Double Feature

Treat glaucoma and cataracts during same procedure.

When absenteeism left General Motors without a fourth of the workers needed at one of its largest truck plants this past spring, the company filled the void by offering permanent transfers to employees laid off at other plants.

Marianne had her glaucoma treated while undergoing cataract surgery.

For nearly 20 years, ensuring the smooth transfer and relocation of employees was the job of Marianne Davies.

“I was a relocation consultant up in Michigan, and one of my company’s biggest clients was General Motors,” says Marianne, now 73. “General Motors has always been very generous with their transfers.”

A little more than two years ago, Marianne and her husband made a transfer of her own, retiring from Grosse Pointe, near Detroit, to Vero Beach.

“We used to go to Naples for vacations a lot,” Marianne says. “Then my sister and her husband moved to Florida and brought my mom along with them. After a while, they wanted us to move as well. We had been in Michigan for 42 years, but we’ve always liked Florida. What is there not to like about it? We love the weather, of course, and we’re really enjoying Vero Beach, so it’s been a good move for us.”

As part of her move, Marianne had to find new doctors to look after her and her husband’s health. Late last year, mostly out of necessity, she began searching for an eye specialist.

“I hadn’t had an eye examination for a couple of years, so I was definitely overdue,” Marianne says. “The other issue was that I just wasn’t seeing as well as I used to. I was having to squint a lot to see far away, which wasn’t normal for me.”

Double Trouble

On the advice of her primary care physician, Marianne visited the Center for Advanced Eye Care. It was there that she was placed under the care of Derek H. Ohlstein, MD. During her first visit with Dr. Ohlstein, Marianne learned of two pressing issues.

The first was glaucoma, a disease in which an imbalance of the fluid flowing inside of the eye causes an increase in pressure inside the eye that can damage the optic nerve. If left untreated, glaucoma can lead to severe vision loss.

My distance vision is really crisp and clear. Even colors are brighter. – Marianne

The other issue was cataracts, a clouding of the natural lens caused by a breakdown of lens fibers, a clumping of proteins or both. Cataracts usually result in blurred vision, an increase in sensitivity to light and/or a reduction in the vibrancy of colors.

The good news is that both are treatable. In fact, as Dr. Ohlstein explained to Marianne, both can now be addressed at the same time, with the glaucoma treatment adding only a few minutes to the time it takes to perform cataract surgery.

“While we’re in the eye taking out the cataract, we can do what we refer to as a MIGS procedure, which is short for microinvasive glaucoma surgery,” Dr. Ohlstein educates. “It’s quick, easy, has a small complication rate and has great benefits for the patient.

“For about 80 percent of glaucoma patients, this MIGS procedure can reduce or even eliminate the need to take eye drops to control their glaucoma, which was something that Marianne wanted to avoid. So this MIGS procedure was a good option for her.”

There are several types of MIGS procedures. What they all have in common is their ability to reduce eye pressure. That can be done by increasing the outflow of fluid through the eye’s natural drainage system, stenting open the drain or decreasing the production of fluid inside the eye.

For Marianne, Dr. Ohlstein performed the Hydrus procedure, which calls for the insertion of an 8 mm-long microstent into a critical canal inside the eye. The microstent widens the canal and keeps it from collapsing, facilitating lower pressure.

“This is an FDA-approved procedure that insurance pays for, and the results have been fantastic,” Dr. Ohlstein explains. “One of the great things about it is that it’s a much smaller procedure that achieves the same goals as a bigger surgery.”

The insertion of the microstent is performed after cataract surgery, an outpatient procedure during which the clouded natural lens is removed and replaced with an artificial intraocular lens, or IOL.

IOLs are made of acrylic or silicone and are coated with special material to protect the eyes from the sun’s ultraviolet rays. During surgery, the IOL is rolled up and placed in the eye. Once in place, the IOL unfolds and side structures called haptics hold it in place.

Like contact lenses, IOLs are available in different focusing powers. Standard IOLs correct vision primarily for distance, but patients can have one eye fixed for distance and the other for reading, an option called monovision.

A third option is multifocal IOLs. One such IOL acts like a bifocal lens to correct distance and either reading or intermediate vision. A more advanced multifocal lens acts like a trifocal lens and corrects distance, reading and intermediate vision.

With a break of a week or two in between, physicians typically perform cataract surgery on one eye at a time using an ultrasonic device to break up the cloudy, natural lens. Once the old lens is removed, the IOL is implanted, permanently correcting the vision.

Now’s the Time

Marianne Davies

After her initial visit with Dr. Ohlstein, Marianne began taking eye drops for her glaucoma because her cataracts weren’t mature enough to come out yet. Six months later, however, Marianne’s vision had faded further, so she returned to Dr. Ohlstein.

“He told me when I first saw him that when I reached the point where I really couldn’t see well, I should come back, and he’d take care of both problems at once,” Marianne says. “So after about six months I decided, This is a good time to get this taken care of.

“I was actually kind of excited about the surgery because I’d reached a point where I could no longer read the news crawl across the bottom of the TV and because I didn’t want to keep using these eye drops, even though they were helping me.”

Dr. Ohlstein performed the procedures on Marianne this past summer. Marianne, who was fit with standard IOLs for improved distance vision, went into the surgery with high expectations. She wasn’t disappointed.

“My husband and a few friends have had cataract surgery, and they all told me how great they were able to see afterward and I was excited about that,” she says. “And once I had my surgery done, I knew what they were talking about.

“I can now read the news crawl on the bottom of the TV without any problems at all, and my distance vision is really crisp and clear. Even colors are brighter. I still wear readers for reading, but I really only need them for the fine print.

“This is an FDA-approved procedure that insurance pays for, and the results have been fantastic.” – Dr. Ohlstein

“And I can tell that my glaucoma is better because my right eye, especially, used to water all the time. That started to go away when I started taking the drops, but it’s happening even less now, so I’m very happy with the surgery.

“And I’m very happy with Dr. Ohlstein and the Center for Advanced Eye Care. Dr. Ohlstein is very nice, and I really like that he didn’t push me to have either one of these procedures. He explained it all to me and let me decide whether to have them and when to have them.

“The same goes for all of his nurses and assistants. They’re all excellent, so I absolutely recommend Dr. Ohlstein, his clinic and the procedures he performed. They’ve made a huge difference
in my life.”

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