One of the more common problems we see in our patients is cataracts. A cataract is defined as an opacity within the lens inside of the eye. There are many reasons why cataracts can develop. Most animals that are diabetic will get them and these can seemingly develop overnight. Many cataracts are also inherited. People often wonder if anything can be done to help them. Fortunately, in most of these cases, surgery can be performed to remove the cataracts and restore their vision.
The first step is to schedule an appointment for a complete evaluation of the eyes. It may seem like your pet has cataracts but there are actually many different problems that often get mistake for them. At the exam, Dr. Budelsky will determine if cataracts are present and if surgery might be an option. There are always testing procedures that must be done before surgery can be scheduled.
The first test is called an electroretinogram. We often refer to this as an ERG. This is a test to determine if the retina is working in the back of the eye. Patients have to be sedated and they are hooked up to a special computer. The machine flashes a series of lights into the eyes and is able to measure how well the retina is functioning. The results are measured in microvolts of electrical activity. We like to see a result of at least 100 microvolts. We consider a result of 75 microvolts average. If we get results of 50 microvolts or less, unfortunately they will not be a good candidate for surgery.
The second test is performing an ultrasound exam of the eye. Since we are not able to examine the back of the eye (due to the cataract) an ultrasound machine is used to image the eye. We are looking for problems with retinal detachments, opacities within the vitreous (gel in the back of the eye), or anything else that would adversely affect the outcome of surgery.
The third and final hurdle is blood work. Typically most patients will need a complete blood count and serum chemistry profile. This is done to make sure they are healthy enough for anesthesia. For pets that are diabetic, it is important that they are well regulated with the diabetes. Unfortunately, many pets that are diabetic will develop cataracts quickly and at the beginning. Having their blood glucose levels regulated is very important to the health of the patient and post operative care. With a little patience, we will eventually get the cataracts out and get them visual.
Surgery is only one part of the equation. There can be a significant amount of after care involved. The owner's ability to treat the eyes after surgery is just as important as surgery itself. Your pet is started on anti-inflammatory medications before surgery and these are continued after surgery as well. Most cases, the pet will go home with two different anti-inflammatory eyes drop that have to be used 4 times a day. There are also oral antibiotics, oral anti-inflammatories, and oral pain medications that we can prescribe as well. During after care, your pet might need an Elizabethan collar, or e-collar (cone), which prevents the patient from rubbing its eyes and causing damage. The sutures used to close the corneal incision are about the thickness of a human hair and it would not take much to break these. E-collars can be really important to the recovery of a pet.
There are 5 revisit exams that are included in the cost of surgery. Owners need to be able to schedule these because it is important to follow up with the patient and make sure the eyes are healing normally. The first exam is the day after surgery. The eyes are examined the following day to make sure that there are no problems with inflammation or increased pressures. The second exam is typically a week later. It is at this time we start decreasing the medications. Usually the drops being used 4 times daily will decrease to 3 times daily. If everything looks good, the third exam is now 2 weeks later. It is at this time the e-collar will be discontinued and the drops will then decrease to only 2 times daily. The fourth exam is now 1 month later. We will decrease to only once a day on the topical medication. The fifth exam is now 3 months. We will discuss any long term medications at this time. In most cases, the 5 no-charge exams will get you out to about the 6 month time frame. However, if there is a problem after surgery, you may use these exams faster.
The most common question that owners have is how soon will my pet be able to see. In most cases they will walk out of the hospital being able to see much better than when they walked in. This vision will improve as the inflammation decreases and the eyes heal. There are a few cases that take longer for their vision to come back. Do not despair if they aren't visual immediately. We all take this journey together and are here to help and answer any questions that you may have.