Shedding A New Light On Cataract Surgery

As a high school student, St. Petersburg native Michael Lyons was given an aptitude test. The test was designed to gauge his natural strengths and potential for success at various occupations. Michael scored highest in accounting, which didn’t sit well with him. 

Michael Lyons

“I said, Oh no, I don’t want to go into accounting. That’s boring,” Michael remembers. “At the time, I wanted to be an architect. But a few years later, I found myself majoring in accounting in college. Ultimately, I became a certified public accountant and have been practicing in Seminole and now Clearwater for the past 33 years.” 

Accounting turned out to be an excellent career choice for Michael. After working for a “Big Eight” firm for 2½ years, he found his niche in a small firm with 16 employees. Much to his delight, he discovered that accounting is far from boring.

 “The work has kept my mind challenged all these years,” the 59-year-old reveals. “I learn something new if not every day, then every week, because things are always changing. And I like helping people reduce their tax liability. I’ve built many rewarding business relationships over the years.” 

When his career began, Michael wore eyeglasses to correct nearsightedness. He later underwent radial keratotomy (RK), a refractive surgery during which small cuts are made on the cornea, the clear outer layer at the front of the eye. The procedure is designed to correct nearsightedness and sharpen vision, but the effects didn’t last long for Michael. 

“When I was in my early 40s, I started needing glasses again,” Michael recounts. “The prescription got a little stronger each year before it leveled off in my 50s. 

“Then one day I read an article in Florida Health Care News about a woman who, like me, was tired of glasses. She underwent a clear lensectomy, in which the lenses in her eyes were replaced even though she didn’t have cataracts. 

“I thought, That sounds wonderful. I’m going to look into that. That’s how I wound up at The Eye Institute of West Florida. But, lo and behold, when the eye doctor examined me, he told me I was developing cataracts.” 

A cataract is a clouding of the lens caused by a buildup of protein deposits. The only treatment is surgery, which is typically performed on one eye at a time, with a break of a week or two in between. 

Each procedure takes only a few minutes and starts with the breakup and removal of the affected lens. Then, a synthetic replacement known as an intraocular lens, or IOL, is implanted. IOLs come in various focusing powers to correct vision issues. 

IOLs are typically made of a flexible plastic such as acrylic or silicone and are coated with a special material to help protect the eyes from the sun’s ultraviolet rays. 

Surgery Challenge 

Michael’s cataracts were discovered by 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. 

“I recommended that instead of waiting until the cataracts became really bad, Mr. Lyons should undergo surgery now because he wanted to be free of glasses again like following his RK surgery,” Dr. Weinstock recalls. 

Dr. Weinstock notes that ophthalmic surgeons no longer perform RK. It was replaced by another refractive procedure, laser in-situ keratomileusis, or LASIK, around 1997. 

“The reason RK was abandoned is because LASIK is more accurate,” the doctor asserts. “In addition, patients who underwent RK typically experienced fluctuating vision. And RK often caused the cornea to take on an irregular shape. 

“But it’s challenging to perform cataract surgery on patients who have had RK or LASIK and want to be glasses-free after cataract surgery. The problem is not necessarily that the cornea has become irregular; it’s that the lens changes due to the refractive procedures.” 

One of the difficulties is accurately gauging the strength of the replacement lens. 

“The typical measurements and formulas we use to determine IOL strength work really well on virgin eyes but aren’t as accurate on RK or LASIK eyes,” Dr. Weinstock contends. “Fortunately, a newer technology IOL is available that addresses this issue.” 

The state-of-the-art replacement is called a light-adjustable lens, and it’s implanted just like other IOLs. The difference is that it can be adjusted postoperatively to ensure the best possible visual outcome. 

About a month after the surgery during a relatively routine appointment, the lens power is customized using ultraviolet light. 

“With this light-adjustable lens, we take the best numbers and measurements before and during surgery,” Dr. Weinstock explains. “Then, we put the lens in the eye, we let the eye heal and we review the results at the patient’s follow-up visit. 

“If the patient’s vision is not perfect, we can adjust the lens inside the eye. To do that, all we need to do is dilate the eyes and have the patient look at a blue UV light. The new prescription is then programmed into a laser, which makes the adjustment. When the vision is where the patient wants it, the lens power is locked in. 

“The adjustment is made in about 30 seconds to a minute, and we can do it up to three times over the course of the first few months after surgery. It’s a much more customizable approach than we’ve ever had before.” 

Dr. Weinstock says the only drawback is that, prior to the final adjustment, the patient must wear special glasses to protect the eyes from UV light. 

“That’s done to keep the lenses in the stage where they are still adjustable,” he notes. “So, yes, you’re wearing those glasses for a month or two, but do you want to wear glasses for a month or forever? Most people will say they’ll wear them for a month.” 

“My Vision Is Excellent” 

During his preoperative consultation with Dr. Weinstock, Michael expressed a desire to have one eye fixed for distance and the other for reading, a process called monovision. According to the surgeon, light-adjustable lenses are a great option for a mono-vision correction. 

“I’m very pleased with the outcome,” Michael enthuses. “My right eye is set for distance and my left eye is set for reading, but I’m also able to work at the computer without glasses. My vision is excellent now. The only glasses I need are sunglasses, which is wonderful.” 

Michael is just as pleased with his experience at The Eye Institute of West Florida. 

“Dr. Weinstock is very knowledgeable,” he raves. “He and his team explained the entire process clearly, and I absolutely recommend them. I tell my friends, If you get cataracts, go to The Eye Institute of West Florida and see Dr. Weinstock and get the light-adjustable lenses.

Florida Health Care News


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    • The Eye Institute of West Florida

      The Eye Institute of West Florida was founded by Stephen Weinstock, MD, in 1974. For more than forty years, the practice has provided excellence in eye care in a warm, personal environment combined with a tradition of service and devotion to th... Read More

    • Stephen M. Weinstock, MD, FACS

      Stephen M. Weinstock, MD, FACS, is a board-certified, fellowship-trained ophthalmologist specializing in refractive cataract surgery. He founded The Eye Institute of West Florida in 1974, pioneering subspecialty eye care in Pinellas County. As ... Read More

    • Neel R. Desai, MD

      Neel R. Desai, MD, is a board-certified, fellowship-trained ophthalmologist specializing in corneal disease, LASIK and refractive surgery. Dr. Desai completed his fellowship in corneal, cataract and refractive surgery at the Wilmer Eye I... Read More

    • Robert J. Weinstock, MD

      Robert J. Weinstock, MD, is a board-certified, fellowship-trained ophthalmologist specializing in cataract, LASIK and refractive surgery. Dr. Weinstock joined the practice in 2001. He is the director of cataract and refractive surgery at The E... Read More