Thursday, May 22, 2014

Surgery for intermittent exotropia

How effective is surgery for intermittent exotropia? The authors of one study noted that 62% of intermittent exotropia surgery patients achieved only a fair or poor outcome and that 60% of the patients required at least one re-operation."

See: Pineles SL, Ela-Dalman N, Zvansky AG, Yu F, Rosenbaum AL.Long-term results of the surgical management of intermittent exotropia. J AAPOS. 2010 Aug;14(4):298-304

Monday, May 19, 2014

Babiators - sunglasses for children

We see a lot of kids at our Vancouver eye clinic. One important aspect of children's eye care is protecting young eyes from the sun. The eyes of children are much more vulnerable to damage from UV rays. The lenses in their eyes do not block as much UV radiation as in adults. Follow the same precautions as you would for an adult, but be sure to choose sunglasses that fit their smaller faces, have impact-resistant lenses, and have lenses large enough to shield the entire eye.

According to a new report issued by The Vision Council in May 2012, parents protect own eyes from the sun better than they protect their kids eyes. The report shows that while 73% of adults do wear sunglasses, only 58% of them make their children wear sunglasses.

Parents may hold back on sunglasses for their kids because of cost or because kids are rough and forgetful with their eye wear resulting in lost or broken sunglasses. To fix this problem, we have begun carrying Babiators kids' sunglasses. The photo above is Dr. Randhawa's daughter wearing her new Babiators in the park. Babiators have a great guarantee to replace lost or broken sunglasses within one year, as long as you register your new pair of Babiators online.

Here is the guarantee straight from their website:

Babiators are durable — made to withstand whatever adventure your child dreams up. We know life can be a bit unpredictable, so should you lose or break your Babiators within one year of purchase, we'll send you a replacement pair — free. Simply register for your Lost & Found Guarantee within 30 days of purchase, and you're all set.register here

UV exposure over time causes eye disease and vision loss

The Vision Council report suggests that too many people still do not understand the serious damage that UV exposure can have on your eyes. Even fewer realize that it is cumulative exposure over time – which happens on both sunny and cloudy days – that leads to vision threatening diseases. One such disease, macular degeneration, leads to permanent vision loss and their is no cure.

The solution is to wear sunglasses and regular eye glasses with proper UV protection. Kids need this more than adults because the lens of a child’s eye is not as good as blocking UV rays as the lens of an adult eye. 

What cataracts and macular degeneration look like

Wearing sunglasses is a serious preventative health measure. Here is what macular degeneration can do to your vision:

UV damage also causes cataracts. Here is what cataracts can do to your vision:

Monday, May 5, 2014

Cataract surgery - risks and complications

Cataract Surgery Complications, Dr. M.K. Randhawa
At our Vancouver eye clinic, we manage a large number of patients with cataracts.  That includes referring them for surgery where appropriate, preparing them for surgery with medication that will make it easier for them to deal with common side effects of the surgery such as dry eye and also managing their post-operative care.

One of the most important things that eye doctors do for cataract surgery patients is explain the procedure as well as it's risks and complications. A new study published in the Canadian Journal of Ophthalmology found that some type of complication during the surgery were found in 10.35% of patients and complications arising after the procedure affected 26.63% of patients. That's a lot of patients and it highlights the need to have effective care for the patient after the surgery.

The most common complication during surgery was posterior capsule rupture (2.83%), whereas the most common postoperative complications were corneal edema (15.42%) and ocular hypertension (7.34%). These are described below.

Posterior capsule rupture

The lens of the eye is held in place by a thin membrane called the capsule. The purpose of cataract surgery is to remove the lens of the eye because it has become cloudy, causing bad vision, and then to replace it with a clear artificial lens.  Surgeons want to keep the capsule in place to hold the new artificial lens implant. If the capsule is perforated during the surgery, it is called a capsule rupture, which can lead to various complications. 

Corneal edema

The cornea is the clear dome covering the colored part of the eye.  The cornea lets light into the eye and focuses it, producing clear vision.  Sometimes the cornea swells after surgery.  This is called corneal edema and it causes cloudy vision. Other names for corneal edema after cataract surgery include “pseudophakic corneal edema,” “pseudophakic bullous keratopathy,” and “aphakic bullous keratopathy.”

Patients with corneal edema usually notice blurred vision or halos around lights. At the beginning, blurriness is often worse in the morning, but improves over the course of the day.
Ocular Hypertension

Ocular hypertension is increased pressure inside the eye.  High intra-ocular pressure can damage the optic nerve and cause permanent vision loss if not treated.


Canadian Journal of Ophthalmology. Journal Canadien d'Ophtalmologie
Factors Affecting Cataract Surgery Complications and Their Effect on the Postoperative Outcome
Can J Ophthalmol 2014 Feb 01;49(1)72-79, N González, JM Quintana, A Bilbao, S Vidal, N Fernández de Larrea, V Díaz, J Gracia