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New lens implants can reduce need for glasses after cataract surgery

Posted on Aug.13, 2010, by , under Innovations for Visually Impaired

If you live long enough, you will probably develop one. Six out of 10 people over age 60, and almost everyone over age 80 has one. Has what? A cataract. Despite this prevalence, most people don’t know the facts about cataracts until they’re “eye-to-eye” with one. Now is the time to educate yourself about the condition and breakthroughs in treatment.

What is a cataract?

Each year, thousands of Wisconsin baby boomers find their ability to perform simple daily tasks slowly being clouded by the development of cataracts. “A cataract is a gradual, painless clouding of the eye’s natural lens located behind the pupil,” notes Dr. Brett Rhode, head of ophthalmology at Aurora Sinai Medical Center . “This lens is made mostly of water and protein and works like a camera lens—focusing light onto the retina at the back of the eye to form the images you see. As you age, some protein may clump together and start to cloud an area of the lens. This is called a ‘cataract.’ As the clouding advances (or cataract ‘ripens’), it can blur and glare vision to the point of inhibiting day-to-day functioning.” Depending on the type of cataract, this clouding may take years or just months to progress. In addition to aging, other causes of cataracts include heredity, eye injuries, medications (such as steroids), and long-term, unprotected exposure to sunlight.

Treatment = Removal + Replacement

“There are no drugs, drops, glasses or exercises that will prevent or cure cataracts. And, at present, lasers are NOT used to remove cataracts. The only effective treatment is to make an opening in the eye, surgically remove the cloudy lens (cataract), and replace it with an intraocular lens implant to once again focus light rays onto the retina,” states Dr. Norman Cohen, the first Wisconsin surgeon to use ultrasonic cataract removal and co-founder of Eye Care Specialists, one of the state’s leading ophthalmology practices.

Intraocular Lens Implants (IOLs)

IOL technology has made cataract surgery one of the most successful procedures available for restoring quality of life. Not only is the cloudiness removed, but vision is often improved to levels not seen in years. Until recently, however, all IOLs were “monofocal” or single-focus, acting like miniature internal contact lenses set for a single strength or prescription power—usually to provide clear vision in the distance for driving, watching TV, and other tasks. For most patients, though, a single distance setting is not enough. They still need reading glasses or bifocals to counteract the effects of presbyopia— the decreased ability of the eye to focus on near objects as we age.

Multi-focal IOLs increase range of vision

Advances in IOL design attempt to resolve this problem. For example, unlike singlefocus IOLs, “multi-focal” IOLs use a series of concentric rings or other built-in features to provide multiple focusing zones for a more full range of vision—day and night; near and far. Studies show that at least 70% of multi-focal IOL patients can see to read, drive, do computer work, or perform most any activity— while never or only occasionally needing glasses. Leading eye surgeon and continuing education lecturer Dr. Mark Freedman reports, “We have had great results with these ‘premium’ lenses. Some patients, though, experience problems with night vision, halos and glare caused by the ring design or pupil size. These issues usually diminish with time, but may, in some cases, never completely go away. Still, most people report that the ability to see both far and near outweighs any side effects.”

Toric IOLs correct astigmatism

Another type of “premium” IOL treats a different, yet common, vision problem—astigmatism. With astigmatism, the cornea is more oval-shaped, like a football, rather than round, like a basketball. Because light rays passing through the cornea cannot meet at a single focal point, images appear imperfect (similar to the distortions on a wavy surface, like a “funhouse” mirror). As such, a person who has both a cataract and astigmatism cannot gain high-quality distance vision after cataract removal unless the astigmatism is also corrected. Similar to “toric” contact lenses, “toric” IOLs are designed to reduce astigmatic distortion, thus enabling some qualified patients to break free from cataracts and reduce their dependence on glasses or contact lenses for distance vision—in just one step. Unfortunately, a combination toric and multi-focal lens implant is not yet available.

Premium Implants = Greater Freedom

“Multi-focal and toric implants are a great option for suitable candidates. They offer the convenience of being able to do everyday tasks, like reading, cooking, watching TV, putting on make-up, and using a computer—without reaching for a pair of glasses,” reports Dr. Robert Sucher, a state leader in cataract removal techniques and IOL implantation technology who has performed more than 25,000 cataract surgeries.

When to have cataract surgery

Freedman advises, “If a cataract is preventing you from doing tasks, new glasses won’t improve clarity, and no other conditions exist which would negate the benefits of removal (like severe macular degeneration), then it’s time for surgery. It’s not necessary to wait until a cataract is so ripe that almost all vision is blocked. In fact, if you wait too long, it can grow so dense that the operation becomes riskier and more difficult.”

Why people hesitate

A surgeon who treats patients from all walks of life across southeastern Wisconsin, Dr. Daniel Ferguson observes, “Some people delay surgery because they think it’s unaffordable. They don’t realize it’s covered by Medicare, Title 19 and most insurances. Even, if these options aren’t available, most doctors find a program or means to help a patient.” He adds, “As for fear of surgery, we strive to make it an easy experience for patients and their families. For example, we use the latest technology so that the operation itself takes only 10-20 minutes. And, to enhance comfort and recovery, whenever possible, we use ultrasonic removal (to gently break up and vacuum out the cataract), and a tiny incision (which can heal without stitches). Afterward, patients go home and resume normal activities within hours, and their vision improves within days. . . . Most people are so pleased with seeing things brighter and clearer, that they can’t wait to have their other eye done.”

Candidacy, Risks & Costs

Not everyone is a candidate for premium IOLs. An eye care specialist must evaluate your eye, health, and other factors to determine which option (standard v. premium) is best for you. Premium IOLs are an elective, out-of-pocket upgrade with Medicare and most insurance companies. In addition to potential glare and night vision issues, premium IOL recipients may not achieve the full multi-focal effect and may still need to wear glasses to fine-tune their vision at various distances.

The surgeons quoted above are partners at Eye Care Specialists, one of a limited number of practices in the U.S. to have its surgical team undergo rigorous American Board of Eye Surgery subspecialty certification for cataract/implant surgery. They are also state pioneers in ultrasonic cataract removal, foldable artificial lens implantation, and “no-stitch” and “no-shot” surgery techniques. All of their surgeons are trained to provide premium multi-focal and toric IOLs to qualified candidates. Call Eye Care Specialists’ Community Education Hotline at 414-321- 7035 for more details and a free 12-page cataract booklet.

CATARACT WARNING SIGNS

Poor vision is not a fact of life as you grow older. Schedule an eye exam if you notice:

  • Foggy, fuzzy, blurred or double vision
  • Sensitivity to light and glare
  • “Starbursts” around lights
  • Difficulty driving at night
  • Holding items closer to view
  • Needing brighter light to read
  • Fading or yellowing of colors
  • Frequent changes to lens prescriptions

Original post can be found at: http://milwaukeecourieronline.com/index.php/2010/08/12/new-lens-implants-can-reduce-need-for-glasses-after-cataract-surgery/

1 comment for this entry:
  1. Etta Siegel

    Question:

    I have a bad astigmatism in both eyes, have developed cataracts in both eyes, am 70 tears old, and get epidural injections (steroids) for spinal stenosis.

    I do a good bit of night driving and am very bothered by glare, play the piano several hours a day and need sharp vision for the music, work at the computer a great deal and read lot. Also, I am a graphic designer and good eyesight is critical.

    I think I should get Bi-Optic Cataract surgery or toric lenses.

    What is your recommendation?

    Thank you. Etta

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