Tri-County Eye’s team of refractive cataract surgeons, Drs. Richard Prince, Jeffrey Gordon, Jocelyn Kuryan, Mona Lisa Nedjar, and Jessica Prince Wolfish offer advanced surgical options using state-of-the-art technology to provide patients the best visual results. Research studies have shown that this surgery and its resultant improvement in visual acuity can enhance one’s activities of daily living and functioning, making it safer to ambulate, especially for the elderly. With many new advanced technology lens implant options for “convenience and lifestyle,” less dependence on eyeglass use can be a reality! Now, cataract surgery can be tailored to one’s specific visual needs; truly vision for the way you live!
The lens of the eye is responsible for focusing incoming rays of light onto the retina and the tissue in the back of the eye that is analogous to the film in a camera. A cataract is a condition in which the lens of the eye is no longer clear but cloudy — becoming yellow, dense white, brownish or even covered with a coating much like frosted glass — all resulting in the lens’ inability to focus light clearly. This results in blurred vision for distance or near and sometimes both; it also manifests as increased glare with lights (such as oncoming car headlights) and difficulty in reading small printed material.
“Clouded” dull image as seen through a cataract
Sharp, bright normal-vision image
Aging remains the most common cause of cataracts. However, certain medications such as high dose and/or prolonged use of oral steroids may lead to premature cataract formation. Additionally, cataracts may be caused by direct trauma to the eye, diabetes, metabolic disorders and even congenital conditions present at birth.
Most people will develop cataracts to some degree as they age. A cataract becomes “visually significant” when it causes a decrease in visual acuity and interferes with activities of daily living. Fortunately, when one develops a visually significant cataract, the out-patient surgical treatment is relatively safe, painless and highly successful in the absence of any other co-existing ocular disorders (such as glaucoma, macular degeneration, retinal disorders and optic nerve problems).
Patients may experience symptoms of cataracts before they become visually significant and require treatment. Some early symptoms of cataracts include blurry vision, glare with oncoming headlights while driving at night, the need for brighter lights when reading fine print, and a dull or faded appearance of colors. A complete, dilated eye examination with your eye doctor will reveal when it is time for cataract surgery. Other ocular diseases must be ruled out to determine the potential for improving vision with cataract surgery alone. However, even in patients with other co-existing ocular conditions such as glaucoma or macular degeneration, cataract surgery has the potential to provide meaningful improvement in visual function.
Cataract surgery involves the removal of the cloudy crystalline lens and replacement with an intraocular lens implant (IOL). Refractive cataract surgery provides the best possible functional visual acuity attainable as a result of lens implant surgery. However, the patient’s prior refractive state — whether he or she has been nearsighted (able to see near better than far), farsighted (able to see far better than near), or astigmatic (irregularly shaped eye surface) previously — becomes a factor when determining the desired post-operative target refraction.
For example, many nearsighted patients have enjoyed the ability to see clearly up close without the use of eyeglasses for most of their lives. For that reason, many of these patients still desire to remain nearsighted after cataract surgery so that eyeglasses will be necessary only for distance but not reading. On the other hand, many farsighted patients have become accustomed to very good uncorrected distance visual acuity and do not mind their lifelong dependence of reading glasses (magnifiers!). As such, many of these patients choose this target result after cataract surgery.
With the development and widespread use of advanced technology intraocular lens implants that are able to correct astigmatism and presbyopia (loss of reading vision abilities with age), more options are available than ever before, addressing a patient’s specific visual needs and desires. The surgeons of Tri-County Eye specialize in this type of “refractive cataract surgery” that more closely and accurately delivers “vision for the way you live.”
Standard, monofocal IOLs correct either for distance or near vision, but not both. Patients can obtain excellent vision with a monofocal IOL, but may require glasses or contacts after cataract surgery to obtain their best vision. Additionally, any astigmatism present pre-operatively is corrected with glasses or contact lenses after surgery. Monofocal IOLs are very frequently used and covered by your medical insurance, minus any co-pays or deductibles.
In addition, some patients have utilized a “monovision” approach in their contact lens correction for years with great success. In this approach, the lens in one eye corrects for near vision and the lens in the other eye corrects for distance vision. For these patients, often duplicating the monovision status (from before the development of the cataracts) results in excellent functional vision with less dependence on spectacle correction.
Toric, Astigmatism-Correcting IOLs
Advanced-technology IOLs are available to correct astigmatism (abnormal curvature of the eye). When toric IOLs are used, individuals may achieve excellent uncorrected vision for distance and only require magnifying eyeglasses for near visual tasks, such as computer work or reading.
Multifocal and Presbyopia-Correcting IOLs
Advanced-technology IOLs are available to correct presbyopia, the condition in which the normal aging process results in the inability to focus at intermediate and near distances, usually commencing in the mid-40s. Multifocal and presbyopia-correcting IOLs provide a full range of quality vision – near, intermediate, and distance – greatly reducing the need for reading glasses, contact lenses, or bifocals.
For patients with a certain degree of astigmatism and for those who are candidates for advanced-technology IOLs, we now offer laser-assisted cataract surgery using a femtosecond laser (FLACS). FLACS is the latest advancement in cataract surgery. FLACS utilizes laser technology to create the most precise surgical incisions, which can allow for more accurate, predictable surgical results and faster recovery.
Your surgeon will be able to determine if you are a candidate for a premium, advanced-technology IOL and FLACS based on your goals and expectations for vision following surgery and the pre-operative measurements of your eyes. No IOL can guarantee complete independence from glasses/contacts, but some of the advanced-technology IOLs can greatly minimize your dependence on them.
Toric IOLs, Multifocal IOLs, and FLACS are available at an additional out-of-pocket cost to patients who are candidates. Although the final cost will depend on the patient’s individual treatment plan, costs range from $1,250 to $2,750 for each eye. Financing options are available for interested patients that qualify.
Once the decision has been made to proceed with cataract surgery, the patient will undergo a series of additional tests in which the eyes are measured to determine the proper power of intraocular lens to insert. Using this data from several advanced technology diagnostic instruments, computerized lens power formulas are then used to calculate, analyze and compare the exact intraocular lens implant power suitable for each individual’s eye to be used in surgery.
The desired refractive result is, simply, the best possible visual acuity attainable. However, the patient’s prior refractive state — whether he or she has been nearsighted (able to see near better than far), farsighted (able to see far better than near), or astigmatic (irregularly shaped eye surface) previously — becomes a factor when determining the desired target refraction.
The information herein is intended to serve only as an introduction to modern, refractive cataract surgery treatment and options. It should not be used to determine whether or not you need the procedure performed. Some of the risks, although infrequent, include, but are not limited to, infection or the need for additional surgery. Your surgeon will counsel you with regard to specific risks, benefits, and alternatives to surgery, as well as additional considerations that might apply.
Cataract surgery is performed on an out-patient basis at Tri-County Surgery Center, a state-of-the-art, Medicare approved and Association for Accreditation of Ambulatory Health Centers (AAAHC)-certified surgical center. Extensive pre-operative and post-operative instructions will be given to the patient at the time of the evaluation. Patients must have a medical clearance form filled out by their primary care physician within 2-3 weeks of the planned surgery date to confirm that the patient is in stable health and can tolerate this out-patient, elective operation. Normally, antibiotic and anti-inflammatory prescription eye drops are instilled into the operated eye starting before surgery.
Patients usually arrive at the surgical center 45-60 minutes before their scheduled operation time. Vital signs are monitored while a small amount of intravenous sedation is used along with topical anesthetic eye drops to ensure a pleasant and pain-free surgical experience.
After the refractive cataract operation is completed, there is a brief stay in the post-anesthesia care unit. The patient is discharged with a plastic eye shield covering the operated eye. No patch is used and the patient usually has some level of vision, although usually blurred, in the immediate 24-hour post-operative period. The eye drops, plus another anti-inflammatory eye drop, are then continued for approximately 2-3 weeks. After that time, the second eye is operated if necessary or the final determination of the post-operative eyeglass prescription, if any, is made. A final dilated eye examination is usually performed 3-4 months after the surgery and then yearly thereafter.
If cataracts have caused your vision to fail, the opportunity to regain excellent quality vision and a more satisfying lifestyle is easily and safely within your reach.
With modern, refractive cataract surgery, you can achieve vision for the way you live!
Warning: Video content contains graphic material of medical procedures! All videos are HIPAA compliant and are the sole possesion of Tri-County Eye Physicians & Surgeons, PC.
Click here to watch real time video of modern cataract surgery employing a temporal, clear-corneal approach with topical anesthesia and ultrasound phacoemulsification; an aspheric silicone lens implant is inserted.
I had the bifocal lens implant and my VISION IS EXCELLENT! I would recommend this surgery to anyone!
I think Dr. Prince is great. What he did for my eyes is fantastic. I hardly ever wear reading glasses since my surgery in June. I can even read the phonebook!
I’m so happy with my vision and my daughter is even jealous of me since I no longer have to wear any eyeglasses!
Dr. Prince did a nice job. I had my one year follow-up recently and nothing has changed. I am very pleased.”
I am perfectly satisfied. I had no problems and everything went fine. I can see well, drive good and read well. Most of the time I can read the newspaper without my glasses.
I don’t need glasses-this is great. I can even see to sew and thread a needle without glasses!