Cataract surgery can correct beginning stages of glaucoma and reverse astigmatism.
A retired teacher, Diane Parker first noticed her eyesight diminishing when she would sit down to grade papers during her days in the classroom.
“Back then, students had to handwrite papers, instead of typing them,” Diane fondly recalls. “I would be reading them and found that I’d have to bring the paper closer and closer to my face in order to see the words. That went on for quite some time because I just didn’t want to face having to wear glasses. I just put it off.
“Eventually, I went to see an ophthalmologist and was prescribed my first pair of glasses. In the beginning, I wore them only for reading, but then you find yourself wearing them all the time, which I did. I was a closet eyeglass wearer. I took them off for photos because I didn’t want to admit I was reliant on them.”
Over the years, Diane made sure to see her ophthalmologist annually. Recently, her doctor in Michigan advised her that it was time to have her cataracts removed.
“I was diagnosed a few years ago with cataracts,” she shares. “I never experienced any symptoms until recently. Everything seemed harder to read, even with my glasses on. Driving at night was much more difficult. And sometimes, I would see what appeared to be yellow splotches of color everywhere for no reason.”
Diane and her husband are snowbirds, splitting their time between their home in Florida and their native Michigan.
“We have two daughters who live here in Pinellas County, so we spend six months a year in Florida,” Diane confirms. “I wanted to have the cataract surgery here, rather than in Michigan.”
It was one of Diane’s local physicians who recommended she see David E. Hall, MD, a board-certified ophthalmologist at Pasadena Eye Center, for a consultation.
In addition to cataracts, Dr. Hall discovered that Diane also had the beginning stage of glaucoma.
“About the same time we decided to proceed with removing Diane’s cataracts, I detected that she had early onset of glaucoma,” explains Dr. Hall. “Glaucoma is characterized by the gradual deterioration of the fibers of the optic nerve. If the deterioration remains undetected and untreated, it causes these fibers to atrophy: They will no longer carry visual signals to the brain. Since damage begins with the outermost optic nerve fibers, those responsible for peripheral vision, patients do not notice the gradual changes until significant, irreversible damage has been done.
“While examining her eyes, I saw what appeared to be only slight damage to the optic nerve. I was able to remove her cataracts and treat the glaucoma at the same time.”
During cataract surgery, Dr. Hall focuses a gentle type of laser light through the same tiny incision by which the cataract is removed and the implant inserted. Using the laser, he performs a procedure called endocyclophotocoagulation (ECP).
“This laser can only be used effectively to treat early-onset glaucoma if you are inside of the eye when performing cataract surgery,” he explains. “It treats the area inside of the iris called the ciliary body. This is the perfect solution for a patient, like Diane, who has very early stages of glaucoma and happens to be scheduled for cataract surgery. The ECP laser light helps to prevent the glaucoma from deteriorating.”
Tom Henkemans started wearing glasses a bit later in his life.
“I started with readers when I was in my early fifties, and my vision got worse over the years,” he recalls. “In a matter of a few short years, I was wearing glasses from the time I got out of bed in the morning until I went to sleep at night.”
Tom came to the United States from the Netherlands in 1995. At 73, he still runs his own business, manufacturing tanning beds.
In his work, Tom spends a lot of hours on the computer, filling orders for shipments all over the United States, as well as Latin America and Canada.
“I found that even with eyeglasses on, I had a hard time seeing the words on the screen,” Tom recalls. “I thought maybe I needed a stronger pair of glasses.”
Tom has been a patient of Dr. Hall’s for many years. Just like Diane, he, too, was told that he had developed cataracts.
“Dr. Hall told me about five years ago that I had cataracts,” Tom recalls. “It wasn’t until about a year ago that my vision got really bad, especially when I was driving. I had a hard time seeing street signs and other objects. I could not focus my eyes. I had a tough time distinguishing colors. I remember arguing with my wife about the color of the roof across the street. I said it was one color and she said it was another. I had trouble with black, brown and blue. I couldn’t tell them apart very well.”
Tom says he knew what he was experiencing was more than just a need for a stronger prescription. He admitted it was time to have his cataracts removed.
“I went to see Dr. Hall and he said, Yes, I think it’s time, and he got me scheduled right away. I was impressed with his knowledge and expertise. His entire staff explained everything to me from start to finish and made me feel very relaxed and comfortable. The entire experience was flawless, and I was in and out of surgery in an hour and a half each time, because they do the eyes about a week or so apart.”
Laser corrects astigmatism
Diane and Tom had astigmatism in both eyes. Astigmatism is a very common vision condition characterized by an irregular shape of the cornea.
Dr. Hall says the staff at Pasadena Eye Center is thrilled to be able to offer patients, like Diane and Tom, femtosecond laser technology to correct astigmatism while removing the cataracts at the same time. The femtosecond (bladeless) laser surgery is the most technologically advanced option for cataract surgery, providing unmatched accuracy, so the procedure is customized to the individual’s eye.
“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. “What the femtosecond laser does is create a curved incision on the cornea – an arch – depending on how much astigmatism there is. We refer to it as an LRI – limbal relaxing incision. Basically, the incision is eighty percent of the thickness of the cornea, and it relaxes the curve of the cornea. This helps reshape the cornea.”
The femtosecond laser then divides the cataract into segments that are removed. The surgery is performed much more quickly and accurately with the femtosecond laser. Overall, the femtosecond laser leaves patients with sharper vision and less dependence on glasses in the future.
You make the choice
“Based on the health of the eye and factors determined in the exam, we discuss lens and surgical options with the patient and decide which lenses to use,” Dr. Hall explains. “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 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.
Tom and his wife enjoy living in a condominium overlooking Boca Ciega Bay. He says he can see far enough now to see the business district, as well as his former home, across the bay.
“I can look out and see the buildings on Gulfport across the water,” he says. “Everything was blurry before; now, it is amazing.
“And the colors are crystal clear. The sky is so blue. I can distinguish colors very clearly now, unlike before. It is like seeing the world in a whole new light.”
Diane says she was pleased with the care that she received from Dr. Hall and the staff at Pasadena Eye Center.
“I felt at ease from the very first time I ever met Dr. Hall,” Diane recalls. “I am so glad I made the decision to have the cataracts removed while we are in Florida because I couldn’t have found a better doctor. I’m very sure of that.
“For me, it was a big deal to have cataract surgery. I was nervous, but they made me feel so relaxed. Dr. Hall talks you through the entire experience. I appreciate his knowledge and bedside manner.
“Now, when I look in the mirror I have to pause and take a second glance. I love not having to wear the glasses anymore. I’m very thankful and appreciative of Dr. Hall.”
FHCN article by Judy Wade. Photos by Jordan Pysz. Graphics from istockphoto.com.