Marguerite Kiernan had worn glasses since she was thirteen
years old, and had been wearing progressive trifocals for the past fifteen
years. Still, by the time she was forty-eight, her vision began getting much
worse.
“I had next to no distance vision,” she remembers, “and it
was very,
very
difficult for me to
see at night, especially when I was driving. Fortunately, a lady at my church
referred me to Dr. Mallon.”
Marguerite scheduled an appointment with William J.
Mallon, MD, a board-certified ophthalmologist and fellowship-trained ophthalmic
plastic and reconstructive surgeon at the Center for Advanced Eye Care in Vero
Beach.
“I was so impressed,” recalls Marguerite. “I was tested
extensively with all kinds of state-of-the-art computers and equipment, most of
which I’d never seen before. And even more notable is that his staff not only
double-checked all the test results, but then they went back over their
findings with each other to verify all the measurements.”
The examination confirmed that Marguerite had cataracts in
both eyes, as well as astigmatism [see sidebar].
“Dr. Mallon came in and explained everything thoroughly to
me,” recounts Marguerite, “and he didn’t talk ‘over my head’ either.
“Then, based on my eyes, vision, medical condition,
overall health, and my vision
goals
,
he went through all my options with me in a manner that I could understand.
That was very important to me; I understood everything.”
“We really spend a lot of time with our cataract patients
discussing their needs and their post-cataract goals,” says Dr. Mallon. “There
are many options to choose from, and my goal is to educate our patients so that
they can make their own best choices.”
Marguerite was pleased to learn that with today’s improved
technology, cataract surgery has now moved into the refractive realm. The tiny
intraocular lens implant that replaces the clouded natural lens is manufactured
with a power that is individualized for each patient. Cataract surgery may, in
fact, reduce or eliminate the need for eyeglasses after surgery.
So many choices
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.
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 are multifocal lenses such as
the
ReZoom
and
ReSTOR
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.”
Then there is the
crystalens
accommodating intraocular lens (IOL), 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,” observes Dr. Mallon. “The crystalens is good for night driving
and for patients who do not mind wearing reading glasses to help them with
their near vision.
“Additionally, we offer three different versions of what
is called an
aspheric
IOL. 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.”
For patients like Marguerite with 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.
Alcon Toric Implant
“The lens of the toric IOL is convex on both sides
[biconvex] so that it can provide both spherical and astigmatic correction,”
explains Dr. Mallon.
“He described my astigmatism as one of the worst he has
ever operated on during cataract surgery,” says Marguerite, “so when he
recommended the Alcon Toric implant, that is the one I chose.
“I elected to have distance vision because, at only forty-nine,
I still drive to work everyday. It’s the first time in my life I can drive
without glasses.
“It’s just wonderful. I have 20/20 vision, and unless I’m
reading
very
small print, I don’t
even need reading glasses.
“I can read street signs. I can see the birds in the
trees. It’s amazing.
“I’m very grateful to Dr. Mallon and his staff. They were
professional and caring throughout the entire process, from the first examination
to my most recent post-exam visit.
“I feel fortunate that they are here on the Treasure
Coast.”