April 03, 2025
3 min learn
As we transfer ahead into a brand new period of ophthalmology, with elevated choices to handle imaginative and prescient points, affected person expectations are extra essential than ever.
Sufferers who is perhaps affected by vitreous opacities after cataract surgical procedure aren’t going to be happy, even when their visible acuity is improved. Crucial factor we will do as their docs is handle affected person expectations. That begins with examination and dialogue with the affected person within the clinic.
Sufferers with vitreous opacities come by means of the clinic in two methods: Typically they see the retina specialist first, and typically they see the cataract surgeon first. Both method, we’ve got to work collectively to make sure discussions happen and to acknowledge their visible signs and complaints. Figuring out what’s bothering them and affecting their high quality of life probably the most is step one.
I’ll see phakic sufferers who complain of degradation of imaginative and prescient and are available to me with a referral for floaters or vitreous opacities which may be blocking or bothering their imaginative and prescient. Typically their visible complaints might be refined, and they don’t instantly use phrases akin to “floaters” or “spots” of their imaginative and prescient. Whereas some sufferers use phrases like “cloud,” “veil” or “spiderwebs” that transfer round of their visible subject to explain their vitreous opacities, different sufferers could have extra problem explaining their visible signs. Cautious questioning by the doctor is usually essential to elicit this historical past. We all know that vitreous opacities are available many alternative kinds, and their impression on imaginative and prescient goes far past simply noticing focal areas that transfer round in imaginative and prescient. I all the time attempt to discover out if sufferers really feel like their readability improves once they transfer their eye round. Do they really feel like they’re able to transfer among the cloudiness out of their visible subject briefly, even for a number of seconds?
If I’ve a affected person are available and I really feel like their signs are in line with vitreous opacities, I’ll take a cautious look on scientific examination. I do an evaluation of each the anterior and mid-vitreous cavity. A whole lot of instances, we will see reasonable to important vitreous syneresis, which can lead to fibrillary opacities or perhaps a Weiss ring. Most of those sufferers who complain of signs in line with vitreous opacities can have a posterior vitreous detachment, however typically they don’t, and that is essential to acknowledge preoperatively.
I’ll use OCT to evaluate the vitreoretinal interface overlying the macula in addition to the vitreopapillary interface over the optic nerve. Some sufferers can have vitreomacular separation of the posterior hyaloid however nonetheless be connected on the nerve. Others have pretty important vitreous opacities, however it’s a must to method them in a barely totally different method and acknowledge that you just might need to think about surgically inducing posterior vitreous detachment on the time of surgical procedure to totally take away the vitreous.
There’s one other group of sufferers we see who’ve undergone cataract surgical procedure and are sad with their imaginative and prescient postoperatively. As vitreoretinal surgeons, we have to determine these sad sufferers, however the problem comes with figuring out the precise situation. Is the affected person not tolerating a multifocal IOL? Is there a posterior capsular opacity that’s bothering them? Have they got vitreous opacities?
There are good scientific research and information that counsel that sufferers who’ve multifocal or prolonged depth of focus IOLs could also be extra prone to be bothered by vitreous opacities than sufferers with monofocal IOLs. They could have a number of complaints, and typically it’s merely that they don’t seem to be completely happy that they’ve good way imaginative and prescient however not close to imaginative and prescient. They anticipated with a premium IOL that they’d be proud of their distance at a number of focal lengths, and they don’t seem to be. With these sufferers, I’ll counsel that they could not get an enchancment in all of their signs. There could also be a number of components at play, but when I really feel like vitreous opacities are contributory, then I’ve a reasonably low threshold for surgical procedure. We have a tendency to search out that these sufferers change into a lot happier as soon as their vitreous opacities are eliminated.
For extra info:
Marc Mathias, MD, an affiliate professor of ophthalmology on the College of Colorado Anschutz Medical Campus, might be reached at marc.mathias@cuanschutz.edu.
Click on right here to learn the Cowl Story, “Vitrectomy presents aid for vitreous opacities.”
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