Desert Health News - November-December 2023

. With over 3 million operations performed annually in the U.S., cataract surgery is extremely common. But does it ever need to be performed twice? Once a cataract is removed, it does not grow back. That being said, there are rare instances when patients may need another surgery months or years after their initial cataract surgery to replace or repair a lens implant. In this article, we’ll cover these scenarios. Themost common reasonpatients say their ‘cataract grewback’ is posterior capsule opacification. This is not a regrowth of a new cataract, but a clouding of the natural capsule behind the lens implant. Because it has similar symptoms as cataracts, such as glare, halos and decreased vision, a capsule opacification is colloquially referred to as a “secondary cataract.” Fortunately, a posterior capsule opacification is easily corrected with a simple office treatment called YAG laser capsulotomy. The next scenario is one of the common reasons patients call for a second opinion consultation, and that is when there is an unexpected visual outcome after routine cataract surgery. Either the initial lens may have been the wrong power or the visual side effects of a multifocal lens implant are intolerable to the patient. In both cases, a lens implant exchange is warranted. In an era with surgical time outs and electronic medical records, it is extremely uncommon that a wrong lens power is implanted during cataract surgery. However, factors in pre-operative measurements and planning such as prior corneal refractive surgery like LASIK, can confound computer formulas cataract surgeons rely on to select an appropriate lens power. If a cataract lens implant needs to be exchanged, it is best to perform the operation in the early post-operative period of the initial surgery. Rule of thumb is that if a lens needs to be exchanged, make the decision quickly and return to the operating room within the first few weeks of the initial surgery. The earlier a lens is exchanged, the lower the risk of complications. The final scenario of having to perform a cataract surgery twice is when the initial lens implant dislocates. This can happen after trauma or in specific disorders like pseudoexfoliation syndrome (50% of all cases), Marfans’ syndrome, Ehlers-Danlos Syndrome, retinitis pigmentosa and prior vitreoretinal surgery. A lens dislocation can cause symptoms of oscillopsia (jiggling vision), rapid changes in focus, light sensitivity and glare. Some patients even report seeing the edge of the lens implant. Fortunately, there have been major advances in surgical techniques that make lens replacement and repair surgery much easier now than ever before. Twenty years ago, it would take surgeons nearly five hours to perform lens repositioning surgery using the older techniques with large dissections and multiple stitches. Today, with modern techniques such as the Yamane, we can usually perform these complex surgeries in under an hour, often without the need for sutures. This means less surgery time and faster recovery for patients. Dr. Tokuhara is a cataract surgeon with Desert Vision Center in Rancho Mirage and a member of Desert Doctors. He can be reached at (760) 340.4700. For more information visit www.desertvisioncenter.com or www.desertdoctors.org . This is a groundbreaking book that unifies mental health problems with physical health problems. Harvard psychiatrist Christopher Palmer presents a new way of thinking about mental health conditions as metabolic diseases rather than behavioral or brain chemistry disorders. His arguments are compelling, backed by solid science and put mental health in line with the most common health problems today including diabetes and the diseases of insulin resistance. Ever since Freud and others described the origins of mental illness, these disorders have been considered problems of emotions or thinking, and more recently brain chemistry. The brain is an electrochemical grid of great complexity and mental health disorders have been thought of as disorders of this unique organ. Such thinking contains some truth, of course, but Dr. Palmer explains how mental health problems are largely disorders of mitochondria, the energy packets in each of our cells. Mitochondrial function largely depends on what nourishment we feed the cell; excess sugar and processed carbohydrates lead to mitochondrial dysfunction. After explaining the process of brain energy and the energy imbalance around mental disorders, Palmer offers a list of causes that consider genetics and epigenetics, chemical imbalances, neurotransmitters, medications, hormones, inflammation, sleep problems, food and the microbiome, mind-altering drugs and alcohol. He then discusses solutions including the benefits of fasting, physical www.DesertHealthNews.com November/December 2023 Medical News The Valley ' s Leading Resource for Health and Wellness 9 www.worldwidetravelhealth.com Arrive prepared with our Traveler’s Report for your specific destination and the recommended vaccinations and immunizations to help keep you safe and at ease. 760.895.4097 41750 Rancho Las Palmas Drive • Suite M1 • Rancho Mirage Where will your adventures take you? Shahriyar Tavakoli, MD, MHA Jade Bedard, MSN-Ed, BSN, RN Certificate in Travel Health TM rldwidetravelhealth.com Serving the entire Coachella Valley www.desertvasclarassociates.com Personalized quality care delivered with compassion and integrity Anna Gasparyan, MD, FACS Vascular Surgeon Desert Vascular Associates 760.902.1511 74000 Country Club Dr. • Suite G-3 Palm Desert CA 92260 DesertVascularAs ociates. Special Interests: Varicose Veins/Venous Insufficiency Carotid Artery Disease Aortic Aneurysms Peripheral Vascular Disease (PVD) Endovascular Interventions Dialysis Access IVC Filters Chemotherapy Port Insertion Accepting new patients and most major insurance plans Palmer's Brain Energy A Review by Joseph E. Scherger MD, MPH activity, love and other emotions, and offers a metabolic treatment plan for the brain consistent with the known healthy foods of nature. Psychiatric Daniel Amen has offered similar food lists in his books. As a functional medicine-oriented physician, I am excited to learn of a new and internationally growing subspecialty of nutritional psychiatrists. I previously reviewed a book by Drew Ramsey, MD, Eat to Beat Depression and Anxiety (May/June 2021). Patients find it very helpful along with certain supplements such as SAMe, saffron and ashwagandha. Brain Energy is written for general consumers and easy to read. Physician leaders in nutrition and health who have shown their support include Mark Hyman, MD, David Perlmutter, MD, Jason Fung, MD and Robert Lustig, MD. These endorsements welcome and praise Palmer for bringing mental health into whole body wellness and the functional medicine spectrum. Dr. Scherger is founder of Restore Health Disease Reversal in Indian Wells, a clinic dedicated to weight loss and reversing chronic medical conditions. To schedule a consultation or for more information, visit www.restorehealth.me or call (760) 898.9663. Ever Need Cataract Surgery Twice? By Keith G. Tokuhara, MD