Cataract Surgery Has Come A Long Way

Advanced technology, replacement lenses lead to better vision.

Vision is priceless. The physicians and staff at Florida Eye Specialists & Cataract Institute believe this to be true and are devoted to bringing premier eye care to residents on Florida’s west coast. That has been their unifying mission since 1981.

The institute’s eye specialists offer a vast selection of services using the most advanced technology available. This includes employing the latest techniques and products for the treatment of cataracts.

“Cataracts are the gradual discoloration or clouding of the eye’s natural lens,” says Dilip “Dr. Samy” Rathinasamy, MD, a board-certified ophthalmologist and cataract surgeon at the institute’s Brandon, South Tampa and Ruskin clinics. “A good way to describe a cataract is in comparison to a window made of clear, thick, flexible plastic.

“As the elements take their toll on the plastic, it becomes discolored, distorting the images that can be seen through it. Eventually, the plastic becomes so discolored that it’s impossible to see anything through it. A cataract develops in much the same way.

“People with cataracts may experience murky or blurry vision. They may notice more glare than usual, especially at night, with halos or starbursts around car headlights and lamps.”

In addition, colors may seem faded or have a yellowish or brownish tint to them. Reading may become more difficult, as it becomes harder to distinguish the contrast between the letters on the page and the background. Frequent prescription changes to eyeglasses or contact lenses may also signal the presence of cataracts.

“Cataracts are treated with surgery,” Dr. Samy discloses. “During cataract surgery, surgeons remove the clouded lens and replace it with an intraocular lens implant, or IOL. There are different types of IOLs. Our goal is to select one that will minimize the patient’s dependence on glasses after surgery.”

Surgery Advancements

Cataract surgery has come a long way over the years, and more can be done now to improve the patient’s vision following surgery, Dr. Samy contends. One advancement is the use of the LENSAR® laser system during cataract surgery.

“LENSAR is on the leading edge in femtosecond laser technology,” Dr. Samy enthuses. “Its added functions and precise laser incisions enable surgeons to remove cataracts with increased safety and position the IOLs with greater accuracy. These innovations lead to better vision following surgery.”

The LENSAR automates certain aspects of cataract surgery that were traditionally done by hand, so the procedure is more efficient, more effective, and safer.

“The laser makes the initial incision into the eye,” Dr. Samy details. “It can also create the capsulotomy, which is an opening into the thin, fragile membrane, or capsule, that holds the cataract. And it does so with exceptional precision.

“A capsulotomy done by hand can be less than perfect. The importance of having a perfect capsulotomy is that the IOL can then sit in a more optimal position, which ultimately gives the patient better vision.”

The LENSAR is useful in other ways as well.

“To correct astigmatism, which is an irregular shape of the cornea that leads to blurry vision, surgeons sometimes make limbal relaxing incisions, which are tiny cuts in the cornea to reshape it,” Dr. Samy describes. “The corneal reshaping done by the LENSAR can reduce astigmatism and help people see more clearly after surgery.”

The LENSAR imaging platform, Augmented Reality, enables the surgeon to view the inside of the eye in great detail. After imaging the eye in high resolution, it creates a 3D reconstruction of the lens, allowing the surgeon to tailor the surgery to the patient.

Toric Technology

Another advancement to the femtosecond laser at Florida Eye Specialists & Cataract Institute enables even more precise placement of IOLs following cataract removal. This innovation is specifically designed for use with toric lenses.

“Toric lenses are another way to correct astigmatism. They have different strengths in different parts of the lens, which make up for the asymmetric power of the misshapen cornea,” Dr. Samy says.

Headshot of Dilip “Dr. Samy” Rathinasamy, MD

Dilip “Dr. Samy” Rathinasamy, MD

“Using the femtosecond laser technology, doctors are able to put markings on the capsule to better align the toric lens. This provides even more precise placement of the lens for correcting astigmatism.”

Dr. Samy points out that the laser performs the most crucial portions of the surgery with unmatched precision within seconds of the click of a button. It is a nice adjunct to the surgeon’s skills and expertise.

“Cataract surgery can be life-changing for patients,” he reports. “That’s one of the things I find so satisfying and rewarding about what I do. I’m happy to be able to restore clear sight to patients with such a quick and easy surgery.

“Technology has advanced the treatment of astigmatism apart from cataract surgery as well,” Dr. Samy continues. “Doctors are able to perform imaging on the operative eye in the office using corneal topography and use the image as a guide on the day of surgery.

“We take a picture of the eye, then superimpose it on the eye during surgery and apply our measurements. When patients lie down, their eyes rotate, but with this technology, we can adjust for any rotation. This enables more precise limbal relaxing incisions for correcting astigmatism.”

Monofocal Vs. Multifocal

The synthetic replacement lenses are made of acrylic or silicone and coated with special material to protect the eyes from the sun’s ultraviolet rays. Like contact lenses, IOLs are available in different focusing powers.

“The most commonly used IOLs are monofocal lenses, which correct for one focal range, typically distance vision,” Dr. Samy reveals. “This results in excellent vision for driving and most daily activities, but people may require reading glasses for very small print. One way to get around that is the monovision approach, where the doctor corrects one eye for distance and one eye for reading.”

Then there are multifocal lenses.

“Most multifocal lenses are bifocals that correct either distance and intermediate vision or distance and near vision,” Dr. Samy educates. “They generally permit the patient to be less dependent on glasses.”

A newer generation of IOL, the PanOptix® by Alcon, is a trifocal lens. It works like a pair of progressive glasses to provide crisp, clear vision in all three vision zones: distance, intermediate and reading.

“Cataract surgery can be life-changing for patients. That’s one of the things I find so satisfying and rewarding about what I do.” – Dr. Samy

“The PanOptix became available in the United States in late 2019, and it’s the only trifocal lens approved for use in the US,” Dr. Samy reports. “It has quickly become a popular lens choice because it virtually eliminates the need for glasses following cataract surgery.

“People today have more active lifestyles and use their computers and smartphones with greater frequency. They want to be able to see at all distances following cataract surgery, and they do not want the hassle of glasses.”

The PanOptix uses different locations on the lens, called the optic, to enable clear vision at all three focal points.

New Generation Lens

The main drawback to multifocal lenses is they sometimes produce visual disturbances, such as rings and halos around lights at night. A year ago, a new multifocal lens came on the market that carries a significantly lower risk of nighttime visual side effects. That lens is the Alcon AcrySof® IQ Vivity® lens.

“The Vivity is a new generation of multifocal lens that we refer to as extended depth of focus,” Dr. Samy explains. “It uses innovative technology that bends light rays entering the eye, allowing light to focus properly on the retina. The retina converts light rays into electrical signals and sends those signals to the brain, which interprets them as images.”

The Vivity corrects blurriness and gives patients clear distance, near and intermediate vision, often eliminating the need for glasses. Another benefit is it can be used with patients who have other eye conditions. Most multifocal lenses are contraindicated in patients with eye disease.

“People with eye conditions such as glaucoma, macular degeneration and diabetic retinopathy are still candidates for the Vivity lens,” Dr. Samy elaborates. “These patients would not be candidates for traditional multifocal IOLs.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb

As seen in Brandon/Sun City Edition of Florida Health Care News.

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