Cataract Surgery

[Newhampster]

I have a cataract in one eye.

I'll be talking to an opthamologist about surgery to repair this (replacing the intra-ocular lens with a new, plastic one).

Any special concerns for diving after this has properly healed?

[I'd assume not but I'm smart enough to do neither the surgery on myself nor provide the medical advice...]

 

[BILLB]

I had cataract surgery on my right eye in 1979. Back then they did not do ocular implants in people under 60 years old. I had to then and still do wear a contact lens in that eye.

I was slated to start my OW class around 1997 when the right eye suffered a detached retina. Its was repaired and delayed my diving career for another year. At the time I started the OW class none of the doctors I was being treated by had any scuba experience. I looked on the WEB and not much there either. The best I was able to gleam is that any one willing to make a guess though diving was OK. And to this writing, I have had zero problems with my right eye although I have to wear a contact lens.

My left eye finally caught up with my right eye in 2001. I had a lens implant and started an unevenful recovery. I did not dive for 6 months. I did continue teaching in the local pool and did dive the shallow depths starting about 2 months after the surgery. During the following months I started to lose vision in the eye until It was uncorrectable.

Inflamation had some how set in and I had to undergo several treatment including an injection of steroids into the eye. Today, the problem is stable but I will probaly have to take medication for the rest of my life to control the inflamation.

Before the problem of inflamation was treated, I did my normal diving which means 50-60 dives both in the cold NE waters and warm Florida oceans. My dive profiles were varied but none exceeded 130 ft and all were no deco.

The current doctor I am now seeing has no opinion about my diving and the inflamation. All I know is that my problems are very uncommon for this type of surgery. I need to contact DAN directly and see if I can find a local doctor who may be a diver and hopefully offer me the piece of mind that diving did not contribute to my problems.

My advice to use is to find a doctor who is a diver or contact DAN now for assistance.

If I do finally learn that the lens implant is the problem, I will not hesitate to have it removed and use the contact lens in that eye too. It will greatly complicate my life, but I WILL NOT give up diving!

 

[Newhampster]

I've only found the following on DAN's site:

Can individuals who have had cataract surgery dive?

Yes. Most cataract surgeons now use surgical incisions designed to provide maximum post-operative wound strength. The recommended waiting time prior to returning to diving depends on exactly what type of incision was made. Ask your surgeon for recommendations for your particular type of surgery.


To see the original DAN piece, click here.

Any other data?

 

[DocVikingo]

Hi Newhampster,

Here's from our very own scubadoc:

"Diving After Eye Surgery

Individuals who have undergone ophthalmic surgical procedures should allow an appropriate period for wound healing before resuming diving.

Factors increasing the risk of post-operative complications:

Marine bacteria may cause infections when they contaminate non-epithelialized wound surfaces of the cornea, sclera, conjunctiva, or lid tissues

These pathogens may enter the eye through unhealed corneal or scleral wounds and result in vision-threatening endophthalmitis; gas in the anterior chamber or vitreous cavity may be affected by changes in pressure and result in vision-threatening intraocular barotrauma

Negative pressure in the air space of a face mask caused by a mask squeeze may result in subconjunctival hemorrhage, lid ecchymosis and edema, and could theoretically cause the rupture ofincompletely healed corneal or scleral wounds.

The risk of infection due to contact of the eye with water is much greater when diving in potentially contaminated ocean, river, or lake water than when showering or bathing in chlorinated city water.

In chamber dives, only gas in the eye remains a consideration.

There are no controlled studies specifically addressing the requisite length of convalescence before a return to diving. The recommendations below are based on the application of wound healing observations in other studies and on clinical experience.

A. Corneal surgery

Full thickness incisions

Very little healing is noted in the first week, followed by a rapid rise to about 30% of normal strength at 1 month.

Wound strength then gradually increases to approximately 50% of normal by 3 to 6 months.

Penetrating keratoplasty in which full-thickness incisions are made in the cornea should be followed by a six month convalescent period.

Radial and astigmatic keratotomy, which do not entail full-thickness corneal incisions or prolonged topical steroid therapy, may be allowed to dive after three months.

The possibility of barotrauma-induced rupture of a corneal wound is a theoretical possibility after any of the above procedures, but would occur only in the setting of an uncommonly encountered face mask squeeze."

Best of luck.

DocVikingo

 

[Newhampster]

Essentially, it depends on the surgical method.

I spoke with DAN.

They did some research and came up with different recommendations depending on the surgical technique.

I had a sutureless scleral tunnel phacoemulsification cataract procedures. In this procedure, the cornea isn't cut. The surgeon goes in through the sclera instead. (The Sclera is the tough, white, fibrous outer envelope of tissue covering all of the eyeball except the cornea. With phacoemulsification, the surgeon goes in and breaks up the existing lens with ultrasound -- and then extracts the remains through a needle.)

This technique is designed to be self-sealing "as a result of the pressure of the aqueous humor on the corneal valve". The net advice for this type of surgery is stay out of the water for a month (and make sure you get cleared by your doctor). Also, be extra careful about mask squeeze.

For other procedures, a delay of 2 or 3 or 6 months may be appropriate. Or more. It depends on the procedure and how it turns out for you.

Here's some of the material DAN sent me.

Below is the article I had mentioned from Dr. Butler.

Few studies have been conducted on the potential complications of diving post eye surgery. However, according to Capt. Frank Butler, Jr., M.D., a naval ophthalmologist, the question of possible barotrauma-induced rupture of surgical incisions in the hyperbaric environment is often raised when evaluating these individuals for diving fitness. One study apparently found that the pressure required to rupture at least one corneal incision in post-RK human cadaver eyes is approximately 215 mmHg (equivalent to approx 9.5 fsw). Although absolute pressure may increase well beyond the above stated pressure, there is generally not a significant pressure differential across the cornea, except in the case of a facemask squeeze where the diver fails to equalize the pressure. This is an uncommon occurrence in diving since the diver need only to exhale through one nostril during descent to prevent this from occurring.

Dr. Butler further advises the limbal wounds made in extracapsular cataract surgery heal more rapidly than clear corneal wounds because of the increased limal blood supply. It is common surgical practice to remove sutures from these incisions at two months, indicating that a three-month wait should be adequate to allow for wound healing, before diving is resumed. Scleral tunnel incisions now used in single-stitch or sutureless phacoemulsification cataract procedures are designed to be self-sealing as a result of the pressure of the aqueous humor on the corneal valve. The possibility of pathogens entering the eye through the healing scleral tunnel must also be considered, however.

A one-month convalescent period is recommended for patients with scleral tunnel incisions, and a two-month period is recommended after procedures employing corneal valve incisions made in clear cornea.

One exception is an individual who has undergone enucleation and who has a hollow implant. There are reports of pressure-induced collapses of hollow silicone orbital implants at depths as shallow as 10 feet. A hollow glass implant was also tested and did not implode at a maximum test depth of 115 feet, but diving with hollow glass implants could not be recommended on the basis of this one test. Individuals with hollow orbital implants should not dive.

 

[Lloyd]

Greetings,
This happens to be the field I now teach in. Since the eye is filled with a liguid, as long as the wound is properly healed in order to prevent infection, you should experience no problem. Your Dr. should be able to tell you when your wounds are safe. All the other post seem to have good info.

BillB,
Unless you got an infection from the wounds, I would quess that you just had bad luck. I can't say for sure since I never saw you, But if your wounds had healed, diving probably did not cause your problems.
Lloyd