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- Myeloma and Cataracts- Updated
Myeloma and Cataracts- Updated
Myeloma and cataracts are closely related. I have always attributed my own cataracts, both eyes, to high dose dexamethasone. I have written about myeloma and cataracts because of my mantra, I wish I knew than what I know now.
To be clear, as is the case with many aspects of my MM experience, cataract treatment has come a long way since my operations in 1997. While cataracts are a problem and can cause problems, the good news, as far as I’m concerned, is that cataracts are one common, long-term side effect that can be treated well.
Does Dexamethasone Cause Cataracts?
Two key takeaways-
- First, the dose of dexamethasone, according to research, had NO inflluence on outcome- your overall survival or your first remission. See the research linked below.
- Second, and this is just my opinion, two different lenses, one close, one far, is what I have. I don’t like my day to day experience with these lenses.
If you are a MM patient considering cataract surgery, email me with any questions you may have- my email address is David.PeopleBeatingCancer@gmail.com
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis
“Key Points
- Dexamethasone dose reductions below 40-60 milligrams weekly are common in multiple myeloma, even for patients enrolled on clinical trials.
- Dexamethasone dose reductions did not impact PFS or OS in newly diagnosed multiple myeloma in multivariate analyses.
New Advances in Cataract Care: Safer Surgery, Better Lenses
“Technological advancements and the development of intraocular lenses (IOLs) have significantly improved the care of patients with cataracts, especially for those who would prefer not to wear glasses…
Thanks to optimized imaging analysis techniques, such as optical coherence tomography (OCT) and Scheimpflug imaging, the lens opacification characteristics of cataracts and corneal conditions can now be captured effectively. In addition, factors such as glare sensitivity, contrast loss, and light scattering can be quantified.
Enhanced Pathology Detection
These advancements contribute to the indication and surgical strategy for the procedure. “Diagnostics are particularly important to exclude other eye pathologies that could suddenly cause problems during surgery or that are relevant for the choice of IOL,” Auffarth explained.
Innovations in Intraoperative OCT
“The surgery itself has also become even better and safer,” Auffarth said. With the use of novel surgical microscopes combined with 3D glasses and a large screen, the surgeon no longer needs to look through eyepieces but can view the surgical field freely in the room. The image quality and depth perception are impressive, according to Auffarth.
Additional diagnostic options, such as intraoperative OCT, and surgical guidance systems similar to a vehicle’s head-up display have been introduced…
More Specialty Lenses
The most commonly used IOLs in cataract surgery are monofocal lenses. These lenses are regarded as having the highest image quality and have a single focal point, which can be chosen on the basis of personal preference for distance, near, or intermediate vision. Corrective eyewear is then necessary for optimal vision in the other areas.
If the goal is to avoid glasses or contact lenses after surgery, alternative IOLs are available. These include specialty lenses with multiple focal points, lenses with extended depth of focus (EDOF), and lenses for astigmatism correction (toric lenses). In the context of refractive lens surgery, such as for correcting presbyopia (age-related vision loss) without cataracts, these premium or specialty lenses are increasingly being used in younger patients…
Alternative to Trifocal Lenses
For a long time, trifocal lenses — those with three focal points — were the most commonly used specialty lenses. These lenses utilize a specialized optical configuration to disperse light into distinct focal areas, facilitating distance, near, and intermediate vision. This technique results in some loss of contrast and partial overlap of focal lengths.
Despite advancements that have reduced light loss from up to 20% to below 10%, “trifocal lenses remain susceptible to light-related side effects such as halos or glare and scattering light phenomena, which is why they are no longer the undisputed first choice,” Auffarth said.
The strongest competition now comes from EDOF IOLs, which no longer have clearly defined focal points. Instead, their focus is distributed over a relatively wide range. The biggest advantage is the reduction in light-related side effects, although there may be some limitations in near vision. The growing popularity of these lenses is demonstrated by a survey from the European Society of Cataract and Refractive Surgeons, which found that in 2023, nearly as many depth of focus lenses as trifocal lenses were used.
Combining Different IOLs
However, both lens systems can also be combined using a mix-and-match configuration. “For example, combining an EDOF IOL in one eye and a trifocal lens in the other eye can be a good option in individual cases to reduce side effects,” Auffarth said.
Monofocal-plus lenses have also been available for some time. These are single-focus lenses with a depth of focus that permits sharp distance vision and some intermediate vision. In the so-called monovision strategy with these lenses, one eye is set to 0 diopters, while the other is slightly nearsighted at minus 1 diopter.
Another alternative is the “blended vision” approach. “Here, we use EDOF IOLs so that one lens provides distance vision, while the other provides near vision, and together they cover the intermediate range.” According to Auffarth, EDOF and monofocal-plus lenses are increasingly being used in patients with moderate pathologies…
In Auffarth’s experience, “academics seem to place more value on their near vision and less on independence from glasses than others.”
Myeloma and cataracts Myeloma and cataracts