Vision Quest

Our health and science expert brings you the answers.

By JUDY SIEGEL-ITZKOVICH
An illustration of an eye (photo credit: COURTESY YAD SARAH)
An illustration of an eye
(photo credit: COURTESY YAD SARAH)
I am 64-year-old man who underwent laser surgery to get rid of my glasses 15 years ago. The operation was very successful, but now my doctor says I have cataracts. He said they are “not yet ripe” so I should wait at least a year for surgery.
But the queue for surgery at a public hospital is at least a year. I read recently in a Hebrew paper that the views of ophthalmologists have changed, and that one should not wait until cataracts “ripen” but to do them as soon as possible.
What do the experts advise?
Y.L., Rishon Lezion
Dr. David Varssano, director of the cornea service and head of the cornea bank at Tel Aviv Sourasky Medical Center, answers: The current recommendation regarding cataracts is to examine them at a stage when they begin to interfere with daily functioning, usually with a slight decrease in visual acuity. If they bother you, you should have a cataract operation.
It may be that after examining you, your ophthalmologist found evidence that predicted a poorer recovery than usual from the surgery, and therefore preferred to wait. You should consult him about this.
Regardless of the date of surgery, you should know that having undergone laser eye surgery to remove your glasses in the past results in poorer results from cataract surgery. Because of this, you probably will need glasses more than a person who did not have laser surgery to manage without eyeglasses.
My 13-month-old son was diagnosed with a very small, benign growth over his right eyebrow that doctors called a periorbital dermoid cyst.
His health fund, Clalit Health Services, said that it was not dangerous but that he should have it removed by a plastic surgeon, probably under general anesthesia because he is so young and would otherwise move around.
When I asked when it would be done, they said they could arrange for a procedure at Soroka University Medical Center in three years! The staff did not explain whether the removal had to wait until he was four years old (which would probably be more traumatic than to do it now) or because there is a long queue for treatment at the hospital. What is a dermoid cyst? Should it be removed quickly or should it wait for three years – or have we been put in a long line by a healthcare system with such delays?
L.S., Beersheba
Veteran Jerusalem dermatologist Dr. Julian Schamroth replies: A dermoid cyst is a developmental growth that usually appears in small children near the lateral (outer) aspect of the eyebrow. It presents as a solid, firm lump that is slightly mobile. It may grow slightly with age. It tends to be a cosmetic – rather than a medical – issue, and many elect to leave it alone.
It was not a long queue that was the reason for the hospital telling you to return when your son is four years old.
Removal requires excision, usually by a plastic surgeon, and the resultant scar is usually minor and hardly noticeable. If the child is small, the procedure will have to be done under general anesthesia.
The decision as to when to do the surgery depends on the following factors: 1. General vs local anesthetic. For minor procedures, local anesthetic is always better than a general anesthetic. In other words, it is probably best to wait until the child is older, say eight or nine years, and can lie still for 10 minutes.
2. Cosmetic: If the nodule is large and attracting stares, then the parents might opt to have it removed at an earlier age. If it is small, I usually recommend waiting until the child reaches an age where it is bothering him/her and he/she wants it removed.
3. Function: If the nodule is causing any impairment of function (e.g., if the nodule is affecting the movement of the eyelids), then an earlier excision is warranted.
I am 73 years old and have recently been diagnosed with prostate adeno-carcinoma, Gleason 7. I would much appreciate it if I could get expert advice on what my best treatment option is.
A.L., Rishon Lezion
Prof. Raphael Catane, a veteran medical oncologist at Shaare Zedek Medical Center, answers: For the majority of patients with localized prostate cancer, Gleason 7, avoiding any treatment is the best choice. They need careful follow up, and the prognosis is excellent.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to jsiegel@ jpost.com, giving your initials, age and place of residence.