ASK THE DOC
Dr. Ravi Thomas, Director, L.V. Prasad Eye Institute, Hyderabad, replies to this week's query.
M.V. Rao
I am a 56-year old male with normal health — no sugar, BP or any other major ailment. I exercise regularly and I wear bifocals. I am an IT professional; I use a PC for 5-6 hours a day, see TV for about two to three hours. This year on March 19, I went for an eye check up. The doctor checked my eyes after dilatation and said that my optic nerves were OK, I don't have glaucoma, but she mentioned cataract in the early stages. For the next two days I was unable to focus on my PC. The doctor checked my pupils and said that they were normal. But I was having problems even while reading after 30 or 40 minutes. So I went to another specialist on March 24. He also dilated my eyes, and said I should not have any problems.
But the problem continued and so I went to a homeopath. He prescribed Cinrraria eye drops and gave some medicines. With that things did improve, but the problem did not disappear. Another eye-doctor also examined me and said I should not have any problems. Further he said that I don't have any cataract as of now. But since the problem still did not disappear, I had a thorough check-up and the hospital gave the same verdict — that I should not be having problems. They also mentioned that there is no cataract.
But unfortunately the problem still persists. Once in a way (may be in a week) when I start reading the newspaper, after 30 or 40 minutes, I have to narrow my eyes and focus to read. I would like to know what is the reason and whether it can be corrected? Though it defies any explanation, the whole problem started when I got my eyes tested for glaucoma on March 19.
Answer: Your detailed and well reasoned letter raises several issues. The drops used to dilate the eyes can cause blurred vision for near sight and difficulty in sunlight. Depending on the drops used, this usually lasts for a few hours or even a couple of days. Either way, the effect can last beyond the effect on the pupil. There is also the rare chance of your cornea having sustained mild trauma during the examination as a result of drops and measurement of pressure, but that is unlikely to have persisted so long. And it would have been picked up by the "second opinion".
Is it possible that the early cataract you were told about caused the problem? But then, another specialist told you that there was no cataract. How do we account for that?
At this point, I must thank you for the opportunity of addressing this question. Many patients "complain" that different doctors have made different diagnoses and given different opinions. The unfortunate truth is that medicine, (including ophthalmology), is not an exact science; the explanation I provide below can be extrapolated to other conditions and diseases too.
The detection of "cataract" depends on several factors, including the type of examination performed. If the first examination was performed on the slit lamp following dilatation — then combined with an examination using an ophthalmoscope that is probably the best method of detecting an early cataract. Did the second doctor perform the examination in the same manner? If not, that could explain the discrepancy. Even if the examination was done in the same manner, the way doctors define cataract can differ. Technically, a cataract means any, even the smallest, opacity in the lens of the eye, and some of us use the word in this way. Others would, rightly, tell the patient only about a "significant" cataract, one that is affecting or is likely to affect vision. Even for research purposes, when a cataract is strictly defined, there can be a difference in labelling a cataract. This lack of "agreement" is a reality that we must accept. For research purposes we can quantify the degree of "agreement" and account for it when we analyse our results. Incidentally, by offering an explanation, I am not making excuses for my colleagues, but seeking your understanding, and that of the readers.
The cineraria drops seemed to have helped. There is no evidence that the drops help the occurrence or prevention of cataract in any way. Having said that, it is ultimately the patients perception that counts, and if it helps you, that is good enough. The question that remains is whether "tear" substitutes would have helped in the same way. You see, one explanation for your symptoms is a marginal dry eye. Any form of lubrication would help in this condition, artificial tears, which are more suitable, or the cineraria drops that you used. And while I have no objection to the drops that are used, I would advise you to be wary of "alternative" medications that are taken internally. Studies of "alternative" medications have shown that a lot of them contain harmful steroids and heavy metals. Please be sure about the source and content of any alternative medications that you may use.
Back to the cataract: can early cataract cause this problem? Yes it can. As can a slight change in the power of the glasses, which may be worthwhile investigating; and the possibility of a dry eye that requires lubrication. Additionally, many of us forget to arrange proper lighting or blink normally when we are at the computer or are reading. It would also be worthwhile to check out your diabetic status again.
Let us now address the perception that perhaps the whole episode might have been precipitated by the "glaucoma" examination. By the way, what you underwent was probably what every patient going to an ophthalmologist should have: a complete eye examination designed to detect any potential problems with your eye. It just happens that glaucoma cannot be diagnosed without such an examination. Regrettably, you experienced symptoms after the examination that are unfortunate, but as you yourself have so logically and correctly reasoned, are probably unrelated. That brings up the issue of how we attribute cause to effect. My teacher Prof. J.P. Muliyel illustrated this with a World War II story. After a heavy air raid, workers digging into the rubble found an elderly person on a toilet seat. He was shaken, but essentially unharmed. Asked if he was okay, he said, "I'm fine. But what happened? All I did was pull the flush" He ascribed the building collapse to his act of pulling the flush. It was just a coincidence. Similarly, your symptoms occurring after the examination were probably a coincidence, helped perhaps by the natural worry caused by the fact that that you had been told you had cataract. That is normal, and you already logically reasoned it out when you stated that "although it defies any explanation ... ".
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