes light walking soon
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After surgery waiting about 7 to 10 days
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before things like running or biking and longer
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waits for swimming and head below the waist
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positions your surgeons instructions can win if they
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differ from this the goal-a
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standard they requested a driver even though just
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getting one there were lots of drops they
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just my I not sure what for but
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there are a lot of drops and they
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did be set it in the
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I didn't have to undress like I would
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for most surgical procedures I was awake during
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procedure pretty I was pretty out of it
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I guess they didn't give me something that
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I be sedative I could tell something was
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being done to my eye and I saw
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something that looked like a circle with maybe
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a couple of lines through the edge of
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it
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could say what it was but I could
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barely see anything but that that that kind
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of was the experience if you want to
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know about it afterwards I saw immediate improvement
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but it took more than a week to
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completely heal and my contact lens strength needed
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to be adjusted and I'm still waiting on
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the new lens to come in for that
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so my vision is not still not back
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to where it should be
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well I hope this helps you understand Cataracts
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a little better and if you're staring down
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surgery yourself I hope the background plus my
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experience makes the decision less mysterious and until
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next time if you got the fever keep
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it burning if you don't catch the fever
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and I will talk to you next time
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on Running: A FEVER