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Cataract surgery and high altitude climbing

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Cataract surgery and high altitude climbing

Postby Gusher » Wed Sep 15, 2010 8:05 pm

Does anyone have any experience or knowledge of any adverse effects of high altitude climbing after having cataract surgery? I know with lasix surgery there can be temporary blindness. Any help would be much appreciated.
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Postby radson » Wed Sep 15, 2010 8:37 pm

http://www.basecampmd.com/expguide/snowblind.shtml

Refractive Changes at Altitude after Refractive Surgery
An acute hyperopic shift in persons who have had radial keratotomy (RK) and then experience an altitude exposure has been reported in past years, and has been observed at altitudes as low as 2744 m (9000 feet). A dramatic example of this phenomenon was that experienced by Dr. Beck Weathers in the Everest tragedy of May 1996 in which eight climbers also lost their lives. Dr. Weathers had undergone bilateral RK years before the expedition. He noted a decrease in vision, which started early during his ascent. Author Jon Krakauer recalls that “. . . as he was ascending from Camp Three to Camp Four, Beck later confessed to me, ‘my vision had gotten so bad that I couldn’t see more than a few feet.“ This decrease in vision forced Dr. Weathers to abandon his quest for the summit shortly after leaving Camp Four and nearly resulted in his death. Another report describes two expert climbers who experienced hyperopic shifts of three diopters or more during altitude exposures of 5000 m (16,400 feet) or higher on Mt. McKinley and Mt. Everest. One report noted no refractive change after 6 hours in post-RK eyes at a simulated altitude of 3659 m, suggesting that the hyperopic shift requires more than 6 hours to develop. Further studies at 4299 m (14,100 feet) on Pike’s Peak revealed that: (1) subjects who had undergone RK demonstrated a progressive hyperopic shift associated with flattened keratometry findings during a 72-hour exposure; (2) control eyes and eyes that had undergone laser refractive surgery (photorefractive keratectomy [PRK]) experienced no change in their refractive state; (3) peripheral corneal thickening was seen on pachymetry in all three groups; and (4) refraction, keratometry, and pachymetry all returned to baseline after return to sea level. There is strong evidence that the effect of altitude exposures on post-RK eyes is caused by hypoxia rather than by hypobarism and that breathing a normoxic inspired gas mix will not protect against the development of hypoxic corneal changes.

There is compelling evidence for myopic mountaineers that PRK instead of RK is their refractive surgical procedure of choice. Individuals who have undergone RK and plan to undertake an altitude exposure of 2744 m (9000 feet) or higher while mountaineering should bring multiple spectacles with increasing plus lens power.

The most commonly performed laser refractive surgery at present is laser in-situ keratomileusis (LASIK). Several studies observed climbers having undergone LASIK and the authors’ conclusion was that LASIK may be a good choice for individuals involved in high altitude activities, but those achieving extreme altitudes of 7927 m (26,000 ft) and above should be aware of possible fluctuation of vision. Data suggest that a small refractive shift in the myopic direction may be present at extreme altitudes. Climbers who do not ascend beyond moderate altitudes should not experience a post-LASIK refractive shift.

http://books.google.com/books?id=ewrDdTrCuzEC&pg=PA150&lpg=PA150&dq=medicine+mountaineering+lasik&source=bl&ots=pmhYi_O90l&sig=hxHBFEeLUB8Id8RMeEvbp2SumwE&hl=en&ei=xR6RTK_ZHY7evQOfgfn3Cw&sa=X&oi=book_result&ct=result&resnum=2&ved=0CBcQ6AEwAQ#v=onepage&q&f=false
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Postby MoapaPk » Wed Sep 15, 2010 8:50 pm

Note the OP described cataract surgery, where the lens is replaced, not RK (which is rarely done these days) or PRK. Sometimes, though, a cataract patient will have corneal surgery to correct vision to near 20/20 well AFTER the lens replacement.

I know people who have had cataract surgery, then have gone to 14000' without incident (in fact, one is there right now).

OP: What do you mean by high altitude?

There is some belief that any surgery with a corneal flap (NOT cataract surgery) is contraindicated when the patient may be involved in sports that involve sudden impulses (such as falling and suddenly stopping while roped... or unroped!).

If you have an additional problem -- such as retinal detachment, where a bubble might be placed in the eye -- strict altitude restrictions might be given. But bubble surgeries are rare.
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Thanks

Postby Gusher » Fri Sep 17, 2010 5:10 pm

Thanks Radson and MoapaPk for the quick replies. That's all very useful information.

By high altitude I am thinking above 17,000 feet. I've climbed Kilimanjaro (19,340') and Mt Elbrus (18,500') with no problems whatsoever with AMS or my eyes. At that time I had cataract precursors but they did not affect my vision at all and I wore hard gas permeable contact lenses on both climbs with no problems. However, a few weeks after the Mt Elbrus climb in July 2009 the cataracts in my right eye got noticeably worse and now my right eye is pretty useless but my left eye is extremely good. I climbed Whitney and Rainier this past summer and felt my depth perception wasn't as good as it once was. I am planning to climb Aconcagua (22,840') in January 2011 and McKinley (20,320') in May/June 2011. And, of course, Everest is a desire/dream down the road.

I wanted to hold off on the surgery until I climbed them but I don't think I can wait any longer. I am going to go to my eye doctor to discuss this, but I don't think he will know much since he is not a climber so I wanted to learn as much as possible before I go to meet with him.
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Postby radson » Sun Sep 19, 2010 6:28 pm

Best of luck Gusher
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Postby ridgeline » Sun Sep 19, 2010 8:24 pm

I had one eye done, other eye is great no cataract at all. Ive had it over 14k with no problem, when I asked the opthamoligist was it going to be a problem at alltitude he was quick to answer, not at all, I said what about over 17k and again he said, no problem.
My wife says in the dark I have a cat eye thing goin on, the lens is clear, our natural lens is flesh color, so it tends to reflect the light off of the implant, colors also appear stronger after.
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