Paul Breglia was having problems with his eyesight.
“I thought I needed new glasses,” remembers Paul, “and
because my wife had recently had a very successful procedure to remove excess
skin from her eyelids [blepharoplasty], I decided to have my eyes checked by
her 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.
“Following my examination, Dr. Mallon told me that my
prescription had not changed but that I was beginning to get cataracts,”
recalls 63-year-old Paul. “He also explained that I would be the one who would
know when it was time to have the cataracts removed. I had been under the
assumption that replacement lenses only lasted so long and that if I had
cataracts removed too early, I might have to have the surgery redone, but Dr.
Mallon assured me that was not the case. He said that intraocular lenses last a
lifetime.”
Although Paul was not ready for cataract surgery, he says
that over the next six months his eyesight deteriorated dramatically.
“I own a detail shop for automobiles,” explains Paul, “and
even using a drop light and wearing my progressive glasses, it was difficult
for me to see close up.
“I am also an avid golfer, and it was becoming impossible
for me to follow my golf ball. I play with one of my brothers who is four years
older than me, and he was always having to tell me where my ball went.”
Although Paul was having problems with both his close-up
and distance vision, it was his night vision that sent him back to Dr. Mallon.
“I had never had any problems with night glare,” notes
Paul, “but in February 2007 on an evening drive back from Tampa, the glare was
unbelievable. I drove at night with my prescription sunglasses just to make it
back safely. It was that experience that motivated me to go back to Dr.
Mallon.”
Choosing the right lens
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 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. 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.”
Great expectations
“No one lens is perfect for every patient,” points out Linda
Richardson, surgery coordinator for Center for Advanced Eye Care. “We want to
know about our patients’ lifestyles and what their expectations are. More
active people — men and women who play golf or tennis or perhaps ski — who also
do close-up work, like Paul, or read a lot or work on computers will probably
want all levels of vision.”
“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,” says Dr. Mallon.
“Although we have many patients who will never need glasses for any activity,
results vary.”
“We really listen to our patients to discover what will
work best for them, and we work hard to educate them as to what each lens may
provide,” reflects Linda. “Patients who read a lot of fine print may require
readers even with a great correction. That is a good, realistic expectation.”
With Paul’s busy, varied lifestyle, he chose crystalens.
“Dr. Mallon listened to me, gave me all the options, and
gave me a realistic picture of cataract surgery,” says Paul. “Then Linda went
through the details with me, including what medications I might need and what
to expect postoperatively.”
“Personal experience put me in touch with the importance
of accurate education and expectations for patients before surgery,” confides
Linda. “I give our patients any required prescriptions ahead of time, and if
they need help, I show them how to use them. Or, if they can’t do it, I make
sure they will have someone there to help them.
“We can also help coordinate transportation. It is
important to make sure that our patients feel comfortable with their upcoming
surgeries.”
“Linda went through everything with me before my surgery,”
assures Paul. “Everyone did an excellent job in educating me. A lot of people
don’t realize how far cataract surgery and technology have come. It’s amazing.
I no longer wear glasses, and when I’m on the golf course everything is clear
and bright.
“Oh, and now I’m helping my brother find his golf ball.”