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Cataract Surgery after a Vitrectomy

This article is contributed by Alaina Kronenberg MD, a cataract specialist in Dearborn, Michigan. I asked her to write this article to better explain cataract surgery after a vitrectomy. I hope you enjoy the article.




A vitrectomy is an operation when a retinal specialist cleans out the jelly in the back of the eye (the vitreous). This is may need to be performed if you have a retinal detachment, bleeding into the vitreous and to sometimes obtain better access to the retina so your surgeon can fix many various problems on the retina.

Cataract DevelopmentCataract Surgery After a Vitrectomy

If you need to have a vitrectomy, it is very likely that the surgery will cause you to develop a cataract. A cataract is when the natural lens inside the eye becomes cloudy. The cataract can sometimes develop fairly quickly after your retinal surgery.

If the cataract develops to the point that it interferes with your day to day vision, your comprehensive ophthalmologist may recommend that it is removed. The purpose of the cataract surgery is to improve your vision as much as possible.

If you have the start of a cataract before your require a vitrectomy surgery, often your comprehensive ophthalmologist and retinal surgeon may agree to remove the cataract before your retinal surgery. This is often recommended because it is safer to remove a cataract before retinal surgery.

Cataract Surgery After a Vitrectomy

Cataract surgery after a vitrectomy has a higher risk of a complication. The vitreous usually supports the capsule of the cataract. If the vitreous has been removed, it is often more floppy with a higher risk of being damaged during cataract surgery. Also, sometimes the capsule that surrounds the cataract was damaged during the vitrectomy. There is a higher chance you will need more that one surgery to completely get out the cataract if you had a prior vitrectomy.


Patients who have had cataract surgery after a vitrectomy need to have realistic expectations on the improvement in vision they may experience. If you have had a prior vitrectomy you also may not be a good candidate for some of the premium implants that help correct both distance and near vision.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126

Does Cataract Surgery Cause Macular Degeneration?

Does Cataract Surgery Cause Macular Degeneration?  Randall Wong, M.D., Ophthalmologist, Fairfax, VirginiaCataract surgery does not cause macular degeneration.  Macular degeneration, however, is often discovered just after cataract surgery when the vision fails to improve as hoped, causing many patients (and their frustrated families) to wonder if the cataract surgery caused macular degeneration.

Failure for Vision to Improve

In most cases of cataract surgery, vision gets better just after the surgery is completed.  In the normal circumstance,  surgery improves the vision quickly within  a day or two.

Patients who fail to improve may be referred to a retina specialist for further evaluation.

Cataracts and ARMD

Both eye diseases become more common as we get older.   Most of the time, it’s easy to distinguish between cataracts, macular degeneration or some other cause of visual loss.

Sometimes we can’t diagnose AMD because we can’t examine the retina.

When patients are referred for cataract evaluation, we do our best to ensure the cataract is indeed the cause of vision problem.  In other words, can the degree of cataract cause all of the patients symptoms?  A dilated eye exam is performed.

If there is an inconsistency, say when there is vision loss, but not much cataract (remember, cataract is clouding of the natural lens of the eye) then other causes of the visual loss must be considered, such as retinal disease, glaucoma, etc.

At times, however, the cataract is pretty dense (cloudy) making direct examination of the retina very difficult.  Just as the patient is unable to see “out” of the eye, we are unable to see “in.”

Disappointing Results

When cataract surgery is performed, but the vision does not improve, everyone is disappointed…the patient, the family and the doctor.  From our end, it is very difficult to explain that something else, for example, macular degeneration, is really causing the problem.

Not surprising, patients start to question if cataract surgery causes macular degeneration.

What Does This Mean?

Ideally, patients with dense cataracts and/or severe vision loss might benefit from an evaluation with a retina specialist.  This “objective” evaluation might avoid some of the disappointment and frustration that results from a “surprise” diagnosis of macular degeneration.

In the end, every one would benefit, because surprises and disappointment erodes…trust.


When a Cataract Comes Back

While not a retinal problem, cataracts can “return” and can mimic the symptoms of the original cataract; blurred vision, glare and distortion.  This can usually be remedied by a simple painless laser procedure called a YAG capsulotomy.

Cataract Surgery with Implant

Like grey hair, everyone gets cataracts.  With time, the natural lens of the eye clouds with time.  This clouding decreases vision.  The lens is similar to an “M&M” piece of candy both in size and shape.  An M&M is a core of milk chocolate surrounded by a candy coated shell.

Cataracts Cause Decreased Vision

When cataract surgery is performed, the cataract surgeon cuts a hole in the outside candy coating.  The “chocolate”  (core of the lens) is then sucked out leaving the empty candy coated shell.  In the real eye, this shell is actually a clear tissue very similar to plastic wrap used to cover food.  This shell is called the “capsular bag.”

Once the cloudy natural lens material is removed, a clear plastic implant is used to replace the natural lens.  Vision is restored.

Plastic Wrap Gets Dirty

With time, from weeks to years, this clear plastic wrap-like material can get cloudy.  The original symptoms of blurry vision and glare return.  Decreased vision from “posterior capsule opacification” occurs in almost every cataract patient.

Using a “laser” to Restore Vision

A YAG laser is a type of laser that uses its energy to cut.  By focusing the laser beam on the back portion of the candy coating shell, just behind the implant, a small hole is created.  This removes the cloudy/hazy tissue out of the line of sight and vision is restored.

YAG Laser Used for Posterior Capsulotomy
Laser Cut Hole in Posterior Portion of Shell (Capsule)

Does the Implant Fall

Properly performed, a YAG capsulotomy will not cause the implant to move.  While it has happened (and to me!), it is unusual as the implant is usually scarred in place.

In theory, there may be a slight increased risk of a retinal tear that could lead to a retinal detachment.

What Does This Mean?

Many of my patients have had cataract surgery.  It is a relief when we find the cause of the decreased vision is only due to PCO (posterior capsule opacification) and not due to diabetic retinopathy or macular degeneration.

Many people erroneously believe (and perpetuated by some docs) that cataracts “come back.”  They don’t.

This is also why many people believe cataract surgery is performed with laser.  It isn’t, but now you know why, and how, the rumor started.

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When You Need Cataract Surgery

Cataract surgery is needed when your vision is not as good as you’d like, and, your eye doctor feels that the elective procedure would help.  In cases of diabetic retinopathy and macular degeneration, there may be other factors that weigh in to the decision of having cataract surgery.

Cataracts are usually elective surgery.  While insurance does cover most cataract surgery, there are a few criteria for having the operation.  Most of the criteria are based on certain vision measurements taken at your eye doctor’s office.  Your visual acuity, with or without glasses, may simply be bad enough to qualify you for surgery.  Sometimes your daylight vision is fine, but you may suffer from significant glare when driving at night with oncoming headlights.  In addition to vision, your doctor simply needs to affirm the presence of a cataract and likelihood of improvement with surgery.

There is no hurry to having surgery.  Unlike a piece of overripe fruit, you really have lots of time.  Choose a time when you are ready for surgery and is convenient for the rest of your friends or family; whoever may be helping you.

There is no strain on the other eye.  Don’t worry about overworking the other eye while waiting for cataract surgery.  There really is not such thing.

Patients with diabetes have some additional concerns regarding the timing of their surgery.  If you have a history of diabetic retinopathy, make sure that the diabetic retinopathy is stable at the time of surgery.  The only way to assess stability is with a dilated eye exam with your doctor or retina specialist.

While the timing is not that crucial in cases of macular degeneration, the expectations of the operation should be reviewed with the doctor.  By definition, patients with macular degeneration already have decreased vision from their retinal disease.  Make sure you and your doctor are on par with your expectations after surgery.

What Does This Mean? Cataract surgery can be a life changing event.  In most cases, there is likely to be full restoration of vision.  The timing of cataract surgery is basically up to you, based upon your own tolerance, or intolerance, of blurry vision.

If you have cataracts, or suspect that you do, I would recommend an examination soon with your eye doctor.  Use this visit as a fact finding mission, you’ll be surprised how much there is to learn about cataract surgery.  You don’t have to commit to surgery.

Take your time to schedule the surgery.  Make sure you are ready.

If you have retinal disease, such as diabetic retinopathy or macular degeneration, make sure you and your doctor are “on the same page” about the timing and expectations of the surgery.


Randall V. Wong, M.D.

Retina Specialist, Ophthalmologist
Fairfax, Virginia

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It's Not About Your Vision, It's About Quality of Life

Decreased vision impacts your quality of life.  Macular degeneration and diabetic retinopathy are the two leading causes of loss of vision in adults.  Macular degeneration and diabetic retinopathy can impact your quality of life.

Your quality of life , besides visual acuity, is also used to measure the outcome, or success, of a treatment.  There are many ways to “measure” visual acuity, but in the end, the visual acuity is just a number.  It is objective.  20/20 is a number.

Your quality of life is subjective.  It is how you, the patient, feel about your vision.  This is the most important aspect (and most troubling) in assessing “success.”

Are You Able to do The Things You Want to Do? Quality of life, or QOL, is not something that is usually discussed per se with your doctor, but we make many decisions based upon your vision and how it impacts your ability to do the things you want to do.

Hobbies, Fun Stuff If your vision isn’t good enough to allow you to enjoy your hobbies or other activities you enjoy, then every attempt should be made to improve your vision.

Driving and Work Most patients that I see that have some visual loss are very worried about losing their driver’s license.  It is probably the biggest concern in patients that have lost their vision due to diabetic retinopathy or macular degeneration.  The second biggest fear is making mistakes on the job because you can’t see.

Activities of Daily Living Simply put, these are activities that we all do, everyday, yet take for granted.  Activities of daily living include eating, walking around the house, brushing teeth, writing a check, etc.  If you can’t see, you might cause physical harm to yourself and others.  You might trip and fall over furniture, burn your hand pouring coffee, fall down the stairs, set the house on fire because you couldn’t adjust the stove, etc.

From an eye doctor’s perspective, every attempt is made to get to see “20/20.”  It is a number, but at this level it is assumed you should have the level of vision to allow a full, super duper, quality of life.

Patients that have some decreased vision, should maximize their visual potential if they feel there quality of life could be enhanced with improved vision.  This could be as simple as changing glasses, considering cataract surgery, etc.  Many changes in vision can be reversed, for example, successful cataract surgery.

Patients with macular degeneration should be seen periodically, but especially if there is recent loss of vision, including distortion.  The earlier you are diagnosed, and, if possible, treated, the better we can preserve your vision and your quality of life.

Patients with diabetic retinopathy have to be seen regularly.  We don’t want to wait for visual changes and the vision does not correlate with the degree of diabetic retinopathy.  Remember with diabetes, we want to diagnose and treat the diabetic retinopathy before there is any change in your vision………………and your quality of life.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia

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Cataract Surgery May Worsen Diabetic Retinopathy

This post will be short and is written as follow-up to “Diabetics Get Cataracts”.

There is a study just published in the journal Ophthalmology where patients with diabetes underwent cataract surgery.  The incidence of diabetic retinopathy was then followed for at least 12 months.  Patients with both Type I and Type II diabetes were followed.

Overall, there was an increased incidence of diabetic retinopathy in the eyes of those patients that underwent cataract surgery versus the eyes that did not have cataract surgery.  In addition, in 45 patients where only one eye was operated upon, there was an increased chance of developing diabetic retinopathy in the operated eye.

What does this mean? This seems to underscore the importance of having cataract surgery earlier than later, that is, have cataract surgery when the retinopathy is either not detectable or barely detectable.  Also, this study included patients 65 years or older.  The results did not follow the visual acuity. Lastly, even though the incidence of diabetic retinopathy increased, the results indicate better outcomes than similar studies using older cataract surgery techniques (i.e. newer techniques are better and safer).  The newer “phacoemulsification” techniques are quite common in the U.S. and have been so for about 10-15 years.

The abstract to the article.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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Do Cataracts Cause Macular Degeneration?

Life as a retina specialist is very rewarding.  It has special challenges.

There are two conditions that increase as we age; macular degeneration and cataracts.  Most people understand cataracts.  Cataract surgery is intuitive.  Vision blurs, glasses don’t help, cataract surgery is performed and vision returns!  Simple…………..right?

What happens when cataract surgery doesn’t help? Frustration, anxiety and doubt develop.  Frustration over the surgery, anxiety about going blind and doubt weakens your faith in your doctor.

It is at this point in the process, someone suggests a visit with Dr. Wong.  This is my least favorite type referral.  I don’t do well with frustrated angry people.  It is now my job to reduce the frustration, ask for forgiveness on behalf of the cataract surgeon, restore the faith in the referring doctor, establish trust in a new doctor (me) and still make a diagnosis!  These are my special challenges.

Many times the actual reason a patient does not see well after cataract surgery is due to macular degeneration.  There are a lot of patients that never find out about macular degeneration until after the cataract surgery.  Sometimes, I’ll be consulted before cataract surgery and will warn the patient about macular degeneration.  While this is the best scenario, it doesn’t always happen.  Why?

Macular degeneration is sometimes difficult to diagnose, especially if you can not see the retina very well.  Remember, patients that need cataract surgery can not see out of the eye very well, but this also means that doctors may have trouble seeing into the eye as well.  Sometimes, there are subtle signs in the retina that are missed due to the cloudy cataract.

On occasion, macular degeneration seems to have been caused by the cataract surgery.  While there is no scientific evidence linking cataract surgery to macular degeneration, the timing of the events has long begged the question.

In the end, if you have developing cataracts, I would recommend you ask your doctor if there is any reason, other than cataract, that may be causing your symptoms.  While cataract surgery may still be in your best interest, your understanding of potential problems prior to cataract surgery will pay off in the end and maintain that special relationship with your doctor.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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What is Informed Consent?

Ever have a doctor recommend surgery or a test in the office?  Did he (proper grammar, not being prejudiced) take the time to explain the reasons for the test, possible complications and the risks?

Informed consent is more than just signing your name to a piece of paper.  Proper informed consent should include a discussion of;

  1. the reason for the procedure and its potential benefits (e.g. you may get better)
  2. alternatives to this treatment or test including consequences of choosing NOT to have the procedure
  3. possible complications
  4. the risks involved, or rather, the chances that these complications might occur

The purpose of informed consent is to allow you to make an educated choice about your health care.  It allows you to participate in your own care once you clearly understand your situation and your options.  Proper informed consent assumes that the discussion of the items above did take place, that you understand your treatment and options and then, and only then, you are giving permission to proceed.

Example of proper informed consent;

“As your doctor Ms. Jones, I recommend that you have cataract surgery to your right eye.  Cataract surgery should improve your vision and it is expected that you will see better than you do now.  It is possible that your blurry vision is actually from something else such as a retinal problem, but from my examination I feel that this will help you.  The procedure will take less than 30 minutes and will be performed under topical anesthesia as an outpatient.  Your anesthesia provider will meet with you prior to the operation.  Possible complications of the surgery include blindness from intraocular infection, bleeding or retinal detachment.  The risks of these complications are very rare and may occur less than 1% of the time, but I feel that you should be aware that complications can occur.  If you do not want to have surgery at this time, it is likely that your vision will continue to deteriorate making it even more difficult to drive, watch TV or read.”

Example of improper informed consent (and probably won’t stand up in court);

“Ms. Jones please sign here.  It gives us permission to do your surgery.”

Remember that your doctor should take the time to go through this explanation.  If he does not, then ask questions.  If he still does not take the time, the feel free to find another doctor.

Technically, informed consent should be obtained prior to any procedure or diagnostic test where complications may occur.

Hope this was helpful,

Randall V. Wong, M.D.
Retinal Specialist/Ophthalmologist

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Cataract Surgery Does Not Cause Macular Degeneration

A recent study reports that there is no link between cataract surgery and the development of macular degeneration.  The Age Related Eye Disease Study (AREDS) was a large randomized prospective trial that examined the chance of developing macular degeneration.  This was a prospective study where patients were examined before and afer cataract surgery for the presence of macular degeneration.  This is the first study, and perhaps the largest, that finds cataract surgery is safe for patients worried about macular degeneration.  Emily Chew, M.D., and her colleagues at the National Eye Institute, examined the data of over 4500 patients who were examined every six months for up to 11 years.

What does this mean? As a retinal specialist, I commonly examine patients that do not improve after successful cataract surgery.  Many times the culprit is macular degeneration, that is, patients fail to improve after cataract surgery due to macular degeneration.  For years, there has been an unproven feeling that cataract surgery makes macular degeneration worse.  Remember, there are two eye diseases that increase with age;  cataracts (okay, maybe not a disease) and macular degeneration.  To find both in the same patient is not surprising, yet it is truly frustrating to the patient who just had cataract surgery and can not see.

I would recommend that we take the conclusions of the AREDS trial at face value.  There is no relationship between cataract surgery and macular degeneration.  From a practical side, if you are worried about macular degeneration and are anticipating cataract surgery, get a second opinion from a retinal specialist.

Read the article.

Randall V. Wong, M.D.
Retina Specialist/ Ophthalmologist


Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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