Elementary, My Dear

OPHTHALMOLOGY

So leave the magnifying glass to Sherlock Holmes. With today’s improved predictability of cataract surgery and the innovative technologies in lens replacements, board-certified ophthalmologists are usually able to reduce patients’ dependence on eyeglasses for either distance vision or near vision, and sometimes for both.

Everything looked hazy to Pat Tressler.

“I was working as a bank teller, and that is a job where your eyesight can be critical,” observes Pat. “I was at the point where I was picking up a magnifying glass every time I came across a number that I wasn’t sure of, and I was picking it up more and more frequently.”

Coupled with the problem of her close-up eyesight, Pat also needed glasses for distance vision. “I didn’t feel comfortable wearing bifocals or progressive lenses,” she admits, “so I was constantly changing glasses. It was terrible, and I still couldn’t see properly.

“Because I suspected I might need new glasses, and I knew I needed a new ophthalmologist, I began doing some research. Then a friend recommended Dr. Mallon.”

Pat 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. He and his staff focus much of the practice on educating their patients.

“During my vision examination, Dr. Mallon discovered I had a cataract in each of my eyes,” remembers Pat [see sidebar]. “The cataract in my right eye was very thick, but it was definitely time to remove both of them.”

Pat was aware 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.

Pat was thrilled by that idea: “I thought, This is great I won’t need glasses .”

Only the beginning

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. Monovison 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.”

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.”

Technicolor World

For Pat, Dr. Mallon recommended ReZoom lenses.

“He was absolutely wonderful,” recalls Pat, conferring equally high praise on his staff. “Everyone is very pleasant, efficient, and caring, and Dr. Mallon made me feel very comfortable and relaxed; he always seems upbeat and eager to answer all my questions. I trust him.”

Pat says the surgery went very quickly and easily.

“Part of the post-op instructions included having someone there to drive me home after the operation,” she remembers, “so I assumed I would spend that day in bed. But once my husband drove me home, I could see so beautifully and felt so good that within a half hour I drove myself to the mall.

“I was so excited. I could actually see the tags on the clothing without digging out my glasses. I could tell what things cost. The sizes were clear to me. The colors were vibrant and beautiful. It was like stepping into a Technicolor World. The haze had lifted off of everything, even that first day. And I had only had one eye done.

“I was already excited about having the second cataract removed.”

Pat says that following the second surgery her job was infinitely easier: “Not only didn’t I need the magnifying glass anymore, but I could look up at customers and see them clearly because I wasn’t looking at them through readers.”

Then, having worked at the bank for nearly twenty years, Pat retired in the spring of 2007.

“I decided it was time to make another change,” she reflects, “so I’m entering a new phase of my life.

“It’s funny. I remember reading about Dr. Mallon and all the new innovative technologies he was offering and thinking, That would be great .

“And it is.”


What is a cataract?

“A cataract is an opacity or clouding of the natural lens in the eye,” educates Dr. Mallon. “In a healthy eye, light passes unobstructed through the clear lens, allowing images to be sharply focused on the retina. If the lens becomes clouded, light is blocked and blurred images form on the retina.

“A cataract develops as a normal process of aging; however, certain conditions can lead to the premature development of cataracts. These include a genetic predisposition, chronic illnesses such as diabetes, medications such as prednisone, and exposure to radiation.”

Dr. Mallon explains that the lens in our eye grows throughout life with new layers added each year, much like the rings around a tree. Eventually those layers become cloudy and darken. “Typically, we see a progression in color from yellow to green,” explains the doctor, “and an advanced cataract will have a brownish color to it. This age-related cataract is called a nuclear sclerotic cataract .”

Other varieties include the cortical cataract, which can look almost like a snowflake, and the posterior subcapsular cataract, which can develop very rapidly.


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FOR MORE INFORMATION
Center For Advanced Eye Care
William J. Mallon, MD
J. Michael Schnell, MD
Adam M. Katz, MD
3500 US Hwy 1
Vero Beach, FL 32960
(772) 299-1404


www.caec.info