Eyeworld

April 2014 so that finding is not completely new. She noted that HRT in its current form can have questionable safety but that cataracts are a rela- tively easy problem to treat. "So the protective effect of HRT for cataract development must be weighed against the serious negative effects," Dr. Tanchel said. Dr. Waxman also supports con- sidering the big-picture effects of HRT. "We would expect women to work with their doctors to make the decision about HRT based on the benefits versus risks of heart disease, stroke, blood clots, and breast cancer," he said. "Further research needs to be carried out to determine whether those getting HRT in the studies col- lated have avoided other risk factors for cataracts throughout life versus those not getting HRT," Dr. Tanchel said. Dr. Tanchel said if HRT were found to be truly protective, it would be useful to develop related drugs that have less systemic effects. EW References 1. Lai K, Cui J, Ni S, Zhang Y, He J, Yao K. The effects of postmenopausal hormone use on cataract: A meta-analysis. PLOS One. 2013;8:e78647. 2. Lindblad BE, Håkansson N, Philipson B, Wolk A. Hormone replacement therapy in relation to risk of cataract extraction: A prospective study of women. Ophthalmology. 2010;117:424-430. Editors' note: The physicians interviewed have no financial interests related to their comments. Contact information Hardten: drhardten@mneye.com Tanchel: CMerz@opubco.com Waxman: waxmane@upmc.edu GET TO THE ROOT OF AN UNSTABLE TEAR FILM LipiFlow ® directly treats the leading cause of tear-lm instability and ocular discomfort: Meibomian Gland Dysfunction. VISIT BOOTH #463 5151 McCrimmon Pkwy Suite 250 Morrisville, NC 27560 Tel: (919) 467-4007 email: info@tearscience.com www.tearscience.com Call us: (919) 459-4891 • www.tearscience.com Visit www.tearscience.com for complete product and safety information. LipiFlow is a registered trademark of TearScience, Inc. Copyright © 2014—TearScience ® —The Evaporative Dry Eye Experts. All rights reserved. Postmenopausal continued from page 21 by Michelle Dalton EyeWorld Contributing Writer Diabetes and the cataract patient This growing population has some unique challenges for anterior segment surgeons D iabetes affects hundreds of millions of people worldwide, and the International Diabetes Federation expects that number to reach close to 600 mil- lion in the next 25 years. More than a quarter of patients over age 65 are likely to have diabetes, and that has altered how anterior segment sur- geons need to treat the cataract population. This particular subset of patients is at a higher risk for postop complications, including cystoid macular edema (CME). "When postop macular edema occurs, it's sometimes difficult to dif- ferentiate between worsening dia- betic macular edema (DME) versus Irvine-Gass related CME," said Rishi P. Singh, MD, staff physician at the Cole Eye Institute, Cleveland, and assistant professor of ophthalmol- ogy, Case Western Reserve Univer- sity. What often happens is the cataract does not allow easy imaging of the retina, so once the cataract is removed, "surgeons may find prolif- erative diabetic retinopathy (DR) or clinically significant macular edema that they didn't know was there." After cataract extraction, treat- ing the remaining DME is of para- mount importance, or the patient may not see as well as those without diabetic complications, said Rohit Varma, MD, professor and chair of the Department of Ophthalmology, and associate dean for strategic planning, Keck School of Medicine at the University of Southern California, Los Angeles. "If patients have known dia- betes, refer them to a retina special- ist to ensure there's no macular edema or retinopathy," Dr. Varma suggested. "Otherwise, the postop cataract outcome may not be as good." Poorly controlled diabetes can damage the small vessels in the retina and cause leakage of fluid that leads to swelling and a loss of cen- tral vision, yet nearly half the sub- jects in a recent study 1 with both DM and eye damage "had not visited a clinician in the same year before the study," Dr. Varma said. "If they've had prior vitreomac- ular surgery or known DR or DME, there are numerous studies that show using nonsteroidal anti-in- flammatory drugs (NSAIDs) for a week before and two to three months after surgery lowers the risk of diabetic-related complications continued on page 24

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