NewScope [July-August 1979]

              ®k NEW5C0PE
GREENSBORO, N. C
WESLEY LONG COMMUNITY HOSPITAL
JULY-AUGUST, 1979
A Clearer View
Alternatives After Cataract Surgery
Human vision, a precious sense, is possible through a delicate organ — the eye.
Basically, light enters the eye through the
pupilary opening, travels through the
lens, and arrives at the retina where the
image is formed. The image then is
transmitted to the brain by way of the
optic nerve. The result? We are able to
capture the world around us.
For an unknown reason, the lens, made
of protein and enclosed in a capsule, can
become opaque or hazy. When this occurs, the person has a cataract, and vision
can deteriorate. Oftentimes, with impaired vision caused by a cataract, the
decision needs to be made by the person
whether vision is sufficient for his/her
needs. If there is a need for improved
vision, and if the attending ophthalmologist (a medical doctor specializing in
the treatment of the eye) considers and
approves the person's physical condition,
cataract surgery may be performed. The
operation consists of removing the lens
and the capsule it is contained in. At this
point, the cataract has been eliminated.
(There are several methods of extracting a
cataract.)
A person's vision following cataract
surgery changes and a very strong correction is usually needed. One of three
choices can be made to remedy this situation.
One alternative is cataract glasses.
These are not easily tolerated by some.
They are rather difficult to adjust to for
some people since the glasses produce a
magnification of about 30 percent of objects seen through them. They do allow
good central vision for the wearer but not
as clear peripheral vision. A common
misconception is that these glasses are
very unattractive and not easy to handle.
Nowadays cataract glasses are made of a
lightweight plastic and can be made fashionable. The overwhelming majority of
cataract patients adjust to the glasses
within 3 to 6 months despite the drawbacks.
A second choice is contact lenses.
However, not everyone can learn to
handle them. Contact lenses are not as
visibly obvious as cataract glasses and for
some are more cosmetically pleasing. For
other patients, especially the older age
group, they are difficult to insert and
remove and are therefore not chosen as
often as the other alternatives. They do
restore a natural, undistorted vision and
are perhaps the safest way of achieving
clear vision for the cataract patient.
Thirdly, an intraocular lens implant can
correct vision after cataract surgery. This
is a small man made lens replacing the
natural one removed during cataract extraction. Basically, the use of an intraocular lens implant replaces natural vision
without need of cataract glasses or contact
lenses. Conventional spectacles are usually needed, however.
Intraocular lens implantation, performed  immediately  after  cataract   re
moval or rarely in a later operation, consists of actually inserting a small, plastic
artificial lens inside the eye. The procedure is usually done under local anesthesia but can be done under general.
Held in place with polypropylene supports, the lens is usually effective in restoring a natural and distinct picture for
the person. Some persons feel that an
implanted lens is much better than adjusting to contact lenses or cataract glasses.
Others may prefer to adjust to cataract
glasses or contact lenses and forego possible complications related to the lens
implant and the risk inherent in the additional surgery. The risk of long term
complications of lens implants must also
not be forgotten. As long as the lens is in
the person's eye, problems may occur. It
is the patient's decision whether the benefits of the lens implant offset the risks
or not. Many people with diabetes, iritis,
glaucoma, or various other eye diseases
are not considered candidates for IOL by
most surgeons. Certainly, someone with
one eye is not a candidate.
Within the past month, another means
of restoring vision after cataract surgery
has been approved by the FDA. These are
soft continuous wear contact lenses which
have to be removed and cleaned every
several months and therefore offer benefits of an intraocular lens.
The End of an Era
Director of Nurses Retires
A front view of the eye with an intraocular lens
inserted into it.
About eight out of twelve ophthalmologists in Greensboro now perform intraocular lens implantations. Wesley
Long Hospital is equipped to handle this
procedure as are the other Greensboro
hospitals. In order for an ophthalmologist
to perform the procedure, which is not
"particularly complicated," approved
courses on the technique which last two to
three days are taken. No Greensboro
ophthalmologist who has taken the course
has been disapproved as an intraocular
lens surgeon or has not passed the course.
The concept behind this artificial lens
dates back to the mid 1940's after it was
discovered that the plastic making up aircraft windshields used in World War II
(pieces of the windshields sometimes
were blown into the eye during battle)
could be tolerated by the human eye without an adverse reaction. Although the
initial.idea of replacing the natural lens of
Matthews
Miss Lucille Matthews, Director of
Nurses at Wesley Long Community Hospital, retired on June 22, 1979. This date
marked the end of her 32 year nursing
career at the hospital.
Miss Matthews joined the nursing staff
of Wesley Long in October 1947 when it
was located on North Elm Street. Past
director of nurses Virginia Williamson
recalls hiring Miss Matthews, "One of
the best days I had at the hospital (Wesley
Long) was the day I hired Lucy Matthews." Matthews worked as a floor
nurse and nursing supervisor afterwhich
she assumed the position of Director of
Nurses in 1952.
Bom in Wallace, North Carolina, she
attended James Walker Memorial Hospital School of Nursing in Wilmington,
North Carolina and graduated as a R.N. in
1936. This fulfilled her lifelong desire to
become a nurse. Since the age of five
when she had a tonsillectomy, Matthew's
ambition was to become a nurse and as
she put it, "just a plain nurse."
After working as a registered nurse at
Duke Hospital in Durham, North Carolina, she spent two years at Indian River
Hospital in Vero Beach, Florida. Joining
the United States Army Nurse Corps in
1941, Miss Matthews was first stationed
at Fort Bragg, North Carolina. She was a
member of the 55th station hospital division and was later stationed in North Africa and Italy during the Second World
War. In Africa, Matthews, along with 28
other nurses, set up the 55th station hospital in Kairouan to care for the wounded.
The 55th division then traveled by ship
to Italy. Soon after the ship docked and
the medical personnel were on their way
to Florence by trucks, Germans bombed
the ship and sank it. All medical supplies
on board were destroyed causing the crew
to secure supplies at a nearby general
hospital in order to set up the 55th station
hospital in Florence.
Miss Matthews returned to Fort Bragg
and was discharged from the army in
1946. She worked at McGuire Veterans
Hospital in Richmond, Virginia following
her army duty. After applying to several
hospitals in North Carolina, Miss Matthews chose Wesley Long Hospital because of, she relates, its smallness and
personable staff.
The staff of Wesley Long regrets that
Miss Matthews has left, but is grateful for
the many years of dedicated service she
rendered.
the eye with an artificial one was a promising one, the first implants caused problems. One such problem was the reaction
of the eye to impurities in the plastics.
Improper fitting and positioning of the
lens inside the eye was another weak
point.
During the 1970's, new methods of
inserting the lens and new lenses cropped
up worldwide. In some cases, after the
lens had been implanted, patients experienced eye irritation and deteriorating vision. Some such problems were serious
enough that all vision or even the eye
itself was lost.
The Food and Drug Administration of
the federal government intervened at this
time and called lens implants to a halt
until the materials and techniques used in
the procedure were refined. In its effort to
monitor lens implants, the FDA began a
program to register and certify all sur
geons who had proper training to do this
procedure and to follow closely for two
years patients who had had an implant.
The purpose of this study is to determine
which lenses and surgical techniques are
the safest and will best stand the test of
time. As a result of the study, it is possible
that the use of only certain lenses will be
allowed or that lens implantation could
altogether be stopped if the results are
unfavorable.
It is important to note that an intraocular lens implant is not a cure all for
patients who have undergone cataract
surgery. Even if the patient's condition
has been carefully studied, complications
can occur during surgery, weeks, and
even years later. Any patient considering
cataract surgery and/or a lens implant
should be fully informed by the surgeon
of advantages and disadvantages related
to both procedures.