Op or not?

My eight year old Labrador Sally developed diabetes last year. It was awful because she was so thirsty all the time and really lost weight, but my vet and his nurses have been fantastic and now the diabetes is under pretty good control. It has been a lot of work and we have had lots of trips backwards and forwards to the vets (thank goodness for pet insurance!), and I have to give Sally insulin injections twice a day.
Sally has been wonderful and lets me inject her without making any fuss. However, she has gone almost totally blind with cataracts over the last few weeks. My vet says that the cataracts are because of the diabetes, but they seem to have come on very quickly. It is really upsetting to see her walking into things, and she has lost all her confidence. My vet says that there might be an operation she could have, but I am so worried – I don’t know whether it would work and whether she would be alright, especially with her having diabetes.
Have any of your readers had the same experience, I wonder?
Can anyone help?
Julie Smith, Manchester

I have seen some really miraculous results when diabetic dogs have had cataracts removed. Suddenly they can see again! It is worth bearing in mind that any veterinary surgeon operating to remove a diabetic dog’s cataracts will understand of all that you and Sally have gone through to achieve stability of her diabetes mellitus, and will also be aware of how to manage the general anaesthetic needed for a diabetic dog.
In my opinion, I would air your concerns with your vet and investigate cataract removal with him, or her. If it would involve referral, then I would take it that next step which would still not commit you and Sally but would enable her to be evaluated as a patient for surgery. Her retinas would also be assessed to ensure that they are healthy so that vision is indeed restored on removing the cataracts.
One can never guarantee any surgery, but when successful this is certainly one of those cases where the bounce returns to the patient’s outlook on life.
Alison Logan, vet

I totally agree with Alison Logan’s opinion. As a veterinary eye specialist, I have operated on many diabetic patients with cataracts and the results can be extremely rewarding – diabetic cataracts can progress extremely quickly, potentially causing damaging inflammation inside the eye, and in some cases the retina can detach. A pre-operative ultrasound scan of the eye is required to look for retinal detachment and also for possible rupture or bursting of the lens (the lens inside the eye is what becomes white when a cataract develops). Lens rupture can make the surgery more challenging. It is therefore important that diabetic cataracts are assessed carefully, and ideally surgery should be carried out relatively quickly to reduce the risks of lens rupture and retinal detachment. Providing the timing is right, diabetic dogs have as good a prospect of a successful outcome as non-diabetic patients.
If you are considering the surgery, it is very important to realise that it will be a significant commitment from your point of view – there will (or should) be numerous visits to the specialist undertaking the surgery, because good pre-operative assessment and careful post-operative management are just as important for a successful outcome as the surgery itself. Post-operative care can be intensive, with multiple drop applications every day for the first few weeks after surgery, and some patients can even require some degree of eye medication for life. This is perhaps less daunting for owners who are already used to the commitment of looking after a diabetic dog, however! In addition to these aftercare issues, the surgery will be expensive, especially if both eyes are operated on (which is advisable) and if modern artificial lenses are implanted inside the eyes to improve vision. I see you mention that Sally is insured, but you need to know that the costs of the operation will come out of the cover that you have for her diabetes, as it is the diabetes which has caused her cataracts to develop. If you have good levels of insurance cover this will hopefully not be a problem, but you should check with your insurance company what funds you have remaining in this insurance year against which to claim for diabetes.
A very important consideration is where and by whom the surgery is to be carried out. Cataract surgery is a challenging operation which should be performed using highly specialised micro-surgical instrumentation. The operation in dogs is more difficult than it is in most humans, and it is therefore very important that it is carried out by a veterinary surgeon who has the latest, appropriate surgical equipment, including an operating microscope and a so-called ‘phaco' machine (the phacoemulsification unit that is used to actually remove the cataract). Equally important considerations are the post-graduate training and skill of the surgeon, and the fact that anaesthesia for cataract surgery is not run-of-the-mill – a full general anaesthetic is required, and the best type of anaesthesia for this operation is done using a ‘muscle relaxant’ procedure. This is not routinely carried out except in a few centres, and it is ideally performed with the supervision of an anaesthesia specialist.
I would recommend that you discuss the topic with your own vet and ask if they can refer you to a recognised eye specialist, and preferably one who is also working with an anaesthesia specialist and performing cataract surgery on a regular basis. A word of caution, however – the subject of specialisation within the veterinary profession can be a slightly confused one, as theoretically anyone can call themselves a specialist! When seeking a specialist it is best to look for the terms ‘RCVS (Royal College of Veterinary Surgeons) Registered Specialist’ or ‘European Specialist’, in this case in the fields of Veterinary Ophthalmology and Veterinary Anaesthesia (there are specialists in numerous veterinary disciplines). These specialists will have been through rigorous approved training programmes in a specialist centre and passed Diploma level examinations in their fields (these are the highest level examinations for vets working in clinical practice, and not to be confused with the lower level qualification of a Certificate, which can be taken by vets working in general practice). To be allowed to use these specific Specialist terms means that the vets involved will be highly qualified and actively working in their fields of expertise – whilst taking Sally to such individuals doesn’t guarantee that the surgery will be successful, it does get things off to a good start, which is very important when you will be entrusting the future of Sally’s vision to their care.
To learn more about cataract surgery in dogs, you can visit our informative website www.willows.uk.net and follow the Information Sheet links on our Specialist Services page.
Peter Renwick RCVS Specialist in Veterinary Ophthalmology, Willows Referral Service, Solihull, West Midlands