Cataract surgery can be customized to the patient’s needs, even after LASIK™ surgery.
Karol Gotte was prescribed her first pair of eyeglasses in the third grade and remembers the experience like it was yesterday.
“They were awful!” she bemoans. “They were very thick, like Coke® bottles! I just really hated them.”
In high school, Karol was thrilled with the idea of contact lenses and maintained those through her college years until her eyes decided they had had enough.
“I developed astigmatism and suddenly the contacts just no longer wanted to cooperate,” Karol explains. “I could not wear them for long periods of time without my eyes becoming irritated. My only option was to go back to wearing eyeglasses, and there was just no way I wanted to do that. That’s when I decided to have LASIK [laser-assisted in situ keratomileusis] surgery.”
In her search for an experienced surgeon, Karol was referred to David E. Hall, MD, a board-certified ophthalmologist at Pasadena Eye Center. That was in 1998, and she’s been a patient there ever since.
“I’ve been a school teacher for over thirty years, so I know a lot of people, and everyone I know seemed to recommend Dr. Hall, so I felt really good about going to him,” Karol shares. “He just made me feel at ease and comfortable from the moment I met him.”
On the day of the LASIK procedure, patients receive eye drop anesthesia to numb the eyes. Then, a specialized instrument called a microkeratome is used to lay back a flap on the corneal surface, allowing the laser to reach the underlying corneal tissue. Careful measurements from an eye exam are used to guide pulses of cool laser light, reshaping the tissue and changing the way the cornea transmits light and focuses it on the retina.
“I had the LASIK surgery done on my birthday in 1998 and within twenty-four hours, I was out with my husband at the mall Christmas shopping,” Karol remembers. “That is how fast the recovery was.”
“At that time, LASIK was an amazing breakthrough in refractive surgery,” describes Dr. Hall. “As a result, patients see clearly immediately following the procedure and have no further need for glasses.”
Karol’s vision was crystal clear, she says, until a cataract developed in her right eye in 2004 and then in her left eye just recently.
“Back when I had the LASIK, he adjusted the right eye for distance and left eye for reading. So, I really did not notice when the right eye started to develop the cataract back in 2004. The left eye was the one where I really noticed a change when I was reading, especially when it came to trying to grade papers and do my job. It was very, very cloudy. And I always thought it was odd that they developed so far apart, but Dr. Hall assured me it happens a lot.”
“Cataracts are going to develop in all of us at one point or another,” Dr. Hall assures. “We are all prone to them, but I want to stress that cataracts can be removed easily, even after someone has undergone eye surgery, like LASIK. The procedure itself may be different, but the results are always the same.”
With Karol, because of the change in the shape of her eyes following the LASIK, Dr. Hall chose to proceed with traditional surgery.
In traditional cataract surgery, surgeons use a hand-held metal or diamond blade to create an incision in the area near the cornea. Then, the cataract, which is located just behind the pupil, is broken up and removed. Next, an intraocular lens (IOL) is inserted and implanted to replace the cloudy, natural lens.
“Without the laser being used, the procedure takes a bit longer and requires a lot more precision,” Dr. Hall says.
“Because of the prior LASIK surgery, the shape of the eye does change a bit, so there are specific adjustments made when calculating the kind of implant lens to use in order to achieve maximum results. We don’t typically make the same adjustments in an eye that has never had surgery before.”
Patients for decades
Kathleen Dusil has been a patient at Pasadena Eye Center for three decades. In fact, she’s been a patient longer than Dr. Hall has practiced there. She says she would never entrust her eyecare anywhere else.
“I’ve worn glasses since I was a teenager, and once I moved to this area, I started going to Pasadena Eye Center,” she relays. “I was going there even before Dr. Hall joined the practice. They are experts in the field, especially Dr. Hall, and they do everything so effortlessly.”
In her spare time, Kathleen keeps busy dabbling in painting and cross-stitching. Prior to cataract surgery, she says she had a difficult time threading the needles and choosing the proper paint colors.
“I like to keep busy and those are two of the crafts I really enjoy,” she says. “It can be frustrating when you want to do something but you can’t because you can’t see clearly enough. I could not wait to get the cataracts removed once and for all.”
Kathleen says over the years, her eyesight grew worse. In fact, her glasses were the first thing she reached for when she rolled out of bed each morning.
“I went from only needing them for reading to needing them all the time,” she recalls. “Then, of course, as I aged, cataracts developed. They got so bad that even the paint on the walls looked like a different color than it actually was. So, it was then that I knew I needed them removed. And I was also really happy to hear about the femtosecond laser Dr. Hall uses. It sounded scary, but wasn’t.”
Dr. Hall says the staff at Pasadena Eye Center is thrilled to be able to offer patients, like Kathleen, the femtosecond laser technology.
“With the femtosecond laser-assisted tool, a laser makes the incisions, both at the surface of the eye and inside the eye, and it is always a precise, flawless cut,” Dr. Hall explains. “It is computer generated; therefore, it is exact and there is no chance of errors. The cut made by the laser is sharp and exact. The laser divides the cataract into segments that are then removed. And the surgery is performed much more quickly and accurately with the femtosecond laser. As a result, it more accurately treats patients with astigmatism, like Kathleen. Her astigmatism was totally eliminated after this surgery. Overall, the femtosecond laser leaves patients with sharper vision and less dependence on glasses in the future.”
Dr. Hall reiterates that it is routine for patients to have IOL implants after cataract removal.
“Based on the health of the eye and factors determined in the exam, we’ll decide which lenses to use and discuss lens and surgical options with the patient. In today’s market, we have many options to choose from that will suit the needs and long-term goals of the individual.”
Monofocal lens: These lenses are the most commonly implanted lenses today. They have equal power in all regions of the lens and can provide high-quality distance vision, usually with only a light pair of spectacles. Monofocal lenses are in sharpest focus at only one distance. They do not correct pre-existing astigmatism, a result of irregular corneal shape that can distort vision at all distances. This does not make the surgery more risky. People with significant astigmatism require corrective lenses to have the sharpest vision at all distances. Patients who have monofocal intraocular lenses implanted usually require reading glasses.
Multifocal lens: Multifocal intraocular lenses are one of the latest advancements in lens technology. These lenses have a variety of regions with different powers that allow some individuals to see at distance, intermediate and near ranges. While promising, multifocal lenses are not for everyone. They can cause significantly more glare than monofocal or toric lenses. Multifocal lenses cannot correct astigmatism, and some patients still require glasses or contact lenses to achieve the clearest vision.
Toric lens: Toric lenses have more power in one specific region in the lens to correct astigmatism as well as distance vision. Due to the difference in lens power in different areas, the correction of astigmatism with a toric lens requires that the lens be positioned in a very specific configuration. While toric lenses can improve distance vision and astigmatism, the patient still will require corrective lenses for all near tasks, such as reading or writing.
A clear choice
Karol says the cataract surgery was “a piece of cake” and would recommend it to anyone.
“I went in around seven in the morning, and I was sitting in a restaurant by ten-thirty, having breakfast with a friend,” she recalls. “That’s how fast it was. And it was so easy – nothing to worry about at all. And the results are well worth it.”
Karol says the fact that so many people referred her to Dr. Hall was a sign that she had to go see him and not another ophthalmologist.
“With so many people singing his praises, I had to give him a chance, and I am glad I did. He’s fantastic, the staff is great and the experience was wonderful!”
Kathleen says her experience with cataract removal using the femtosecond laser was fast and easy. Now, she says her vision is so clear, it’s as if she were given a new set of eyes.
“That waxy, yellowish coating that was on everything I looked at is gone, finally,” she says. “I can see to thread the needles, and I see colors much clearer now. It is truly amazing. The world looks so different.”