“I Didn’t Know What I Wasn’t Seeing”

Combined cataract surgery and iStent® revitalizes vision

Edward Perla didn’t want to bother with his eye doctor’s repeated suggestions that he do something about his cataracts. But the surgery he put off for so long turned out to be one of his biggest blessings.

Photo by Nerissa Johnson.

Edward Perla

Edward, 82, also has glaucoma. For some eight years, he managed the fluid pressure in his eyes with three different prescription drops twice a day, which was inconvenient and messy.
“You go to bed and forget to take them; you’ve got to get up and take them again,” he complains. “You miss your eye; it goes on your cheek. It was a pain in the neck.”
Still, Edward’s eyes didn’t hurt, and he figured he could see well enough with his glasses.
He finally relented when he couldn’t cope with the glare from the TV, and oncoming headlights while driving at night. Edward couldn’t read the words scrolling along the bottom of the screen on ESPN. Headlights and street lights appeared to have illuminated circles around them, and he was afraid he might eventually have an accident. Driving only in the daytime wasn’t an option because he works some nights as a security guard.
Adam M. Katz, MD, of the Center for Advanced Eye Care in Vero Beach, has examined Edward’s eyes since 2013 and recommended he see surgical glaucoma specialist Sarah S. Khodadadeh, MD.
Edward recalls Dr. Katz’s words. “Eddie, you’ve got to see this doctor. She’s good. And your cataracts are way past what they need to be to qualify for surgery. I said, Okay, I’ll do it.

One Procedure, Two Outcomes

Dr. Khodadadeh, the only surgical glaucoma specialist in Indian River County, evaluated Edward for cataract surgery and conducted updated tests to determine the severity of his glaucoma. She found his vision was “just on the border of not being able to pass your driver’s test.”
Because cataracts progress slowly, patients sometimes don’t notice they’re having difficulty seeing. Glaucoma is called the silent thief of sight because it typically has no symptoms. The most common type of the disease harms the optic nerve through increased intraocular pressure.
Dr. Khodadadeh drew up Edward’s treatment plan based on her evaluations and his lifestyle, age and medical history. She opted for minimally invasive surgery to alleviate both his glaucoma and his cataracts.
Photo courtesy of Center for Advanced Eye Care.“I did what’s called a combined cataract surgery with iStent,” Dr. Khodadadeh reports. “The iStent is actually the world’s smallest implantable medical device for the human body.”
While numerous microinvasive glaucoma surgical devices are available, iStent was the first and now is commonly used in this country and internationally.
“When you have high pressure in the eye, it’s not draining properly,” she explains. The iStent creates a bypass between the front part of the eye and its natural drainage pathway to increase the flow of fluid.
That, in turn, lowers the pressure and decreases the amount of medication patients need to stop the disease from progressing.
“Sometimes, we can even eliminate the need for eye drops,”
Dr. Khodadadeh adds. “It just depends on how severe the glaucoma is and where the eye pressure needs to be.”
The iStent must be implanted at the same time as cataract surgery, she stresses. Edward had his eyes done separately, about two weeks apart.
“It takes roughly ten minutes to do the surgery and an additional minute for the glaucoma procedure,”
Dr. Khodadadeh describes. “The incision we make is very small. There are no stitches. We use topical anesthesia, so there’s no IV. I don’t put patients to sleep,” which avoids side effects such as low blood pressure and confusion upon waking.
Dr. Khodadadeh’s patients benefit from her extensive training, knowledge and experience. She completed a glaucoma fellowship at Yale University and trained in Detroit, where there’s a high incidence of the disease. She also co-authored a chapter in the 2015 edition of the textbook Advanced Glaucoma Surgery about traditional and novel surgical techniques to manage glaucoma.
“Everyone will develop a cataract eventually, typically by their mid sixties,” Dr. Khodadadeh educates. “Glaucoma will not happen to everyone, but as we all get older, we have more risk of developing it.”
Glaucoma patients tend to have more complex cataract cases. With her extensive training, she provides them with better outcomes.
“After iStent surgery, patients leave the Center for Advanced Eye Care with sunglasses, but no eye patch, and can resume normal activities that day,” Dr. Khodadadeh informs. “In contrast, a traditional glaucoma procedure may require a few months of recovery time. After any cataract procedure, vision is a little fuzzy for twenty-four hours.”

Life-Changing Treatment

For Edward, the only drawback to his experience was using eye drops up to eight times a day both before and right after his procedures.
“The operation is nothing,” he proclaims. “You don’t feel anything, it’s quick, and you’re in and out.”

Photo by Nerissa Johnson.

Edward’s world is no longer dull and blurry.

The New Jersey transplant and Marine Corps veteran is practically giddy at the results.
“After she did the surgery, I just couldn’t believe the difference,” he enthuses. “It’s almost like I have a new life with my eyes. I didn’t know what I wasn’t seeing.”
His world is no longer dull and blurry. It’s more colorful, and “the detail is unreal,” Edward says. He especially notices how different his high-definition TV looks.
“I guess it wasn’t high-definition before,” he quips.
His improved vision has helped him on the job. He works part-time in the guard shack at the front entrance of the Bermuda Bay community in Indian River Shores, recording visitors’ names, destinations and license plate numbers. Before his surgeries, he couldn’t make out tags unless drivers pulled forward and stopped. Now, they need only to drive slowly through the gate.
Another plus is he no longer uses prescription eye drops, although Dr. Khodadadeh points out he may need them again in the future because glaucoma is a chronic condition.
“Once a patient’s glaucoma is stabilized, I see them every four months, whether they’re on drops or not,” she elaborates. “Even if the cataracts have been removed and the glaucoma is controlled with the surgical procedure, there’s still a risk for progression, or the eye pressure to elevate. As we get older, we lose the ability to drain fluid from the eye. It’s something you need to keep following, almost like high blood pressure.”
Going forward with Dr. Khodadadeh as his eye care specialist is just fine with Edward, who found her to be professional, personable and very involved in her work.
“She really cares that she’s helping you,” he observes.
Now that he’s enjoying improved vision, Edward wonders why he waited so long to have it corrected.
“This is the best thing I ever did,” he raves. “It changed my life.”

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