What is a Cataract?
A Cataract is a clouding of the eye’s natural lens, which occurs as we age. The initial result is increasingly blurred vision. If left untreated, cataracts will eventually lead to a complete loss of vision. Currently, the only treatment for cataract is to surgically remove the eye’s natural lens and replace it with a synthetic one (see ReSTOR and Toric lenses) – a clear plastic Intraocular Lens (IOL) made of either PMMA, Acrylic or Silicone. These materials are all biocompatible in the eye and have proven safe for many decades of life.
Cataract surgery is one of the safest and most common surgical procedures performed today. The statistics are impressive. Of the 1.5 million cataract surgeries performed each year, 98% are complication-free and 95% result in improved vision.
Dr. Tinoosh performs no-stitch cataract surgery under topical anesthetic drops. No needles will be used during surgery and patients often require no patch after surgery. More than 98% of patients are pain free, and most see clearly within hours to days after the procedure. There are several types of IOL’s available. Dr. Tinoosh will provide a thorough examination and evaluation to help determine which lens is best for you.
Cataract Lens & Lens Implants
Intraocular Lens Implants (IOLs) – Cataract Surgery.
Dr. Tinoosh specializes in refractive custom cataract surgery. We try to minimize the refractive error (prescription) as much as possible during cataract surgery, in order to lessen our patients’ dependency on glasses post-operatively. Besides Dr. Tinoosh’s surgical skills, this also requires attention to details during the pre-operative assessment and choice of intraocular lenses. Intraocular lenses are measured using laser interferometry with the Carl Zeiss IOL master. In dense cataracts, immersion A-Scan ultrasonography is also used to confirm the intraocular lens implant measurements. There are many types of IOL’s (Intraocular Lenses) on the market and new ones are being developed every day, including lenses to correct for astigmatism, block UV light and a range of other specific characteristics. Very few insurance carriers cover specialty lenses. Each of these lenses requires specific training and certification for implantation.
There are different types of IOL’s, Monofocal and Multifocal:
Monofocal: This is the traditional IOL, approved by the FDA in 1981. It is a single focus lens that allows for vision at a set distance – near, intermediate or far. Corrective lenses may be needed after cataract surgery with this IOL to compensate for your particular visual needs. When cataracts are present in both eyes, patients may elect to have both eyes implanted with IOL’s that correct for distance. This provides good distance vision, but patients will require reading glasses for up close functions. Patients may elect to have one eye implanted with a near lens and the other with a far lens, a technique called Monovision, which many contact lens wearers are already familiar with. Dr. Tinoosh uses the most advanced monofocal intraocular lenses available, and the wavefront optimized lenses whenever it is possible. These intraocular lenses have the best potential for visual quality and for better night vision.
- Toric Monofocal
- Multifocal or Accommodating
These are the newer IOL’s that allow for greater range of vision and decreased dependency on glasses or contacts. The best part of these accommodating lenses is that they correct for Presbyopia (hardening of the eye’s natural lens as we age). These lenses work in different ways. Depending on your visual needs and characteristics, Dr. Tinoosh will make sure you understand the options and help you make the most informed decision possible. It is important to understand that although these lenses give more ranges of vision, the visual outcome cannot be compared to the natural lens of a perfectly seeing eye at a young age where the eye has perfect ranges of vision. Patients may be spectacle free for most of the time, however, they may still need glasses for some hard visual tasks like night driving or reading, especially in dim illumination or reading very fine print. Here is a very general overview of some of the lenses Dr. Tinoosh prefers.
An Apodized Diffractive lens with multiple zones, which responds to the way light is focused in the eye at various distances – the center is optimized for near vision, with a gradual tapering to the outer edge of the lens that is optimized for distance. The ReSTOR lens provides excellent far away and close-up vision. It provides reasonable intermediate vision (computer distance). It functions almost like glasses with bifocals. AcrySof ReSTOR was approved by the FDA in 2005. Dr. Tinoosh uses the latest generation, the ReSTOR aspheric IOL. This is a wavefront optimized intraocular lens that improves on the previous generation. The ReSTOR IQ currently comes in 2 versions, for maximum optimization of near vision.
TECNIS® multifocal Lens
The advanced TECNIS® Multifocal is an implantable lens that significantly improves vision after cataract surgery and corrects presbyopia. Designed to help you regain younger vision and be free of glasses, the TECNIS® Multifocal Lens can provide you with high-quality vision at all distances and in all lighting conditions—even in dim light. If you enjoy activities such as reading, boating, quilting, playing golf, sightseeing, or surfing the Internet, the TECNIS® Multifocal Lens allows you to lead an active lifestyle. (Only with the TECNIS® Multifocal IOL: • High-quality vision even in low-light environments, such as reading a menu in a dim restaurant or driving at night. • Excellent vision for all distances—near, far, and everything in between. • Nearly 9 out of 10 patients never have to wear glasses.)
Crystalens is a revolutionary new breakthrough in vision enhancement. It is the first intraocular lens (IOL) replacement for cataracts that focuses like the eye’s natural lens, allowing for continuous vision up close, far away and all distances in between.
By using the eye’s muscle to move the lens backwards and forwards naturally in response to the brain’s desire to see at different distances. Crystalens enables the eye to focus continuously and seamlessly through a range of distances, including near, far and everything in between. Patients experience the same vision they had when they were younger, for most without the inconvenience of corrective lenses. The Crystalens is ideally suited for men and women aged 50 to 64 years of age with cataracts who want to not only restore clarity in their vision, but restore their near, intermediate, and distance vision.
When cataract is removed, a lens is placed inside of the eye. It is a great eye surgery, because patients who had been nearsighted or farsighted can now be made to have excellent vision without glasses.
Symfony Lens delivers a continuous full range of high quality vision with reduced incidence of halos and glare comparable to a multifocal IOL. The Symfony lens, which treats presbyopia (age-related long-sightedness) is implanted into the eye during a normal cataract operation.
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Look forward to better vision with personalized options for +3.25 your lifestyle. TECNIS Multifocal Low Add Patient Education Brochure
Accommodating IOL (Crystalens)
Crystalens AO Lens is an artificial lens implant that can treat both a person’s cataracts and presbyopia —the clouding or hardening of your lenses, and the loss of near and intermediate vision, respectively. Crystalens was modeled after the human eye. Like the natural lens, it is a lens implant that uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Crystalens dynamically adjusts to your visual needs. Many patients will have greater freedom from glasses after surgery, but you may still need reading glasses for small print or other near vision tasks.
Crystalens AO is implanted during one of the most commonly performed surgeries in the world. Over 3 million cataract surgeries are performed in the US every year.
Key Features & Benefits
The first FDA-approved accommodating intraocular lens – meaning that it uses the natural focusing ability of the eyeCrystalens AO was inspired by the eye’s natural crystalline lens.Unlike multifocal lenses, Crystalens AO directs all available light received by the eye to a single focal point, so that you can focus on objects at all distances.
An Important Choice
During cataract surgery, your physician will replace your natural lens with an IOL. Today there are multiple types of IOLs, each delivering a different performance profile based on how the lens is designed. Ask your doctor about standard monofocal IOLs, multifocal IOLs, and Crystalens accommodating IOLs to see which is right for you.Standard monofocal IOLs deliver improved vision at just one distance, usually far. Multifocal IOLs are designed to deliver improved vision for distance and near. However, some patients may experience some halos and glare when driving at night, and some patients have difficulty adjusting to their new vision.
Crystalens IOLs are designed to reduce your need for prescription glasses during your normal daily activities. Crystalens has flexible hinges that enable it to move and flex with your eye, in response to the eye’s focusing muscle. Its movement is similar to the eye’s natural lens.
Monovision addresses the problem of presbyopia that most people start to encounter at the age of 40-45 when they begin to need reading glasses or bifocals for close vision. With monovision, the dominant eye (the eye you would use to focus a camera) is focused for distance vision, and the non-dominant eye is focused for near to intermediate vision. This can be done with contact lenses, refractive surgery, or intraocular lenses. Monovision certainly isn’t appropriate for everyone. However, when paired with the right person, it can be a great fit. Monovision is a blend of near and distance vision, and is ideal for people with an active lifestyle. However, there is a caveat to consider: since it is a compromise, most people’s vision is not perfectly crisp up close or far away. Instead, it offers the best of both worlds.
If you’re considering refractive surgery as a permanent form of monovision, it might be best to consider a “test drive” with contact lenses before making a decision. Often times patients are unsure whether they would prefer to have their eyes surgically corrected so they have to work in tandem (thus monovision) or just have both eyes corrected to see equally. There are costs and benefits with both; it really depends on Dr. Tinoosh’s assessment of your eyes and your personal habits.
Clear Lens Extraction
This procedure is considered elective or cosmetic for those patients seeking to eliminate the need for glasses for distance, intermediate and near vision. This procedure is similar to cataract surgery, where the natural lens is removed and replaced by an Intraocular Lens Implant (IOL). The indication of the procedure is to correct the patient’s prescription using intraocular specialty lenses that correct distance, near, intermediate vision, and astigmatism. In some cases, patients with severe astigmatism will require limbal relaxing incisions to reduce astigmatism. This procedure is sometimes preferred in some patients who are not candidates for laser vision correction such as LASIK or PRK laser vision correction. For more information, please call our office or you may request us to mail you a brochure on the various IOL options.
LenSX (cataract) Surgery
The LenSX® Laser system became one of the first femtosecond devices to be used in effectively eliminating a number of maladies pertaining to the eye. Since that time the LenSX® Laser has become an industry leader in a multitude of ocular procedures designed to correct astigmatism, hyperopia, myopia, and cataracts as well. Although these procedures differ in nature, the LenSX® is fully equipped to handle each respective condition. As of late, cataract removal has become the most recent focus of attention for eye specialists across the country. As opposed to the different types of LASIK procedures, cataract surgery involves a different approach, which is when the LenSX® Laser is used to effectively correct visual impairments of cloudiness, blurriness, and glare, which are all commonly known symptoms occurring in those who are likely to have developed cataracts. This particular outpatient procedure is minimally invasive and time efficient as well. Once the affected areas are removed, subsequent lens implantation will be the next step. A greater percentage of patients who’ve undergone this type of treatment are not only able to see better, many have noticed improved contrast and a brighter view of the color spectrum.
With the LenSX® Laser, a number of technical aspects are applied to give cataract patients a better view of the world around them. Enhanced procedure automation is used to dramatically reduce margins of error by obtaining and analyzing images of the eye beforehand, thus providing a broader scope with which to work. These images are tailored to suit each individual patient’s needs. Precise and customized incision architecture with the LenSX®Laser is designed to enhance accuracy when compared to hand-held diamond knife incisions. Implementing this type of bladeless technology has proven to augment the healing process significantly. Capsulotomies performed with the LenSX® are executed with greater precision as well. Perforating the capsule of the eye’s crystalline lens without removing it is standard protocol, where the outer bag of the capsule is left in place and used to insert the intraocular lens implant (IOL). Forming fragmentation patterns are also an important part of completing the surgery, as the laser fragment method is quicker and more accurate than conventional cutting. High-definition optical coherence tomography (OCT) technology is capable of capturing high resolution images that can allow eye specialists to detect corneal abnormalities at their infancy stage and treat them accordingly. Early detection, when combined with the appropriate treatment, can stem the tide of cataract formation before visual acuity begins to falter.
LenSAR Cataract Laser
Cataract surgery has come a long way since its inception back in the mid eighteenth century, when eye doctors used the technology they had available at the time, which undoubtedly had a vast number of limitations when compared to how the practice has evolved over time. Modern-day cataract procedures have been able to assist in helping millions see clearer and in many cases, increasing the brightness factor in many pairs of eyes as well. As the technology itself continues to evolve, the LenSAR Laser is living proof of the precision techniques used to restore visual impairments. Built solely for refractive cataract surgeries and subsequent lens implantations, the LenSAR design is the first of its kind, focusing strictly on helping cataract surgeons do what they do best. The latest upgrade to the LenSAR includes the Streamline™ with wireless remote functionality, and the Cassini™ Corneal Shape Analyzer. When used in concert, all of the intricate details such as corneal shape analysis, cataract density configuring and fragmentation patterns, accurate curvature incisions can be administered effectively within minutes. Surgical efficiency has once again been taken to the next level. The LenSAR’s imaging capabilities are extremely accurate; a state-of-the-art 3-D reconstruction method is used to treat the anterior segment with precision laser targeting. In addition to the above amenities provided by the LenSAR Laser, phaco (phacoemulsification) time is an important energy reduction process designed to minimize corneal endothelial cellular loss, as well as corneal edema during the early post-operative stages of recovery, which can increase the speed of overall healing with virtually zero degeneration. The LenSAR Laser imaging system is also capable of capturing images from two different angles, which in turn can provide up to 16 detailed images of the eye’s ocular axis. All designed to get a pan view of the cornea, optical surgeons are now getting a complete picture of what’s entailed and being able to detect existing and potential maladies. Augmented Reality™ is the type of technology used to collect optical biometric data and trace the rays to form a clearer three-dimensional picture. As each pair of eyes are shaped slightly different, Augmented Reality is configured to immediately adapt to the differences in eye shapes and provide the highest resolution imaging available. All of the above-mentioned technologies play integral roles in ensuring that cataract patients receive the best possible refractive treatment services. With the LenSAR Cataract Laser and a team of experienced eye specialists controlling the best possible outcomes, prospective patients can look forward to getting a more detailed look at their surroundings for years to come.
STAAR Visian ICL
Correcting abnormal vision can be carried out through a variety of topical surgical treatment options, yet each respective procedure will differ depending upon each individual patient’s needs. Over the last few decades, tremendous strides have been made in order to provide more permanence to the practice of ocular corrective solutions. In a majority of cases, myopia, aka nearsightedness, is the most common affliction, thus affecting millions who are unable to see clearly from a distance.
As a result, prescription eyeglasses and contact lenses were used to clear up the blurriness. Though quite effective through the years, patients wearing contacts or glasses were required to maintain one or the other or both on a daily basis; those who wore contacts had to be very careful not to lose them or have one pop out from time to time, or forgetting to take them out as scheduled. Eyeglasses presented a few problems as well, such as constant smudging, keeping the frames intact, and having to periodically change lens densities. The STAAR Surgical method of correcting myopia is now one of the most effective ways to take the fuss out of visual aid maintenance. The Visian ICL (Implantable Collamer® Lens) is all but doing away with dated optometric practices. Overall, lens implantation has proven to work very well in post-cataract surgical patients; on the other hand, the ICL procedure is even less invasive, mainly due to the fact cataract surgeons often end up not altering the cornea via refractive methods. The Collamer® lens implant is a bio-compatible material that requires very little or no maintenance to speak of; once inserted, the lens material bonds itself to the eye, which is in accordance to pre-determined visual specifications.
This type of technology appears to be a real game changer, especially when compared to corrective LASIK surgeries that involve corneal manipulation, which cannot be changed once the incisions are made. Newer bladeless technologies are also unchangeable once performed; when dealing with the STAAR Visian ICL, the lenses may need to be removed and changed every few years or so without any additional alterations. It’s also important to point out that minimal side effects have been documented following the ICL procedure, as opposed to various LASIK procedures that can cause the onset of “dry eye” in nearly 30 percent of those treated for myopia. The ICL is also the only lens implant on the market that provides built-in UV protection, thus reducing the amount of harmful ultraviolet ray penetration. The ICL implant process takes about 15 minutes per eye, and in most cases, normal vision is immediately restored. The implants are also removable and replaceable without affecting future treatment options. By having the Visian ICL implantation performed, seeing the world in high definition again is now more than just a possibility.
STAAR VisianToric ICL
While a number of ocular procedures are geared to treat an even wider range of visual abnormalities, the STAAR VisianToric ICL (ImplantableCollamer® Lens) is designed to work wonders for patients whose circumstances may not meet the criteria for LASIK or PRK (Photo Refractive Keratectomy) surgeries. The Toric ICL method differs from these other procedures by taking a gentler approach to these sensitive eye conditions that may exceed standard optical protocol corrections. When it comes to more severe cases of myopia (nearsightedness), the Toric ICL has opened up the door to a brand new world of high definition visual quality and acuity, which may eliminate the hassles involved when dealing with eyeglasses or contact lenses. The Collamer® lens is bio-compatible, meaning that the materials used are well-suited to work within the parameters of normal eye function. The Toric ICL is unique in the sense that the lenses are placed between the iris and the eye’s natural lens without having to manipulate the corneal areas. Corneal refraction is often performed with LASIK procedures that involve creating a corneal flap, which can often result in tissue loss; although LASIK treatments can be extremely effective, corneal manipulations are irreversible. The Toric ICL surgical option does not include corneal alterations, meaning that tissue loss or damage is virtually nonexistent. For those who have ultra-thin corneas, severe myopia, astigmatism, or any other sensitive eye issues such as persistent dry eyes or prescriptions that are out of range, the Toric ICL is tailored to successfully treat patients who possess any of these ocular maladies. After getting a complete diagnostic assessment and a targeted course of treatment, the procedure takes about 15 minutes to complete. It’s also important to be aware of the fact that the Toric ICL procedure is performed in two segments, treating one eye at a time. Upon the completion of treating the first eye, a one week waiting period is mandatory, which is commonplace when it comes to most every surgically implanted eye procedure. The positive results regarding the Toric ICL continue to show promise for prospective patients, while a greater percentage of those who’ve already undergone this type of treatment have noticed significant improvements in three different areas: visual acuity, visual quality, and sharper contrast as well. In nearly every case, post-operative patients are more than pleased about how painless it is and how little time it takes to recover. Most importantly, vastly improved all-around vision has now become a reality, and the lenses are also replaceable, if or when the time comes.
TRULIGN™ and Crystalens®
The Trulign IOL (intraocular lens) implant is the latest Toric version of the Crystalens® line of minimally invasive visual enhancement procedures. Also known as accommodative correction, the Trulign IOL is designed to restore visual acuity at multiple distances, as opposed to earlier models geared towards correcting presbyopia (farsightedness) only. The condition itself is most common among patients in their 40s and beyond, which is when normal eye function often begins to falter and can no longer focus or adapt to closer objects; one of the most common complaints related to this condition is the ability to read without having to use eyeglasses or contact lenses. The term intermediate vision is the distance where most patients experience this type of difficulty, which is the visual field ranging between 24 to 36 inches. The Trulign IOL, with its advanced technological improvements, is not only capable of correcting intermediate vision problems, but astigmatism as well. It’s also important to point out that all other visual fields should remain unchanged or even improve, which of course depends upon individual circumstance. In addition, the Crystalens and Trulign Toric are known for improving contrast sensitivity, which is a really important aspect when focusing on finely detailed objects. The internal weavings of the Trulign IOL have been developed over time in order to create a longer lasting remedy for postoperative cataract patients. Following the average outpatient cataract procedure, inserting IOL implants are standard operating protocol. The latest Trulign Toric model is considered to be a premium IOL, meaning that many of the common side effects have been virtually eliminated in most cases. Aside from getting rid of the cloudiness and reducing glare, the halo effect can be minimized as well. When it comes to those who have night vision issues, the Trulign IOL may not be able to correct this problem. Although this procedure has a stellar reputation for improving overall vision, the likelihood of regaining perfect 20/20 vision is a remote possibility. Patients may also need follow-up procedures down the road; the most common latent function of having this procedure performed is the eventual, but gradual clouding of the lens capsule. While it may seem as though the cataracts have reappeared, the condition concerning the capsule can easily be corrected with spot laser treatments; also known as a YAG laser procedure, the treatment often takes less than an hour and the problem will likely be solved. Before making a final decision on which procedure may work best for you, consulting with your eye specialist concerning the pros and cons regarding the Trulign Toric IOL is highly recommended. Dr. Tinoosh will discuss possible and probable outcomes, which can vary from patient to patient.