The natural lenses of our eyes are normally clear. When they get cloudy, it’s a medical condition called cataracts.
People affected by cataracts usually experience blurry vision, like looking through a cloudy window. I think of cataracts as similar to the cloudy appearance that car headlights sometimes develop over time.
What causes cataracts?
According to the American Academy of Ophthalmology, the main culprit behind cataract formation is age. As with so many age-related conditions in medicine, most people experience changes in their eyes around the age of 40. Those who are unfortunate enough to develop cataracts most often start to see the first symptoms around age 60, with diminished vision occurring years later.
That’s not to say that age is the only reason that someone could get cataracts.
Genetics can play a role, as can diabetes, eye injury, and damage from the sun and its ultraviolet rays. To lower the risk of developing cataracts, ophthalmologists and optometrists recommend wearing sunglasses when outside.
What’s the difference between an ophthalmologist and optometrist?
Ophthalmologists are physicians who attended medical school and complete additional clinical training in performing eye surgery and diagnosing and treating diseases of the eye.
Optometrists are also referred to as doctors but did not attend medical school. In optometry school, optometrists learn how to test vision and prescribe corrective lenses, either through eyeglasses or contact lenses. Additionally, optometrists are the typical front-line providers who diagnose eye diseases. While they’re able to treat some eye conditions, the standard of care requires them to diagnose more serious problems that may require surgical treatment and then refer patients to an ophthalmologist for a higher level of care.
Some of these conditions include things like retinal detachment and cataracts. Retinal detachment is an emergency medical condition and an optometrist should secure same-day care for patients with an ophthalmologist. Cataracts are typically a more gradual process that can be treated less urgently by an ophthalmologist.
Eventually, a cataract progresses to the point that it’s too much for the patient to tolerate. Usually that comes in the form of poor vision.
When that time comes, the only real treatment is cataract surgery. Cataract surgery is the most common type of procedure performed by an ophthalmologist. There are over 3.6 million cataract surgeries in the United States annually.
Cataract surgery is performed by an ophthalmologist. It involves removing the cloudy lens and implanting an artificial intraocular lens (IOL) in its place. It’s usually done as an outpatient procedure that doesn’t require a hospital admission.
The eye is generally divided into anterior and posterior chambers, with the dividing line being the iris. The iris is a thin structure that gives the eye its color. Anterior means in front of the iris. Posterior means behind the iris.
When the eye anatomy is strong enough to support it, ophthalmologists prefer to implant the intraocular lens in the posterior chamber (it’s called a posterior intraocular lens or PIOL). Sometimes, though, the eye structure won’t support it, so the ophthalmologist places it in the anterior position (called an anterior intraocular lens or AIOL).
One of the known risks of attempting to place a PIOL during cataract surgery is damaging the posterior capsule, or area behind the iris. Most often, the posterior capsule damage comes in the form of a tear, which causes the leak of vitreous. Vitreous is the jelly-like substance that fills most of the inside of the eye.
The standard of care requires ophthalmologists to be aware of potential injuries or tears to the posterior capsule that can cause vitreous to leak. When vitreous leaks from the posterior capsule and migrates to the anterior area of the eye, it’s called vitreous jelly prolapse.
Vitreous jelly prolapse is risky business. When an ophthalmologist identifies vitreous jelly prolapse, the standard of care requires careful removal of the vitreous in a procedure called anterior vitrectomy.
When it goes untreated, vitreous jelly in the anterior chamber can cause serious medical conditions including retinal detachment and cystoid macular edema (CME).
Retinal detachment is itself an emergency situation where the retina pulls away from its normal location at the back of the eye. This separation keeps the retina from its normal blood supply that brings it oxygenation and nutrients. Optometrists and ophthalmologists look for the classic symptom of retinal detachment, which is flashes and floaters in the vision.
Cystoid macular edema/CME is a serious medical condition that can be caused by an abnormal connection of the vitreous to the macula, which is the area near the center of the retina.
When a person experiences vitreous jelly prolapse, medical experts believe that it causes traction that pulls the retina forward, causing retinal detachment and/or CME.
While most cataract surgeries yield welcome results in the form of improved vision, in our experience, the most common problem occurs when ophthalmologists don’t recognize, diagnose, and treat complications. In eye care, an easily correctable problem can progress into a permanent visual impairment without prompt treatment.
If you’ve experienced poor optometry, ophthalmology, or eye care that’s caused a permanent injury, then contact a top-rated skilled Houston, Texas medical malpractice attorney for help in evaluating your potential case.