Astigmatism fixes after cataract removal

Toric IOL, limbal incision among approaches to get you out of glasses.

When Ramona Coles was first introduced to William Harris some 60 years ago, dating him was out of the question. The reason was strictly territorial. As the Beach Boys sang in one of their hit songs at the time, Ramona wanted to be true to her school

“I was going to Walt Whitman High School in Huntington, New York, and he was going to Huntington High,” Ramona explains. “I don’t know if it’s still the same, but they were big rivals back then, so I wasn’t all that interested in him.”

That changed after Ramona and William left high school. While he was away from home in the military, William began writing to Ramona. Through their correspondence, they developed a bond that remains strong to this day.

Ramona and William Harris

Ramona and William Harris

 

“Our entire courtship was through letters,” Ramona confirms. “We wrote back and forth for a year and a half and got to know each other. That led to us realizing we both were seriously interested, and we eventually got married.”

Bound by their faith, these “avid students of the Bible” have been together for 55 years. They have shared many experiences, one of which was the slow development of cataracts.

Triggered by a clumping of eye proteins and/or a breakdown of lens fibers, cataracts are a natural clouding of the normally clear lens that can lead to blurred vision, an increase in sensitivity to light or a reduction in the vibrancy of colors.

Now among the 90 percent of seniors who develop them, Ramona and William learned they had cataracts several years ago, when their eye doctor, Alexandra Kostick, MD, FACS, FRCSC, of Atlantic Eye Center discovered them during a routine exam.

“The fact that I was seeing both William and Ramona is not unusual for my practice,” Dr. Kostick notes. “We typically treat more than one member of the family because we are a very family-oriented practice that gladly treats entire families.”

Remove and Replace 

When they were diagnosed with cataracts, neither William nor Ramona was suffering enough for Dr. Kostick to act on them. However, Ramona had cataract surgery on her right eye in 2016 and her left eye two years later.

In both cases, Dr. Kostick removed each clouded lens and replaced it with an artificial intraocular lens (IOL).  The IOLs are made of acrylic or silicone and coated with a special material to protect the eye from the sun’s ultraviolet rays. 

Like contact lenses, IOLs are available in various focusing powers. Standard IOLs typically correct distance vision, while multifocal IOLs can correct distance and near vision in much the same way as bifocal glasses or contact lenses.

The most advanced IOL is a trifocal called the PanOptix®, which corrects distance, intermediate and near vision. The PanOptix is Dr. Kostick’s “IOL of choice” for patients who want a multifocal lens, but not all patients are candidates.

“People who have macular degeneration or retina problems or had refractive surgery such as LASIK or PRK are not candidates for the PanOptix,” Dr. Kostick confirms. “For those patients, I now recommend the Alcon AcrySof® IQ Vivity®.

Recently approved by the FDA, the Vivity is designed to provide crisp, clear distance and intermediate vision as well as functional up-close or reading vision in patients who are not candidates for the PanOptix.

Ramona’s cataracts were removed before the PanOptix and Vivity lenses were developed, so she was fit with a standard IOL in her right eye and a toric lens designed to correct an imperfect curvature (astigmatism) in her left eye.

An astigmatism can cause blurred vision, eye strain or even headaches. It’s a common condition that was corrected with the toric lens.

This past October, Ramona returned to Dr. Kostick complaining of blurred vision in her right eye.

“When Ramona returned, her vision in the right eye was almost back to the level she was experiencing before she had cataract surgery,” Dr. Kostick reports. “When I examined her, I noticed a significant opacity in the form of scar tissue behind the lens implant in that eye.

“That’s fairly common after cataract surgery. A lot of cataract patients get some scar tissue development after surgery, but the good news is we can take care of that in about a minute using a laser.

“It’s a pain-free procedure that doesn’t require any prior workup or medical clearance and is covered by insurance. Once we performed that treatment on Ramona, her vision immediately returned to what it was after her cataract surgery.”

In the months since, Ramona’s vision has improved. Not only does she no longer need glasses to see distances, but her dependence on reading glasses has also been dropping.

“If I’m sitting at the table looking at my laptop, I find myself taking my glasses off because I can actually see better without them,” Ramona insists. “I didn’t anticipate that, but I’m very happy about it.”

Eye-Popping Results 

As Ramona learned of the scar tissue, William learned his cataracts had progressed to the point where they needed to be removed. He also learned he had an astigmatism in each eye.

To correct the latter problem, Dr. Kostick performed a limbal relaxing incision (LRI), a procedure that relaxes the steepest part of the cornea’s curvature and makes it more round. The incisions are made on the outer edge of the cornea called the limbus. Typically done in tandem with cataract surgery, an LRI takes about five minutes per eye. 

The LRI allowed William to be fit with standard IOLs instead of toric replacements. The results were eye-popping.

“I had cataract surgery on one eye in October and the other in December, and after each surgery, I noticed an immediate difference in my vision,” William relates. “I really could not believe how much better I was seeing.

“I’ve worn glasses for years, including for reading, and just the other day we got something that I had to read the fine print on, and I was able to read it without any glasses at all, so I am very pleased with the results.”

So is Ramona, who echoes William in praising Dr. Kostick for her “professionalism and caring nature.” Both agree they feel like they’re part of a special family at Atlantic Eye Center and have gladly recommended Dr. Kostick to others.

Dr. Kostick greatly appreciates the recommendations. 

“As doctors, we pride ourselves on the referrals we get,” Dr. Kostick notes. “I can honestly say that my staff members go out of their way to ensure that every one of our patients is cared for to our utmost capability.

“We strive to make our patients part of our extended family. We want to make them comfortable by creating a very caring environment and make sure they know that they are going to be treated with a personal touch whenever they come here.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. js
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    • Atlantic Eye Center

      Flagler County’s leading female board-certified ophthalmologist, serving the county since 1996, is at Atlantic Eye Center. Benefits the center offers you include: A multi-trained and highly regarded doctor Unparalleled eye care experi... Read More

    • Alexandra Kostick, MD, FACS, FRCSC

      Alexandra Kostick, MD, FACS, FRCSC, is board certified by the American Board of Ophthalmology. After earning her medical degree at the University of Manitoba in Winnipeg, Dr. Kostick served a mixed surgery internship at St. Boniface Hospital at... Read More