What Is a Cataract?
Inside the front of the eye is a lens, much like the lens of a camera. Its function is to focus light rays onto the retina (the film in the camera) at the back of the eye, which then transmits pictures of what you see to the brain.
This lens must remain clear for the light to properly pass through and reach the retina. When all or part of the lens becomes cloudy, like a whitewashed window, the vision becomes blurred. This clouding is referred to as a cataract. A cataract is part of the lens. It is not a film or growth over the eye.
Causes of Cataracts
There are several types of cataracts. Some can be present from birth (congenital) and others can form due to an injury to the head or eye (traumatic). Some are disease related (diabetes). Most cataracts are the result of the normal aging process of the eye. Over 95% of today’s population over 60 years of age have some degree of cataract development.
Symptoms of a Cataract
Dimming and blurring of vision are the main symptoms of cataracts. Colors may seem faded or altered and reading may become difficult or even impossible. With some types of cataracts, sunlight, car headlights, or halos around lights at night may be very irritating and interfere with vision. Many patients feel as though a film is covering their eye, however, this is really the cataract (clouded lens) which is obstructing vision from inside the eye and is not a film on its surface (Fig. 1).
Treatment for a Cataract
Surgery is the only effective treatment for cataracts when glasses are no longer an option. There are no medicines, diets, or drops that will make a cataract go away. There is no laser surgery available at the present time to remove a cataract.
Decision to Have A Cataract Removed
In the great majority of cases, you are the one who will decide when to have cataract surgery. In the past, surgeons usually waited until a cataract reached the mature or ripe stage to remove it. However, modern surgical advances have made it safe and possible to perform cataract surgery at any stage of development. Therefore, if you are not able to drive a car and your lifestyle requires it; if you have difficulty reading and you do a lot of it; if you cannot do your own shopping; if you are losing a lot of golf balls; if you are forced to make significant changes in your way of life because of poor vision, you will probably want, and can, have your cataract removed. Cataract surgery is the most successful of any surgery on the body with success rates of 98% or higher.
Preparing for Surgery
There are several steps that are required prior to surgery. A standard medical examination and laboratory tests will be performed by your medical doctor to ensure your general health for surgery. Your eye will be measured by painless ultrasonic waves (Intraocular Lens Biometry) to determine the dimensions of your eye and the prescribed power of the intraocular lens implant that will be required to correct your vision, once the cataract has been removed
There are several methods used to remove cataracts. Each has its advantages and disadvantages. Each patient is evaluated individually for the type of surgery and type of intraocular lens implant (IOL) best suited for their particular cataract and their particular eye.
Some physicians and acquaintances may tell you they had laser removal of their cataract. There is no laser technique for removal of the original cataract. They have probably had Phacoemulsification, and are calling it laser – even though it is not .The Phacoemulsification technique (Fig.1) is the most advanced technique for cataract removal and is normally performed on an outpatient basis under local or topical anesthesia. The operation takes about 20 minutes and is usually painless during and after the surgery.
The lens of the eye is like an orange with a peel around the outside and a central core (Fig. 1). We call the outside peel the CAPSULE and the inner core, the CATARACT. In the Phacoemulsification technique, the front capsul or peel is removed. The core or cataract is then broken into many small particles by an ultrasonic probe and suctioned out of the eye, leaving the posterior capsule (peel) behind (Fig. 1). A plastic, acrylic, or soft silicone lens implant is then placed where the natural lens was, resting on the posterior capsule (peel). Intraocular lens implants are the most natural way to restore your vision after cataract surgery and are used in almost all cases.
There are several Intraocular lens implant options available to achieve distance vision and/or near vision after the cataract or clouded lens has been removed.
www.acrysofiqtoric.com (link to our preferred toric IOL)
https://surgical.jnjvision.com/us/iols/other.html (link to our preferred standard IOL)
https://surgical.jnjvision.com/us/iols/multifocal.html (link to our preferred multifocal IOL)
Laser Assisted Cataract Surgery
While a laser is not used specifically in the cataract removal, we now have the LensAR laser available to assist with cataract surgery. This laser is utilized to provide a safer cataract surgery by softening the cataract before its removal.
Refractive Cataract Options
If your desire is to see a full range of sight with minimal or no dependence on glasses for distance, intermediate and near vision, we can address your presbyopia with a depth of focus lens which allows for a continuous range of high-quality vision
Intraocular Lens Biometry
While biometry, the method used to calculate the power of the Intra-Ocular Lens (IOL) which will be used to replace your clouded lens or cataract, is very accurate in the majority of patients, the final result may be different from what was planned for many reasons. Most commonly, as the eye heals the IOL can shift very slightly toward the front or the back of the eye. The amount of this shift is not the same in every patient and it may cause different results than predicted. Errors in measurement, machinery, or calculations can also cause the result to be different than expected. Patients who are highly nearsighted or highly farsighted have the greatest risk of differences between planned and actual outcomes. Patients who have had LASIK or other refractive surgeries are especially difficult to measure precisely and may have very different outcomes than planned. If the eye’s visual power after surgery is considerably different than what was planned, glasses or contact lenses may be needed, surgical replacement of the IOL might be considered, or refractive laser surgery may be used to correct the error. There may be additional costs for these procedures.
Types of Lens Implants
Monofocal Lens Implant
You can choose to have a monofocal (single focus) lens implant for distance vision and wear separate READING GLASSES. This is the conventional procedure – meaning costs are usually deductibles only, if you have insurance or Medicare.
Monovision Lens Implant
With this method, a different powered implant is placed in each eye- one for near vision and the other for distance vision. This combination of one distance eye and one reading eye is called monovision and would allow you to read without glasses. This technique has been employed quite successfully in many contact lens and refractive surgery patients; however, results of this technique cannot be guaranteed. There is an added out-of-pocket cost for this technique.
Multifocal IOL (Lens Implant)
These lens implants (IOLs) provide distance vision AND restore some or all of the focusing (accommodating) ability of the eye for near vision. Depending upon the technological features of these IOLs, they may be described as accommodating, apodized diffractive, or presbyopia-correcting. All of these lenses are multifocal, meaning they correct for both distance vision and some other ranges, such as near or intermediate. These lenses are referred to as a Premium lenses/ procedure and there is an added out-of-pocket cost for this technique.
Toric Lens Implant
An implant designed to correct astigmatism.
ORA Guided Cataract Surgery
Cataract surgery used to be about preventing blindness. But with today’s precision techniques, advanced lens replacement and guidance from the ORA System®, your surgeon can return your vision to the way it was years ago.
It used to be that a surgeon needed to wait weeks after performing surgery to determine your vision results. Thanks to ORA, this is no longer the case. Now, during the procedure, your surgeon can take measurements of your eye. ORA measurements are taken after the clouded cataract is removed, when the surgeon has a clear view, allowing him to tailor the procedure to your individual eye and refine your visual outcome.
Dr. Van Buren can now provide tailored results to optimize your surgery to maximize your final vision! Now, during your procedure, Dr. Van Buren can take real time measurements of your eye. ORA measurements are taken after the clouded cataract is removed when the view is clear. These findings allow Dr. Van Buren to refine your final visual outcome.
The Visian ICL offers unparalleled quality of vision, providing excellent contrast. Two unique factors help explain this superior optical performance. First, the Visian ICL is made of Collamer – a soft, flexible lens material that contains a small amount of collagen – making the lens extremely biocompatible for a lifetime of clear vision. Second, the lens is placed inside the eye, where it continues to focus light accurately without any maintenance required.
The Visian ICL is inserted into the eye by Dr. Van Buren through a small, micro incision. The lens unfolds in the eye and is positioned between the iris and the natural lens where it stays indefinitely. The procedure takes approximately 15 minutes and is performed on an outpatient basis.
The Visian ICL does not alter any structures within the eye or on the cornea. If necessary, it can be removed from the eye by a simple surgical procedure.
Invisible and Undetectable
You won’t be able to see the Visian ICL in your eye, and neither will anybody else. Exceptional quality of vision will be the only reminder that you have had 21st century vision correction.
Advanced Lens Material
The Visian ICL is made of Collamer, an advanced lens material that has unique properties. Collamer transmits light and reduces reflections that can interfere with vision, so you see clearly. Made of a copolymer and collagen, Collamer is also highly biocompatible. It allows the Visian ICL to rest quietly in position while accurately correcting vision. Collamer is the only lens material made with collagen – the best choice for a lens that is going to remain inside you body for a lifetime.
Implantable Contact Lenses (ICL)
Who is the Best Candidate for ICL
The Visian implantable contact lens is a state-of-the-art refractive error solution that is ideal for anyone who has the need or desire for quality vision correction.
Good candidates for the Visian ICL include patients who:
- Are nearsighted, including those with mild, moderate, and severe myopia (-3D to -20D prescription).
- Have proper anterior chamber depth and acceptable eye tissue cell density (this will be determined by Dr. Van Buren after a comprehensive eye exam).
- Have not had a change in their eyeglass prescription of more than 0.5D in a year.
- Are not currently pregnant.
- Have no known allergies to medications used during refractive surgery or no other contraindications.
- Have dry eyes, severe myopia, or a thin cornea (non-LASIK candidate).
Why Patients Seek Visian ICL
Patients seek the Visian ICL because they expect the highest quality of results from their refractive vision correction procedure. The advantages make the Visian ICL a sought after treatment for nearsightedness.
High quality of vision – The Visian ICL not only improves your visual acuity, but it also enhances your quality of vision by producing sharp vision.
Wide treatment range – In comparison to other refractive procedures, the Visian ICL offers the widest treatment range for treating myopia (-3.0 diopters to -20.0 diopters).
Foldable – Because the Visian ICL is foldable, a small incision is required during the procedure. This feature makes the procedure efficient (no sutures needed) and improves healing time.
Invisible – The placement of the Visian ICL into the posterior chamber of the eye makes the lens invisible to both the patient and any observer.
Rapid Healing – The time required heal after Visian ICL procedure is much faster than LASIK. Patients enjoy functional vision even on the day of the procedure.
Proven track record – Implanted in over 65,000 eyes worldwide, the safety and amazing improvement in vision quality of the Visian ICL has been proven over the last 15 years.
How is the Procedure Done
15 Minutes That Will Change Your Life. Prior to the implantation of the Visian ICL, you will receive topical anesthetic drops. You will also receive some relaxing medicine. First, a microscopic incision will be made where the white of your eye meets the colored part. Second, the flexible ICL will be folded and slipped into your eye. Finally, the ICL is positioned behind the iris where it stays.
That’s it! Because the incision made is microscopic it will heal naturally in a very short period of time without needing any sutures. Implanting the Visian ICL is an outpatient procedure, and takes about 15 minutes. About one hour after the procedure you will be able to leave the clinic.
Frequently Asked Questions
Who are candidates for Visian ICL?
If you are over 21 and nearsighted, you are an excellent candidate for Visian ICL. It is preferable that you have had no previous ophthalmic surgery or history of ophthalmic disease such as glaucoma, iritis, or diabetic retinopathy.
Exactly where is Visian ICL placed in the eye?
Visian ICL is placed in the “posterior chamber,” behind the iris and in front of the eye’s crystalline lens. The lens does not touch any internal eye structures and stays in position.
What is the track record of Visian ICL?
Extensive research and development preceded the introduction of Visian ICL. It is now being used by more than 65,000 patients worldwide. The satisfaction rate among patients is extremely high – above 99%. Visian ICL provides excellent and stable outcomes.
What if your vision changes?
Visian ICL offers treatment flexibility. If your vision changes dramatically, the lens can be removed and replaced, or another procedure can be performed at any time. With Visian ICL, you can wear glasses or contact lenses if necessary.
Can they dry out or get dirty like a contact lens?
No. Visian ICL avoids problems experienced with traditional contact lenses. It is designed to remain in place inside your eye, without maintenance. A routine, annual visit with you eye doctor is recommended to make sure everything is fine.
Can Visian ICL be seen by the naked eye?
No. The lens is positioned behind the iris where it is invisible to both you and observers. You enjoy a cosmetic appearance that is natural. Only your doctor will be able to tell that vision correction has taken place.
Does it hurt?
No. Most patients state that they are very comfortable throughout the procedure. Dr. Van Buren will use a topical anesthetic drop prior to the procedure and usually administers a light sedative as well.
Will I be able to feel the Visian ICL once it is in place?
No. You will not feel anything different. The Visian ICL is designed to be completely unobtrusive after it is put in place. It stays in position by itself and does not interact with any of the eye’s structures.
What is Pterygium?
Pterygium in the conjunctiva is characterized by elastotic degeneration of collagen (actinic elastosis) and fibrovascular proliferation. It has an advancing portion called the head of the pterygium, which is connected to the main body of the pterygium by the neck. Sometimes a line of iron deposition can be seen adjacent to the head of the pterygium called Stocker’s line. The location of the line can give an indication of the pattern of growth. The exact cause is unknown, but it is associated with excessive exposure to wind, sunlight, or sand. Therefore, it is more likely to occur in populations that inhabit the areas near the equator, as well as windy locations. Additionally, pterygia are twice as likely to occur in men than women.
As it is associated with excessive sun or wind exposure, wearing protective sunglasses with side shields and/or wide brimmed hats and using artificial tears throughout the day may help prevent their formation or stop further growth.
Symptoms of pterygium include persistent redness, inflammation, foreign body sensation, dry and itchy eyes. In advanced cases the pterygium can affect vision as it invades the cornea with the potential of induced astigmatism and corneal scarring
As it is a benign growth, pterygium typically does not require surgery unless it grows to such an extent that it covers the pupil, obstructing vision or presents with acute symptoms. Some of the irritating symptoms can be addressed with artificial tears. However, no reliable medical treatment exists to reduce or even prevent pterygium progression. Definitive treatment is achieved only by surgical removal. Long-term follow up is required as pterygium may recur even after complete surgical correction.