Cataract.
Hello, I/we will share my/Mochi’s story/experience on Cataract and his surgery here. It’s an on going stressful journey that has not end.
Firstly, what exactly is a cataract? The lens in the eye is made mostly of water and protein. The protein is transparent and it allows light to pass through and focus on the retina. When the structure of the protein changes and starts to cloud a small area of the lens, loss of transparency happens. Similar to a raw egg white and a cooked egg white. Cataract happens when there is a change of opacity in the lens. In time, when the cataract matures, it will grow larger and cloud more of the lens, making it difficult for your pet to see. As it matures, it gets harder as well. A cataract may suddenly come and mature anytime. It could take a week, or a month, or a few months, or few years.
A mature cataract may change into a hypermature, which are usually reduced in size due to loss of water and proteins from the lens. This causes the lens to shrivel and the lens capsule to wrinkle—similar to a grape turning into a raisin. A cataract cannot be reversed but can only be removed through surgery. (from research, some eye drops mentioned that they have been proven to reduce cataract but I find that it may not be true for dogs).
Cataract may also cause pressure in the eye to build up, and they might get glaucoma. Glaucoma is likely to be painful, causing headache/migraine. You may read more on cataract here. http://animaleyecare.net/diseases/cataract/
If you decided not to have your dog under go surgery, it is recommended for you to bring him for frequent check-ups. Doctor may prescribe you eye drops to help maintain accordingly. As there are many eye problems that may appear due to the side effect of cataracts. Of course every surgery comes with a risk as well.
Mochi’s cataract matured rather quickly. Within a month, his eyes was very very cloudy, it shocked us.
in this picture, his eyes was deliberately dilated to see it’s severity level
There are many causes & reasons mentioned on the internet on why one would develop cataract. But it may be hard to point out exactly. Some of the reasons includes:
- genetic genes
- accident / trauma / impact to the lens of the eyes
- inflammation/irritation in the eye may cause the structure of the protein to change
- aging
- other side effects like diabetes.
Pets with diabetes often get hit with cataract and they have been known to mature very quickly. - lack of nutrient (according to this article https://www.holisticpetinfo.com/Tips-for-Pets-with-Diabetes_b_26.html &
https://www.holisticpetinfo.com/Cataracts-in-Dogs_b_23.html ) - born with a specific nerve which should have been gone when a puppy is born, but sometimes it’s still there, hence that causes inflammation to the eyes. (what the first doctor told us that could be possible for Mochi’s situation)
Early June 2015, we suddenly spotted Mochi with a cloudy eye (left eye). We brought him to our usual clinic in Subang, the doctor confirmed that he has the cataract. (The doctor even confirmed it wasn't there a month ago when we visited him with Mochi.) We were given a couple of choices, surgery of course was one of it, and there was this eye drop, called “Can-C” which was said to work by some people.
Doctor also advised to leave it since it was only 1 eye that has been affected with cataract. This means he still has one good eye. Doctor advised to avoid surgery for now and to try the Can-C drops
We went home and researched. Some reviews said it worked very well, some said there was no changes seen, 50-50. So I ordered them for Mochi. (Mochi’s eyes have been producing pus since June 2014, in which the doctor said it was just dried eyes).
(We ordered one box of Can-C to try out to see if his eyes was sensitive to it. It cost us USD40, consisting of 2 bottle of drops which last 24 days approx. We ordered the next 6 box (12 bottles) for USD198)
On 20th July Mochi started on “DMG chew” as it was recommended by a friend to boost his immune system. I realise that his eyes does not produce pus anymore too.
In September 2015, 3 months after, his right eyes developed cataract too. We started his right eye on “Can-C too. We’re concern now because both eyes are affected. We looked for an eye specialist. Lets call her “Dr C”. She was recommended and known by the vets and friends around.
On 7th Nov 2015 he was prescribed with Nevanac eye drops. A surgery was scheduled in January 2016 because the doctor was busy in November and December.
11th December 2015, we put him on Ocu-Glo. A supplement recommended by Dr C that says to suppress the cataract from maturing. Although there is only one website that supports this result, we decided to give it a try anyways. It was very costly as our currency was at one of it’s worst points. It cost us total Singapore Dollar 339 for 3 bottles. (After researching, it was cheapest in Singapore compared to anywhere else).
1st week January, Dr W (a doctor that works together with Dr C) called me and now suddenly told me that I cannot bring Mochi home after the surgery. Earlier before, she mentioned that I could. Now I cannot, and started warning me about how dogs left at their vet at night gets anxious being alone and hurt themselves. Yet they are reluctant to suggest any other solutions, but again and again, warned me that they have told me and cannot be responsible if anything happens to Mochi. I was very very angry during the phone call because they didn’t even allow me to speak, instead they kept going on about their stories on how they had dogs injuring themselves, other incidents and accidents, etc etc. I kept insisting for a solution and not a warning. They wouldn’t allow me to stay at the vet over night or bring my dog home, or allow me to work with other vets that would allow me to stay together with Mochi. At the same time, they said if I didn’t leave Mochi overnight at their vet for the drip, he could get infected with glaucoma, and a whole lot of other things which frighten me. At last they suggested me to look for another doctor at Animal Medical Center. I did some research, at the same time I heard of so many horror stories there like how many pets have died in their hands. Also they do not allow visitors to stay for more than 15 minutes. And after some time decided, I decided to go with them, Dr C in Subang.
7th January 2016. Mochi did an eye ultrasound and ERG test which was required a week before scheduled surgery date. It was such a frightening experience for me and Mochi. I have an eye phobia and I had to be there beside Mochi. The ultrasound is exactly how you scan a mother’s womb to see the baby. Mochi’s eyeballs were placed with jelly liquids and then a device which rubs on his eye ball over and over again. It tooked a long time and of course he struggled. The scans were given to me on a usb. (I thought it was blur and not too clear, but that’s just my thoughts at the moment.
Next was the ERG test which was more horrifying to me. (ERG test has to be done in a pitch dark room, but she did not) They placed a lens into his eyes. The lens is connected to a wire. There were also 3 or 4 other wires which had to be jabbed into his head, eye, behind the ears. (google “eye erg test” and see the images omg) And because there were so many wires, it came out easily, all of them. One sneeze, one bit of movement, even the lens came out. Also, imagine 4 human, one long malamute in a small room, a room with 2 table, 2 devices.. a room which is so small, it cannot even half of 2 single mattress in it at the same time. I was a bit shocked as well when the doctor told Mochi to shut up, but okay that’s another story. The scan, disturbance, error in reading, took almost an hour and the ERG result didn’t even appear in one eye because it doesn’t seem to be recording anymore ! And I paid for the test, but of course, they said my dog wouldn’t co-operate, hence there was no reading done. Truly pissed. So anyway, her conclusion of the ultrasound was that she sees a leak in the lens. In her opinion, no vets in Malaysia is qualified to have this surgery done for his scenario and situation. For the ERG results, she said that one eye cannot be read. And the values… well one minute she mentioned it was good and one minute she mentioned it was not. I thought I was hearing things, but my friend who came along assured me she heard the same thing. And we both sensed that Dr C hesitated and seemed unsure about some of her answers.
close up shot of Mochi’s dilated eyes before both test are done
ultrasound scan results
ERG scan results
She gave us a referral letter, the scan results of ERG and ultrasound and told us to look for vets overseas.
Between 7th January 2016 – 9th January 2016 Mochi’s eyes was inflamed and there were pus (Result from the stressful ERG & ultrasound test). I contacted Dr C. Her advice was somewhat unclear. Told me to get sodium chloride from pharmacy and wash Mochi’s eys. But when I send her photos of various types of sodium chloride on which to purchase (they all had such long medical terms!), she said she does not know, and asked me to head to the vet on the following day instead to get them there instead. Dr C works with another doctor at the vet, Dr W (the one who previously called me and pissed me off in Early January). While I was there, I asked to see Dr W because I wanted to ask if I still need to wash his eyes when there is no more pus now. I was there an hour and what was she doing ? Putting medicines into bottles. They said it’s something she does in the morning. At least let me know how long! The nurse said she doesn’t know. The nurse advised me to get the item and advised me on how many times to wash a day. Her next advice was different. I was pissed after waiting so long, I purchased a small amount of sodium chloride (clean water) for RM16 ! Only to have Dr C finally replying me that it’s not needed since there was no more pus. I am totally pissed with this particular Animal Clinic.
Between 10th January 2016 – 15th January 2016 I wrote to doctors in Singapore and Australia, and I was going to send to one in Africa. (Although I have no idea how to go about if they are able to perform the surgery). I received a reply from a known doctor in the ophthalmology area. He recommended Animal Medical Center again. I am back to the 2nd option earlier which I was reluctant to send Mochi to because of all the horror stories. I even had people personally contacting me and telling me about how their healthy pet died there =(. My friend told me to just bring Mochi for consultation and judge from there. I was worried I might make a wrong decision and make a wrong judgement.
I wrote to Animal Medical Clinic, the doctor replied and told us to bring Mochi in for evaluation. He also mentioned that Dr C that we had consulted was not really a certified surgeon. I was so shocked ! partly shocked because if she was going to perform his surgery, I would have endangered him with a non certified surgeon. Shocked also because a couple of vet actually spoke highly of her. One even mentioned that she was the mother of all vets. This explains a lot on why I had so many doubts on her.
22nd January 2016. We bought Mochi to the Animal Medical Clinic for consultation. The doctor sounded confident, and more importantly, I felt confident in him. I understood his explanation easily, compared to Dr C. He also said the ultrasound scan from Dr C was blurry and unclear so he has to do the test again. The also mentioned that he could see much interference from the ERG results from Dr C. Most likely because it wasn’t done in a dark room. Waste of effort, time and test done since it wasn’t able to give a satisfying result. The doctor also did few other test on Mochi’s eye. He feels that it’s possible for Mochi to do the surgery, but can only confirm with a new ultrasound and ERG test again. Doctor also said that we could bring him home immediately after the surgery, this was the deal breaker for me ! I didn’t want to leave him overnight after hearing so many scary stories. The surgery would only take 10 minutes, but we can only collect him approx 3 hours after surgery while waiting for the anaesthetic to wear off. After discussing with SJ, we decided to proceed with the cataract surgery for Mochi.
(Ever since Mochi had cataract on both eyes, he is afraid to move around the house. He often gets stuck here and there and sometime cries. If or when he walks, his head would be few inches off the ground and he would walk very slowly almost crawling. He often hits very hard onto doors, cars, trees etc. And began to get aggressive with other dogs)
28th January 2016. The ultrasound and ERG test was performed. Mochi was a good candidate for the cataract surgery. Doctor says the Left eye was better for the surgery due to the reading. So we will proceed with the left eye first.
I want to note a few things. -There wasn’t any result in Can-C eye drops which claims to lessen cataracts for Mochi’s case.
- If your dog has cataract, use a harness and not a collar because the collar will cause a bit of pressure to his eyes.
Left Eye Cataract Surgery
16th February. – Surgery Day 1 We had to fast him from 12 midnight from food and water. Because it would all come out during surgery if we didn’t. It was stressful upon meeting with the doctor. Stressful because we were told that we could bring him home immediately to care for after this cataract surgery. But upon arrival at 8am, the doc told us it was better to leave Mochi overnight for reasons that he mention that sounds reasonable, but at the same time, felt uncomfortable and worried about leaving him there overnight for many reasons, mainly scary stories heard about. We went home sadly to retrieve his food and to return at 3pm to pass the food. We were also told that we are not to see him because it would get him excited then anxious and stressed when he parted from us.
Doctor called us at 11.10am. Cataract eye surgery done by 11am, he is beginning to wake up from the anaesthetic then. Doctor told us that he was not able to fit in the lens as part of the eye capsule tore due to stubborn cataract stuck hard while it was being sucked out.
Benefit of the Lens (intraocular lens IOL) includes helping them to focus, preventing shrinking of eye capsule which might cause wrinkle and certain growth cells which may cause visual problem. Of course the insertion of lens is better but if without, dogs are able to adapt with the long sighted eyes. Primary objective of the surgery is to have a successful surgery removing the cataract and the lens is good only if there isn't any issue inserting.
(1 and the half month later, I realise this was something worrying, you will see why at the later part of this article at Day 45 explanation)
We arrived at 3pm to pass the food. Doctor told us that Mochi could come home with us, he could see that we are super worried and really want Mochi home with us. I am so glad! And really thank God for that! Had been praying all morning and also thinking of so many diff questions and ways to ask the doctor to let Mochi come home with us. Really glad!
Meeting Mochi. Mochi was disoriented, he walked into the wall, his legs were so week he kept falling and couldn't stand up. We brought him home.
Mochi is really sad, but lucky he still eats and drinks when we give him. He is also in pain and irritated in the eye and cone :( . Discharging pus but doctor says its expected for first 5 days at least. His pretty eye lash and whiskers like eyebrow is shaved off. He sleeps most of the day and only wake up to go toilet, and when it's time for his eye and oral medication.
Day 2 for Mochi was pretty bad. His eyes were inflamed. Cloudy looking and red like an unfresh fish at the market. Feel so sad looking at him. He suffers much when we gave him the eye drop medication. He would shake vigorously and try very hard to rub his eyes for 20 minutes and he would shake his head so hard, he knocks into walls.
"Cloudy looking and red like an unfresh fish at the market."
Brought him to the doctor in the morning and he was given additional eye drop medication due to the inflammation.
Back at home, he would try to rub his eyes on the bean bag and corners of the wall or use our knee, thigh. Smart guy. Even with the cone on his head, he is able to think of ways. Other wise he rubs his face (eyes) hard on the cone too. The surrounding of his eyes gets red too.
(he has total 3 eye drop medication and has to be applied 3-5 times a day, oral medication 3 types but no issue on oral medication.)
Day 3 night, after another episode of suffering eye drop medication, irritated painful eyes, tantrum throwing... only did SJ suggest to ask the doctor if this was normal ... Can't believe I didn't think of it. I immediately emailed the doctor.
Day 4 morning. Doctor replied my email and mentioned that eye drop intervals should be 3-5 minutes . (We are currently giving him 3 different eye drops all applied together). Argh!! And then I googled and saw almost all websites mentioning that if you are on eye medication, it should always be 5 minute interval before applying a different eye drop. Side effects are burning, cloudiness of eyes, headache and sooooo many more !! . This is probably why his eyes got worst on day 2! (Doctor said he told us this but we both didn’t hear such thing. Cant put blame here but I feel it’s something important that should be emphasized on the “Post Cataract Surgery Treatment Protocol”)
But the good news is that the whole day 4, after applying the eye drops with 5 minutes rest period, all eye drops didn't cause him discomfort. And I think the cloudiness of the eye has very very very slightly gotten a little bit better. And there is almost no more pus discharge!
Day 5. Cloudiness of the eye has cleared almost 95%! His eyes looks a lot better ! Brought him to the doctor for check up. Doctor says it looks good. 2 eye drop medication lessen from 3 drops a day to 2 drops a day. That's great news for us.
(It takes an estimated 30 days for his eyes to be completely healed without any complication)
Scheduled for doctor's appointment on day 12.
Day 6,7. Healing process continues. Hope no future complication arise.
Day 18. Mochi somehow injure his non surgery eye =( not sure what happen or how he injure it. !!! rushed him to the doctor immediately that morning. it looked like blood clod on top of his right eye. he was prescribed with 2 eye drops. More eye medication for him -_- . Also an eye drop for the surgery eye to help with his dry eyes. (Antipan)
Day 21. Something is not right with the medicine given by the doctor on day 18. We start to wonder if it's normal that he seems irritated with the eye drops by now. We suspect that something is not right, so we wrote to the doctor in the night.
Day 22. Doctor replied and said that Mochi's eye could have an allergic reaction and so we should stop and get a replacement drop. We got the replacement drops that night.
Day 29. Removed his e collar. Funny how it seems like he's missing the ecollar haha... His surgery eye ball looks like it juts out more than the other eye. He is set to meet the doctor again on day 34. His left eyes doesn't look like it's healed completely, he closes it most times. The right eye looks fine to me, but would need doctor's special equipment to test properly.
example of his medication schedule, it got too complicated so I made a new Excel file after day 24 as my mom had to take care of Mochi for a few days
Day 34. Every thing is fine for now.
I want to note a few things - It’s important that any eye drops you put for your pet, there is an interval of 5-10 minutes as some eye drops will cause a chemical reaction together, such as burning, cloudy eyes, inflammation. - If your vet ask you if you would want the IOL lens for your pet or not, say YES. (Although it is common in the early years for performing a cataract surgery without the lens, the risk of retina detachment that cause blindness is higher) - If your dog is unable to have the IOL lens inserted, make sure to monitor his eyes, movements. Toys where he may take and swing vigorously has to be removed from their sight. - Use harness and not collar for your dog. Collar contributes to pressure on the eyes.
Day 45 (approx). 2nd April 2016. Somewhere along 1 and half month after surgery. His eyes were inflamed, super red, had pus. You can clearly see the red veins in his eye ball.
(sometimes it gets worst than this, a lot redder, he had rubbed the pus away before I was able to capture it)
Brought Mochi to the doctor and found out that this happens when he gets excited or too much impacts happens on him. Etc out for walk, flinging his toys vigorously, jumping around too much. The reason for this is that during his Cataract surgery, they were unable to fit in the IOL lens. When the lens is not present to hold the eye structure, the "jelly" of the eye moves and it will cause irritation/inflamation to the eyes. I did some research, and read that if this happens too much, it could cause a tiny tear in the retina walls which will also result in retina detachment. That means he will permanently be blind.
If there is a huge impact or if you jerk him too hard suddenly, that could also cause an immediate retina detachment & immediate blindness. Damn I'm so worried now for his future ! no more stuff toys for him to fling around !
(More images of Mochi’s surgery experience here :-
More about IOL lens not being present in the eye.
image diagram from http://www.merckvetmanual.com/
The "jelly" part of the eyes (called vitreous chamber in this above chart) will move if your dog jerks or has some sort of abrupt movement/stop.
The jelly part moves and irritates the eyes and causes inflammation since there is no lens now to hold the jelly in place.
WORST case scenario, the jelly part shifts too much towards the empty part of the lens and the retina detaches and cause immediate permanent blindness.
(read retina detach below)
Although it is mentioned in this website that it should be treated promptly (probably also because it’s a website for human eyes), our doctor told us if this happens for Mochi, he would immediately be blind permanently and nothing can be done. However the website is good explanation on retina detachment.
I find there is also a risk if his eyes are always inflamed (due to much movement from walk, playing, going out).
According to above website link, this is the reason why. :- (info taken from website link above)
Exudative retinal detachment
In this type of RD, fluid seeps out of the blood vessels in the retina into the space between the retina and the RPE. This can occur as an uncommon complication of various conditions. For example, very high blood pressure, inflammation of small blood vessels (vasculitis), certain cancers and certain rare blood vessel disorders. (see diagram below)
Right Eye Cataract Surgery
2nd May 2016. Today we took him for an ERG & ultrasonic eye test for the right eye to see if he was fitted for cataract surgery. (This will be his 2nd cataract surgery).
Result: His eye is suitable for the surgery. But, The bad news is that quite likely, they won't be able to fit in the IOL lens.
Again, Without lens, if one day impact happens to him (jerking too hard on leash, or if he hits an object hard, or even playing with a toy too vigorously, or having a basketball hit his head), a retina detachment will happen as the lens is not there to hold the eye structure properly. Retina detachment will cause immediate and permanent blindness.
(Doc explained that from the result, it looks like the cataract is too thick and covered much of the capsule surface. If the surface area is too huge, sometimes they cut out that part of the capsule, and if the cut out hole is too huge, the lens being too small will not be suitable to be placed in as it will fall out of the hole. (likely to be in this situation). Another reason the lens will not be able to fit in, sometimes the capsule will be torn during the surgery as suction of stubborn cataract may cause that to happen.)
They were also unable to insert lens into the left eye during his cataract surgery 3 months ago (February 2016). In the worst case scenario, if a car hits him or even a basketball, the impact will likely cause him to be blind both eyes permanently.
If we don't do surgery, that cataract eye may bring him other eye problems, and cause him headache/migraine. If cataract matures, it also means that he would be blind in that eye. But mature time for a cataract is unknown. It could happen within few weeks, or few months or few years, This we will never know.
He is 5 years old in a couple of months. Not good to do a cataract surgery when he is older too.
We were in dilemma considering to cancel his cataract surgery scheduled a week after he did his ERG test.
Left and Right eye taken in the afternoon (pupil not dilated so you are unable to see the cataract in the left eye)But the right eye is crystal clear and it looks like there are textured pattern inside that marble eyes.The left eye is all of the same colour and duller than the right.
6th May 2016. We decided to postpone the cataract surgery until a time he is affected by his cataract (example headache / inflamed eye / visible discomfort). We asked the doctor how old is too old for a dog to have a cataract surgery performed. He mentioned 13 years is the cut off time. Pretty surprise as I personally expected somewhere around age 8. Of course the severity of the cataract has to be considered as well. We plan to bring him for regular check ups every month to monitor this.
We hope this is the right decision at the moment since he is happy now; he is able to move around without vision problem, he dares to walk into any tight space. We have to monitor that he doesn’t play too hard.
25th July 2016. We brought mochi for an eye test and check up, because we decided to go ahead with the cataract surgery after re discussing with the doctor. Reason being that Mochi’s cataract is maturing too quickly, and likely to be mature by end of the year. If we delay any longer, the higher the risk and more complication will arise. We had decided this 2 months ago but we could not go ahead with it as we were busy with my sister’s wedding and a planned family trip to Korea. Another reason we decide to go ahead with the surgery was because, a side effect of cataract is glaucoma, which is another eye problem which the eye pressure will go up and it also causes much pain and blindness. Upon the check up on 25th July, Mochi was diagnosed with a new eye problem, cornea dystrophy 😭😢. Collecting of minerals in the middle of the cornea which irritates and inflames the eye and causes blurred vision and possible vision loss if not controlled properly. He needs to do monthly check up, to up or down the dose. Problem now is he allergic to the only medication (antipan eye drops) sigh !!!
It's genetic problem and not a side effect of cataract or surgery. It's just another type of problem. And it's gonna come in the right eye too. Lucky thing is that it hasn’t appear in the right eye yet, otherwise, the cataract surgery cannot be performed.
And no wonder so often his eyes teared and sometimes he can't open them for a few days. He is given some oral medicine to lessen the inflammation. He is prescribed for Systane drops 3 times a day & Antipan drops 3 times a day. But since he is allergic to Antipan, he uses Vismed now, which doesnt work like how Antipan should, but we have no choice. Monthly monitoring with the doctor is needed for a life time for this.
His Right eye cataract surgery is scheduled for tomorrow. 2nd August 2016. Praying for smooth recovery and no complication.
3rd August 2016 So we collected Mochi yesterday at about 330pm. Left him there at 9am. The doctor held his leash and he Happily galloped into the "staff only" zone. Doctor joked "ohhhhh he remembers and knows his way around". I don't know to laugh or not cause I was worried and thinking.. This mochi is heading towards something he is not gonna like....
So we picked him at 330pm. Surprisingly he was super jumpy and happy to see us. Back 6 months ago when he had his other eye surgery, he was so sad, depressed, suffering. The doctor wanted to explain more to us on mochi's surgery but quickly asked us to go home since mochi is so hyper. (Being too hyper could cause his eyes to go red from all the excitement and movement). I accompanied him at the back seat. It was hard for him to get comfortable with that giant cone in his way. I also helped to block the sunlight whenever it falls onto his eyes.
So cute, dad called and asked about him, then dad visit. He is mochi's first visitor. And mochi was super happy. Dad was also surprised cause the last time, mochi was like a dead fish. So far so good. His eyes is still cloudy on day 2, doctor says it would take a few more days. Rykel who had the same surgery done on both eyes has clear eyes. Lucky guy :) .
Oh another good news is that the doctor managed to insert the IOL Lens inside. A true miracle because initially the doc did an eye test and told us the bad news, which was that he would not be able to insert the lens in due to the eye structure. Really thank God for this as I had 0 expectations on the lens.
Pray the next 29 days will be smooth recovery for mochi. Currently there are some pus discharge and his eyes is painful and itches. He tries hard (successful sometimes) to rub his eyes onto corners of walls and sofa and anywhere that has corners.
1st March 2017
Both eyes are healed completely from the surgery but it often gets inflamed. Sometimes for unknown reasons. We are maintaining it with Maxitrol, once after walks or active activities. And one more when ever he is showing signs of eye discomfort. He also gets Systane and Vismed eye drops as often as we can daily to lubricate his eyes. He gets lots of pus discharge and we need to constantly clean his eyes. Sometimes the pus and liquid from his eyes hardens the fur around his eyes, and that tends to pull his skin. so he has red, injure skin around the eyes too =( .
