Premium implants give patients more glasses freedom than ever. The Ophthalmology Group offers patients a choice of implants, correction for distance and near or for astigmatism correction to limit glasses need to over-the-counter type magnifiers. It’s the patient’s decision.
The Ophthalmology Group was one of the first practices in The Purchase Area to offer the benefits of small-incision cataract removal and lens implantation. During the past 30 years, we have helped thousands of seniors enjoy the beauty of restored vision through advanced microsurgical cataract procedures. We were also the first practice in our area to offer cataract patients the added comfort, convenience and cost-savings of having their procedure performed in a private, outpatient setting.
What is a cataract?
A cataract is simply a clouding of the eye’s natural lens—and if we live long enough—everyone will eventually develop cataracts. That is because they are a basic part of our body’s aging process. When a cataract develops, the natural lens in our eye becomes cloudy and prevents light from passing through the lens and reaching the retina. This results in poor vision. The lens in our eye also loses its ability to focus as we get older, thus the need for reading glasses, etc. This is also simply a part of our overall aging process. Fortunately, the lens in our eyes that develops into a cataract can be easily removed and replaced with a man-made lens with specific focusing power for your individual needs.
How do you know if you have a cataract?
- Dim, blurred or foggy vision
- Colors that seem to fade
- Difficulty reading or watching television
- Difficulty driving, especially at night
- Trouble seeing glare or halos
- Sometimes seeing double images
- The center of your eye (pupil) may appear white or yellowish
A cataract evaluation at the Ophthalmology Group begins with a thorough eye examination. This exam will determine the reason for your decreased vision. Cataracts may co-exist with other eye problems. If cataract surgery is indicated, you and your physician will decide what type of lens
implant is best for you.
New technology and advanced techniques have allowed for smaller incision with faster restoration of vision. Anesthesia for cataract surgery is local. Sometimes the eye is numbed for surgery and a patch is worn home afterwards. “No-shot” anesthesia is the choice of many patients and requires no patch to be worn after surgery. Our doctors generally remove cataracts using a procedure called phacoemulsification. This process uses ultrasound to gently disintegrate and vacuum the lens particles through a tiny incision made in the eye. Because these particles need to be physically removed from the eye, a laser cannot and is not used to perform cataract surgery. Phacoemulsification along with foldable lens implants allow the surgery to be done through a smaller incision than ever before.
Once the natural lens of the eye (the cataract) is removed, another lens must replace it. An intraocular lens implant is an artificial lens that is placed into the eye after the cataract is removed. The implant stays in the eye permanently, and cannot be seen or felt. Using a lens implant allows for the best possible vision after surgery. In many cases, patients who have worn glasses all their lives are less dependent upon them, especially for distance vision. Without a lens implant, heavy glasses or contact lenses are required after surgery.
Remember: Cataract surgery is an elective procedure . . . the choice to have surgery is yours.
Multifocal and Accommodative Lens Implants
Today many people are choosing to correct their refractive errors with options other than eyeglasses or contacts.
Various forms of refractive surgery—such as LASIK—improve vision by permanently changing the shape of the cornea to redirect how light is focused onto the retina. In some cases, instead of reshaping the cornea, the eye’s natural lens is either replaced or enhanced by an implanted
intraocular lens (IOL) that helps correct vision.
The role of multifocal and accommodative IOLs in clearer vision.
The eye’s lens, which contributes to your focusing power, has four primary functions:
- Transparency: to provide a clear medium through which light rays from an object can reach your retina;
- Optical: to focus a sharp image of an object onto the retina;
- Anatomic: to create a functional barrier between the front (anterior) and back (posterior)
segments of the eye;
- Accommodation: to vary the eye’s refractive power, providing clear images of objects over a
wide range of near, far and intermediate distances.
For people with cataracts, the lens of the eye becomes cloudy. Light cannot pass through it easily, and their vision is blurred. Cataract surgery is used to remove the cloudy lens and replace it with a clear IOL.
In some cases, people without cataracts who want to reduce or eliminate their need for glasses and who may not be candidates for LASIK may choose to have an IOL implanted in a procedure called Refractive Lens Exchange (RLE). This procedure may be used to correct moderate to high degrees of myopia (nearsightedness), hyperopia (farsightedness) and presbyopia (the inability to focus at near distances with age). When the natural lens is removed during cataract surgery, or removed as a form of refractive surgery, IOLs are inserted to take the place of the natural lens. IOLs are artificial lenses surgically implanted in the eye replacing the eye’s natural lens. These lenses help your eye to regain its focusing and refractive ability.
The most common type of implantable lens is the monofocal, or fixed-focus lens, which is intended to give clear vision at one distance. In order to see clearly at all ranges of distances, one is required to wear glasses or contact lenses.
Other types of lenses which are gaining in popularity are the multifocal and accommodative lenses. These IOLs may be used to treat myopia, hyperopia and presbyopia, and may allow less reliance on glasses and/or contact lenses to see clearly at both distance and near.
A multifocal IOL has several rings of different powers built into the lens. The part of the lens (ring) you look through will determine if you see clearly at a far, near or intermediate distance.
An accommodative IOL is hinged to work in coordination with the eye muscles. The design allows the accommodative lens to move forward as the eye focuses on near objects, and move backward as it focuses on distant objects.
How the IOL is implanted.
The IOL is implanted in an outpatient surgical procedure that takes approximately 15-2 minutes.
In addition to a pre-operative eye exam, measurements of the eye are taken to give the surgeon the necessary information to perform the procedure. These measurements include:
- Refractive error measurement;
- Pupil evaluation and size measurement;
- Measurement of the curvature (keratometry) and overall shape of the cornea (topography);
- Measurement of the length of the eye from the cornea to the retina (called an A-scan);
- Calculations to determine the correct power of lens (IOL) to use.
After the eye is numbed with topical or local anesthesia, one to three small incisions are made close to the edge of the cornea. A tiny, high-frequency ultrasound instrument is inserted into the eye to break up the center of the eye’s natural lens. The natural lens is then gently vacuumed out through one of the incisions. The IOL is folded and inserted through the same incision that was used to extract the natural lens and placed into the “capsular bag” that originally surrounded the natural lens. After the procedure, these incisions are usually “self-sealing,” requiring no stitches. Once the multifocal or accommodative IOL is implanted, your eye can focus on near, intermediate and far distances.
It should be noted that the focusing ability of the lens may not be fully realized for six to eight weeks after the procedure. In addition, your eye must re-learn how to focus on objects at various distances in order to see clearly. Patients who are pilots, night drivers or those who spend a lot of time in front of the computer may not be good candidates for the multifocal or accommodative IOLs. Patients who are intolerant of a small amount of glare and/or halos around lights, especially at night, may not be good candidates for these types of lenses.
Some of the risks and possible side effects of IOL implantation include:
- Over-correction or under-correction (with a possible need for a retreatment);
- Increased floaters or retinal detachment;
- Dislocation of implant;
- Halos and glare;
- Decreased contrast sensitivity;
- Clouding or hazing of a portion of the IOL (called posterior capsular opacification);
- Dry eye;
- Possible need for additional surgery to fine-tune the IOL prescription;
- Loss of vision.
Talk with your ophthalmologist about your vision needs.
While multifocal or accommodative IOLs do offer some people an alternative to dependence on glasses or contact lenses, they are not recommended for everyone. You may not be a good candidate for these IOLs if you are generally satisfied with glasses or contact lenses and unwilling to accept the uncertainty in the outcome of the surgical procedure. Even after the procedure, certain people may still need to wear glasses or contacts.
Surgery, contacts and glasses each have their benefits and drawbacks. the best method of correcting your vision should be decided after a thorough examination and discussion with your ophthalmologist. Discuss your needs and lifestyle with your physician to determine the best procedure for you.
Cataract surgery is the most commonly performed, safest and most effective surgery performed worldwide. What could make it better? The answer is: going dropless! The Ophthalmology Group is proud to be the first in the area to offer this new way of
post-operative cataract care.
Eye drops help the eye to healafter surgery. But, if we ask patients what is the most aggravating thing about cataract surgery, they tell us it is issues related to their drops. The schedule for taking three types ofdrops at different times ofthe day and tapering them over a month’s time is confusing. Using drops is also cumbersome, especially ifyou have arthritis or are sensitive about anything around your eyes. Finally, the drops are expensivel Even with drug coverage, most people end up spending $200’300 on drops for both eyes.
It is not surprising that eye doctors are searching for alternatives to topical drops and it turns out the “infusion may be the solution”. Medications placed into the jelly of the eye, behind the new lens implant at the time ofcataract surgery, have been shown to last a long time, treat inflammation and prevent internal eye infection at least as well as drops.
Many people feel that because of the convenience to both the physician and the patient and the cost effectiveness, dropless cataract surgery may become the standard of post-surgical care.
Dropless Surgery FAQs
Who can go dropless?
Cataract surgery patients having their surgery at our Eye Surgery Center. We will inform you of the pros and cons of the dropless procedure.
Who shouldn’t go dropless?
Patients who are at risk of increased inflammation or retinal swelling after cataract surgery like people with diabetes, a history of iritis, or a macular pucker. Also, people with advanced glaucoma may not be candidates.
Is there a downside to going dropless?
There is a theoretical risk for ocular damage from the infusion of medication although this has been extremely rare in Europe where dropless cataract surgery has been around for years.
What are the side effects?
Patients have to realize that the immediate vision for several days after the surgery is not good. They “see” the medication in the eye as blurred vision and a large floater. As the medication dissolves, the blurred vision and large floater cleals and ultimate vision should be the same as with drops.
You mean, no post-op drops, ever, after cataract surgery?
For most people, yes, although about 10ol0 of people have breakthrough inflammation and have to take the steroid drops, anyway. Careful follow-up after cataract surgery is still necessary.
Also, some surgeons still prescribe the non-steroidal eye drop because it is not in the intraocular infusion.
What’s the cost?
NO cost to the patient!
Because the infusion is part of the cataract procedure, we are unable to bill patients directly for the medication.
For more information regarding dropless cataract surgery or to schedule an appointment with the area’s most experienced and comprehensive cataract surgeons, call The Ophthalmology Group at 1-800-EyE-2000.
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The Ophthalmology Group
Paducah, KY 42001