The diabetes is more and more common in the modern societies. Our habits, the lifestyle, lack of exercise and high intake of sugar result in almost all of us have a relative with this disease. So, what to do when the doctor tells you that you have high blood sugar? Well, in the first place it is not the end of the world, it is possible to have a normal life with diabetes. But it also means that you will have to change some aspects of your life, especially the diet and have more exercise.

Ablue-eye-close-up_1122-369nd it will also mean to have to go to the doctor more frequently, among others to an eye specialist. High blood sugar can cause retinal disease and in some cases, it may finally produce vision loss. When a person starts to see blurred it is more difficult to regain the lost vision so it is better to prevent. All the type 2 diabetic patients should have their eyes checked when they are diagnosed to have high blood sugar and then, they should have eye check-up once a year. To perform a thorough examination it is necessary to put drops to dilate the pupils. Only in this way, the doctor will be able to see whether any treatment is necessary.


There are different possibilities when we have to treat diabetic retinopathy. We can use a laser, intraocular injections, or surgery. We opt for surgery when there is blood inside the eye and we cannot deliver laser treatment, of the retina is detached. But for the majority of patients, we can use laser or injections. Which option is better? Well, the answer is pretty straightforward- these treatments are completely different and they cannot be compared.

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The results of the laser treatment are much slower, sometimes it takes more the six months to see the visual improvement, but they are forever. On the other hand, the injection is very fast and the vision may improve only after a few days. This is fantastic, but this effect in some cases will only last for a few months. This is why it is necessary to put another injection, and then another and another.

In our opinion, the best option is to combine the advantages of both treatments. The injection will give us a quick visual improvement and the laser will allow us to maintain this effect for a longer time. The result will be more permanent and it will be not necessary to put so many injections.

Traditional Or Laser-Assisted Cataract surgery?

Patients may be confused when considering to undergo cataract surgery. If you check the internet for information, you may be offered a choice of two surgical options: traditional cataract surgery or laser-assisted cataract surgery.

Cataract surgery is one of the most common surgeries in the world and it is recognized as a safe and effective procedure. In recent years, laser-assisted cataract surgery has been offered as a new step forward in this field. But, is it really?

Modern cataract surgery is called phacoemulsification. The objective is to break, melt and vacuum the lens out of the eye using the ultrasound issued by a probe. We set it into the eye through such small incision that self-seals. Surgeons create these incisions with small precision metal or diamond blades. We also open the lens capsule with a circular tear that allows us to reach the lens body and remove it. The surgery finishes with the implantation of an artificial intraocular lens that replaces the former human cloudy lens into the remaining capsular bag.
With laser-assisted cataract surgery, a computer analyses the characteristics of your eye to create the incisions, the round capsular tear and cut the lens in small pieces to be then removed using the same ultrasound probe that we use in traditional cataract surgery. The IOL is implanted the same way also and the corneal incisions usually do not require stitches. Both procedures are basically the same technique and the recovery and results are the same.

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It seems we have an enhancement in cataract surgery but no study has shown today that laser-assisted cataract surgery results in fewer complications or better visual outcomes than traditional cataract surgery. With any type of cataract surgery, your outcome depends in large part on the skill and experience of your eye surgeon. For a skilled surgeon is not a problem to perform the steps that the laser do, and the steps where there are more surgical problems are those not made by the laser that requires the skilled surgeon’s hand.

There are no clear indications today for laser-assisted cataract surgery over the traditional procedure. Some centres are offering it in cases of high astigmatism to create corneal specific incisions to decrease it, but we also can add LASIK or PRK to enhance this cases after the cataract surgery. We call this procedure bioptics.

The final consideration is that the price is higher for laser-assisted cataract surgery. Laser machines are expensive and there is an extra cost to be charged for the surgery fees. When we talk about health, I think the price is the last thing to talk about, but we have to. Most of my patients choose the expensive procedure if it gives an advantage over the cheap one. They can be better results, lower pain, fastest recovery… But for what we have seen by now, there are no clear advantages to perform most of the cases with the laser. On the other hand, this technology is under development now and it can give us more benefits in the future. I think it can be the next step forward to enhance cataract surgery. And it shows that the current “traditional” phacoemulsification with all the technological development it has had, is difficult to be improved.

Tip – It is funny to talk about “traditional” surgery to refer a technique that was a big jump 30 years ago. At that time, most of the surgeons were changing to it from the “traditional” extracapsular extraction. But time passes very fast!


It is very common for diabetic patients to complain of photophobia (discomfort or pain to the eyes due to light exposure). There are many reasons, the most important one is that it is always very sunny here. The amount of sunlight is much higher than, for instance, in Europe, so it is also more difficult to move around if you are more sensitive to light.

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Other reasons are related to the eye conditions, like for example, cataract or retinopathy. So if somebody has problems in the retina or had an eye operation it is normal for them to be more sensitive to light. This is why we always use intraocular lenses with special UV filter to protect the retina when we operate diabetic patients and, of course, everybody should wear sunglasses when outdoors.



When Should Cataract Surgery Be Performed?

Due to our increasing life expectancy, cataracts have become a common issue, mainly for elderly people. Cataracts have only one solution: surgery. This word sounds quite scary but current surgical techniques for cataracts have increased its safety to the highest levels ever. Despite this, there may be some misconceptions when someone is told to be developing cataracts.

Cataracts are usually caused by the aging process. Our skin changes according to our age and our lens do the same. The human lens is key for the eye to focus the images. All the incoming light to our eyes passes through it.


As we age, the natural clear lens inside the eye becomes progressively harder and cloudier. Cataracts develop at different rates for different people, and even between the two eyes of the same person. Although some varieties of cataracts tend to grow more quickly, most of them use to have a slow development and can take years to give symptoms. The vision becomes blurred and some activities are more difficult to perform, as night driving, the patients refer glare with bright lights or increased photophobia and he can complain of difficulty with seeing the small print on TV or the newspaper.


Any surgery, as any human activity, is not 100% safe. But the technology available now has made this procedure today the safest ever. When you complain about progressive increasing blurred vision and you are told to have cataracts there is only one option: go for surgery. Of course, this is not an emergency and the surgery can be arranged on the next weeks but if we tell the patient to wai, it is not usually a good advice because the vision will not improve with the time and he is complaining already of the effects of the cataract on his vision and activities.

There are health reasons to advise to do the surgery the earliest possible. The older the patient, the worse the recovery. The recovery for any surgery is better when you are 60 than when you are 80. Some diseases, as diabetes, can develop with the aging and may have effects on the health and the wound healing.

Operation.jpgThere are also technical reasons. A long time ago, it was normal practice to delay the cataract surgery as much as they could because the procedure was different. With the development of phacoemulsification and the technology available, the sooner, the better. With the time, the cataract lens becomes harder and it is more difficult to break, melt and aspire. A hard cataract was an advantage a long time ago, but it is a disadvantage today.

We also have to consider the speed of evolution. Cataract development changes the focus of the eye thus changing its refraction. If the development is slow, updating the glasses can improve the visual symptoms for years. But when a new glasses prescription no longer improves the sight adequately or the development is fast, this is when surgery is indicated.

Once we reach a point where the quality of life is getting worse, the patient should balance the risks and the benefits. Delaying the surgery increases the risks especially in some circumstances, such as in Fuchs’ dystrophy, pseudoexfoliation or narrow-angles. The Ophthalmologist should point them out. When you feel you are frequently impaired, the benefits will outweigh the risks, and it’s time to go for surgery. You should not feel any hurry but also have enough information to be sure this is the right decision.



One of my friends, a flight attendant from the Spanish airline Iberia, has recently asked me the following question:
Do you know something about a drug, commonly used by ophthalmologists, that makes your eyelashes grow beautifully? My American colleagues are currently using it, applying a drop of the product with a cotton swab to the eye rim. I believe the price of this eye drop is 10 times less than the specific eyeliner sold in beauty centers to make your eyelashes grow…
I was astonished and at the same time intrigued by her question. Of course, I knew what she was talking about. But was it really true that her friends, American flight attendants, were actually using glaucoma drugs to make their eyelashes grow? Did they know the risks they were assuming? And on the other hand, was there a specific beauty product designed to make your eyelashes grow? Was it safe? I decided to find out more about this eyeliner…

Close-up of beautiful little girl brown eye
Regarding her initial question, for me the answer was crystal clear: the use of prostaglandin eye drops (e.g. Xalatan ®, Lumigan ®…), potent medications used for glaucoma patients, applied with a cotton swab to the eye rim, was not safe at all.
Glaucoma, (being primary open-angle glaucoma, the most common type) is a silent disease, that progressively causes visual field loss. It develops slowly over time and there is no pain. Side vision starts to decrease, followed by central vision, resulting in permanent blindness if not treated.
An increase in intraocular pressure is involved in most cases of glaucoma. That’s why the goal of any glaucoma treatment (not only medications but also laser and surgery) is to decrease eye pressure. A number of different classes of glaucoma medication are available, being prostaglandin analogs the most effective ones. But unfortunately, prostaglandins, have some side effects. They may cause changes in iris color and eyelid skin, the growth of eyelashes, stinging, blurred vision, eye redness, itching, and burning.
But, wait a minute wasn’t the growth of eyelashes, what these flight attendants were looking for? Yes, but unfortunately, the growth of the lashes, may not always result exactly in what they were expecting. In some cases, the size, the thickness, and distribution of the lashes may resemble more a mustache than the sensual image, these ladies were dreaming of. Lashes can grow very rigid, disorganized and in the wrong direction, rubbing on the eye.
On the other hand, frequent contact of prostaglandin drops with the surface of the eye can change a blue iris into a brown one and can increase conjunctival and eyelid skin pigmentation, causing dark undereye circles.

These side effects have to be balanced with the desired effect on the eye pressure, that a patient with glaucoma needs, in order to maintain his vision. But is the risk worth taking for to achieve longer lashes? I believe it is not.
And what about that specific product sold as an eyeliner to achieve lashes growth? What is it exactly? Surfing the web, I found a special story:
It all began when a Doctor wanted to give his wife a very special gift…

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RevitaLash® was developed by Michael Brinkenhoff, M.D. as a special gift for his wife, Gayle, while she was recovering from metastatic breast cancer treatments. Gayle’s once-beautiful eyelashes had become dull, brittle and lifeless. Dr. Brinkenhoff believed that he could find a way to give Gayle’s eyelashes the look of renewed health, strength and beauty.


So I found out, that prostaglandins, were being used to help patients that had lost their eyelashes and eyebrows after chemotherapy treatments. To help them improve their self – esteem and not only after chemotherapy treatments but also in cases of stress alopecia, eyelid psoriasis, and severe blepharitis.
Even for these cases, and applied to the eye rim, not with a cotton swab, but with a fine eyeliner, prostaglandins can cause the side effects mentioned above. However, it is always a matter of balance between risks and benefits. And from my opinion, the side effects of prostaglandins, when being used in a patient with a potential sight-threatening disease like glaucoma, can be assumed.
In other circumstances, the risks may increase the benefits, and even, patients with severe loss of eyelashes, secondary to chemotherapy for cancer, must always be aware of the potential side effects of topical prostaglandins, applied to the eye rim.

Dr. Luisa M. Sastre, MD, PhD
Consultant Ophthalmologist at Quironsalud Ophthalmological Institute

TIP ! – Glaucoma is a silent disease that can cause permanent blindness if untreated. You should visit your ophthalmologist for an eye check-up, at least once a year or every two years, from 40 years onward, especially if you have a family history of the condition, migraines, high blood pressure, or obesity (which are risk factors for glaucoma).