For cataract surgery, selecting right lens is key

OPHTHALMOLOGY

“It’s a new era in cataract surgery,” observes William J. Mallon, MD, a board-certified ophthalmologist and fellowship-trained ophthalmic plastic and reconstructive surgeon. “So many different choices in intraocular lenses will decrease dependence on glasses, so the key is learning my patients’ postoperative goals and then helping them make the right decision.”

Dr. Mallon, founder of the Center for Advanced Eye Care, focuses much of his practice on educating his patients.

“We really spend a lot of time with our cataract patients discussing their needs and their lifestyles,” says Dr. Mallon. “My aim is to inform our patients so that they can make their own best 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. 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 downsides 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.”

Patient dependent

“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.


“I can see without glasses”

Ambie Studley knew she was developing cataracts.

 “I was speaking with a neighbor of mine about it,” remembers Ambie, “and she told me she had been using Dr. Mallon as her eye physician. She told me about him and said she thought that he was definitely the best eye doctor in Vero Beach, so I scheduled an appointment with him.”

Ambie recalls that her first consultation went very well. “I liked him very much. Dr. Mallon is very knowledgeable, and he is a nice man. I felt I could trust him.”

Dr. Mallon pointed out to Ambie that she could delay her cataract surgery for a while if that was her decision.

“I was going to hold off on it,” she confides, “but once I thought about it, I decided to go ahead and have it done.

“My husband was with me when Dr. Mallon explained about all the choices there were in intraocular lenses.  I am farsighted and have worn glasses, and then contact lenses, for about 25 years. The idea of reducing my dependence on glasses sounded pretty positive.”

After discussing all the choices available in intraocular lenses with her husband and Dr. Mallon, Ambie chose to have ReZoom lenses.

“It was a more expensive choice than some,” reflects Ambie, “but my sweet husband stressed how important my eyesight was and encouraged me to go for it. I really appreciated that.”

Ambie had surgery on one eye and then on the other two weeks later.

“I was happy with everything,” she notes. “Dr. Mallon has a beautiful new office. His nurses were very pleasant. I felt no pain at all. It was just a very good experience.

“And my eyesight improved immediately. It was wonderful.”

According to Dr. Mallon, Ambie now has excellent distance, intermediate, and near vision. She describes the benefits of her new lenses. “It’s fabulous. I no longer have to put my contacts in every morning, take them out every night, clean them, or fool with glasses.

“I’m really happy I did it. I can see without glasses.

“It’s been like a miracle.”


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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