Long-Term Visual Outcomes with MacuHealth

Cataract surgery consultations have changed dramatically during the past few years. Previously, most of my consultation time was spent educating patients on how cataract surgery was performed. Patients would ask about the type of cataract they had, how the cataract is removed, what replaces the old lens, what type of implant they were getting, and lastly, will they see clearly again?

Today, I still spend a significant amount of consultation time answering those types of questions, but one common question emerges more frequently: “How long after cataract surgery will I have good vision?” When you think about it, that is a very interesting and insightful question regarding how the field of eye care has changed, and how the patient population perceives it. Patients are looking for a long-term visual improvement, but what warranty can a doctor really provide?

Traditionally, cataract patients are of advanced age, so when that question came up you would naturally, and confidently, inform the patient that the new lens would last for the duration of his or her lifetime.

Today, patients are having cataract surgery at a younger age. This could be for a number of reasons, including trauma, medical conditions such as diabetes, and increased demand on good vision for their work or lifestyle.¹ Today’s young adults are being diagnosed early, as they experience difficulties seeing while driving or working on computers and mobile devices.

As people live longer, the cumulative amount of time the lens implant will need to provide clear vision is much greater than it was years ago. Determining the optimal time to have cataract surgery is an important consideration for both patients and surgeons.

Achieving an Outstanding Outcome

Clinically I focus my efforts on two areas in the preoperative stage. The first is making sure the patient has been properly educated about the cataract surgery. Does he or she know what type of surgery he or she is getting and what outcomes to expect? Once the patient completely understands the procedure and expectations are discussed, my next concern is whether the eye is healthy enough to undergo a cataract procedure. I carefully look at the anatomy of the eye, evaluating the ocular surface to make sure the cornea is not overly dry. Then, I look at the health of the retina as well. During this process, we inspect the macula to determine if it is clear of age-related macular degeneration (AMD) and diabetic eye disease, and we check to ensure the peripheral retina isn’t detached or torn. For each patient, I also obtain an optical coherence tomography (OCT) of the macula to assess the anatomy of the retina to further ensure the eye is healthy.

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This is an important step because there have been instances when we’ve found something on the OCT that suggests an underlying issue preventing good vision, even with a successful cataract surgery. In some cases, it could require additional surgery or long-term medical management that could compromise quality of vision.

Once this exam is complete, we review the findings with the patient and offer next steps. If we are going forward with cataract surgery, I like to set expectations of immediate outcomes based on the preoperative examination. However, we are still making an educated assumption because we won’t know the surgical outcome until the surgery is complete and the eye has healed.

Usually patients are extremely happy with their surgical outcomes. Inevitably, one of the first questions they ask is, “What can I do to maintain this outcome for the long term?” When asked this question, I start with the basics that all physicians should be telling their patients: Control your diabetes and blood pressure, keep your cholesterol in check, exercise, do not smoke, and eat a lot of green, leafy vegetables. Good systemic health is going to help maintain good eye health.

In addition to that advice, I recommend they use artificial tears to keep the ocular surface healthy. I ask them not to rub their eyes, and I instruct them to wear UV protection sunglasses when outdoors. One of the most important things I tell them is to supplement their diet with triple carotenoid therapy of lutein, zeaxanthin, and meso-zeaxanthin–the three most important nutrients for your macula.²

Nutritional Supplements are Evidence-Based Medicine

Five years ago, there wasn’t much data to explain why we recommended nutritional supplements to protect the retina. However, in the past 2 years, significant data have been published, providing me information I can share with the patient to strengthen the case for this recommendation.³

First, we have learned that if we can improve the patient’s macular pigment density layer, then we can achieve better visual function.³ This is demonstrated in the CREST (Central Retinal Enrichment Supplementation Trial) 2016 trial that was published in a peer-reviewed journal as a level-one evidence-based medicine.⁴ The placebo-controlled, double-blinded, randomized clinical trial concluded that supplementing with lutein, zeaxanthin, and meso-zeaxanthin improved visual function. Patients in the study showed less glare, better contrast sensitivity, and faster photostress recovery. It is important to note that those who had normal macular pigment density layers actually saw better, as well as patients who had below normal macular pigment density layers.

Secondly, the CREST AMD trial looked at patients with early-onset AMD and found similar results. When supplemented with lutein, zeaxanthin, and meso-zeaxanthin for a 2-year period, AMD patients’ vision increased.⁴ This is critical for AMD patients; if we are able to provide them with evidence-based supplements that improve their visual function, I think it is something all patients should be considering.

From a cataract surgery standpoint, we know through the Beaver Dam Study that, after cataract surgery, patients have a higher risk of developing AMD.⁵ With this in mind, it is our responsibility as physicians to do anything we can to help slow the progression in the event of AMD or at least maximize the patient’s visual function. Because of these two studies, I ask all my patients to supplement their diets with a triple carotenoid therapy consisting of lutein, zeaxanthin, and meso-zeaxanthin.

Maintaining an Outstanding Outcome

Cataract surgery is a considerable investment of time and money by our patients, and they want not only the short-term outcome of seeing clearly again, but also the long-term outcome of seeing clearly for the rest of their lives. We are now able to educate and advise our patients on both the cataract surgery and maintaining healthy vision for the long term.

One of the things we’ve learned through the process of the two aforementioned studies is when the best time is to educate patients about making lifestyle changes for long-term outcomes. That time is on the preoperative side, before cataract surgery takes place, or even before cataracts develop.

What I mean by this is to educate patients the minute they walk through my door. Introducing them to proven science that is available to them can have long-term effects. I like to start my patients on a nutrient that will optimize their macular performance. The product I use is MacuHealth (MacuHealth), because it contains lutein, zeaxanthin, and meso-zeaxanthin (Figure). MacuHealth’s triple carotenoid therapy was the product used in the published studies I’ve mentioned, and thus it is ideal for our patients.

Disclaimer: Pregnant and lactating women should consult a doctor before using. Food supplements should not be used as substitutes for a varied diet or healthy lifestyle. These statements have not been evaluated by the FDA. The product is not intended to diagnose, treat, cure, or prevent any disease.