A cataract is a “clouding” of the eye’s natural lens, which results in blurred or hazy vision. Treatment for cataracts involves removing the cloudy natural lens and replacing it with either a monofocal, toric or multifocal intraocular lens implant (IOL).
More than 20 million adults in the U.S. have developed cataracts, making it the number one cause of poor vision in the United States. Cataracts are caused mainly by age, trauma, heredity, and exposure to ultraviolet radiation. Cataracts can also occur as a result of eye disease, after the use of certain medications, or as a result of medical conditions, such as diabetes.
Cataract surgery has undergone tremendous technological advances since the days of your parents and grandparents. As one of Indiana’s leading cataract and refractive surgeons, J. Rex Parent, M.D. was one of eleven physicians in the United States (out of 17,500 ophthalmologists) who participated in the national study leading to FDA approval for the first “multifocal” intraocular lens and the first surgeon in the Midwest to implant a multifocal lens. Dr. Parent implanted his first multifocal IOL in 1984 during this study.
Dr. Parent continues to stay abreast of the latest developments in eye care. He has participated in many FDA approval studies involving several types of multifocal IntraOcular Lenses (IOL’s).
REfractive Laser-Assisted Cataract Surgery (RELACS)
The procedure consists of numbing the eye with drops, followed by removing the cataract from the eye with an ultrasound-vacuum device though a micro-incision.
A Femtosecond laser can be used to increase precision of the procedure by creating the surgical incisions, correcting astigmatism and softening the cataract prior to ultrasound lens removal. A Femtosecond is to a second as a second is to 31.7 million years, in other words, incomprehensibly quick. The Femtosecond laser offers a level of accuracy exceeding that of manual surgery methods. The Femtosecond laser first images your eye and makes precise 3D maps of relevant structures to plan a procedure that is unique to you. A bladeless, computer-controlled laser then helps the surgeon perform your surgery with exacting, individualized precision not attainable with traditional surgical methods. Laser-assisted cataract surgery procedures offer more predictable and precise results.
Your surgeon can use the laser to create a precise circular opening in the lens capsule to access and remove the cataract. This precise incision helps your surgeon place the intraocular lens implant in the intended position, which improves the likelihood of glasses independence after the procedure. Also, the laser can soften the hard cataract, which allows the surgeon to remove the cataract more gently.
A foldable multifocal, toric or monofocal implant is then inserted through the micro-incision after the cataract has been removed from the eye. The procedure is often completed in 10-15 minutes. The recovery time is very rapid, usually within a few days. Only one eye is done at a time, but the second eye can be done within a week or two.
The Eye Center of Fort Wayne was the first center in Northeast Indiana to offer multifocal intraocular implants (IOLs). Dr. Parent was one of eleven ophthalmologists in the United States (out of 17,500 ophthalmologists), who participated in the national study leading to FDA approval for the first multifocal IOL. Dr. Parent was also the first surgeon in the Midwest to implant a multifocal IOL.
The multifocal IOLs offer the possibility of seeing well at more than one distance without glasses. In fact, the majority of patients do not need glasses after having the procedure. Some patients may still need occasional glasses, but far less than patients receiving the standard monofocal IOL.
Toric intraocular implants can be utilized to reduce astigmatism, which improves distance vision without glasses. Low to moderate astigmatism can be successfully corrected with the Femtosecond laser. Higher amounts of astigmatism may require both Femtosecond laser and a toric IOL to obtain the best outcome. Reading glasses will likely be needed after surgery since a Toric IOL helps correct astigmatism and improve distance vision, but does not offer the ability to see at more than one distance.
Dr. Parent discussing Advanced Cataract Surgery on PBS
Host – Mark Evans Guest – J. Rex Parent, MD
What is a cataract?
A cataract is a “clouding” of the eye’s natural lens, which results in blurred or defocused vision. According to a recent article published in the Archives of Ophthalmology, more than 20 million adults in the United States have developed cataracts, making it the number one cause of poor vision in the United States. While not all cataracts require surgery, nearly 3 million cataract procedures are performed annually in the United States According to the National Eye Institute, the number of Americans with cataracts is expected to rise to over 30 million people by the year 2020.
What causes a cataract?
Cataracts are caused mainly by age, trauma, heredity, and exposure to ultraviolet radiation. Cataracts can also occur as a result of eye disease, after the use of certain medications, or as a result of medical conditions, such as diabetes.
Can cataracts be prevented?
Cataracts cannot be prevented and are the leading cause of treatable blindness worldwide.
How is the procedure done?
The eye is anesthetized to ensure the patient’s comfort during the procedure. The natural lens is removed by using ultrasonic vibrations through a micro-incision of 3mm or less in length.
In most cases, no stitches are required, because the small incision is self-sealing. The natural lens is replaced by a foldable monofocal or multifocal intraocular lens, which is inserted through the micro-incision.
The lens spontaneously unfolds, similar to a butterfly opening its wings, as it is placed into permanent position. No stitches are required because the small incision is self-sealing.
The procedure is usually done as an outpatient procedure in an ambulatory surgery center. The only difference between cataract surgery and refractive lens exchange surgery is that cataract surgery is performed to remove a patient’s cloudy lens and refractive lens exchange is performed to reduce one’s dependence on glasses or contact lenses.
How long has Dr. Parent been performing cataract surgery?
Dr. Parent performed his first phacoemulsification surgery, or removal of cataract by ultrasound, in 1975. Dr. Parent participated in the first FDA study on a multifocal lens in 1984. In 1991, Dr. Parent began performing sutureless, clear corneal incision cataract surgery.
What is the difference between a monofocal and a multifocal intraocular lens?
A monofocal lens corrects only one distance, so you will still need to wear glasses after the surgery to see at other distances. A multifocal lens can improve your distance, intermediate, and most of your close vision. The purpose of a multifocal lens in order to be less dependent on glasses. This multifocal lens does not rebirth the patient, but does allow them remarkably improved vision at most distances.
The monofocal lens is the standard lens used in cataract surgery and is covered by Medicare or private insurance. If the patient chooses the multifocal lens to be less dependent on glasses, the patient is responsible for the cost of the upgraded lens. Neither Medicare nor private insurance will cover the cost of the upgraded lens.
Does the lens move in the eye?
The lens does not move in the eye. It is held in place by locking itself into the capsule. The capsule is the liner, similar to Saran Wrap, which held the eye’s natural lens in place.
Can cataract surgery correct astigmatism?
Yes. Astigmatism can be reduced or eliminated with Laser-Assisted Cataract Surgery and / or Toric intraocular implants.
Can both eyes be done at the same time?
No. The eyes should not be done at the same time because it is an invasive surgery. The doctor wants to make certain the operative eye is healing correctly before proceeding with the second eye. The non-dominant eye or worst cataract is usually done first.
How long does the procedure last?
The procedure itself can last anywhere between ten to forty minutes varying with each individual.
Are you asleep during the surgery?
No. The patients are very sleepy, but remain somewhat awake so that they can cooperate during the procedure. They are given medication to help keep them relaxed and the eye is anesthetized to ensure the patient’s comfort.
What is the healing time after cataract surgery?
The patient is allowed to perform their routine, daily tasks immediately after the procedure, but it could take up to three months for them to adjust to their new vision. Their vision can continue to improve for up to one year.
Will the cataract come back?
No, the cataract will not come back. During cataract surgery, the surgeon removes the natural lens, which has caused the cataract, from its cellophane-like lining called the lens capsule. Weeks to years after cataract surgery, the capsule may become cloudy or wrinkled and cause blurred vision. A posterior capsulotomy is a simple laser procedure that makes an opening in the back, or posterior, part of the capsule to restore your normal vision.
Will the intraocular lens implant need to be replaced?
As far as studies show, intraocular lenses last beyond a lifetime. The need for replacement is not an issue.