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Cataract Surgery and Premium Lenses

Cataracts are the result of the natural lens inside the eye becoming cloudy as it ages. Everyone, if they live long enough, will develop cataracts at some point in their lifetime, and we presently do not know how to prevent their formation. Cataracts block the light as it passes from the front of the eye to the back of the eye. Most patients in the United States will have cataract surgery when their vision decreases to the point that it interferes with their activities. It is important to realize that cataracts by themselves do not harm the eye. They only decrease vision by blocking the transmission of light. Cataracts can also be caused by trauma, previous eye surgery, congenital conditions, and some medications.

In cataract surgery, as the cataract (the opacified natural lens) is removed from the eye, a clear artificial lens (IOL – intraocular lens) is placed into the eye to replace the natural lens. The power of this lens is calculated by the surgeon to provide a certain refractive outcome and in contemporary cataract surgery, many patients with significant refractive error can expect to see better without glasses than they ever have in their life. Frequently, patients will become less dependent on their glasses as they can do most tasks such as driving or reading the newspaper without glasses. However, all patients, to see their best at distance and at near would need glasses with some type of bifocal or contact lenses with reading glasses. Patients with pre-existing astigmatism will still need to have their astigmatism corrected with glasses or contact lenses. It is also important to realize that there are limitations and that by calculating the lens power even with the most sophisticated of methods, there is still a margin of error that cannot be overcome with current technology.

The lens of the eye is a transparent structure behind the pupil that focuses light rays coming into the eye. This structure generally becomes clouded as one ages, resulting in a gradual loss of vision.

The clouded lens is known as a cataract and is the leading cause of vision loss in the United States today, While it is difficult to prevent the development of cataracts, removing cataracts surgically is a relatively simple procedure.

During surgery, a small tunnel-like incision is made in the white part of the eye (sclera) at the edge of the corneal. The lens is then removed through a procedure known as phacoemulsification, in which an ultrasonic probe is used to break up the cataract and then suction out the remaining pieces. Once the cataract is removed, a new lens is inserted through the same incision by means of a tiny tube in which the lens is folded. Upon insertion into the lens cavity, the new lens unfolds into place.

LenSx® Laser
Revolutionary Advanced Option for Cataract Surgery

We are happy to announce we are now able to offer bladeless laser cataract surgery. Beginning in December 2012 a new precise computer-controlled option is available at MECA.

The LenSx® Laser enables our surgeons to customize the procedure to your eye. Integrated optical coherence tomography (OCT) captures high-resolution images of your eyes and provides measurements and data used to plan and perform a surgery to exacting specifications not attainable with traditional surgery.

In traditional cataract surgery, the surgeon uses metal surgical instruments and blades to make the incision and remove the cataract. With the LenSx® Laser a femtosecond laser adds high-resolution OCT mappings of your eye and computer-controlled steps that are customized with your measurements to plan and perform customized and precise incisions in cataract surgery.

After examining the health and measurements of your eyes your surgeon will be able to determine if this new advanced technological option is right for you.

If your doctor recommends cataract surgery to improve your vision, you need to be aware of several optional procedures that are now available to enhance the refractive outcome of the surgery. Traditionally, cataract surgery was considered a way to restore clarity and the elimination of refractive error was a secondary goal. However, as techniques and technology have progressed, the refractive component of cataract surgery has become increasingly important.

The refractive component of cataract surgery involves the ability of the surgeon to correct pre-existing refractive errors at the time of cataract surgery. Refractive errors are the problems in vision that can be corrected by wearing glasses or contact lenses. There are four basic types of refractive error: myopia, hyperopia, astigmatism, and presbyopia (link these terms). Myopia, or nearsightedness, refers to eyes that see better at near than distance. Hyperopia or farsightedness, refers to eye that see better at distance than at near. Astigmatism refers to eyes that have irregular shapes to their cornea causing distortion in images whether they are at near or at distance. Presbyopia refers to the loss of the ability to change focus of the eyes with age. Usually, presbyopia starts in the forties and requires people to wear reading glasses or add bifocals to their glasses.

Most often a Single Vision IOL is inserted into the eye at the time of cataract surgery. Careful preoperative measurements allow the physician to choose the correct power IOL for your eye to focus at a distance. Reading glasses or bifocals would be needed to see clearly to read.

Monovision or blended vision involves selecting intraocular lenses that will leave one eye focused for distance and the other eye focused at near. This allows you to be spectacle free for most tasks. This approach is best used on patients who have done this with contact lenses and know its limitations.

Astigmatism is irregular curvature in the cornea. The cornea is shaped more like a football instead of a basketball. A single vision IOL will not correct corneal astigmatism. There are two options for patients with small to moderate amounts of pre-existing astigmatism.

  • Astigmatic Keratectomy or Limbal Relaxing Incisions. (AK or LRI) At the time of cataract surgery, the surgeon can make extra incisions in the cornea to decrease the amount of astigmatism. This technique is simple and generally decreases astigmatism to very small amounts depending on the pre-existing astigmatism.
  • Toric IOL – IOL with the astigmatism built in. This lens will correct either at distance or near and astigmatism up to a certain limit. Although the toric IOL corrects the astigmatism portion of one’s prescription, it does not have the presbyopia/near correction available.

Multifocal IOLs have rings of different powers built in the lens surface. Depending on which ring you are looking through determines if you are seeing at near, intermediate or distance. These lenses are superior to the traditional monofocal lenses, but some patients notice an increase in visual symptoms such as glare and halos at night.

In summary, cataract surgery has progressed to the point where outcomes are better than ever with the vast majority of patients very pleased with the results. Today there are also more options that should be considered prior to cataract surgery and we want our patients to be the best educated patients who can make the best informed decisions regarding these options. The doctors and staff of MECA look forward to seeing you and will be ready to answer any questions you might have.

Patient Expectations: The majority of our cataract surgeries are performed in our outpatient ambulatory surgery center on the second floor at MECA. Before surgery, patients are generally given a mild sedative to help them relax. In addition, the eye is topically anesthetized using eye drops. The patient is awake throughout the surgery and able to talk with the doctor. The surgery itself is a relatively simple procedure and takes less than 30 minutes. Patients are not greatly restricted after surgery in terms of their everyday activities. However, for a few days the patient is advised not to engage in overly strenuous activity or any activity that may subject the eye to trauma.

The eye may appear red and irritated for a few days after surgery, but the patient should not experience pain. Patients will come in for a follow up visit the morning after surgery to make sure that the eye is healing properly and to discuss any concerns the patients may have. Vision may be blurred for the first few days after surgery, but will gradually improve and most patients find that they are able to see without glasses better than they ever could before. However, cataract surgery may not completely correct vision, especially if there is another underlying eye disease and the use of reading glasses or bifocals my be prescribed by your physician.