Monday, April 14, 2014

Different Multifocal Lens Implants in Each Eye?

Question: I have cataract in both eyes and need cataract surgery. Is it possible to have a ReSTOR® multifocal lens implant in one eye and a different multifocal that would do well in dim light? Would Medicare pay for one single vision lens implant if I have a multifocal lens implant in the other eye?

Answer: While it is possible to mix and match multifocal lens implants, it is not a generally used practice as it can result not only in adding some benefits, but in extending some problems and optical complexity. Generally one would “mix and match” if there was a need to modify the near and intermediate range of vision this could be attempted-BUT could result in the highlighting of side effects of each. Follow the recommendations of your cataract surgeon. Medicare will pay for the monofocal lens only-even if you have a multifocal in the opposite eye.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, April 1, 2014

Toric Lens Implants & No Astigmatism Correction

Question: I had cataract surgery and toric lens implants. After an extensive exam yesterday, I have found out I still have almost all of the astigmatism that I had before surgery nearly 2 years ago.  How can I find out if I really have the toric lens?

Answer: If you are questioning whether in fact your cataract surgeon actually used toric lens implants to correct astigmatism rather than conventional spherical or aspheric implants, there are several things you can do. First, you may have been given a small identification card tat identifies the brand and parameters of the lens that was implanted in your eyes. This would identify whether it was a toric lens. If you do not have this card, then perhaps it might be best to schedule an appointment with another cataract surgeon who can review your preoperative records and the results of your recent exam and then after his or her own exam render an opinion regarding the history and state of the astigmatism correction for you.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, March 18, 2014

Lens Implants after LASIK

Question: I had cataract surgery in my left eye 10 days ago. I have terrible halos, rings and pentagon shaped bright lights around all lights at night that are unbearable. I also have blurriness for distance that is much worse than before surgery and double vision. I had LASIK done with monovision 5 years ago with relatively good success. I'm 59 years old. Yesterday my cataract surgeon told me the best solution is to remove my Technis® Lens Implant he had put in as soon as possible and put in a monovision lens or a Crystalens® lens before doing the left eye. I have astigmatism. Which do you think I should choose for my eyes?

Answer: Lens implants after LASIK can be tricky. Depending on the type of LASIK you had and the presence of corneal aberrations, as well as any contrast reduction from the LASIK flap-one needs to VERY carefully select the type of lens implant AND consider optical aberrations and if they are going to interfere with lens implant optical performance. Further, the multifocal lens implants in and of themselves cause many of the symptoms you are describing. You need to have an aberrometry, a careful examination of the placement and position of the lens implant and a determination of the likely cause of your symptoms-only then will it be possible to make the best choice. Certainly the lowest risk choice is to avoid the multifocal or accommodative lens implant and stay with a monovision correction. Last, if you have a meaningful amount of astigmatism this needs to be carefully considered as well so as not to leave it uncorrected. Both the monovision option with a toric lens implant or a Crystalens® toric lens implant can hopefully address that for you. 

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

ReSTOR® Multifocal Lens Implant & Astigmatism

Question: Four months ago had cataract surgery using ReSTOR® Multifocal Lens Implant in both eyes including corneal relaxing incisions for previous astigmatism. I am adjusting to the various distances for reading and computer and the need for good lighting. However my distance vision is blurry so have a problem reading street signs until almost on top of them.  It has been suggested that more relaxing incisions should be done and in the office. 

Answer: It is impossible to know whether you might need additional relaxing incisions as it is not obvious whether the cause of your distance blur is indeed uncorrected astigmatism. Generally if one has a meaningful amount of uncorrected astigmatism it would also impact clarity at other distances and not just distance vision. Before having additional relaxing incisions you might want to get a second opinion and definitive reason for the decreased distance vision. While it could very well be due to the astigmatism, it could be due to other causes or just an inability to tolerate and get the desired performance from that lens implant design-which does cause a considerable contrast reduction. And, it may be that an alternative to the relaxing incisions might provide the beast clarity.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, March 4, 2014

Cataract Surgery Risk & Diabetic Retinopathy

Question: I have had Type 1 Diabetes for close to 34 years and have had vitrectomy and scleral buckle on my right eye 20 years ago along with a gas/fluid exchange. The buckle is still nice and low in that eye and I also developed a cataract and had cataract surgery and a lens implant 8 years ago. I have now developed a cataract in the left eye at age 52. I have also had PRP diabetic retina laser in both eyes. Most of my peripheral vision has been lost in the right eye after the vitrectomy, so my question is, should the cataract surgery be done immediately on my left eye since my quality of life is not being impacted and I still correct to 20/20 in the left eye with full peripheral vision. Are there also greater risks to the cataract surgery now that the PRP was performed years ago? I currently see a retinal specialist and also an ophthalmologist who is a cataract surgeon.

Answer: Generally, the decision to have cataract surgery is up to the patient based on whether there is any decline in quality of life, mobility limitations or safety concerns because of diminished vision from the cataract. If you still correct to 20/20 and do not experience any limitations you can delay the cataract surgery until you judge that it is a problem. There should be no increased risks due to the PRM but your retina specialist will most likely consult with your cataract surgeon and clear the stability of retina and vitreous for surgery when it is time.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, February 25, 2014

Eye Color after Cataract Surgery

Question: When you have cataract surgery does your eye color change or remain the same? I've seen some people's eyes darken or lighten.

Answer: There really should be no change in eye color after cataract surgery unless there is either a complication changing the iris shape or significant inflammation or other complication.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Allergic to Lens Implant Material


Question: My wife has cataracts and needs to have them taken care of, however she is allergic to acrylics and is afraid to have that done for fear that her body will not accept the lens implants. 

Answer: The acrylic materials used in lens implants are typically highly biocompatible and non reactive as they are carefully tested and there is virtually no residual monomer, however there are indeed reports of low grade inflammation in rare patients that are allergic to acrylics. That aside, your wife's cataract surgeon could consult with the lens implant manufacturer and subject her to a test by exposing her to the material perhaps on an underarm area taped for some time or better yet the cataract surgeon could simply use an alternative lens implant material, for example a silicone material or a collagen-silicone material. The best thing to do is to discuss this with the cataract surgeon.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Thursday, February 20, 2014

Playing Oboe after Cataract Surgery


Question: Since I play oboe, which requires a rather extreme amount of pressure to blow, would it be advisable to not play for a while after cataract surgery, and how long a time would you think would be advisable?

Answer: The best answer to your question about playing the oboe after cataract surgery really should come from your cataract surgeon as he or she knows the exact course of your surgery, incision status or any potential complications that might have occurred during your cataract operation. That said, the general opinion of cataract surgeons is that waiting a week after an uncomplicated cataract and lens implant surgery should be sufficient to resume your oboe activities.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monday, February 10, 2014

Cataract Surgery While Pregnant

Question: I am 36 years old and have lost my vision in my right eye due to a cataract. My left eye is becoming more blurry daily. I am 19 weeks pregnant and have been told I cannot have the eye surgery until after my pregnancy from my OB-GYN. I am concerned because I don't want to cause more damage to my eyes by waiting, besides I cannot see. Does this type of surgeryhave risks for the baby?

Answer: Most cataract surgeons would prefer to wait until after the pregnancy to perform cataract surgery. The risks of cataract surgery to the baby are minimal especially if the surgery is performed with eye drop anesthesia and probably even with local anesthesia. Still, there is always risk during surgery and for that reason it is preferable to wait. That said, you do not identify why you have cataracts-and a progressive cataract, and this is more alarming if it is related to your pregnancy and overall health. If you are a high risk pregnancy or have other medical problems, if you not have already done so, you can at least schedule a consultation with a cataract surgeon in your area and allow them to follow your eye health.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Wednesday, February 5, 2014

Retinal Detachment Risk after Cataract Surgery with High Myopia

Question: I am a 49 year-old male, have had cataracts in my right eye for 7 years which is also extremely myopic with a -12.00 correction. Fortunately, my left eye vision has held up, and I have been able to function normally with my left eye vision for many years. Starting last year, my left eye started to develop cataracts.  I have been myopic my whole life, and my left eye has gone from about -6.5 before I developed cataracts to -7.5 now.  With correction, I used to see 20/20 in both eyes. Now with cataracts, my vision is 20/30 in the left, and almost blind with my right.  I have also developed presbyopia so I need reading glasses in both eyes.

Because I am relatively young and myopic, my ophthalmologists have told me that I am in the high risk category for retinal detachment after cataract surgery. Therefore, I have delayed my cataract surgery for as long as possible. Given that my left eye is getting blurry and my right eye cataract is are getting dense, increasing the cataracts surgery risks, I have decided to get cataract surgery soon.  Given that my left eye is still functional, I have decided to get a cataract surgery in my right eye first, with no plans on the left eye surgery, hopefully until many years later.

I was told that I am left eye dominant, so even with near-blindness in my right eye, I have lived a normal life. If I correct the right eye vision for distance thru the cataract surgery, I was told that I would have to wear contacts on my left eye to balance out the vision. 

My question is as follows:  If I don't wear contacts, but rather wear glasses such that the left eye correction is around -3 (versus full correction of -7.5), and right eye would have no correction (except for reading glasses), would I be able to function for reading and distance?  In other words, given that I am left eye dominant, but after the cataract surgery on the right eye, I will have distance vision on the right eye and partial correction on the left eye through glasses, would my brain be able to function or will I be too dizzy?  I'm just trying to see if I can avoid wearing contacts everyday and still function. Thank you so much for your advice!

Answer: It sounds like you are getting careful consideration from your ophthalmologists who know your situation the best. The decision to have the cataract surgery in the right eye first sounds like a good idea-BUT-you may want to have a thorough evaluation of your retina by a retinal specialist if you have not already done so in order to be sure the retina will withstand the cataract operation and to determine whether any prophylactic treatments of holes, tears, weakening or degeneration might help to reduce your risk of retinal detachment. After clearance by a retinal specialist you can be more confident that you have taken any necessary precautions. Regarding the -3.00 D difference after surgery, it is likely to cause headaches and possibly dizziness if you don’t wear a contact lens. You need to know that the best result is when both eyes have had the cataract surgery and thus while delaying the left eye surgery might seem prudent, it does make things even more risky surgically the longer you delay. Of course this is up to you and your cataract surgeon. You can try the eyeglasses with the -3.00 D difference and see if you tolerate it but it is questionable.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monday, February 3, 2014

Light Flashes & Floaters after Cataract Surgery

Question: I had cataract surgery 5 months ago on my right eye and am still bothered by flashes of light and floaters. I had been sensitive to sunlight and problems with night driving and my ophthalmologist suggested that I have cataract surgery to correct my distance vision.  I took his advice, he did the surgery and I have regretted ever since. My distance vision of course has improved but the flashing and fluttering that I am experiencing in the outer corner of my eye causes me much frustration. I also am experiencing more floaters than I previously had.  I have returned to his office and have been examined as recent as a month ago but he informs me that I have astigmatism and this is as good as I can expect. The eye examination was done without dilation.  My vision was so much better 5 months ago.  Please inform as to what my recourse is. 


Answer: You do not state whether your cataract surgery was uncomplicated or whether there were cataract surgery complications during your surgery that may have predisposed you to the ongoing flashes of light, floaters or fluttering. Assuming that it was an uneventful cataract operation it is not uncommon for many patients-perhaps 30-50%-who have cataract surgery, to experience a condensation, shrinkage and even a detachment of the vitreous gel, which does often cause the symptoms you describe. In almost all instances these symptoms pass after several months and become unnoticeable. These particular symptoms are not likely to be related to the astigmatism. In addition some patients experience some “light effects’ as they adapt to the vision with a lens implant. For you own satisfaction it might be worth considering getting a second opinion on the status of your vision with a top cataract surgeon in your area.   

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Maine Cataract Surgeons Launch New Web Site for Seniors


Eyecare MedicalGroup has launched a new web site with important patient information to help patients learn about eye diseases and surgery and in particular includes information about advances in technology, treatment and procedures that are especially helpful for senior eye problems. “The EyecareMedical Group cataract surgeons all felt strongly that we needed to use our web site to share information with patients who are at risk of suffering vision loss from cataracts. By understanding more about cataract surgery and lensimplants, we believe seniors will be able to make more informed decisions about their eye health and  not allow vision loss from a cataract to interfere with their daily activities, driving, mobility and overall quality of life,” commented Bruce Cassidy, M.D., a Cataract& Refractive Surgeon. “Further, as the choices of advanced technology lens implants have become more extensive, they have also become more confusing for seniors having cataract surgery. So, we wanted to provide them with easy to understand options," explained Robert Daly, M.D., a Cataract Surgeon &Glaucoma Specialist at EMG in Portland, ME. “As a group, we are quite dedicated to helping patients get the information and education they need. This is especially important when we consider age related eye problems such as cataracts, glaucoma and macular degeneration,” summarized Cataract Surgeon& Glaucoma Specialist Samuel Solish, M.D.

To learn more about Eyecare Medical Group inPortland Maine, cataracts, cataract surgery or lens implants, you may visit the new web site at www.eyecaremed.com.

Wednesday, January 29, 2014

Monovision Lens Implant & Distance Vision


Question: I had toric lens put in right eye during cataract surgery with no since I still have to wear glasses for distance. I'm considering monovision lens for left eye so I can still read without glasses. If I do this will glasses enable the left eye to see distance clearly?

Answer: First, if you still need to wear glasses with the toric lens implant for distance, you need to find out why and whether there is a solution to get you seeing better. It is important to know the reason and understand whether it has anything to do with the lens implant, the cataract surgery or the health of your eye-especially the retina. Second, if you now correct the left eye for near-NO-you will not be able to see clearly at distance with the left eye. You need to get better answers from your cataract surgeon and if you are not satisfied seek a second opinion. 


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Friday, January 17, 2014

Multifocal Lens Implant Cost & Decision

Question: Why would a person having cataract surgery settle for monofocal lens implants and still have to use glasses, when he could have a multifocal lens implant? Why are multifocal lenses so expensive?  What is the difference between the different brands of multifocal lenses such as AcrySof®ReSTOR®, Tecnis® and the other brand names?  Medicare said they would pay for the monofocal lensimplant and if you want an advanced lens such as a Tecnis® Multifocal lens implant, the patient would have to pay the difference. Why would the difference be as much as $2500 dollars per eye difference?

Answer: First some patients having cataract surgery don’t mind wearing eyeglasses and thus don’t really see much benefit in electing to have a multifocal lens implant. Second, in order to have the best success with multifocal lens implants it requires careful patient selection in terms of optical characteristics, previous refractive error and overall expectations and ranges of vision the require. They are NOT for everyone. So NOT all patients get the option or choice of a multifocal lens implant-and thus they have to have a monofocal lens implant. Each multifocal les implant type has an optical design that works best for certain eye characteristics and which one to use is really up to the cataract surgeon-NOT the patient. Medicare DOES NOT pay for the correction of near vision or astigmatism after cataract surgery whether it be with eyeglasses, contact lenses or lens implants. This portion of the correction after cataract surgery is the obligation of the patient and NOT Medicare. The incremental fee for multifocal lens implants is the necessary fee to cover the costs associated with considerable incremental preoperative testing, measurement and calculations, plus the cost of the lens implant itself, plus any costs should a lens exchange or power adjustment be necessary. Most patients find this to be a bargain given the multiple long term cost of buying eyeglasses for their lifetime-to say nothing of the improved convenient day to day ability to see clearly at multiple distances.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Risk of Cataract Surgery after Retinal Detachment

Question: I have had 3 surgeries for retinal detachment with laser, vitrectomy and gas bubble, since have developed cataract. What are the risks to my retina with cataract surgery?

Answer: There is some increased risk of having cataract surgery if you have had prior retinal detachments ad surgery. However, IF the retina is well attached, stable and otherwise free of holes, tears, thinning and other degeneration AND your retina surgeon gives you clearance to have the cataract surgery then you can proceed with the expectation of only minimal increased risk of a recurring retinal detachment.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.