Cataract Surgery & the Cataract Operation with Diabetes and Diabetic Retinopathy

Reviewed by:

Paul Koch, MD, Leslie Doctor, MD, Raj Rajpal, MD

Cataract Surgery for patients with diabetes or who have diabetic retinopathy will continue to be an important consideration as the incidence of diagnosed cases of diabetes as well as cases of prediabetes continues to grow in our population. According to 2011 estimates released by the Centers for Disease Control and Prevention (www.cdc.gov) Diabetes now affects nearly 26 million Americans of all ages and 79 million people have what doctors call "prediabetes". Prediabetes, which the CDC says affects 35 percent of adults, is a condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes.

The  growth of the  diabetic population is thought to be primarily due to the  rise in the number of overweight Americans. In addition it is also due to the changes in the  way physicians diagnose diabetes and the diagnostic criteria changes endorsed by the American Diabetes Association.

In addition with more than 1 in 4 Americans over the age of 65 having full blown diabetes, it is very likely that more and more diabetics will seek consultation with Cataract Surgeons regarding Cataracts and Cataract Surgery. While the overall functioning of the retina due to diabetic retinopathy may impact the results, it is important that patients understand that modern Cataract Surgery can provide excellent results for patients with diabetes.

For patients with known diabetic retinopathy who are under the care of a retinal specialist, your Cataract surgeon may wish to coordinate certain aspects of your care with them in order to get the best possible results. If you are a new patient seeing the Cataract Surgeon for the first time they may request a retinal consultation for you.

One of the retinal problems created by diabetic retinopathy is called diabetic macular edema. As part of your examination and consultation your Cataract Surgeon may wish to perform a test called ocular coherence tomography (OCT) in order to carefully observe and review the status of the macula, specifically to look for macular edema.

Regarding the actual cataract surgery operation procedure, if your Cataract Surgeon is using the most modern small incision phacoemulsification cataract surgery they are not likely to make any modifications in their procedure. In the August 2009 edition of the journal Ophthalmology researchers reported that "the risk magnitude for diabetic retinopathy progression after phacoemulsification surgery was found to be substantially lower than the progression rates previously documented after surgery using older surgical techniques."

It is possible that they will prescribe and ask you to use a type of eye drop called an NSAID (non-steroidal anti-inflammatory agent) for some time before your Cataract Surgery and for as long as three months after your surgery. Also, in certain instances your eye surgeon may recommend that either he or she at the time of Cataract Surgery, or your retinal specialist after the surgery, place an injection of an anti-vascular endothelial growth factor (Anti-VEGF) agent such as Avastin™ in order to retard the possible growth of new blood vessels in the retina.

If your macula is healthy, and at the discretion of your Cataract Surgeon, it may be possible for you to elect to have a near vision presbyopia correcting lens implant (IOL) such as a multifocal lens implant or an accommodating lens implant. These intraocular lens implants (IOL) will offer you the advantage of reducing your dependence or possibly eliminating the need for reading glasses or bifocals after your Cataract Surgery. If you have had macular edema, are at risk for macular edema or appear to have any irregularity in your macular this choice will be discouraged.

If you have diabetes or diabetic retinopathy and develop a Cataract these are some of the possible steps that a Cataract Surgeon may take to minimize the risks and complications of Cataract Surgery in order to get you the best possible results.

As always, choose a reputable Cataract Surgeon with experience in performing Cataract Surgery for diabetics and who takes the time necessary to evaluate you properly and guide you through the right decisions.

The information that has been provided here is intended to give patients a basic understanding of Cataract Surgery, Diabetes and Diabetic Retinopathy. It is possible that your individual experience might be different. None of the information provided here is meant to be a substitute for or replace your eye doctor's consultation nor does it replace the need for you to consult with your Cataract Surgeon about specific details of Cataract Surgery and Intraocular Lens (IOL) Implantation.

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