Optical Options

Different replacement lenses bring the world into focus.

Though immersed in a world of science fiction and fantasy, about which he writes award-winning short stories, novels and novellas, Rick Wilbur also returns to Earth as a professor of journalism, mass media and creative writing. These pursuits necessitate long hours of intense research and reading, so Rick’s vision is precious to him.

Photo by Jordan Pysz.

Richard Wilber

“I’ve worn glasses since seventh grade,” he recalls. “I was a heavy reader as a kid, which probably made my eyes worse. Because I read so much, the bottom parts of my glasses were for reading, and the tops had these little half-moons that were more for distance vision, like reading the chalkboard at school.”
Always the storyteller, Rick shares the tale of how his family discovered his need for glasses. His father, a major league baseball player, frequently took his five children to his games. It was at one of those contests that Rick’s poor vision was discovered.
“We were at a game and I asked my father, Why do they even bother with the scoreboard since nobody can read it?” Rick relates. “My father looked at me and asked, Can’t you read the scoreboard? I said, No. It’s just a blur, so he took me to see an eye doctor to get glasses.
“Next time I went to a game with my glasses on, I looked through the top of my bifocals so I could see the scoreboard. It was a revelation.”
Years later, Rick was once again visiting an eye doctor, board-certified ophthalmologist David E. Hall, MD, at Pasadena Eye Center. Unaware of why, Rick had been experiencing several symptoms of cataracts, a clouding of the eye’s natural lens.
“Dr. Hall said, You know, you have some cataract issues,” Rick recounts. “I didn’t realize that. I had noticed I was cleaning my glasses all the time. I thought they were dirty. It was humbling that it didn’t occur to me that the problem was with my eyes, not my glasses.
“In retrospect, I had other symptoms as well, like trouble driving at night and seeing halos over lights, but the cataracts came upon me so slowly that I didn’t notice I wasn’t seeing colors and details as well as I used to. I forgot how bright colors are.”
Dr. Hall recommended cataract surgery on Rick’s left eye because the cataract was significantly worse in that eye. Rick’s right eye was not as severe and didn’t require surgery right away.
“Since I’m a writer, I work on my computer for hours every day and then read from my Kindle or print books,” discloses Rick. “I needed to see at about fifteen inches and then at ten to twelve inches. The replacement lens implant for my left eye improved my vision at those distances.
“The surgery didn’t take more than ten or fifteen minutes. The Pasadena Eye Center staff prepared then sedated me. When I came out of surgery, I went right home. From a patient’s perspective, cataract surgery is a very easy procedure to go through, and it offers a dramatic change. After surgery on my left eye, my vision was shockingly better.”
Rick was so impressed with the outcome of his first surgery that he decided to have the surgery done on his right eye as well. The second procedure was completed less than a year after the first.
“The idea with this surgery was to help me see better at a distance,” describes Rick. “This way, my eyes can work together, so I’ll be able to see both near and far. The results are amazing.”

Establishing Suitability

Before patients are scheduled for cataract surgery, a battery of tests are performed to evaluate the health of their eyes and their suitability for surgery. There are also tests to determine the most appropriate intraocular lens implant, or IOL, for each patient.
“Initially, we perform a routine eye exam during which we check the strength of the eyes and their general anatomy,” notes Dr. Hall. “We then dilate the pupils to examine the backs of the eyes, the retinas and optic nerves. If the patient’s eyes are healthy and they decide to have cataract surgery, they come back for a topography test.
“The topography test examines the shape of the cornea, the front part of the eye. The test results look similar to the maps in National Geographic that are color-coded to mark hills and valleys. During the topography test, we measure astigmatism, which is when the cornea is not perfectly round.
“I’d forgotten what really clear vision can be, and now, there it is. The surgery gave me back vision I haven’t had since my youth.” - Rick “We can correct astigmatism during the cataract surgery to give patients the clearest vision possible.”
Another test performed prior to cataract surgery is the OCT retinal scan. This scan is done to check for any problems that may be hidden under the surface of the retina and are unable to be seen under normal light. The OCT can expose conditions such as swelling and scar tissue, which if serious, can interfere with the success of some premium IOLs.
“We obtain the measurements for calculating the lens implant prescriptions two ways,” explains Dr. Hall. “One is with light energy, and the name of the instrument we use is the IOLMaster®. The IOLMaster measures the length of the eye from front to back, from the cornea to the retina.
“We also measure the length of the eye a second way, using ultrasound. The measurements from the IOLMaster and ultrasound tests are fed into a computer program. That takes the curvature of the cornea, which was measured with the topography test, and the length of the eye and tells us which lens implant would work best for an eye that shape and size.”

Root Cause

Lynda Lovell can attest to the fact that, unlike wine, whiskey and some allergies, eyesight does not get better with age. As Lynda drew closer and closer to retirement a few years back, she noticed her vision was growing progressively worse.

Photo by Jordan Pysz.

Lynda Lovell

“My vision just became very, very poor,” Lynda relates. “I could no longer see things as far off in the distance as I once did, and it was getting harder and harder for me to read numbers or any fine print. The words and numbers would just kind of blur together.”
Lynda first attacked the problem by doing the same thing anyone else with fading vision would do. She visited an optometrist. Later, after the new eyeglass prescription she was given failed to solve the problem, she visited another.
Finally, after the second optometrist prescribed yet another set of new prescription lenses that also failed to significantly improve her vision, Lynda decided to see if there was anything the doctors at Pasadena Eye Center could do for her.
“I pass by their office all the time when I’m driving, and I happened to have a good friend who had been to see them as well,” Lynda explains. “My friend said she really liked Dr. Hall, so I decided to make an appointment with him.”
Dr. Hall quickly found the root cause of Lynda’s ever-deteriorating vision. Unfortunately for Lynda, the problem was no longer one that could be solved by simply prescribing a stronger set of eyeglasses.
“She had cataracts,” Dr. Hall reveals. “And sometimes, in the early stages of cataract development, in addition to the lens getting cloudy, the way the lens focuses also changes. That’s why a simple change in eyeglass prescription can sometimes be helpful.
“But that change will only let you get by for a little while. There’s a limit to how far you can go making those changes because eventually, the vision just gets too cloudy. That’s where Lynda was when I first checked her vision.”
Dr. Hall’s initial examination of Lynda’s eyes included a test to determine whether she was suffering from macular degeneration, a retinal disease that can also cause blurred vision, particularly in people over 50. She was also tested for glaucoma.
The ophthalmologist found no evidence of either of those two issues, but while learning that Lynda’s distance vision was measuring at 20/100 on a scale in which 20/20 is clear and crisp and 20/400 is the worst, he discovered she also had a lot of astigmatism in her
right eye.
An astigmatism is a flaw in the curvature of the cornea or eye’s lens, both of which are normally smooth and evenly curved on all sides. The flaw can cause vision to be distorted because it prohibits light rays from being focused sharply onto the retina.
In the case of someone such as Lynda, who needed to have her cataracts removed and did not want to have to wear glasses for distance vision following the surgery, the astigmatism creates an added challenge for ophthalmologists such as Dr. Hall.

Selection Process

It is necessary, before the removal of a cataract, to select a new IOL to be implanted in the eye. For patients with an astigmatism, however, a special intraocular lens is needed if the patient is to avoid wearing glasses following the procedure.
“A patient like Lynda, who has a lot of astigmatism, could get the regular implant lens, but then she would still need to wear glasses to correct the astigmatism,” Dr. Hall educates. “For patients like that, we have the toric implant lens.
“The toric lens has a prescription ground into it that is just right for her amount of astigmatism. She got that lens for her right eye, and because she didn’t have any astigmatism in her left eye, she got the more routine, spherical implant lens for that eye.”
Lynda had the cataract removal and lens implant surgery done on her left eye first. She waited two weeks before having the same procedure done on her right eye. It was during her brief wait that she realized how beneficial the surgery would be for her.
“I was astonished at how well I was seeing, and that was after having just the left eye done,” Lynda recalls enthusiastically. “I was still wearing glasses for my distance vision, but they had replaced the corrective left lens with a regular lens.
“Even with that, I was already seeing things a lot clearer and crisper, including when I would read or look at something up close. Then I had the other eye done, and I just loved it. I remember walking around for a month or two just smiling all the time.”
Rick opted for routine replacement lenses in both eyes. He doesn’t mind wearing glasses to read, but he wanted both eyes working together for distance, so he could achieve the results he sought through a more standard lens.
“Rick was fortunate,” Dr. Hall says. “He had a little bit of astigmatism, but not enough to keep him from seeing 20/20 in each eye after surgery. He doesn’t use glasses at all for distance vision anymore, just for near vision.”

Seeing Is Believing

Rick and Lynda are thrilled with the results of their cataract surgeries. Rick is overwhelmed by the improvement in his vision.
“After my second cataract surgery, I had the same kind of revelation I did seeing that scoreboard at the baseball game,” he states. “I’d forgotten what really clear vision can be, and now, there it is. The surgery gave me back vision I haven’t had since my youth.
“Now, I see really well both up close and distance with my two eyes working together. That’s a very welcome change. I’m fine when I drive at night; I see very clearly. I do wear glasses for reading, but I’m not sure I even need them. I’m still getting used to my new vision. I know people often say this about cataract surgery, but I wish I’d had it done sooner.”
Like Rick, Lynda can hardly believe the results of her surgery. She now describes her distance vision as being “perfect” and adds that it’s all due to the care she received from Dr. Hall and the staff at Pasadena Eye Center.
“I’ve recommended them to several friends,” Lynda explains. “I even recommended them to my mother. The staff there is professional and very friendly. It’s a nice, well-run office, and I didn’t feel nervous at all.”
Rick agrees and says he owes his success to Dr. Hall and the staff at Pasadena Eye Center.
“Dr. Hall is terrific,” he shares. “He’s personable and expert at the same time, as everybody wants their doctors to be. He and his staff are fantastic.”

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    • Nathan R. Emery, MD

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    • Dennis C. Ryczek, OD

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