Cataracts are a natural part of the aging process but they do not have to interfere with your lifestyle. Tremendous advancements in technology and lens implants now make cataract surgery more painless and beneficial than ever. Nationally, over three million procedures are performed annually. Remarkably, many patients experience vision quality that is superior to their pre-cataract baseline.
What is a cataract?
A cataract refers to the clouding of the eye’s natural lens inside the eye. A cataract may occur as part of the normal aging process, or may be caused by UV light, heredity, eye trauma, diabetes, and even some medications. Over time, cataracts can severely reduce your vision, usually causing sensitivity to light as well as fuzzy or blurred vision for both distance and near objects.
Virtually every patient over age 55 has some form of cataract formation in their eyes. Symptoms may include blurry vision, color distortion, impaired depth perception, double vision, and poor night vision with halos and glare. Every patient has their own tolerance for blurred vision but often patients remark that they wish they would have their cataract surgery sooner given the improved vision they now enjoy.
Cataract versus normal vision
Specialists in Cataract Surgery
Drs. Beers and Liu are widely recognized as leaders in the field of cataract surgery. Dr. Beers has taught residents at Stanford University using the latest techniques in cataract surgery for almost two decades and Dr. Liu has extensively trained residents at UC Irvine. We have performed over 9,000 cataract surgeries with excellent results. Over 99% of cataract surgery results in visual improvement.
We perform cataract surgery at our own Peninsula Eye Surgery Center, conveniently located across the street form our office in Mountain View. Newly opened in 2005, the surgery center is comfortable, well equipped and expertly staffed. Last year, more cataract surgeries were performed there than at any other outpatient eye surgery center in Northern California.
How Long Does the Procedure Take?
The cataract surgery takes 20 minutes. Drs. Beers or Liu carefully place numbing drops in your eye, remove the cloudy cataract lens with a fine ultrasound probe using phacoemulsification, and replace your new lens with a new artificial lens that has been selected for the shape of your eye. Careful measurements using ORA technology can be done to help ensure that the power of the new lens is correct for each patient. Once the procedure is complete, antibiotic and anti-inflammatory eye drops are placed. No eye patch is needed. The small incision heals quickly. Because no sutures are needed, most patient resume their normal activities just a few days after surgery.
What is ORA?
The ORA system is a measuring technology that guides the surgeon to determine the most accurate intraocular lens (IOL) power to correct refractive error and astigmatism resulting in the clearest possible vision after cataract surgery. The ORA system T works by directing a beam of low intensity laser light into the eye after the cataract has been removed. The laser light reflects off of the patient’s retina and sensors in the instrument analyze the reflected wave of light exiting the eye. This real time analysis measures the unique optical characteristics of each eye, and gives the surgeon an accurate measurement of the eye’s refraction. This is especially critical for patients who select a premium lens implant such as a multifocal, toric, or crystalens lens or if they have had prior refractive surgery such as with prior surgery such as LASIK.
Intraocular Lens Options
It is important to understand that there is no one best intraocular lens. Each patient has different needs and goals regarding their desired final visual outcome following cataract surgery. In
addition, each person’s eye is shaped differently and therefore not every patient is a good candidate for each type of lens. At Peninsula Laser Eye Medical Group we take pride in discussing all of the options and helping patients decide which lens is best for them given the shape and health of their eye. Drs. Beers and Liu meet with each patient personally to discuss the lens options and likely visual results to help each patient decide which lens suits their lifestyle and visual needs.
The Light Adjustable Lens
The Light Adjustable Lens (LAL) was approved by the FDA in 2017 and is the only intraocular lens available whose power can be adjusted after cataract surgery. Despite the many formulas that are available to help your surgeon choose the right power of intraocular lens during cataract surgery, there are factors related to healing and final lens resting position that are outside of a surgeon’s control. Now with the LAL we can adjust the lens power three weeks after healing has completed to achieve the best possible vision for our patients without glasses. This allows patients to trial and adjust their vision to their own personal needs.
How does the LAL work?
The LAL contains macromers which are UV light adjustable molecules. The molecules can be adjusted with a special UV light apparatus in the office after surgery to correct astigmatism, nearsightedness and hyperopia. Therefore, after surgery the patient can have their vision fine tuned for distance and/or reading. Many patients choose to have both eyes set for distance but others choose to have their dominant eye set for distance and their non-dominant eye set for computer reading. In addition, the lens can be adjusted more than once so patients have the opportunity to “Test drive” their vision before the final locking in of the lens is done at approximately six weeks after surgery. Once the lens is “locked in” it cannot have further adjustments.
It is important to limit UV light exposure after your surgery until the LAL lens is “locked in.” UV protection glasses are provided and prescribed to be worn after surgery to protect your LAL lens until it can be adjusted and “locked in” by your surgeon. The LAL does have an ActiveShield protective layer that was developed to protect the LAL from an accidental uncontrolled UV light exposure such as a patient walking outdoors without wearing sunglasses the first week after surgery. Rest assured that with this built-in ActiveShield a brief exposure to UV light will not cause your LAL lens to be altered in a negative way.
What are the risks or disadvantages of the LAL?
There is no additional risk to cataract surgery from using the LAL lens. The procedure is no more complex when the LAL lens is used and the LAL lens does not cause the haloes or starbursts that can be induced from multifocal lenses.
Standard Monofocal Lens
This is a single focus lens that provides clear vision at one distance. This lens is often covered by insurance and provides clear vision if a patient does not have astigmatism. Patients who choose this lens for distance often need to wear reading glasses after surgery unless monovision is performed. With monovision the dominant eye is set for distance and the non-dominate eye is set for near. Patient who have done this in the past with contact lenses or with prior LASIK will sometimes choose this option. Although there is some loss of depth perception with monovision, many patients tolerate it very well.
Astigmatism is when the cornea is shaped like a football instead of a basketball. This causes the vision to be blurred at near and in the distance. A shadow image, loss of clarity, and even double vision can occur if the astigmatism is not corrected. A toric lens has astigmatism built into it and therefore can be placed into the eye to correct the corneal astigmatism. This lens is an excellent choice for patients with astigmatism and can provide clear distance vision or monovision if a patient desires.
A multifocal lens is a lens that can focus at multiple distances without flexing. There are now quite a few multifocal lenses available all with slightly different proprietary technology. Multifocal lenses can now also treat astigmatism so more patients are candidates for these lenses. Some are designed to provide clear distance and computer vision. Others are designed to provide clear distance and close near vision. All of the multifocal lenses cause some degree of nighttime haloes or starburst because the intraocular lens is focusing at different distances. The PanOptix and Synergy lenses are examples of the newer multifocal lenses. Fortunately nighttime and glare symptoms are less with the newer lenses and many patients are able to filter out the artifacts through a process called neuroadaptation. Please see the multifocal center page on our website for more details about how these lenses function.
Our Bay Area ophthalmology office, serving Mountain View and San Jose, will determine if you are a good candidate for cataract surgery or Crystalens. Call (650) 961-2585 or schedule online today!