THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 492.5 Guest: Sheri Rowen, M.D., F.A.C.S. Topic: Cataracts Host: Richard Roeder Producer: Ed Graham

NEMA: This is a discussion about cataracts and their treatment. My guest is ophthalmologist Dr. Sheri Rowen from the Katzen Eye Group in Baltimore, Maryland.

NEMA: Dr. Rowen, what is a cataract?

Rowen: A cataract is the natural lens of the eye that has become cloudy. We have a lens in our eye just like a lens in the camera and with age, it becomes cloudy and hard and when it becomes hard, it cannot move the way it's supposed to. It's supposed to move in shape and size. That's how we can see distance and near. Well, once this happens, it loses its elasticity and cannot move back and forth and also cloudiness occurs and color changes occur in there. Sometimes they get very brown so the colors now are not normal and when you're looking through cloudiness, you see a haze or a glare and it's not a skin that forms over the eye. It's your own natural lens that becomes cloudy.

NEMA: Is the cause of cataracts understood?

Rowen: Not really. We know that it happens with age. We know that some people are born with them. We know that there is a genetic component. Sometimes people get cataracts early on when their parents have. We know that it's related to certain illnesses like diabetes. There's also probably a higher rate of it in association with glaucoma patients. If you're on steroids you can get cataracts so there are some known causes but for the most part, it's an aging change that happens. There's probably a relation with anti oxidant factors, with oxidative factors, free radicals, things like that but they really don't know all of the answers yet.

NEMA: Talk about the difference in the way cataracts were treated in the past and how they're treated nowadays.

Rowen: I'd say 20 30 years ago, people were making incisions that encompassed an entire half of the eye which made the eye lose it's integrity. They had to sew it up. In fact, in the '50s and '60s, there wasn't even any suture material that was proper so they laid on their back with sandbags on each side so they couldn't move their head for two weeks. Well now what's happened is our incisions have changed to the point in fact, what I'm doing is a 2 1/2 millimeter incision which is barely a fingernail's width apart and the incision is created without having to dissect a lot of tissue. The incision is made with diamond knives and it's painless and it requires no sutures to heal. This is in terms of what I'm saying the most advanced techniques are. We're using very small incisions. We're using foldable lenses to go in the eye. I'm using no anesthetics other than drops in most of my cases so I don't have to even put any injection or needle around the eye so any problem with that is eliminated and the patient can see immediately after surgery. They don't even have to go home with a patch on.