Laser Cataract Surgery Update

The dream of laser cataract surgery is finally here. The first commercial laser was delivered to a doctor in Texas this month. The first real cases should be done shortly. The laser will allow the surgeon to perform 80% of the surgery with the precision of the laser. There are 3 companies competing in the market. LenSx with Alcon, LensAr, and Optimedica. So far LenSx has the early lead with FDA approval. It's still too early to tell who has the best platform. We have learned with other technologies that the first to market isn't always the best. Many doctors feel this could revolutionize cataract surgery the way phacoemulsification did in the 1970s.

Astigmatism Explained

Astigmatism means that your eye is not a perfect sphere but oval shaped like a football. When light enters an eye with astigmatism it is focused irregularly. Astigmatism can be corrected in many ways.

1) Glasses- Spectacle lenses are ground with a cylindrical correction to compensate for the irregular curve in the eye.

2) Contact lenses- Rigid contact lenses rest on the front surface of the eye to provide a new regular surface. Soft toric contacts have astigmatism correction within the lens.

3) Laser vision correction- Lasik surgery will reshape the front surface to correct astigmatism as well as nearsightedness or farsightedness.

4) Cataract surgery- During cataract surgery a toric implant will correct astigmatism. Relaxing incisions in the cornea similar to RK will reshape the cornea to reduce astigmatism.

Astigmatism is usually something we are born with but may shift over time. Sometimes it is caused by corneal disease or trauma. Thankfully there are many ways to treat it.

Droopy eyelids

You know you have them. You try to ignore it. You tell yourself it's just a part of aging.
Droopy lids or more properly upper eyelid ptosis has many causes. Most are related to aging where the skin gets loose and the levator muscle slips back. Some are related to neurolgic problems like stroke, bells palsy or myesthenia gravis. The lowering of the upper brow may also contribute.
The good news is that most of these issues can be resolved with outpatient surgery. Very often they will also be covered by medical insurance.
So stop drooping and get it checked out. All you have to loose is some extra skin.

Laser Cataract Surgery Has Arrived

The hottest buzz at the recent Academy of Ophthalmology meeting (AAO) was the unveiling of Laser assisted cataract surgery. I bet most of you thought it was already done with a laser. Actually current state of the art cataract surgery is done with ultrasound. A technique called phacoemulsification or phaco for short. With the current operation the surgeon manually creates the incision, opens the capsule and then uses the ultrasound to break up and remove the cataract before placing an implant lens.

The laser procedure uses a femtosecond laser, the same laser used to create a flap in LASIK surgery. This laser is capable of making precise incisions into the cornea that are exact every time. The laser will then make an opening in the capsule to a desired size. Lastly the laser energy is directed into the cataract itself to break it's bonds. The only manual parts are the aspiration of the softened cataract and the placement of the implant lens.

The excitement of this new procedure is tempered only by the question of additional cost and who will bear this cost. If current trends continue it will not be covered by insurance and the patient will need to decide if it worth the extra cost.

Glaucoma- The silent thief of sight

Glaucoma has earned the moniker "silent thief of sight" because afflicted patients may have no symptoms until it is too late to save their vision.

The hallmark symptoms of glaucoma are elevated eye pressure and progressive loss of peripheral vision.

1)Elevated eye pressure

Normal eye pressure should be between 10-20. Patients can present to the doctor with pressure as high as 50 with no symptoms, if the pressure has been rising slowly. Elevated pressure stresses the circulation of the optic nerve, slowly damaging the nerve fibers.

2)Loss of peripheral vision

As the optic nerve is damaged it will affect peripheral or side vision before affecting straight ahead vision. A person can lose a significant amount of side vision before they notice it. The good news Glaucoma can be treated if found early. The treatments range from eye drops and laser to surgery for severe cases. If you are over 40 especially if you have a family history of glaucoma you should have a yearly screening exam. Nearsightedness and African descent are also risk factors.

Do yourself a favor and get your eye pressure checked. There may be a silent thief right behind your eyes.

New lens implant options

Implant technology for cataract surgery has improved leaps and bounds in the last 20 years. The evolution started when the first foldable implants were developed. This allowed the implant to be inserted through a 3mm incision. Prior to that the incision needed to be enlarged to 6mm, and needed to be sutured. The foldable implant, made of silicone or acrylic, was the beginning of sutureless surgery. The next big leap was in 1997 with the approval of the first multifocal implant called Array. The multifocal lenses evolved to the ReStor,ReZoom and ReStore 3.0. The Crystalens was also introduced as the only accomodating implant. All of the lenses are designed to give a patient distance and near vision after cataract surgery. Another huge advance is the Toric implant which corrects astigmatism. Just last week it was announced that a lens that corrects distance,near and astigmatism is being used in Europe. With all this new technology it's a great time for patients who need cataract surgery.