2/22 Kismet AMPS 145 cataracts vs lenticular sclerosis

[Courtney and Kismet]

Hi everyone,

It has been a long time since we last posted. I hope everyone is doing well! Kismet is doing great, but we got some bad news today that I'm still trying to process.

Kismet went to the vet back in September and he was given a clean bill of health. His old vet moved away so we took him to a new vet this morning for a wellness checkup. His readings have been a little high lately and I just wanted to rule out any other problems like UTI. The vet felt his bladder and remarked how small and empty it was and decided not to take a urine sample. Since he isn't exhibiting any other signs of an UTI, the vet didn't seem to think an invasive test was necessary. In the past, whenever we have lost regulation, it is almost always because of an "obscure" and symptom-free UTI. The new vet's reluctance to test K worried me a little bit given Kismet's history, but I figured he is the expert and if he doesn't think it is necessary, then I'd trust his judgment. I'll try a dose increase and see that helps bring down his numbers. If not, back to the vet we will go.

The most shocking part of the visit was when the new vet asked us how long K has had cataracts. The vet was surprised that we didn't know K had cataracts as he suspects that he has likely had it for some time. He even told us that K likely only sees shadows. When I asked about our options, he advised against surgery since Kiz will be 8 in May and "it will just come back because of the diabetes." He also told us he will likely go completely blind but he should adjust perfectly fine. When I asked about taking him to an ophthalmologist, he advised us that it wasn't necessary and they probably would recommend surgery just to make money. I appreciate his candor, but I am also a bit incredulous about this diagnosis. He used a light to examine K's eyes but performed no other diagnostic tests. He didn't even think a blood test was necessary since we had a full blood panel in September and we conduct regular glucose curves.

I have always noticed K has had some haziness to his pupils and his pupils always seem more dilated than other cats. I have brought up my concerns to prior vets who have always assured me that he was fine. His eyes look the same that they always have. I like to think I'm hyperaware of his health, the complications associated with diabetes, and what symptoms to look for. This is not to say I am an expert or couldn't miss something, but rather, I am confident that his eyes have not changed in appearance since his last vet visit in September or over the past few years since I first noticed the haziness. I'd also like to think I would have noticed signs of progressive vision loss.

Kismet gets around perfectly fine. He has never bumped into furniture or other objects nor has he displayed any other symptoms that would indicate visual impairment. When we got home from the vet, I did a few vision tests and he seems to be able to see well (more than just shadows.) He could just be over compensating with his other senses, but he was able to see thin string that I held in the air about 3 feet in front of him. When I swung it from side to side as quietly as possible, he tracked it with no problems. He was able to track my finger perfectly fine. He makes eye contact and slow blinks back when I blink at him. when be was sitting on the couch, I stood across the house (about 20 feet away) and silently moved around the room. He tracked me every step. I don't think his vision is as poor as the vet told us it is.

In my research on cataracts, I learned of a condition called lenticular sclerosis which is sometimes misdiagnosed as cataracts. It is characterized by a blue/gray haziness to both pupils but doesn't usually affect vision, although it can. From what I've read, it seems more consistent with what I have observed in Kismet than cataracts.

At any rate, I plan on taking him to an ophthalmologist for a second opinion. Maybe there is nothing to be done, regardless of his diagnosis, but if there is I'd like to do whatever is possible.

Does anyone here have any experience with cataracts or lenticular sclerosis? I'd love to hear about your experiences.

Thanks,

Courtney and Kismet

 

[Doodles & Karen]

I don't have any experience with cateracts or the other condition but you're doing the right thing on getting a second opinion from an ophthalmologist. Then you can make an informed decision. My mothers cat has an eye that is completely fogged over and it does not affect her vision. The kitty is 19 yrs old and not diabetic though. Sending vines for your Kismet. Hope others can offer more then just a comment.

 

[Wendy&Neko]

Hi Courtney, scritches to sweet Kismet. Missed our night time PJ parties. Glad to hear K is otherwise doing well.

I grew up with a kitty that lost one eye due to infection and the other had hardly any vision caused the lens popped forward and crystalized so he could only see around it. He still liked to climb fences.

I second the idea of an ophthalmologist vetty appointment. Tagging @Tricia Cinco(GA) & Harvey who was a regular visitor to the ophthalmologist vet.

 

[carfurby (GA)]

Courtney, I'm sorry to hear about Kismet's eye issues. I think it's smart to get a second opinion from the opthamologist. Please let us know what you learn. I'm glad Kismet is doing well otherwise. Sending prayers.

 

[Ella & Rusty & Stu(GA)]

Hi Courtney, I agree with the others that it would be good to have an opthamologist look at Kismet's eyes. So happy that Kismet is doing well. Best of luck with the eye doctor!

Nice to see a post from you,

Ella & Rusty

 

[Gussie's mom (GA)]

As one who has a cat who sees an animal specialist ophthalmologist I'm very glad to hear you will be taking Kizmet to see one! I've heard of diabetes causing diabetic retinopathy and vision loss as the blood vessels proliferate and break, but I have never heard of cataracts being caused by diabetes...that's a new one to me..not so sure it's accurate either...

 

[Tricia Cinco(GA) & Harvey]

Hi Courtney,

Sorry, I haven't been on line all day so just now saw that Wendy tagged me. Sadly I have a lot of experience with Veterinary Ophthalmologists, as three of my last five cats had eye issues, including Cinco who went completely blind before a vet caught his eye issues, and Harvey who had cataracts.

You should absolutely go see an ophthalmologist. Personally, I would also look for a new vet. The only think I liked about this one was that he acknowledged the value of home testing.

It's too bad you don't have a veterinary teaching hospital near you (I believe the only one in Florida is in Gainesville), but there should still be some excellent specialists in Miami. Since your vet won't recommend one, you'll have to do your own research.

It does sound unlikely that Kismet has cataracts, as in my experience, they do affect vision. When I talked to Harvey's OV about removing his, he never said anything about their coming back (they don't in people, so why would they in cats?). He just said Harvey's weren't bad enough to need removal. Harvey's vision was slightly diminished, but not enough to affect his QOL. Cinco was already blind (glaucoma) when his were diagnosed, so removing them was never discussed. It is pricey, but so is any surgery for a cat, and Kismet is young enough that he may be a good candidate for surgery, depending upon what other health issues he has.

I hope you find a good ophthalmologist and get some answers. If there is any way I can help, don't hesitate to let me know.

 

[Gill & George]

Hi there I have some experience with eyes in general, I'm an Optometrist.

Firstly, Tricia is correct in saying that cataracts won't return once they are removed, basically cataracts is an opacity that develops in the lens and during cataract surgery the whole lens is removed, so there is no way that it will come back.
In humans cataracts can be secondary to diabetes/high BG, but my vet tells me that this is not so in cats. Having said that, my george, age 16 has cataracts, and I do wonder.
Lenticular Slerosis, is a natural aging of the lens, the lens in children is usually crystal clear and slowly as we age the lens thickens from the centre, discolouring, yellowing, hardening and eventually becoming opaque, so ultimately it turns into a type of cataract. There are different types of cataract depending on their aetiology.
this is the type of cataract that develops on from lenticular sclerosis, note the yellow appearnace, because it thickens centrally, this type affects quality of vision more, there is also some radial cataracts in this one (like those in the pic below)

this is another type starts in the periphery, like spokes in a wheel and would only affect vision in the latter stages, no central thickening in this one.

It can be very difficult to judge how well an individual, human or feline, can see just by observation, I never cease to be amazed how well some individuals see given the extent of their cataract.

Lastly I would like to say that if you do see an ophthalmologist, and he will be perhaps better placed to give you an assessment of K's cataracts, consider this when thinking about whether you are going to opt for surgery.
Speaking from a human point of view, we would refer our patients for surgery when the cataracts starts to impinge on QOL, that can be different for different individuals, and it boils down to what that individual is using their eyes for and what their visual expectations are. I have applied that to George, he's not worried by his cataracts (he has the spoke wheel type I've examined them myself) but I figure if he can still see well enough to chase a moth round the kitchen like he did the other night, then I don't need to worry.

 

[Sue484]

Weird how things change from country to country. I had my cateracts done 4 years ago when I was 45. My eye doctor said the ways of thinking was changing and it is much better to remove cateracts early rather than wait until they are "ripe" as it is much easier and recovery is quicker. He said that although the cateracts won't come back, the sack that the lens sits in is still the original, natural one and that can cloud over. In which case a quick laser and it goes. Also Frankie's eyes are clouding too. My vet has inspected with a light and drops and said the lens is clear, it is just ageing which would indicate lenticular sclerosis. His sight is fine, he still chases his toys and can spot a treat at 20 feet!!

 

[Gill & George]

Weird how things change from country to country.

LOL, actually Sue that's the criteria in the UK
But your experience absolutely makes the point of QOL, for a 45 year old, who still works, drives, and has greater visual needs, you would indeed opt for surgery sooner than eg a 90year old who is housebound and whose passion is listening to the radio.

My eye doctor said the ways of thinking was changing and it is much better to remove cateracts early rather than wait until they are "ripe" as it is much easier and recovery is quicker.

Having a cataracts 'ripen' is far from ideal, it carries it's own risks and complications, it's not what I meant when I describe measuring QOL, a ripe cataracts would mean the Px would no functional vision in that eye.

It's been the case for a long time now in the UK that we don't wait for a cataracts to 'ripen', mostly to do with the way they perform extractions now as opposed to 20+years ago.

With the type of extraction you had they leave the capsule and insert an artificial lens inside the capsule, the main complication is subcapsular thickening, which in humans is an easy fix with a zap from the yag laser only requiring a local drop of anaesthetic and mydriatic, this would be a little more complicated in a cat, and I would imagine require them to give a general anaesthetic for them to do this procedure, this would assume of course that the would do an extracapsular capsular extraction.(ECCE)
Truth is I don't know if they would do an ECCE in a cat or if they would do a whole lens extraction (intracapsular cataract extraction ICCE) where they would remove the capsule as well, in this instance no capsule would be left behind and therefore no complication of subcapsular thickening. This latter method is not often used in humans, because having an IOL implanted in the capsule is preferable to the alternatives available.

I had a friend whose dog had congenital cataracts and they had a whole lens extraction without implant, so in this particular puppies case, there wasn't a risk of capsular thickening, because that was also removed.

With any surgery there are risks, in humans ECCE there are minor risks and usually the benefits far outway the risks, in a cat this might be different, down to the cat's anatomy or even the procedure, eg ICCE carries a more significant risk of retinal detachment.

I do think that it would be a good idea for Kismet to visit a Ophthalmologist, apart from aging (and kismet isn't that old) cataracts could be secondary to other conditions(general and ocular), so it would be best to exclude them. But I would say if all that Kismet has is cataracts, as long as he is coping well I personally wouldn't opt for surgery, unless there is some complicating factor that the ophthalmologist highlights.

 

[Sue484]

I'm in the UK! Your signature says you live in Spain, so I assumed that was the Spanish way.

It is certainly a good idea for Kismet to see the Opthalmologist, I just decided not to with Frankie as his vision seems fine.

I get your point about QOL and comparing me and a 90 year old. I never thought of it in that context. Good job you are an optometrist, you explain things so much better than me!!

 

[Gill & George]

I'm in the UK! Your signature says you live in Spain, so I assumed that was the Spanish way.

I do live in Spain, moved here 5years ago, but I graduated in UK and worked there for 20years (god it seems like yesterday).
I kind of exaggerated with the comparison LOL, but you get the gist.

 

[Sue484]

Ha ha. I did wonder!

 

[Tricia Cinco(GA) & Harvey]

Great info, @Gill & George. I had forgotten you are in the field.

 

[HWright]

Echoing thanks for great info, too. @Gill & George snd @Tricia Cinco(GA) & Harvey

Courtney, Hi and am glad you're bringing Kismet to opthamologist and hoping that it'll all work out.

My GA Bo came to us at the age of 20& years with a lot of health issues (no FD) including both eyes with the blue haze Lenticular Slerosis, and one eye was quite recessed.