Cataracts

Definition: Cataracts are opacities in the lens of the eye.  Many people mistakenly think the cloudiness is on the surface (thought to be a “film on the eye), but in fact, the cloudy lens is deep inside your pet’s eye. 

Why Did Your Pet Get Cataracts? 
Most cataracts are inherited and are found in many breeds such as the Cocker Spaniel, Poodle, Husky, Schnauzer, Golden and Labrador Retrievers and Terriers.  Other causes of cataracts include; Diabetes, trauma, inflammation and puppy milk replacers.  Many cataracts will worsen to the point of blindness but certain types, especially in the Retriever breeds, can remain small for the entire life of the patient.  A common phenomenon occurs in many developing cataracts where the patient can develop an allergic type of reaction to the cataract.  This allergic reaction is a local reaction and can result in many complications such as scar formation and glaucoma.

How Are Cataracts Treated?
Treatment for cataracts is surgical removal and may be done in one or both eyes depending on the specifics of each patient.  Before surgery is performed, your pet will have a consultation with one of our ophthalmologists to determine whether he or she is a good canidate for the procedure.  Additional testing may be needed to determine the overall health of the eye.  If your pet does not pass these tests, removal of the cataracts would not improve vision and therefore, surgery should not be performed.  
Cataract surgery is elective and requires a significant time commitment on your part.  Eyedrops must be administered several times daily before surgery and for the rest of the pet’s life.  The patient must wear a protective plastic e-collar for 2 weeks after surgery and your pet will not be able to to be groomed during this time.  The postoperative check-ups are usually performed one, two weeks, 1 month, 2 month, 4 months, 6 months and then as needed. The success rate is over 90%, but as with any surgery there are risks.  
The surgery is performed under general anesthesia and the patient goes home the same day.  Phacoemulsification is the same technique performed for human cataract removal; the tiny probe breaks up the cataract with ultrasonic vibration and draws out the cataract particles.  Many people believe that cataract removal is done with a laser but that is incorrect!  New lenses are place into patients that have the structures to support them after the cataract is removed. 

Cataract Surgery-What to Expect 

Pre-Operative

• Exam – Your pet has just been examined and diagnosed with cataracts in one or both eyes.  PLEASE READ YOUR DISCHARGE SUMMARY AND SURGERY ESTIMATE FOR DETAILS.  Should you wait to do cataract surgery for longer than two months, a recheck appointment will be necessary to re-evaluate the eyes for changes that  could affect surgery results.  
• Eye Drops – Your pet will need to be on an ophthalmic drops called Dexacidin (neo/poly/dex) or similar for at least 5-7 days prior to surgery.  This is a steroid/antibiotic medication that will help control any inflammation or infection and prepare the eye for cataract surgery.  
• Physical Exam and Blood Work – If your pet has not had pre-operative blood work with in the last 6 months, blood work will need to be done in order to assess your pet’s physical readiness to undergo anesthesia.  This can be done by your regular veterinarian or by our hospital.  If your veterinarian performs the blood work, please have the results faxed to our office prior to the surgery. 
• Diabetic Concerns – If your pet is diabetic, DO NOT give the insulin on the morning of surgery, as your pet will be fasted.  We will be monitoring your pet’s blood glucose throughout the day and will administer insulin if necessary. 
• The Night Before – Your pet can have food up unit 10:00p.m. the evening before surgery and water until the morning of the surgery.  
• The Morning of Surgery – Prior to surgery your pet will needed to undergo administration of various drops over a two-hour period to prepare the eye(s) for surgery.  An EKG will also be performed; therefore, we require your pet to be admitted between 8:30-9:30a.m. on the day of surgery.  Please walk your dog to allow him/her to eliminate prior to admission.   

Post-Operative

• Elizabethan Collar – Your pet will be sent home wearing an E-collar that will need to stay on for a minimum of 10-14 days.  It is very important to keep this collar on at all times as there are very tiny sutures on the cornea that could be easily disrupted by rubbing.  Pets usually adapt to having the collar on after a short time and are able to eat, drink and sleep while wearing it.  If you notice your pet refusing to eat/drink with the collar on, it may be briefly removed during feeding time if under strict observation. The collar should be placed back on your pet immediately after feeding. 
• Medications – The success of the surgery depends highly on your proper and timely administration of the medications.  Initially this is a demanding task, as some of the medications need to be given five times a day. Medications should not be changed without Dr. Stanz or Dr. Mineo’s consent.  If you run out of your pet’s medications prior to your next scheduled appointment, please call the office for refills.  Medications can be obtained at our office or mailed to your home.  
• Activity Restrictions – Your pet should be kept as quiet as possible for the first couple of weeks after cataract surgery.  Vigorous play, especially with other pets, should not be permitted.  After the first day or two, you may be able to resume normal controlled walks on a leash or harness.  
• Recheck Examinations – After cataract surgery, your pet will need to be seen on a regular basis for recheck examinations with Dr. Stanz or Dr. Mineo.  The first two post-operative exams are included in the cost of the surgery, although there will be an additional charge for medications. Afterward, you will be charged for recheck exams and medications. Generally, the schedule for post-operative exams are as follows; 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months and then as needed.  If there are any complications during or after the surgery, rechecks may be scheduled on a more frequent basis.

Post operative care

• Elizabethan Collar (E-collar)- This lovely “party hat” is worn by all patients to minimize their ability to rub and traumatize the eye.  If allowed to rub the eye, sutures could break (dehisce) and the incision could burst open.  It is to remain on 24 hours a day until the doctor tells you its ready to come off.  The typical time frame for wearing the “cone” is 2-3 weeks. It can take that long for the corneal incision to heal and become strong.  The protective collar also acts as a “bumper”, since vision is often  blurry for a few days after surgery.  The collar minimizes the risk of direct eye injury.  
•  Sutures (stitches)- The sutures used to close the corneal incision, where the instruments were inserted into the eye to remove the cataract, are absorbable.  This means they will dissolve over 4-6 weeks and do not need to be removed. 
• Activity- Restricted activity is very important to insure your pet does not injure the eye during the first 4 weeks.  Running, jumping up and down on furniture, going quickly up and down stairs, vigorous head shaking, playing with other pets and chasing toys is not allowed.  We ask that you modify their behavior as strictly as possible to allow the eye to heal properly.  Neck leads are avoided as they will increase pressure within the eye and put stress on the corneal incision and sutures.  We recommend that your purchase a harness to use for the 4 week period after surgery. 
• Recovery from Anesthesia- It may take 24-48 hours for your pet to fully metabolize the drugs given for anesthesia.  Your pet may not want to eat much the evening after surgery and may want to sleep more than usual.  This is normal and should improve of the next day.  If your pet’s appetite and level of alertness does not gradually increase, or if there is any vomiting or diarrhea, please call and inform us. 

What to watch for

• Persistent Squinting- Cataract surgery is not overtly painful.  Your pet should be comfortable and holding the eye open.  It is normal to observe occasional squinting when the pet is exposed to bright light (photosensitivity) and after eye medications are instilled.
• Yellow/Green Eye Discharge- Increased redness at the top of the eye or a slight cloudiness of the cornea (surface dome of the eye) is expected.  Eye discharge that appears grey/brown or clear mucous is normal for a few days after surgery. Please let us know if you feel there is an excessive amount of discharge noted. 
• Signs of Overt Discomfort- These include lethargy, hiding, whining, wincing, vomiting, diarrhea, or decreased appetite.  These signs are abnormal and should be reported to a staff member of Animal Eye Care.  
• Emergencies- If your pet has a problem, your first action is to call the hospital at 716-608-7700 During normal office hours you will speak to a member of the ophthalmology staff.  After hours emergency please refer to the number provided to you by our staff at discharge.

Caring for Your Blind Pet

Unfortunately, blindness in our pets occurs more often than we would like. Causes of blindness include retinal disease with no known treatment, glaucoma for which some treatments are available (often with affects that are short-lived), cataracts, retinal detachments, serious eye injuries and a variety of other diseases.   
Vision in cats and dogs is quite different from ours.  They have better night vision and peripheral vision than we do, but their ability to focus and see fine detail is less developed.  Also, they do not have well developed color vision. Our pets are less dependent on vision than we are.  They utilize their senses of hearing and smell very efficiently.  Because of this, loss of vision in cats and dogs is less traumatic compared to loss of vision in people.  They will not feel sorry for themselves and usually adapt very well to the loss of vision.  Pets that become blind seem to undergo a 1-2 month period of adaptation and during the same time many changes occur.  They will bump into things and it can be a difficult time for your pet and your.  All of these signs will pass with time. Over 95% of blind pets readily memorize the layout of their home and yard and can function normally or near normally with poor vision or no vision. It does take time for them to learn to get around using their other senses. They will make very happy pets with some help form you to make their life a little easier.  

Memory is used to navigate the house.  Avoid changing the environment, such as moving furniture or food and water bowls.  If your pet is placed in a new environment, allow some time to adjust to the new surrounding. Be careful of stairways, open doors or other objects that could injure your pet. Put chairs back under the table after meals.  Things that are left out will cause your pet to bump into them and become disoriented. Teach them to walk on a harness or lead so they can be exercised safely. Choke collars are discouraged.  Keep talking to your pet while walking, your voice will guide them.  Encourage exercise, whether in a fenced yard or on a leash to prevent excessive weight gain. Never let your pet out without supervision unless in a fenced yard. BE CAREFUL OF IN GROUND POOLS.  Encourage them to use their other senses to compensate for vision loss. Buy noisy toys or toys that have a distinct, recognizable odor.  Be creative with different scents to mark areas.  Use different scents of favored extracts or even something as simple as hanging a car air freshener or potpourri sachet on a door.  This will help them to recognize where they are in the home.   Some people get a companion animal that the blind pet can follow around using its hearing and smell.  Some Behavior changes (aggression, depression and fear) can sometimes be observed with sudden blindness.  Avoid stressing or scaring blind pets. Instruct family members, including children to vocalize the pet’s name and approach slowly. This fear usually passes with time, as the pet learns to adjust to the blindness.  Most causes of blindness are not painful, so the quality of life of a blind pet is very good.  If pain is involved, it will cause the pet to be depressed. Other signs to watch for are associated with changes in the appearance of the eye such as reddening of the white of the eye, increase in the size of the eye, large amounts of discharge or scratching and rubbing at the eye. Feed and water your pet in the exact same place every day.  This area will become a reference point if your pet becomes disoriented.  Emphasize the senses they still have , sense of smell, hearing taste and touch.  Be very vocal with you pet. Use textured materials to mark areas. Throw rugs or indoor/outdoor carpeting are great to help guide your pet.  Blind cats and dogs can have a good quality of life and make very happy pets as long as you follow these few guidelines.  If you have any question or concerns please call our office at 716-608-7700

Online support for clients with blind pets

Online Support for Clients With Blind Pets Littlest Angel Vest, for blind dogs who can’t use a cane Angelvest.homestead.com Eye Protection for Dogs, goggles for dogs! www.doggles.com “Living With Blind Dogs”, a resource book and training guide for the owners of blind and low vision dogs and “Blind Dog Stories: Tales of Triumph Humor and Heroism” by Caroline Levin www.petcarebooks.com