What Are Cataracts?
A cataract is a clouding of the natural lens of the eye that occurs slowly as we age. Cataracts are an incredibly common occurrence- The majority of Americans have a visually significant cataract or have had cataract surgery by age 80. Every human will eventually develop cataracts if they live to be old enough.
Cataracts can form in one or both eyes and can cause blurry vision. The symptoms of cataract can include blurry or hazy vision that cannot be improved with glasses, poor night vision, glare and/or halo at night, difficulty reading and yellowing of the vision.
When a cataract is causing vision loss that decreases the quality of life for a patient, many opt to regain their vision with cataract surgery.
Treatment: Cataract Surgery
If new prescription glasses are unable to clear your blurry vision due to cataracts, the only option for successful treatment is cataract surgery.
Only you and your doctor can decide if cataract surgery is right for you. The first step is to schedule a cataract exam (typically covered by your medical insurance) or free cataract surgery consultation. During this examination, you will undergo a comprehensive eye exam to examine your eye, test your vision, and discuss the options available to you.
Cataract surgery is a relatively safe and effective procedure. A high percentage of patients get significantly improved vision after cataract surgery. The risks of cataract surgery are low, but exist. Your doctor will discuss this in detail prior to surgery.
During cataract surgery, your surgeon will remove the cloudy lens of your eye and replace it with an artificial lens called an Intraocular Lens (IOL) in a procedure that typically takes 7-10 minutes and is performed under topical (eyedrop) anesthesia in addition to a relaxing medication that is given by mouth or IV. Cataract surgery is typically comfortable and often results in much better vision in the first few days after surgery.
Types of Cataract Surgery:
Traditional Cataract Surgery
Traditional cataract surgery has been used successfully for years and involves using a manual metal or diamond blade for incisions into the eye and lens followed by removal of the cloudy natural lens with an ultrasound device. Traditional cataract surgery is covered by your medical insurance.
Laser-Assisted Cataract Surgery
Laser-assisted cataract surgery involves the use of a femtosecond laser (Ziemer Femto Z8) to assist in making incisions during the cataract surgery. These incisions are more precise than manual incisions. As a result of the laser dissecting the natural lens, less ultrasound power is used for its removal, resulting in a faster recovery of vision than traditional cataract surgery.
While laser-assisted surgery offers benefit for any patient, it may be even more useful in patients with certain medical conditions of the eye including dense cataracts, traumatic cataracts, Fuch’s dystrophy (an inherited condition of the eye that can lead to significant corneal swelling after surgery) and pseudoexfoliation (a disease of the eye of unknown origin where whitish material is deposited in the front of the eye that causes small pupils and weak zonules – the delicate strings that attach the natural lens to the eye).
In Dr. Dougherty’s hands, laser-assisted is slightly safer than traditional treatments and multiple studies have demonstrated increased precision of the vision correction outcome with laser-assisted surgery. The downside of laser-assisted cataract surgery is that it is not covered by any insurance and is an out-of-pocket expense as part of a vision correction package.
Dougherty Laser Vision is the first Ophthalmologist on the West Coast to use the FEMTO LDV Z8 laser.
The Ziemer Femto LDV Z8 for Cataract Procedures
Ziemer’s Femto LDV Z8 laser is Swiss-engineered and FDA-approved. The Z8 technology provides precision in the cornea and power in the lens with fragmentation. In traditional cataract surgery, these incisions are performed manually, with a blade, in a linear fashion. Ziemer’s laser technology, however, allows for the incision to be made in a variety of patterns with an incredibly fast sequence of low-energy laser pulses, lending procedures consistently optimal results.
Dropless Cataract Surgery
Dropless Cataract Surgery is a revolutionary new technique that makes the already safe and effective cataract surgery even better. Dropless means that the patient is typically no longer required to use postoperative eye drops to combat inflammation and infection. At the time of surgery, a combination of antibiotic and steroid is placed into the eye. As a result, the expense and hassle of eyedrops after cataract surgery is avoided. There is evidence that medication directly placed into the eye at the time of surgery may decrease the risk of infection and swelling compared to eyedrops. The main side effect of the dropless medication is that you may see floaters in your vision for the first few days after surgery.
Intraocular Lenses (IOLs) Available at Dougherty Laser Vision
Premium IOL Packages
At the time of cataract surgery, an intraocular lens (IOL) must be placed into the eye to replace your natural lens in order for you to see. Traditionally, a basic IOL was placed at the time of surgery with the expectation that glasses or contacts would be needed to maximize vision after surgery. At DLV Vision, we offer a range of IOL’s as part of a Premium IOL package that can help improve vision and decrease or eliminate the need for glasses or contact lenses at the time of surgery. Unlike many surgeons, at DLV Vision, we see each cataract surgery as a unique opportunity to correct your vision to minimize the use of glasses. Each Premium IOL Package offered at our center includes astigmatism correction as well as Laser Vision Correction (LASIK or PRK) at no charge after surgery, if necessary, to maximize your vision without glasses.
Softec HD Premium Lens Implant Package
Softec HD Lens was developed to meet higher patient expectations for higher quality vision.
The Softec HD is manufactured as a bi-aspheric IOL, which improves quality of vision compared to traditional IOL’s. In addition, this lens is one of the most precisely manufactured IOL’s in the world. As a result, the Softec HD comes 0.25 D increments which allow for a more precise vision correction outcome; most IOLs on the market are only available in less accurate 0.5 D steps. Lastly and most importantly, the Softec HD is made of a hydrophilic acrylic material, which studies have shown allows for an increased depth of focus and better intermediate vision without glasses. While the Softec HD will not eliminate reading glasses unless monovision (1 eye set for distance, and 1 eye set for near) is employed, many patients get good intermediate vision in addition to excellent distance vision without glasses.
Find out more about the Softec HD Lens, watch the video below.
Toric Astigmatism Correcting IOLs
The cornea (clear window in front of the eye) on a normal eye has a circular shape whereas, in an eye with astigmatism, the cornea is shaped more like an oval. This oval shape creates 2 points of focus in the eye.
Astigmatism is a common eye condition that affects millions of people and often leads to blurred or impaired vision at both distance and near. With advancements in lens technology, it is now possible to correct astigmatism with Toric lenses that correct astigmatism. The FDA Approved premium Toric lens is a single “vision” lens that is implanted during cataract surgery to replace the clouded lens.
If you’re looking to release yourself from the dependency of glasses after surgery and you can not tolerate monovision (1 eye set for distance and 1 eye set for near), you should ask about the options for multifocal lenses to expand your range of vision. Tecnis Multifocal (MF) lenses allow a patient to have the advanced vision at distance and near regardless of your pupil size. Multifocal IOL’s work by using diffraction rings on the lens that optically split the incoming light into distance and near so that you can see both distance and nearby the brain paying attention to the appropriate image.
Tecnis MF IOL’s all allow for distance vision and are available in 3 powers for close vision – +2.75 for arms length, +3.25 for book distance, and +4.00 for very near tasks. The main downside of MF IOL’s is that you will notice halos (rings around lights) or halo (blurring around a point light source) at night or in low lights due to the rings on the optic (see animation below). The night vision symptoms tend to be mild and improve with time in most patients but can sometimes affect an individual’s ability to drive at night or to perform other visual tasks. The other downside of MF IOLs is that there is only a single near point that is clearly in focus rather than a full range of vision.
Tecnis Symfony® Intraocular Lens is a type of multifocal lens called an Extended Depth of Focus (EDOF) IOL that can give a continuous range of vision from distance to intermediate (computer vision). The FDA approval includes a version of the lens for people with astigmatism, the Tecnis Symfony Toric IOL.
The Symfony typically provides high-quality vision. Some IOLs may leave patients with an inability to focus clearly due to competing wavelengths of light passing through the lens at different angles (known as chromatic aberration), or with vision that is not completely focused because of the shape of the lens (known as spherical aberration). The Symfony lens has been engineered to correct these issues.
The main downside of Symfony IOL’s is that while good distance and intermediate vision may be achieved, most patients require glasses for reading, particularly for fine or low-contrast print. The other downside of Symfony is the tendency for glare, halo, and/or starburst (rays of light coming seen to be coming off of a point light source) in low light or nighttime that can sometimes affect an individual’s ability to drive at night or to perform other visual tasks.
Basic Monofocal IOLs
Monofocal IOL’s are lenses that have been used for decades as part of cataract surgery. The advantage of a Monofocal lens it that they allow your doctor to set different ranges of focus. After your consultation, your doctor will suggest setting the distance for near or far vision. Based on the focus setting of your Monofocal lens, a patient will still need to wear glasses for distance vision or reading glasses for close up. Most cataract patients that choose the Monofocal lens elect to set the IOL’s for distance vision, then relying on reading glasses for close up objects.View Video
In-Office Cataract Surgery at Dougherty Laser Vision
Dougherty Laser Vision offers in-office cataract surgery to patients who have an HMO, high deductible PPO insurance or no insurance at all. Benefits of in-office surgery include less cost to the patient and more convenience than a traditional surgery center. In addition, we can offer cataract treatment on both eyes on the same day.
For HMO patients, the other benefit is that we are able to offer Premium intra-ocular lenses (IOLs) to improve vision without glasses or contact lenses. Many surgeons (including most HMO surgeons) only offer the basic IOL that requires the use of glasses for best vision after surgery. With Premium IOL’s placed in our in-office cataract surgery suite, you can have your astigmatism treated and potentially decrease or eliminate the need for glasses or contacts for both distance and near vision!
If you would like to learn more about your options for cataract surgery, call or schedule a Cataract Examination at our offices in Westlake Village, Beverly Hills, Camarillo, or San Luis Obispo today.
Dr. Paul Dougherty is certified by the iSBCS, the International Society of Bilateral Cataract Surgeons