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Cataract Surgery

Options for specialty Intraocular Lenses (IOL) and additional procedures during Cataract Surgery

Please read the descriptions below of the options you may have when choosing to have cataract surgery with Douglas A. Katsev, MD.

LRI: Limbal Relaxing Incisions:

Small incisions in the cornea to correct astigmatism. Astigmatism is an irregular shape of the cornea causing vision to be unclear.

Technis/Technis Multifocal IOL:

This is a multifocal intraocular lens implant that is intended to sharpen distance vision and night vision to minimize the need for glasses after cataract surgery. Even with a good result there may be a need for glasses to fine tune reading vision. There is also a possibility of halos while night driving.

Rezoom:

This is a multifocal intraocular lens implant that is intended to sharpen distance, near, and mid-range vision. Glasses may be needed for fine print and halos might be noticed with night driving until the brain learns to accommodate for the change.

Restor:

The Restor lens is a multifocal intraocular lens that is a revolutionary lens that improves vision in a range of distances from up close vision to distant vision. Although you still may need glasses to correct mid-range vision.

Crystalens:

This lens accommodates to focus at various distances. The lens "flexes" to focus near, midrange, and distant vision.

Toric Lens:

The Toric lens is intended to correct not only distance or near vision, but the irregularity in the corneas shape (astigmatism).

Refractive Mono Vision:

One eye corrected for distance and the other corrected for near vision.


 IOLs: Advancements in Cataract Surgery

Each year more than 3 million people have surgery to remove a cataract (a clouding of the eye's normally clear lens). In the past, thick glasses or contact lenses were used to restore vision after the cataract was removed. Now, However IOLs (intraocular lenses) are used in most cataract surgeries.

In the healthy eye, light passes through the clear cornea and lens, which work together to enable your eye to focus as you view objects at different distances. Images of the objects you see are projected onto the retina - the light-sensitive lining inside the eye.

A cataract casts a blurred image onto the retina. Cataracts are part of the natural aging process and are fairly common. Usually, cataracts will develop in both eyes, although one eye may be affected months or, in some cases, years before the other.

Diagnosing Cataracts

Vision problems, such as glare or difficulty reading fine print, are early signs of cataracts. Your ophthalmologist (a doctor specializing in the care and treatment of the eyes) checks the progress of your cataracts with vision tests and regular eye exams before recommending surgery.

IOLs: New Lenses for Your Eyes

Cataract surgery with IOL implant is a successful method for treating cataracts. When the cloudy lens is removed during surgery, aphakia (an eye without a lens) results. Pseudophakia, an eye with an IOL implant, eliminates the need for thick aphakic glasses or contact lenses. Intraocular lenses can be monofocal or multifocal. Talk with your doctor about which type is best for you. Also, find out if the IOL is covered by your health insurance.

Eye with IOL

The cloudy lens is replaced with an IOL, a clear plastic or foldable silicone implant. There are many types of IOLs, and the kind you receive depends on the surgical procedure performed. In many cases, a posterior lens implant is done. During this procedure, the IOL is placed in the posterior chamber of the eye behind the iris. In an anterior lens implant, the IOL is positioned in the anterior chamber, in front of the iris. After either procedure, you may need glasses for best distance or reading vision.

Before Surgery

Before surgery, an A-scan (a painless ultrasound test) records the size and shape of each eye. The A-scan is attached to a computer and is used to help determine the focusing power of your IOL. In some cases, laser interferometry is used to measure your eye. After the testing, your doctor usually discusses any possible risks or complications of the surgery, and asks you to sign a surgery consent form.

Types of Cataract Surgery

There are two common types of surgery for removing a cataract, and many kinds of IOLs. Your ophthalmologist will discuss which type of surgery - and which IOL - is appropriate for your particular situation. Your ophthalmologist usually will remove a cataract and implant the IOL during the same surgery.

Phacoemulsification

In this procedure, the lens material is removed, leaving the rear covering of the lens (posterior capsule) in place. The surgeon uses an ultrasonic device to break up the lens material (phacoemulsification) and remove it from the eye by suction. The IOL is implanted in the posterior chamber behind the iris and held in place with flexible loops or tabs.

Extracapsular Procedure

In this procedure, the lens material is removed, leaving the posterior capsule intact. Your surgeon scoops out the lens material in one piece. The IOL is implanted in the posterior chamber behind the iris and is held in place with flexible loops. The incision for the procedure is larger than for phacoemulsification.

Your Surgical Experience

Your surgery will be done at a hospital, a surgery center, or a clinic. Routine blood, urine, and other tests may be performed that day, or several days in advance. Your surgeon will operate on one eye at this time, and on the other, if necessary, at a later date so that you will always have the use of one eye.

Preparing for Surgery

You are asked not to eat or drink anything after the midnight before surgery. The morning of surgery, eyedrops are used to dilate your eyes, and you may also receive a mild sedative to help you relax. You will also be given a local or topical anesthetic to numb the area around the eye to be operated on.

In Surgery

When you are brought to the operating room, you are given a local or topical, and often an intravenous (IV), anesthetic. Your surgeon and the operating room nurses will be present and, in certain cases, a surgical assistant. An anesthesiologist or nurse anesthetist administers further anesthesia as needed. Because of the delicate nature of this surgery, your surgeon uses an operating microscope that both magnifies and illuminates the eye. The entire procedure usually lasts less than an hour.

After Surgery

After cataract surgery with IOL implant, a bandage or shield will be placed over your eye to protect it. Most individuals will be able to go home within a few hours - be sure to have a responsible adult drive you home, since you won't be able to drive the day of surgery.

Recovering at Home

While your eye is healing, your doctor asks you to use eyedrops. You may also be instructed about the use of an eye shield, and when to return for follow-up care. Your vision may improve gradually during these weeks, but the final results of cataract surgery with IOL implant take time.

Eyedrops

Eyedrops are important for proper healing. To apply, Tilt your head back or lie down. Pull your lower eyelid down, forming a "cup." Apply the prescribed number of drops and close your eye. To avoid infection, do not touch the bottle to your eye.

Eye Shield

Your doctor may suggest wearing an eye shield. for a while during recovery. This helps protect your eye from injury and bright light. At night, a shield adds extra protection. Place the shield over the eye and tape it comfortably, but securely, in place.

Follow-up Care

You will have several follow-up visits with your doctor. Gradually, the restrictions given during your recover will be lifted. Weeks to years after cataract surgery, the posterior capsule may become cloudy, affecting your vision. Your doctor may need to make an opening in the capsule with a laser to improve vision.

Glasses

It may take a couple of months for your eye to heal completely. During this time your eyes may be "mismatched." After cataract surgery, you may still need glasses for certain activities. As soon as your eye has healed, your doctor can prescribe your new glasses.

Tips for A Safe Recovery

While your eye is healing, your doctor may ask you to follow one or more of the special precautions below. These precautions help protect your new IOL and to help ensure a speedy and safe recovery. Try to follow your doctor's advice as your eye heals.

  • Kneel to pick up things instead of bending over, to avoid pressure in your eye.
  • Get help lifting heavy objects. Lifting can create pressure in your eye.
  • Do not rub or press on your eye.
  • Soap and water can irritate your eye, so bathe or shower from the neck down.
  • Wearing sunglasses may be recommended to protect your eyes from ultraviolet light.
  • Ask if someone else can drive while you are wearing an eye shield.
  • Try to sleep on the side without the shield.
  • Watching TV and reading are okay, but take breaks as needed.
  • Keep follow-up appointments with your doctor.

The Benefits of IOLs

In the past, thick glasses or contact lenses were necessary to restore vision after surgery to remove cataracts. Today, intraocular lenses are available - a proven advancement in treating cataracts. Because IOLs improve vision, eliminate the need for thick glasses, and don't need daily handling, they are the treatment of choice for cataract patients.

 

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