Cataracts and Cataract Surgery

Cataracts cause slow, progressive loss of vision. Over time as we age, the natural lens in the eye clouds and loses its ability to focus and transmit light. Early in the process, updating the eyeglass prescription may help, but this is only temporary. Cataracts are caused most commonly by the aging process, but certain factors, like diabetes, high blood pressure, excessive UV exposure, trauma, and certain medications can also be a factor. Most everyone will develop cataracts at some point if they live long enough.

Cataract surgery is the most common and most successful surgery performed today. Cataracts are removed surgically in an outpatient surgical center setting. In preparation for surgery, a mild relaxing agent is given through an IV in the arm, and the eye is numbed with eye drops. The doctor will then remove the cloudy cataract lens from the eye by dissolving it with ultrasonics (sound waves) and aspirating it from the eye. The cataract is replaced with an artificial intraocular lens (IOL). The surgery is very short and safe, and you will return to your regular activities rather quickly after surgery.

Once you and Dr. Epstein have decided that it is the correct time for cataract surgery, several things will occur. First, you will be scheduled for an appointment with the doctor to discuss cataract surgery as it specifically pertains to you. At this visit, the doctor will review the procedure in detail and will answer any questions you may have. Following this visit, you will then be contacted by phone by our surgical coordinator to discuss surgery date options. Once your surgery dates are booked, you will need to schedule a physical with your primary care physician. This physical is only good for 30 days, so please plan accordingly. Finally, the coordinator will schedule you for an appointment in our office to measure the eye. These eye measurements help Dr. Epstein determine what your IOL lens options will be. Additionally, your surgical instructions, including the use of your surgical eye drops, will be reviewed with you in their entirety at this appointment. You will be required to visit the office the day after surgery for a post-operative examination.

Intraocular lenses (IOL’s) are used to replace the cataract that was removed during surgery. IOL technology has advanced steadily in recent years, allowing patients more options in choosing their surgical outcome. Modern IOL’s are technologically advanced, and they can correct near-sightedness, far-sightedness, astigmatism and presbyopia, if the patient desires this correction.

There are three different types of lenses to choose from:
  1. Monofocal lenses:
    Monofocal lenses focus at one distance. They do not correct astigmatism. You should expect to have to wear prescription distance glasses after cataract surgery to correct any astigmatism you may have, as well as needing prescription glasses to read, see the computer, or view anything else that is within about three feet in front of you.
  2. Monofocal lenses with astigmatism correction (toric lenses):
    Astigmatism (or toric) correcting lenses are also monofocal, meaning they focus at one distance. Since they correct all of the power needed to see in the distance, glasses are typically not needed for distance vision tasks. You will still need glasses to read, see the computer, or view anything else that is within about three feet in front of you, but those reading/intermediate glasses can be purchased over the counter (“cheater” glasses).
  3. Multifocal/Extended depth of focus lenses:
    Multifocal/extended depth of focus lenses offer multiple areas of focus. They also correct astigmatism, if needed. Patients who choose this type of lens should expect to be significantly less dependent on glasses for distance, intermediate, and near vision after surgery, since these lenses given patients the greatest range of vision.
Dr. Epstein and his surgical coordinator will review all of your specific lens options at length, and will help you choose the lens that best matches your lifestyle.

Whichever lens you select, you will have better vision after surgery, since your cloudy cataract will be removed and replaced with the new and clear IOL. The differences between the varied lens options come down to how much, and for what activities, you want to (and don’t want to) wear glasses for after surgery. Once you have healed, your vision will typically stay in the same focus for the rest of your life, and there is no need to repeat the surgery in the future.

Dr. Epstein is an accomplished surgeon who has performed over 10,000 cataract surgeries. He uses a “no stitch, no needle, no patch” technique which allows for a safe and quick recovery after surgery. Dr. Epstein is a “doctor’s doctor,” having operated on many local doctors, other surgeons, nurses, their families, and hospital and surgery center staff members, who know how excellent his outcomes are and who have trust in his skills.

To learn even more about cataracts, please click here.

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Glaucoma is an eye disease that results in damage to the optic nerve. Elevated eye pressure can cause permanent damage to a previously healthy optic nerve. There are two types of glaucoma: open angle glaucoma and narrow angle glaucoma. Open angle glaucoma is the most common form of the disease. Narrow angle glaucoma is much less common and is caused by a blockage of the drainage channels of the eye. Glaucoma is more common in older adults, in patients of certain races, and in patients with the disease in their family history. Glaucoma testing includes eye pressure monitoring, visual field testing, scanning laser optic nerve imaging, and dilated optic nerve evaluations. If your eye pressure is abnormally high, the doctor may prescribe eye drops to help lower your eye pressure.

To learn even more about glaucoma, please click here.

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Dry Eye

Dry eye syndrome (DES) is a fairly common condition that occurs when the surface of the eye does not receive adequate lubrication. Symptoms of dry eye may include irritation, stinging, burning, foreign body sensation, redness, sensitivity to light, and, in some cases, blurry vision. There can be many reasons for this lack of lubrication, some of which include allergies, inflammatory conditions, autoimmune diseases, and hormonal changes associated with aging. Sometimes, DES is due to lifestyle. Spending prolonged periods of time on near tasks such as reading, sewing, and phone/tablet/computer use can exacerbate dry eye symptoms because it has been shown that patients blink less when performing these activities for an extended period of time.

We recommend the “20-20-20” rule to help minimize the symptoms of DES: while performing a prolonged near task, take a break every 20 minutes, and focus on something at least 20 feet away, for 20 seconds. Additionally, the use of artificial tears can be helpful in the treatment of DES. We recommend trying some of the different over-the-counter brands to determine if you have a preference, and then using them at least three times a day. Staying well hydrated, as well as humidifying the air in the winter months maybe also be helpful. If you are diagnosed with more advanced DES, prescriptions eye drops, as well as plugging of the tears ducts, may be recommended as a treatment course.

To learn even more about dry eye, please click here.

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Macular Degeneration

Macular degeneration (AMD) is a disease that affects the retina, or the lining of the back of the eye. The retina is a nerve cell layer that is responsible for gathering and organizing the images we see, before they get sent through the optic nerve and to the brain. The macula is an area of the retina that represents your central vision and is responsible for your fine, detailed vision (like reading or sewing). When the macula becomes damaged or degenerated, this may cause areas of vision that appear distorted, wavy or “grayed out.” There are two types of AMD, wet and dry. Dry AMD occurs more frequently, and the visual changes are typically more gradual and less severe. Observation is indicated in patients with dry AMD, as well as a diet rich in green leafy vegetables, carrots, and fish rich in fatty oils, sun protection and smoking cessation. Wet AMD is the more aggressive type of the disease and it can adversely affect the vision much faster and more profoundly. Wet AMD patients are usually referred to specialty eye doctors called retina specialists whom we work in conjunction with. These doctors will determine if intervention is required to treat the wet AMD. Treatment usually includes intraocular medicine injections or laser treatment.

Dilated eye exams along with retinal imaging are the best ways to exam patients for macular degeneration, and high risk patients should be dilated at least once per year to assess for any disease progression.

To learn even more about macular degeneration, please click here.

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Diabetic Eye Disease

Diabetes is a disease which causes a patient’s blood sugar to be unstable because the body cannot make or store insulin the way it normally should. This instability can affect the eye in several ways. High blood sugar changes the fluid gradients in the eye, specifically in the lens, which can initially result in variably blurry vision in the short term, but can lead to premature cataract in the longer term. Diabetes can also cause the walls of the blood vessels in the back of the eye (in the retina) to be unstable and “leaky,” which is classified as diabetic retinopathy. Good blood sugar control is imperative for good ocular health. Diabetics should be dilated at least once per year to be screened for any diabetic eye disease changes.

To learn more about diabetic retinopathy, please click here.

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