Arsham Sheybani, M.D., Assistant Professor of Ophthalmology at Washington University in St. Louis, talks about a new procedure that fixes a side effect of cataracts surgery.
Interview conducted by Ivanhoe Broadcast News in January 2017.
What is cataracts and what’s happening in the eye when that happens?
Dr. Sheybani: For the most part it is an aging process, so we all get older if we live along enough. The cataracts forms and that is essentially the lens of the eye, just like the lens in a camera getting cloudy usually; and as it gets cloudy your vision decreases. Some people have glare and when that occurs there is no great way to reverse it, so surgical we take care of it by removing the cataract and then placing a new clear lens in that space where the cataract was.
Okay, and that is very standard surgery.
Dr. Sheybani: Very standard surgery, I mean you are looking at just estimates, three to three and a half million cataract surgeries done in a year, especially with the Asian population it is going to be more and more prevalent.
That usually is enough to cure?
Dr. Sheybani: It is probably one of the safest surgeries in medicine. The success rate is extremely high, I wouldn’t call it easy surgery at all but people who are trained in it can be very, very efficient and very effective at removing cataracts and putting new lens in.
Every once in a while, for a percentage of the population it doesn’t work, there is a side effect. Can you talk to that a little bit?
Dr. Sheybani: Sure, there is quite of bit actually can go wrong. In some particular cases, patients have what is called dysphotopsia, which are light issues that they have. Whether it is glare or halo’s or sometimes it is shadows in the vision and one of them negative dysphotopsia occurs relatively rarely so about we think pretty early on about fifteen of the time people will get it, but for long-term it’s about one to three percent of the patients after cataract surgery have this. It is a pretty annoying might be a modest way to put it; shadow right here on the side of their vision that is always there and for some people it is not that bothersome and for other people it can be really, really bothersome to the point where they want the lens out; they want something done to reverse it.
Now, does it impact their ability to drive or anything else? Because you said something about the peripheral or the side vision.
Dr. Sheybani: Exactly, it is a side vision; it depends on the person. Some people are so distracted by it, yes, but other people, like I said maybe fifteen percent maybe higher by some studies might get it early on and after time it just goes away. Either that or they tune it out so it really depends on the person and it is very variable. We can’t always do a test that says for sure you have it but one simple way to find out is patients can actually place their hand all over to the side where they are having the symptoms and if that shadow goes away after they do that it is a pretty specific way to say they do have this negative dysphotopsia In their shadow.
What are the treatments for that right now?
Dr. Sheybani: Traditional treatments there has been several that have been tried it started first with certain lasers. About fifty percent of the time it worked and didn’t, and now the more we know about it and the more people are doing it, it is not something that is commonly done. The other option is to position the lens in a different part of the eye essentially and if you do that it has some success but not always. Probably the most definitive treatment has been removing that lens and putting a whole new lens in which in the realm of, kind of cataract and lens surgery can sometimes be pretty aggressive surgery and not a lot of people will do it.
Okay, now you have tried something else to remove that side effect? Tell me exactly what it is and how it works?
Dr. Sheybani: Sure, we had a patient who had cataract surgery and she was seeing extremely well afterwards with a great result and to tell you the truth it actually only happens when the cataract surgery is done very well, so it’s kind of interesting, right? But she had the shadow that she was just very, very bothered by and her surgeon had tried multiple different things; thick rim glasses and when she came to us, and we told her, well if we take her lens out her vision is going to be a lot worse without glasses. She had a special lens with torque lens so it crushed her stigmatism or her regular curvature at the same time and she really didn’t want to have that done. We tried initially was to position her lens in a different part of the eye; something that has been described before. She really didn’t have a lot of great relief with it and after a couple of days the lens fell back into its natural position.
Dr. Sheybani: Everything was bad, so we did some research in to kind of why people think was going on and kind of looked at some more optic studies, basic physics behind why we think it is happening. We had an idea, well I thought that the offending agent just based off a lot of these studies that were done was part of the lens itself; the lens material kind of close to the nose. What we did is we went in and we shaved that down, so it is actually a pretty low evasive surgery it doesn’t require removing the lens and putting a whole new lens in place and it worked beautifully. Not only was she able to keep the lens that she had and maintained her great vision but it got rid of the shadow immediately on day one.
Could you describe where that was and exactly what you did?
Dr. Sheybani: Well troublesome may not be the best word only because, like I said it only happens when lenses are perfectly positioned but the part of the lens over toward the nose is what bends the light; little too far back or maybe a little bit too high on the retina. There are various theories of what happens but the way the light bends, they cast a shadow on the retina but then patients perceive it as this kind of crescent shadow over to the side. What we did was actually took a pretty normal lens and we modified it by shaving that one corner down.
You do that while the lens was in the eye?
Dr. Sheybani: While the lens was in the eye, exactly and that’s potentially the tricky part; I needed to leave the lens. Not only is it does not matter where it is position, but even the rotation of her lens matter because it was correcting her astigmatism. We kind of had to leave everything in place in order to do this and you are working with a really, really little small incisions.
In laymen’s terms, can you describe to me what you did?
Dr. Sheybani: The traditional surgery we exchange the lens that requires some larger incisions. We have to cut the lens out, take it out in pieces, put in a larger lens in place in an area that can potentially rub against her tissue and cause problems down the line. Essentially, what we did this time we worked a very small incisions, they are about 1.2 milliliter incisions and we have very tiny instrumentation that we can use to elevate that lens up a little bit and then with very, very small scissors as you see on the video. We cut that part of the lens that I thought was causing this light to kind of bend abnormally and cause other symptoms.
What was the final result?
Dr. Sheybani: She did excellent, literally that first day she was like it was completely gone. I really didn’t want to believe it myself because I was a little skeptical, and you know she is in health care, she knew that we were doing something that wasn’t done before and kind of experimental in a way but immediately she said it was gone; she was thrilled. We waited a while until we did another laser that is commonly done after cataracts surgery to help kind of clear up her vision some more and since then she’s been doing great. It is one of those things where I wanted her to wait till she was out probably a year and she is a little over a year now before we start offering it to other patients.
You are ready to accept other patients then, you feel comfortable with this?
Dr. Sheybani: Now we are and we just published the technique in one of the major cataract refractive journals and I think it is something where people who are doing this anterior antitype of surgery even local physicians; they are used to antitype of surgery should be a technique they can replicate.
This technique doesn’t have a name?
Dr. Sheybani: We call it optic truncation, so the optic is kind of the business end of the lens that is focusing the light, and truncation is we kind of trunk it; it made it a little shorter. You don’t want to do it too aggressively; otherwise, it was other lens issues that can happen, but we literally peeled off a fine amount of that lens material and essentially kind of shaved it at a slant to where the light scatters more and doesn’t leave a shadow.
How did you know how much to go in and do it?
Dr. Sheybani: We really did not, I knew how much I didn’t want to take off and part of that is based on her pupil size and we knew if we took off too much she could end up with a lot of glare. I knew how much we didn’t want, I had a good feeling that if we could modify the lens just enough to bend the light differently from how I was doing it; it would be enough.
How quickly was she able to recover and see?
Dr. Sheybani: The surgery is very low as far as some basic, so literally that next day, I give them minimal restrictions. She was not all that blurry off the bad, she is someone that demands a lot of her vision so she’ll probably tell you, it was kind of blurry at first, then got better after everything was healed but yeah she did extremely well. And because it was so low and invasive it is not like some of the other surgeries, the recovery is a lot faster.
You had mentioned the term astigmatism, what she has going on with that?
Dr. Sheybani: Sure, it is very commons. Some people will have some degree of astigmatism, there they regular curvature on everything was bad. One of the eye, so not all of the light gets bent symmetrically essentially, and so there is these specialty lenses that correct for that which are fantastic lenses which is a another reason she did not want to lose that lens because your next option of lens does not correct for astigmatism. Then she might have to do Lasik over the top or some refractive surgery and she preferred not to do that.
That was one of my next questions, would she need any additional procedures?
Dr. Sheybani: Not as much as we can tell, she’s been so far out now and doing so well; I really don’t suspect any other issues. We have actually done kind of our high resolution imaging just to make sure that the lenses are where we want it, and it is not touching any other tissue and it is completely in a safe place.
Is there anything that I didn’t ask you that you want to make sure people know about?
Dr. Sheybani: No, just one of those things that if you approach your surgeon about dealing with his issue make sure it still bad enough to where it bothers you to where you want surgery. One easy way to kind of test that is, if you are getting that dark shadow over to the side, that same side just kind of shield your eye with your hand; and if it goes away that is what’s going on. If your surgeon feels comfortable talking to you about it, he could be some options.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Washington University Eye Clinic
314-362-3937
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here.
