Cataracts by Dr. Myron Lewyckyj
Cataract consists of a clouding of the natural lens of the eye. The vast majority of us are born with a lens within our eye that is crystal clear and this typically stays clear for quite some time. The average person starts to develop some yellowing or clouding of their natural lens approximately around the age of 50, although this is highly variable.
There are some people who may be born with cataracts or develop them very early in life. The clouding and yellowing of the lens continues on a typically gradual basis throughout the years until such a point where it creates enough obstruction of vision that we consider this to be a cataract.
Cataracts may be removed in an effort to improve a person's vision, to restore his ability to function optimally visually and in some cases for other reasons such as physical interference of the lens in the normal physiological functioning of the eye. This may be the case, for example, in certain types of glaucoma.
Since cataract is often a gradual process that occurs over a period of many years, people may be more or less aware of the effects that cataract formation has had on their vision. Additionally, a person's activities or work environment, recreational hobbies, etc., may determine what level of cataract constitutes a significant interference for them. These days besides just attempting to safely and effectively remove a cataract and replace it with an implant, we also have at our disposal a variety of options for improving the overall refractive state of the eye and decreasing a person's dependence on eyeglasses.
All of these factors might be considered in developing a strategy to optimally influence and improve a patient's vision.
I am proud to offer to my patients the most comprehensive and state of the art choices when it comes to cataract.
The cataract surgical procedure that I perform offers many modern and beneficial features, including: phacoemulsification of cataract with ultrasound energy through a small incision, no suture surgery, rapid recovery, no patch—but rather a clear protective lens worn until the following morning, and the ability to resume most normal activities the day after surgery.
I have refined the technique for performing phacoemulsification surgery over the past couple of decades in order to optimize such factors as rapid recovery and minimize any risks. My experience in teaching phacoemulsification at Northwestern University and my good fortune of having been able to perform over 10,000 procedures during the course of the past two decades has allowed me to develop special modifications of technique which I believe optimize my results. I've presented my various modifications of surgical technique at multiple international cataract and refractive surgery conferences.
Besides working diligently to maximize the potential benefit of the surgical procedure performed, a large part of the process of giving patients the greatest benefit from their cataract surgery involves selecting the appropriate type of implant and custom tailoring the refractive outcome that a patient can expect to their individual needs.
Each cataract patient is fitted with an implant that best suits their visual needs and the specifics of their eye structure. A standard implant can be use to correct farsightedness or nearsightedness.
Some of the newer options we can offer include either the use of Toric lens or corneal incisions to minimize astigmatism. Astigmatism is an irregular shape of the cornea or a football-shape as opposed to a basketball shape Patients undergoing cataract surgery will typically see well in the distance with a standard implant. However, those who have significant astigmatism can further improve the sharpness of their distance vision by neutralizing this astigmatism. The use of corneal incisions or a Toric lens allows an even sharper, finer focus off in the distance as it allows us to make up for irregularities in the corneal surface. The correction of astigmatism with cataract surgery typically requires an extra cost that is not covered by insurance. However, it does allow people to achieve an even finer or more precise level of uncorrected vision for distance targets.
I am also now proud to be able to offer the possibility of multi-focal implants. The Restore multi-focal implant, for example, allows the correction of distance and close vision simultaneously. In our youth, our lenses are able to change shape in order to allow us to focus either off in the distance of up close. Multi-focal implants have concentric rings on the surface that are alternately focused for either far or close. This allows people to achieve a great deal of flexibility and functionality without their eyeglasses. Most people with multi-focal implants never were any glasses. Occasionally, people with this type of implant may wear a light prescription for a little sharpening or fine tuning, either at distance or for extended periods of close reading or perhaps for an intermediate range. However, this is the exception rather than the rule. Because a multi-focal implant creates a type of vision that the brain has not previously experienced, people may take a varying amount of time to adapt to the implant. Most will adapt to their multi-focal vision almost immediately. However, it is not uncommon for people to take several weeks to several months before they feel they have become fully adjusted to this type of vision. It doesn't mean they can't see things in the interim, but their ability to see with increasing detail and feel completely adapted to their vision improves during the adjustment period. Approximately 15% of people may see some ring-like halos at night time with this implant. Typically those that see these rings are able to compensate by not looking directly at light at night time and generally do not feel it is a significant obstruction in their vision. However, people who do extensive night driving should be aware that this may be an obstacle. In general, the response to the multi-focal implant has been overwhelmingly positive. All in all, the multi-focal implant is definitely the closest things we have to returning our eye to its original youthful state.
For all these reasons, the multi-focal implant is gaining widespread acceptance and popularity very rapidly. This has been the most exciting development in cataract surgery of late.
Despite the many positives of multi-focal implant, it's not necessarily the ideal solution for everyone. There are some people who have been trained to use monovision, or one eye to focus at a distance and one eye to focus at near, over a period of many years through the use of their contact lenses. Some of these people may be satisfied just by creating a monovision scenario with the basic implants. The depth perception is not ideal; however, people who have had this for many years may have learned to compensate. Furthermore, some patients simply don't do many tasks at near. The vast majority of their activities may be focused on driving, outdoor sports. and they may do very little reading. The additional ability of being able to read without their glasses may not be important to them.
For these and other reasons, it is important to adjust the type of implant chosen and the selection of a post-operative refractive state of the eye on an individual basis. These factors must be scrutinized with the patient's activities, desires, visual status and previous history.
It is my goal to handcraft an optimal cataract procedure and implant selection process for each individual patient of mine to maximize their satisfaction and potential benefit. Fortunately, these days we are able to offer a wide range of options to help us achieve this goal.
As a courtesy to other patients, please notify us of cancellations or need to reschedule at least 24 hours prior to your appointment.
Dr. Myron Lewyckyj