Say Goodbye to Glasses

After cataract surgery, trifocal implants enable clear vision at all distances

Anja Makosky thrived in the insurance industry for more than four decades. She possessed a license to sell insurance, but selling really wasn’t her thing. She preferred to work on the customer service side of the business.

“I like to help people, so customer service was a good place for me,” Anja elaborates. “The work was fun, but after 42 years it was time to hang up my hat and say goodbye. I took early retirement at age 61.” 

“I wake up every morning thrilled with how wonderfully I can see!” – Anja

“I wake up every morning thrilled with how wonderfully I can see!” – Anja

 

After she retired, Anja began to experience problems with her eyesight that became progressively worse. 

“My vision was not clear,” says Anja, now 65. “It was blurry and cloudy, especially in my right eye. It got to the point where I was afraid to drive at night and started getting nervous about driving during the day as well.”

From friends, Anja learned of the excellent reputation of Robert J. Weinstock, MD, director of cataract and refractive surgery at The Eye Institute of West Florida, which has offices in Largo, Clearwater, St. Petersburg and Tampa.

Dr. Weinstock examined Anja’s eyes and recognized immediately the cause of her symptoms.

“When I first saw Ms. Makosky, she was experiencing significant trouble with her vision, even with her contact lenses,” Dr. Weinstock recalls. “She was seeing a lot of halos at night and was struggling with glare. Her vision difficulties were due to cataracts — a natural clouding of the eye’s normally clear lens — that had developed in both eyes.”

Dr. Weinstock recommended cataract surgery, which is typically performed on one eye at a time, with a break of a week or two in between. Each procedure takes just minutes and starts with the breakup and removal of the clouded lens. Then, a clear replacement lens is implanted, permanently correcting the vision. 

Goals for Surgery

Also known as intraocular lenses, or IOLs, replacement lenses are typically made of a flexible plastic such as acrylic or silicone. They are also coated with a special material to help protect the eyes from the sun’s ultraviolet rays.

During surgery, a folded IOL is placed inside the eye. Once in place, the IOL unfolds and side loops called haptics hold it in place. IOLs come in different focusing powers, which correct a variety of vision issues.

“The original, older-model IOLs corrected a patient’s vision primarily for one zone such as distance, meaning the patient still needed to wear glasses for reading,” Dr. Weinstock observes. “Patients could get around this by having one eye fixed for distance vision while the other was corrected for reading, a process called monovision.”

In the past, cataract surgery didn’t correct astigmatism, an irregular shape of the cornea or lens that causes blurry vision.

“But today, we can perform a more advanced cataract procedure using lasers that are much more precise, and we can correct astigmatism as part of the surgery,” Dr. Weinstock details. “We can also implant special replacement lenses that can help patients see clearly at multiple zones without glasses after their surgery. They are called multifocal IOLs. Most are bifocals that correct either distance and intermediate vision or distance and near vision.” 

A newer generation of IOLs, 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.

“When we implant the PanOptix and use the laser to correct the astigmatism, people are typically able to see well at all distances without glasses after cataract surgery,” Dr. Weinstock says.

Not all patients are candidates for the PanOptix lens, however. These include people who have had macular degeneration, other retina problems, or a refractive surgery such as LASIK or PRK. None of those contraindications applied to Anja.

“Ms. Makosky wore contacts most of her life and hated glasses,” Dr. Weinstock discloses. “Her goals for surgery were to obtain clear vision, eliminate the halos and glare, and be free of glasses following cataract surgery. 

“We implanted the PanOptix lens in Ms. Makosky’s eyes and achieved her goals. Both of her eyes can now see near, both can see middle, and both can see distance. And she is completely free of glasses and contacts.”

Seamless Vision 

For 23 years, Lisa Bartels served as a teaching assistant in the New York school system. She started out working a few hours a day with a kindergarten class and later took a full-time position in pre-K.

“For distance or driving, I don’t need glasses anymore!” – Lisa

“For distance or driving, I don’t need glasses anymore!” – Lisa

“As a teaching assistant in pre-K, I wiped a lot of noses and tied a lot of shoes,” Lisa muses. “Really, I assisted the teacher and helped the 18 kids in the morning and the 18 kids in the afternoon get ready for real school life come kindergarten. I retired about five years ago and moved to Florida.”

Lisa, 61, is still taking care of children. She watches her grandchildren and assists her daughter with child care. But Lisa became uneasy about driving her grandchildren to school and activities when her vision began to decline due to progressive cataracts. 

A patient of The Eye Institute of West Florida since moving to the Sunshine State, Lisa sought advice from her regular eye physician at the practice.

“I told the doctor, I can’t see anything. The glare is awful and there are halos around every light,” Lisa recounts. “I was starting to get nervous about driving, especially in the morning. I drive someone to work a little after 6 a.m., and when it’s dark, I have a very hard time seeing.

“I thought I just needed an upgrade to my glasses prescription, but the doctor said I should consider having the cataracts removed because they were ready to go.”

The doctor referred Lisa to Dr. Weinstock, who examined her eyes and concurred that the cataracts were the cause of her visual disturbances. Lisa was scheduled for cataract surgery, first on the left eye and then the right eye.

“Ms. Bartels complained of blurry vision even while wearing glasses,” Dr. Weinstock reports. “She also noticed that there was a lot of glare at night, and she had trouble driving in the dark. That was a big issue for her because she is very sensitive to glare. 

“She was used to wearing glasses but had never worn contact lenses. She desired clear distance vision. Her main priority was to obtain a seamless blend of distance to middle vision. She was OK with wearing a light pair of readers for near-vision tasks.”

Customized Process 

Based on Lisa’s eye measurements and goals for cataract surgery, Dr. Weinstock determined that the PanOptix was not the best IOL choice for her. Rather, he recommended a lens recently approved by the FDA, the Alcon AcrySof® IQ Vivity®.

“The Vivity is not a multifocal lens like the PanOptix,” Dr. Weinstock discloses. “It is an extended depth of field, or EDOF, lens. Instead of providing clear vision at three focal points – near, middle and distance – the Vivity provides seamless distance to middle vision with some near vision correction. 

“The Vivity was the better option for Ms. Bartels. Clear distance and intermediate vision were her priority, and we were able to achieve that for her. Now, she has seamless vision from distance all the way to the middle range. She no longer has to wear glasses to drive or work on the computer, and she has no trouble whatsoever adjusting.”

The Vivity lens does not get patients as free from glasses following cataract surgery as the PanOptix typically does, Dr. Weinstock observes.

“People who receive the Vivity lens often still need glasses for reading very fine print,” the cataract surgeon elaborates. “But the Vivity lens provides a more natural vision that the brains of people who have worn glasses in the past are used to. The Vivity is a slightly different solution than the PanOptix for patients with a slightly different profile and needs.”

The availability of the PanOptix and Vivity IOLs speaks to the customization process that is followed by the eye specialists at The Eye Institute of West Florida. Their approach to cataract surgery and choice of replacement lens is not a one-size-fits-all methodology.

“So much depends on the patients’ vision before surgery, their use of glasses or contact lenses, and any other conditions affecting the eye that may be present,” Dr. Weinstock explains. “If a patient has glaucoma or macular degeneration, that will also affect which replacement lens we place in the eye after surgery to optimize the vision.

“Additionally, the right lens depends on the patient’s goals as well as their professions. We might choose one lens for someone who works on a computer all day and a very different lens for someone who is a pilot or a truck driver who drives a lot at night. There are many different solutions, so it is an extremely customized process.”

Working out the specifics of that process is an important part of the preoperative evaluation at The Eye Institute of West Florida. During the evaluation, the doctor gathers all the pertinent information about the patient to customize the patient’s vision after cataract surgery.

“The surgeon essentially puts the puzzle pieces together to determine which replacement lens makes the most sense for the patient’s goals and what approach will make the patient happiest after surgery,” Dr. Weinstock assures. 

“100 Percent Vision”

Dr. Weinstock performed cataract surgery on Anja’s right eye in July and her left eye in early August. Anja was delighted by the difference in her vision following surgery.

“When I opened my eyes for the first time after surgery, I was shocked by how well I could see,” she enthuses. “I had 100 percent vision. It was amazing.

“My vision now is excellent. I can read without readers. I can see everything in the grocery store. It seems like I can see five miles up the road. It’s incredible. When I went for my follow-up appointment, my vision was 20/20 in both eyes. I have no trouble driving at all. I wake up every morning thrilled with how wonderfully I can see.”

Lisa’s worse eye was the left, and her recovery from that surgery took a little longer than Anja’s. 

“After surgery I went to bed early. The light was bothering me,” Lisa remembers. “The next day, my vision was not perfectly clear. The following day, it still was not great. I was getting nervous so I called Dr. Weinstock’s office. He said, You still have some swelling in the cornea, but your eye is doing what it has to do. It is progressing. He told me it can take a little time, but my eye will be fine.

“It did clear up and was much better the next week when I went for surgery on my other eye. After cataract surgery on my right eye, I could see perfectly. When I saw Dr. Weinstock the next day, I said, Wow. It’s a bright world out there!

As Dr. Weinstock predicted, the Vivity lens provides Lisa with clear vision from distant to intermediate ranges. But she still needs glasses for up-close tasks.

“I picked up a pair of +1.00 power readers that just magnify a little bit,” Lisa says. “I keep them in my bag or next to my bed and wear them if I’m reading very small print. For distance or driving, I don’t need glasses anymore.

“And driving in the dark is much better now. It had been getting scary. I was becoming like an old person with my head smashed against the windshield trying to see. The surgery has made a big difference, which is important to me. After all, I’ve got things to do with my grandchildren.”

Lisa is also pleased with the surgeon who performed her cataract procedures.

“Dr. Weinstock is very knowledgeable and professional,” she describes. “He does his job well and he gave me all the information I needed. But I had to do my part as well by putting drops in my eyes three times a day for three days before surgery. And it worked. I followed Dr. Weinstock’s instructions diligently, and things worked out well for me.” 

Anja agrees with Lisa’s assessment of Dr. Weinstock.

“He’s very nice and very cordial,” Anja raves. “I’d recommend him in a heartbeat to anybody that has problems with their eyes. I’m so pleased with him. I cannot praise him enough for what he did for me. He’s my lifesaver.” 

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