Good Call

Tom Walton’s vision was deteriorating.

“I play doubles tennis, and it was difficult for me to make line calls,” remembers the sixty-six-year-old pharmacist. “Additionally, I couldn’t read the dashboard of my car at night, and I wasn’t seeing the color white anymore. Everything looked flat and dull beige.

“In March of 2007, I went to see my ophthalmologist, Dr. Mallon.”

William J. Mallon, MD, is a board-certified ophthalmologist and fellowship-trained ophthalmic plastic and reconstructive surgeon at the Center for Advanced Eye Care in Vero Beach. He and his staff focus much of the practice on educating their patients.

“A small cataract had started in my right eye, but I wasn’t ready to do anything about it at the time,” admits Tom.

“When a patient comes in for an appointment, we perform a full eye exam, including dilation and refraction, which determines what a patient’s best vision is,” says Dr. Mallon. “We may also perform special testing called brightness acuity testing, which helps determine what someone sees in the real world. As an example, someone seeing a tennis ball against a court line is significantly different than seeing the high contrast of black letters on the white background of an eye chart in our office.

“Once we determine someone has a visually significant cataract, it is up to them to decide if and when they should have it removed.  I consider myself a navigator; I try to give good direction, but ultimately patients are the captains of their own ships, and they have to make the decision about when to have surgery.”

“When I told Dr. Mallon I was not ready for cataract surgery, he wrote me a prescription for eye drops and corrective lenses,” recounts Tom. “However, within eight months I was having problems again.

“By this time I had cataracts in both eyes and was ready to have the surgery.”

“We really spend a lot of time with our cataract patients, discussing their needs and their post-cataract goals,” notes Dr. Mallon. “There are many intraocular lens [IOL] options to choose from, and my goal is to educate our patients so that they can make their own best choices.”

Patient dependent

Along with deciding when their eyesight has deteriorated to the point that they want their cataracts removed, patients also need to choose what type of eyesight they want following surgery.

“Every lens we offer is patient dependent, meaning that no one lens is perfect for every patient,” emphasizes Dr. Mallon. “With today’s improved predictability of cataract surgery, we are usually able to reduce patients’ dependence on eyeglasses for either distance vision or near vision, and sometimes for both. Although we have many patients who will never need glasses for any activity, results vary. That is why I really listen to my patients and spend enough time with each one to learn about his or her lifestyle so we can determine what is going to work best for that patient before selecting the right lens implants."

Choosing the right lens

Patients can have both eyes corrected for distance vision, in which case they will require glasses for near vision, or they may choose to have their eyes corrected for close-up vision, in which case they will require glasses for distance. Some patients may also choose monovision, a technique where the dominant eye is focused for distance vision and the nondominant eye is focused for near-to-intermediate vision. Monovision can help patients be as independent from glasses as possible.

But that is only the beginning.

“Several types of lens implants are available today,” educates Dr. Mallon. “Along with the monofocal lens, there is the Crystalens accommodating intraocular lens, which is a hinged implant designed to allow the optic, or the part of the lens that you see through, to move back and forth as you constantly change focus on images around you. It uses the natural focusing ability of the eye and provides a single focal point throughout a continuous range of vision from far to near. The lens is actually designed to move inside the eye, so it simulates more of a natural type of vision. The quality of the distance, intermediate, and near vision will depend somewhat on the individual patient.

“These are good lenses for active patients for whom distance is their most important visual zone, but they want good intermediate vision as well. The Crystalens is good for night driving and for patients who do not mind wearing reading glasses to help them with their near vision.”

Then there are multifocal lenses such as the ReSTOR and ReZoom lenses, which provide more than one focal distance.

“These lenses are similar to a bifocal,” notes Dr. Mallon. “The ReZoom lens seems to deliver better vision in the distance and intermediate range, whereas the ReSTOR performs better in the near and distance range but is not as strong in the intermediate zone. ReSTOR might be a better choice for a patient who is an avid reader or does a lot of close-up work such as threading needles or painting in miniature.

“The down sides to ReSTOR and ReZoom lenses are that they can give some patients glare at night, and each patient must go through a period of adaptation where the brain really learns how to use these new tools. Not everyone learns them at the same rate, which can vary from a few days up to several months.”

For patients with an astigmatism who want monovision or single-vision lenses, a new toric IOL can correct both vision and astigmatism simultaneously without having to make extra incisions on the eye.

“Additionally, we offer three different versions of what is called an aspheric IOL,” informs Dr. Mallon. “These single-focus lenses have been shown to provide patients with improved contrast sensitivity, which results in superior night vision and reduced aberrations in the eye. However, these lenses are not well-suited for every patient.”

The right choice

Tom chose Crystalens. Dr. Mallon performed surgery on his left eye January 23, 2008, then on his right eye two weeks later.

“It’s been like a complete turnaround as far as my vision is concerned,” marvels Tom. “Whites have gone from dull beige to brilliant. I can see everything on my dashboard. And it has really sharpened my tennis ball perception; I can see whether or not the ball hits the line every time.

“In fact, some of the people I play tennis with have had lens implants at other places and say they aren’t happy with their results, but Dr. Mallon and his staff are great. In fact, Dr. Mallon’s staff members always seem to be so outgoing, friendly, and helpful that I brought them a box of candy on Valentine’s Day.”

Tom reports that the only time he requires any glasses other than sunglasses is when he is reading something closer to him than eighteen inches: “Then I may need reading glasses, depending on the lighting situation, and even that might resolve itself as time goes on.