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CATARACT



What is a Cataract?

A cataract is a clouding or opacity within the eye's lens (see video below). The lens, like that of a camera, is important for focusing light rays onto the retina. When the lens becomes cloudy, light rays do not pass into the eye easily, resulting in blurry vision.



FAQ+


FAQ

What is a Cataract?+

A cataract is a clouding of the eye's internal lens. When the lens becomes cloudy, blurry vision results.

What is done to treat cataracts?+

A cataract may not need to be treated if the vision is only slightly blurry. There are no medications, eyedrops, exercises, or glasses that will cause a cataract to disappear once formed. Surgery is the only way to remove a cataract. When you are no longer able to see well enough to do the things you like to do, cataract surgery should be considered.

In cataract surgery, the cloudy lens is removed from the eye through a small surgical incision, and the lens is replaced with a permanent intraocular lens (IOL) implant. This surgery is performed on an outpatient basis. Dr. Mudgil typically uses topical drops to numb the eye, and the anesthesia staff administers IV sedation to help keep the patient relaxed. There is no pain with cataract surgery.

Will I need glasses after surgery? +

The short answer is YES, at least some of the time. Most patients who receive a traditional monofocal IOL see well enough to drive without glasses after surgery. There is no guarantee that glasses will not be necessary after cataract surgery, as that is not the primary purpose of standard surgery. However, if you are a candidate for a premium intraocular lens (IOL), the spectacle dependency can be reduced for either distance, reading, or both. Please see the link for Premium IOL. At the time of your cataract consultation, we will discuss with you your various lens options.

Will Cataracts come back? What is YAG laser capsulotomy?+

Once a cataract has been removed it will never come back. However, there is a chance that the posterior capsule membrane that rests behind the IOL can get cloudy in time. Some call this a "secondary cataract," but the correct term for this condition is "posterior capsule opacification" (PCO). PCO is treated with a painless laser procedure called YAG laser capsulotomy. The procedure takes about two minutes and does not require an incision or a return to the operating room. Once PCO has been treated, it should never occur again.

No Stitch, No Needle Surgery+

Laser (femtosecond) Cataract Surgery+

Premium Intraocular Lenses+


Premium Intraocular Lens (IOLs)

Premium intraocular lenses (IOLs) are a family of intraocular lenses that are designed to give enhanced vision performance relative to a standard monofocal IOL. These upgrade lenses are not covered by insurances, as they are considered elective options to reduce spectacle dependency. At Mudgil Eye Associates, we offer a variety of premium intraocular lenses. While there is no perfect intraocular lens, and no lens can completely restore vision to your youthful years or guarantee a particular outcome, the premium intraocular lenses are an attractive option for those with active lifestyles who desire to maximize their freedom from spectacles.

Toric Intraocular Lens+

For patients with corneal astigmatism, a toric intraocular lens implant can be used to reduce astigmatism post-operatively, allowing for improved distance vision without glasses. In particular, many patients after toric IOL implantantion find that they are far less dependent on glasses for driving. Additionally, reading vision may only require standard over-the-counter reading magnifiers. Whether or not all of your astigmatism can be resolved with a toric lens will depend on your individual anatomy and amount of astigmatism. Compared to a standard intraocular lens, a potential side-effect of the toric lens (less than 3% of individuals) is that the lens may rotate out of alignment while the eye heals, requiring it to be nudged back into position in the operating room. This lens is ideal for patients with active lifestyles who enjoy activities requiring excellent distance acuity, such as golfing, watching TV, and driving.

Crystalens® +

You may remember that up until your late thirties, you had no difficulty focusing from distance to near. In a classroom, you could look at the board and then immediately at reading material, having no problems even with fine print. This is because the lens in your eye had dynamic focusing abilities, called accommodation, and it behaved like a quick auto focus camera. The loss of our eye's ability to accommodate in our forties is known as presbyopia, and it is the reason we begin needing reading glasses and bifocals. In layman's terms, we lose the autofocus accommodative ability because the proteins of our eye's lens become less pliable. This intraocular lens is designed to treat presbyopia by improving accommodation and restoring some autofocus function to your eye that was lost when you turned forty. Like the natural lens in your younger years, it uses the eye muscle to flex and accommodate in order to focus on objects in the environment at various distances, there-by dynamically adjusting to your visual target. Crystalens is the first and only FDA approved accommodating intraocular lens in the United States. Because the Crystalens provides a single focal point throughout a continuous range, fewer patients with Crystalens experience problems such as glare, halos, and night vision difficulties than multifocal implant patients. Typically, most patients with a Crystalens will enjoy accommodative vision from distance to the computer range. Whether closer reading (such as reading in bed) will be possible with a Crystalens will depend on the eye's ciliary muscle being able to facilitate accommodation to that degree. Usually, patients will still require a very weak reading magnifier for very close range or small print reading. This lens is ideal for those who have strong distance and intermediate (such as computer) vision needs.


Accommodation of Human Eye


Accommodation of Crystalens®

Trulign Toric Crystalens®+

This advanced intraocular lens combines features of both the toric and Crystalens implants that are discussed above. This is an accommodating intraocular lens of the exact same presbyopic correction design as the Crystalens, but its optic is designed to also correct the eye's corneal astigmatism. Unlike the standard Crystalens, which cannot be offered to patients with astigmatism, this lens allows even astigmatic patients to attain focus at distance, intermediate, and some near ranges without glasses. The extent of sustained near focus, as with the standard Crystalens, will depend on the eye's muscle being able to facilitate accommodative effort. Usually, patients will still require a weak reading magnifier for very close range or small print reading. This lens is ideal for those with astigmatism who have strong distance and intermediate range (such as computer) vision needs.

TECNIS® Symfony IOL - a multifocal IOL+

The Symfony IOL has recently been approved by the FDA as a multifocal implant, allowing for improved distance and reading vision. It is specifically designed to provide a broader range of continuous vision, and it usually allows patients to read closer than what can be achieved with the Crystalens (accommodating IOL) family. With typical multifocal IOLs, patients can experience an increase in night vision glare and halo symptoms, which are most common during the first year after surgery.

However, the Symfony multifocal lens design is unique in that it is marketed as reducing glare and halo symptoms to only what is expected from an ordinary monofocal IOL. The Symphony IOL also has reduced chromatic and spherical aberration distortion, allowing for better contrast enhancement. An exciting feature of the Symphony IOL is that is also available as a toric implant, allowing patients with corneal astigmatism to also benefit from this technology. This new IOL option is for patients who want excellent postoperative vision at most distances, to minimize spectacle dependency. The Symfony implant has been offered in Europe since 2014, where it has produced outstanding results for tens of thousands of patients. We are excited to be able to offer this technology to our cataract patients now in the United States. If you are interested in reduced spectacle dependency after cataract surgery, we will discuss which of the available options are ideal for your unique condition.

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iStent® for Glaucoma+


iStent® for Glaucoma with Cataract

For patients with mild to moderate glaucoma, the iStent® device is an exciting FDA approved implant option for lowering intraocular pressure. The iStent is literally the world's smallest medical implant device. It is implanted into the trabecular meshwork at the same time as the cataract surgery, without need for additional incisions or anesthesia. Clinical trials demonstrated that patients who had cataract surgery combined with iStent® placement had lower eye pressures and required fewer glaucoma drops, than glaucoma patients who had cataract surgery alone. The iStent® may help reduce a patient's medication burden, reducing the cost, inconvenience, or side effects of topical glaucoma therapy. The iStent® may also help delay or avoid the need for more risky surgical interventions in the future. The iStent® is covered my most insurances, and it is considered a minimally invasive form of glaucoma surgery. If you are on drops for glaucoma and are to undergo cataract surgery, this may be a suitable procedure for you to achieve better glaucoma control and/or reduce your dependency on eye drops.

The main risks of the iStent® procedure are predominantly the same as those associated with cataract surgery alone. Additional risks unique to the iStent® include:

  1. Failure to significantly improve eye pressure, in which case you would continue with the same glaucoma medications. In general, it takes at least 6 weeks to determine intraocular pressure outcome.
  2. Dislocation of the iStent®, which may require a second surgical procedure to reposition or remove the device.
  3. Obstruction of the lumen of the iStent® by your iris or other tissue within the eye.
  4. Bleeding at the site of the iStent® insertion. This is common and usually self-limiting. Rarely, this may be significant and result in delay of visual recovery or eye pressure rise.
We would be happy to discuss your candidacy for the iStent® procedure at the time of your cataract consultation visit.

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