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Dr. Alan Mendelsohn: How to Prevent Unnecessary Eye Surgery with Ocular Preventive Care

Prevention is the best cure and this is definitely the case when it comes to the eyes. Instead of worrying about surgery, don't put yourself in a position where you need it.

South Florida ophthalmologist Dr Alan Mendelsohn talking about eye surgery.

I’m an eye surgeon and my livelihood is from doing eye surgery. Now it’s an inevitability that all of us eventually will develop cataracts, cataracts quite simply is when the lens and the eye gets gray and cloudy, vision slips, and then we need a five-minute outpatient laser procedure which will sharpen visual acuity tremendously. So, setting aside cataract procedures which again everyone sooner or later will need, the key thing I want to stress is that people can prevent unnecessary surgery.

How? When you’re around the house, working on your car, you always want to make sure you have safety goggles on. Between hammering nails, sawing, chiseling, and the various activities that we’re doing, unfortunately things do fly into the eye. At least 10 times a week I personally will pull things out of a cornea, glass, metal, or wood splinters. Usually we’re fortunate that the damage is superficial & we can remove them readily in the office. It takes two/three/four minutes but sometimes god forbid these objects like the little piece of a head of a nail can penetrate all the way through the eye requiring major surgery in an operating room. These things are preventable with correct safety protection.

Interestingly especially with us in South Florida before and after the storm we see a tremendous uptick in the number of corneal injuries, ocular injuries in general, why? Between putting up all the plywood, putting up the shutters, making all the preparations, the hammering, the sawing, the drilling, things get into the eye. After the storm passes, the cleanup. Whether it’s removing the plywood, putting the shutters back to their normal position, removing all the trees and branches and debris, things fly into the eye. So while we’re in a rush to get ready for the storm and we’re eager to clean up after the storm, instead of the usual maybe 10 eye injuries a week that I’ll see, quite frequently we’ll see 20/30/40, just like we did before and after Hurricane Irma. So that protection is super important.

Second recommendation –  there are certain physical activities where we know there’s a very marked increase in eye injuries; playing paintball, people think it’s benign it’s not, there are frequent eye injuries, bleeds to the eye, major trauma requiring surgery. BB guns, pellet guns, things of that nature penetrating injuries to the eye sometimes they’re even inoperable unfortunately, so these activities I personally I would include boxing on the list, with the tremendous blows to the eye retinal detachments can occur sometimes the retinal detachments are major and even those can be inoperable. So there are certain activities that are considered leisure activities but it’s a definite danger to the human eye and one can prevent surgery by preventing these type of activities.

Then there are other things in the normal course of events, so for example, when we’re outside daylight hours you always want to make sure you have sunglasses on. With sunglasses the incident survived-cancer drops dramatically. That could be major reconstructive surgery to remove an eyelid tumor and the reconstructive process. Also there can be growths on the wall of the eye when they’re smaller they’re called Pingueculas, they get larger they’re called Pterygium the pterygium will start to grow over the eye, blocking vision that requires major surgery to dig them out. Again, it’s preventable by having correct sunglasses and other damages to the eye from the Sun as well, with the sun protection makes it very very huge difference.

Other things that are very helpful is for many systemic conditions such as diabetes the blood vessels can leak, when the blood vessels will leak in the back of the eye that’s called either diabetic retinopathy, or diabetic maculopathy. Keeping the blood sugars low is crucially important so there is a blood test that’s taken every three months and diabetics call the Hemoglobin A1C, again Hemoglobin A1C. Keeping that level at a low level is hugely important, I’ll give you an example. Hemoglobin A1C level of eight, if someone’s conscientious, they get the level down to seven going from eight to seven is one percent decrease. While that might not sound a lot, I like a lot that one percent decrease is a 30% reduction in chances of bleeding in the back of the eye.

Diabetics also have to exercise and to be careful with dessert snacks, things like that. Another thing that can result in procedures macular degeneration if God forbid there is bleeding in the back of the eye, this could result in the necessity of shots called intra material injection. There’s a lot of preventative things, for example, simply by not smoking greatly decreases the chance of macular degeneration. Going back to sunglasses protection, if those have any signs of macular like drusen by having taking vitamins called areds 2, can have a profoundly beneficial effect. Eating things such as fish, salmon in particular, very helpful. We’re working on digital devices, having blue blocker can be helpful as well, so there are a lot of preventative things that can be done. Starting with the yard work, the car work, having safety glasses, refraining from activities like paintball, the BB guns, the pellet guns, wearing sunglasses.

With different systemic conditions where the eyes can be affected being very conscientious and diligent can have a profound effect.

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