Expert Cataract Surgery with Astigmatism Correction

Courtesy Photo
David has 20/20 vision in both eyes with his cataracts removed, IOLs implanted and astigmatism corrected.

After 12 years of teaching special education, David Sarin decided he needed a change, so a few years ago, he did an about-face, switched careers and became a social worker case manager. The latter is a job from which he garners great satisfaction.“In my previous job, I worked with children; now, I work with adults who have mental and physical health issues,” the 53-year-old acknowledges. “I loved the classroom and loved teaching, but I’m very happy doing what I’m doing.” About two years ago, David began having health issues of his own, specifically with his eyes. A glasses-wearer who had been prescribed bifocals since he was 40, David soon learned that his newfound vision problems were the result of cataracts. “My optometrist discovered the cataracts in 2021 and said they were pretty significant, but my right eye was worse than my left,” David describes. “By then, the vision in my right eye had gone downhill so badly that I was almost blind in that eye. “My vision was blurry, colors were faded, and I was having trouble driving because I couldn’t see in the distance. It was even worse at night because there was a haziness around lights that made it difficult to see. “I now understand why some people slow down at a green light. If they’re like me, they probably can’t see whether the light is red, green or yellow because of the haze caused by their cataracts.” A cataract is a clouding of the lenses caused by a buildup of protein deposits. The only treatment for cataracts is the surgical removal of the lenses. This procedure is typically performed on one eye at a time, with 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 the patient’s refractive 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. Recognizing the need for surgery, David’s optometrist recommended that he visit 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. “Around the same time, I also spoke with a nurse who had a boyfriend who was a patient of Dr. Weinstock,” David recounts. “That was two recommendations for Dr. Weinstock, so I figured that was a good way to go. Not only that, but Dr. Weinstock’s father is an ophthalmologist as well, and I liked that.”

Two Techniques

During David’s first visit, Dr. Weinstock confirmed the presence of cataracts in both eyes as well as the need for surgery to remove them. He also diagnosed David with astigmatism, a common refractive condition that causes blurry vision. “With astigmatism, the cornea, or front part of the eye, is not perfectly round like a basketball,” the doctor explains. “Instead, it is subtly shaped more like a football, so when light hits the cornea, it does not focus properly on the retina because it is not hitting a nice smooth, round surface. “People must wear glasses or contacts to correct astigmatism, but in someone who has cataracts, if we only fix the cataracts and not the astigmatism, the patient will still have to wear glasses after surgery to see well. Even though the replacement lens provides good distance vision, the astigmatism will still prevent the patient from seeing clearly in the distance.” With modern techniques, astigmatism can be corrected at the time of cataract surgery. There are two approaches. “If the patient has a low amount of astigmatism, we can use a laser to treat the cornea and make it round,” Dr. Weinstock explains. “That way, when we put the replacement lens inside the eye, patients can see well in the distance without glasses. “If we implant a multifocal lens inside the eye, the patient can see distance and near. But we still must take the critical step of rounding out the cornea for the best vision.” The Eye Institute of West Florida uses the LENSAR ALLY® Laser System to correct astigmatism at the time of cataract surgery. The LENSAR ALLY is considered the most advanced femtosecond laser, which is known for its fast, precise capabilities. The procedure, known as a limbal relaxation incision, places precise cuts at the eye’s outer edge, called the limbus, to alter the cornea’s shape. “The LENSAR ALLY communicates with the machines we use in the clinic to measure the eye,” Dr. Weinstock describes. “The machines send that information directly to the laser, which gives us the most accurate measurement of the astigmatism and shows us the exact place to treat the cornea to round it out.” The second way to correct astigmatism at the time of cataract surgery is to implant a special type of IOL called a toric lens. These lenses are typically recommended to patients with significant astigmatism because it cannot all be corrected by the laser. But laser is still used to mark the proper orientation for the toric lens inside the eye, which is critical for successful astigmatism correction. “One of Mr. Sarin’s eyes had a low amount of astigmatism, which we corrected with the laser,” Dr. Weinstock recalls. “The other eye had a lot more astigmatism, so we implanted a toric lens that has the astigmatism correction built in. “Cataract surgery that also corrects astigmatism falls into the category of refractive cataract surgery. In these cases, we go beyond removing the cataracts and prescribing new glasses after surgery. Instead, we identify other problems that cause patients to have bad vision and require glasses, and we fix them. And that can be done seamlessly, painlessly and quickly in one session using the laser or a special lens.” When discussing a treatment plan, David told Dr. Weinstock that he wanted good distance vision and did not mind wearing reading glasses for close-up tasks. “In Mr. Sarin’s case, both eyes were implanted with a monofocal lens, with which all the light rays are focused for sharp distance vision,” the doctor informs. “But with the astigmatism correction done at the same time, he no longer needs prescription eyeglasses because he now has 20/20 vision in both eyes.”

“Amazing” Vision

David’s first cataract surgery, on his right eye, was performed in April 2022. Surgery on the left eye was completed two weeks later. David has been very pleased with the outcome. “My distance vision is amazing, absolutely amazing,” he raves. “I saw clearly within three to five days after surgery. Probably on the third or fourth day, I was, like, Wow. “Dr. Weinstock said I might need a pair of readers for near vision, but I actually see pretty well up close without them. If I’m going to sit down and read a book, I might use readers, but I can see the computer and my phone with no problem without readers.” David is also quite impressed by his cataract surgeon as well as the staff at The Eye Institute of West Florida. “Dr. Weinstock did a phenomenal job. I couldn’t be happier with my results,” he exclaims. “I would trust him with anything to do with my eyes. He also has a really good bedside manner. I definitely recommend him to anybody with eye issues. “All the nurses and techs, everyone who was involved with my care, were very informative and told me what to expect when I went for my preop and surgeries. And everything went smoothly. I am very impressed with everybody at The Eye Institute of West Florida.”

Robert J. Weinstock, MD

Cataract, Ophthalmology

Robert J. Weinstock, MD, is a board-certified, fellowship-trained ophthalmologist specializing in cataract, LASIK and refractive surgery. Dr. Weinstock joined the Read more...

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