Cataracts are a condition when the natural clear lens in the eye begins to physically change into a cloudy lens. In the early stages of cataracts, this clouding of the natural lens scatters light that enters the eye resulting in glare, especially at nighttime while driving. Patients may also notice frequent changes in the prescription of their glasses and colors may appear faded. As the condition progresses the cataracts grows in size and increase in hardness, resulting in impaired vision that is generally not correctable with glasses. In some instances, the cataracts may grow so large that they push on the drainage structures of the eye, putting patients at an increased risk for Glaucoma.
In cataract surgery, the large cloudy lens is removed by hand with a small handheld device and is replaced with an artificial lens that restores light to the back of the eye. There are many different types of artificial lenses and surgical procedures that can be used depending on what the patient is looking to get from their cataract surgery and what the patient is a surgical candidate for (determined at your pre-operative evaluation).
Standard Lens Implant: This lens implant will replace the cataract and restore light to the back of the eye. For patients who do not have astigmatism (a misshaped cornea), this lens results in good distance vision without the need for glasses. Glasses will, however, still be needed for up-close activities, such as reading, eating, and viewing your car dashboard.
If a patient does have astigmatism, this lens implant will not correct it, requiring the patient to permanently wear prescription glasses at all times for good vision.
To maximize visual potential, if the patient has astigmatism the astigmatism should be corrected. However, because there are different degrees of astigmatism (mild, moderate, severe), a thorough pre-operative evaluation is needed. If mild amounts of astigmatism are detected, we recommend the patient elect to have a limbal relaxing incision (LRI), either done with a diamond blade or with a femtosecond laser. For patients with moderate to severe amounts of astigmatism, a Toric lens or Accommodative lens should be considered.
Toric Lens Implant: For patients with significant degrees of astigmatism, a Toric lens is highly recommended as a baseline option. Toric lenses are designed to optically cancel out the astigmatism in a patient’s cornea. In most instances, this results in distance vision that is sharper and clear than what is possible with glasses. However, over-the-counter readers will still be needed for up-close activities, such as reading, eating, and viewing your car dashboard.
If a patient has a significant degree of astigmatism yet is looking to get away from glasses for most, if not all, of their activities, a special toric accommodative lens should be considered.
Multifocal Lens Implant: Utilizing an advanced concentric ring design, multifocal lenses allow patients to see at multiple distances: up-close, intermediate, and far away, usually without the need for any glasses. For patients looking to be free from glasses and readers for most daily situations, the multifocal implant presents as a great option.
Multifocals work best in pairs and also when a patient’s eyes have very little astigmatism. If mild amounts of astigmatism are detected during pre-operative evaluations, it should be corrected with a limbal relaxing incision done with either a diamond blade or a femtosecond laser. In very specific instances a special multifocal lens can be utilized with patients with moderate degrees of astigmatism. However, should the patient have more severe degrees of astigmatism, an accommodative lens should be considered as these patients are not candidates for multifocal designs. Furthermore, if a patient does many activities in low lighting conditions for extended periods of time, such as driving at night, an accommodative lens implant should also be considered.
Accommodative Lens Implant: The most advanced lens design, the accommodative lens implant mimics the natural movements of the human lens giving a natural range of vision over multiple distances; up-close, intermediate, and far away, usually without the need for any glasses. For patients looking to be free from glasses and readers for most daily situations, the accommodative lens implant presents as a great option.
Accommodative lenses work best in pairs but can also be used under a variety of astigmatism situations. If mild amounts of astigmatism are detected, it should be corrected with a limbal relaxing incision, done by either a diamond blade or a femtosecond laser. If moderate or severe amounts of astigmatism correction are detected, a special toric accommodative lens can be used, giving patients with high degrees of astigmatism the benefits of a full range of vision. Furthermore, for individuals that work in low lighting conditions, the accommodative lens implant enhances contrast over multifocal designs.
Other elective procedures:
Diamond Blade Limbal Relaxing Incision (LRI): The most cost effective means by which astigmatism is corrected. By utilizing 138,000 data points from our anterior segment tomographer (performed during your preoperative evaluation), a highly accurate 3D model of the eye can be created to examine the unique geometries that create your astigmatism. In conjunction with a special geometric calculator, your doctor can determine how to accurately correct your astigmatism.
Femtosecond Assisted Cataract Surgery: Operating at a speed of one millionth of one billionth of a second, a femtosecond laser system is a highly sophisticated way of performing cataract surgery. Instead of the doctor performing all portions of the cataract surgery by hand, the doctor uses a computerized surgical system to perform some of the most critical steps of cataract surgery. There are three key benefits to using the femtosecond system that patients should know about:
1) Highly accurate astigmatism correction: In situations where a diamond blade limbal relaxing incision is not accurate enough to correct a patient’s astigmatism, a computerized laser approach is recommended.
2) Softening of dense or specific kinds of cataracts: For patients that have very dense cataracts, or have had cataracts form in an usual way, a femtosecond laser can be used to soften and precisely break apart the cataract. The result is a cataract surgery with a reduced risk of complications in these specific instances.
3) Superior corneal protection: For patients that have pre-existing diseases with the cornea or have corneas that cannot tolerate surgery as well as others, a femtosecond laser provides a gentler cataract surgery, minimizing the stresses on a compromised cornea.
As the Capital Region’s only certified physician on both Femtosecond Laser Platforms, we are proud to have Dr. Cheng offer these technologies to our patients.
Orange Wavefront Aberrometry System (ORA): Used by your surgeon at the time of your cataract surgery, ORA allows for the best post-operative outcomes possible by providing your doctor the ability to precisely measure dimensions of your eye as well as the position of your intraocular lens. The length and dimensions of the eye are very important to your surgeon and influence which power of implant is placed in your eye, and your subsequent vision afterward. ORA is recommended for patients that have had prior cornea or refractive surgery (e.g. LASIK, PRK, RK), or patients who are having a toric lens implanted. While ORA is not needed in all cases, your doctor will let you know if ORA is recommended in your particular case.
Reduced Drops Cataract Surgery: Traditionally, most patients need to take two to three eye drops several times a day before and after their cataract surgery. For patients that have difficulty with eye drops or are not able to self administer eye drops, reduced drops cataract surgery presents as a viable alternative. With reduced drop cataract surgery, the doctor injects a long acting form of medication into the eye at the end of surgery instead of the patient self administering drops each day. In many instances patients require only one drop, or none at all. Ask your doctor if you are a candidate for reduced drops cataract surgery.
iStent: A device smaller than Lincoln’s eye on the US penny, this special stent is used to lower pressure inside the eye in patients diagnosed with Glaucoma, reducing or eliminating the need to use pressure reducing drops. This is especially helpful for patients who have difficulty in self administering their drops or are unable to do so altogether. As the Capital Region’s only comprehensive ophthalmologists specializing in premium lenses and placement of the iStent, we are proud to have our physicians Dr. Cheng and Dr. Lemanski offer this surgical option to our patients.