Medical/Surgical Eyecare

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What are cataracts?
Cataracts occur when the normally clear crystalline lens of the eye begins to become cloudy or hazy. Patients often notice blurred distance vision, the need for more light to see well, or complain of glare, haloes, or double vision.
What causes cataracts?
 —  Cataracts are caused by changes to the proteins that your lens is composed of. They occur naturally as part of the aging process, but can form rapidly if the eye is traumatized.
 —  Medical conditions like diabetes can accelerate cataract formation, as can exposure to cigarette smoking and UV radiation. Certain drugs such as steroids can also cause cataracts to form.
Are all cataracts the same?
 —  No, there are many different forms of cataract. Typical age-related cataracts come in 3 varieties:
 —   Nuclear cataracts form in the middle of the lens and cause the lens to become yellow or brown. The result is a slow blurring of distance and later near vision, glare, and yellowing of colors. The progression of nuclear cataracts is often so subtle patients are not aware of their visual impairment until they have an eye examination or drivers license test.
 —  Cortical cataracts are spoke or wedge shaped and form at the edge of the lens, moving toward the center as they progress. They often cause significant glare, particularly with night driving.
 —  Posterior subcapsular cataracts form faster than the other two types of cataract and form a plaque on the back surface of the lens. They may be associated with steroid use or trauma to the eye, and affect younger patients typically. When this type of cataract first forms the patient often thinks they have a dirty lens on their glasses and complains of smudgy vision. As this cataract progresses reading vision is affected, and the patient experiences significant glare, starbursting of headlights, and double images.
How are cataracts diagnosed?
Cataracts are diagnosed by an ophthalmologist or an optometrist during an eye examination. Your doctor will dilate the pupil of your eye with drops and examine the entire lens. When diagnosing a cataract, it is important that the entire eye be examined for other eye diseases such as glaucoma or macular degeneration which can contribute to vision loss and affect the outcome of surgery.
What is my next step?
 —  Schedule a consultation with Aaron Florkowski, M.D. today. This extensive evaluation is typically covered by your medical insurance policy and will determine if you are a candidate for the procedure and the success you should expect afterwards. During your examination, Dr. Florkowski will:
 —  Determine the extent the cataract has blurred your vision.
 —  Take measurements of the shape and dimensions of your eye with optical imaging and ultrasound.
 —  Examine the health of your eye including the cornea, optic nerve and retina
 —  Discuss your candidacy for the cataract procedure including your options for different intraocular lenses


How were intraocular lenses discovered??
In the 1940's an ophthalmologist who cared for many RAF fighter pilots, Sir Howard Ridley, noted that when pieces of shattered aircraft canopy entered the eye they did not create inflammation and could remain in the eye indefinitely. This began early experimentation with placing acrylic lenses in the eyes of patients after cataract removal.While today's intraocular lens is much more complex in shape and able to be folded to allow it to enter a very small incision, the concept remains the same: to improve the focusing ability of an eye after the natural lens is removed.
Do all patients have intraocular lenses implanted at the time of surgery?
Ideally every patient has an IOL implanted. Prior to the 1970s aphakic (no lens) surgery was performed. Postoperatively patients required the infamous "coke bottle glasses" to see and experienced loss of depth perception, distorted vision, reduced peripheral vision, and blind spots. With modern IOLs patients enjoy very high quality distortion free vision.
Will my eye react to the intraocular lens?
 —  No, the implant will not be rejected by your eye. Millions of implants are placed every year and are extremely well tolerated by their owners.
 —  The IOL is permanently fixed within the eye and will not move. It is not affected by exercise or activity, and will not come out of the eye.
What is a monofocal IOL?
A monofocal IOL is a lens that is focused at only one distance. For example if a monofocal IOL is placed in the eye and focused to see far distances, the patient will see best in the distance but require glasses or contact lenses for intermediate or near focusing. Implantation of monofocal lenses is covered by most insurance plans. To learn more about your lens options click here
What is pseudophakic monovision?
Monovision is a technique in which a monofocal IOL is placed in the patient's dominant eye (the eye used for shooting, taking pictures, etc) and focused at distance. A second monofocal IOL is placed in the non-dominant eye and focused at the near/intermediate range. The resulting "blended vision" allows patients some freedom from reading glasses at the expense of giving up a small amount of distance clarity.
What are Toric IOLS?
Toric IOLs are monofocal IOLs that correct astigmatism. Astigmatism results when the anterior surface of the eye, called the cornea, blurs the optical image prior to it reaching the lens. This blur can be reversed by a toric IOL, creating a crisp, focused image in the eye. The resulting vison without glasses is much clearer than if a standard multifocal lens were implanted. Although the surgery is covered by insurance, the additional cost of implanting a Toric IOL is not covered and is paid for by the patient. To learn more about Toric IOL implantation click here
What are Multifocal IOLS?
Multifocal IOLs such as the ReSTOR are lenses that provide focused vison at distance, intermediate, and near ranges. They are implanted with the goal of providing spectacle free vision for most tasks, near and far. Although not all patients are candidates for such a lens, those that have them enjoy freedom from their glasses and contacts postoperatively. The cataract surgery is covered by insurance; however, the additional cost of implanting a multifocal IOL is not covered and is paid for by the patient. To learn more about Multifocal IOL implantation click here


Can I have both of my cataracts operated on the same day?
The standard of care in the United States is to remove one cataract at the first surgery, then the second cataract if needed 1-4 weeks later. While cataract surgery is very safe, allowing some time for the first eye to heal assures that it can function and support your vision as the second eye recovers.
Can I drive myself home?
At the surgery center, an anesthesiologist will place an IV and sedate you. You should not drive at all on the day of surgery and will need somone to drive you home.
How is my eye anesthetized?
Your eye will be completely numbed by a series of drops and gels placed in the eye at the surgery center. No needles are required to anesthetize the eye.
How long does cataract surgery take?
An average cataract surgery takes between 15-30 minutes, depending on the severity of the cataract.
What will I experience during cataract surgery?
 —  You will have a sterile drape on your body, with only the eye exposed. An eyelid holder will assist you in keeping your eye open during the surgery.
 —  Most people describe the cataract surgery as very colorful, and it is is often described as looking into a kaleidoscope or the aurora borealis. The eye is frequently bathed in saline solution and may feel quite wet.
 —  Cataract surgery is not painful, and patients often comment about the comfortable experience they had during and after the procedure.

  General Questions

How fast will my vision improve after cataract surgery?
Everyone heals at a different rate. Most patients recover 80% of their vision in the first week after surgery and the rest over the next 6 weeks.
Do I need to wear a patch or eyeshield?
You will be discharged from the surgery center with a clear eyeshield over the operated eye. As the vision clears you will be able to see through the shield. You should wear the eyeshield until your postoperative appointment the next day and sleep with the eyeshield on for 1 week after surgery.
Do I need to use any drops after cataract surgery?
You will be prescribed 3 different drops to prevent infection, supress inflammation, and promote faster healing. These prescriptions and instructions for their use are provided at the preoperative visit with Dr. Florkowski.
What about bending over and heavy lifting after cataract surgery?
Most problems related to lifting and bending occurred with older surgical techniques where larger incision sizes were employed. With modern microincision cataract surgery you will not harm your eye by bending over or lifting. We do encourage you to restrict lifting to 50 pounds or less for 1 week after surgery as you recover.
What do I do with the sunglasses I was sent home with?
You may experience increased sensitivity to light for the first few weeks as your eye adjusts to more light entering the eye. This will pass, but you should use the provided sunglasses as needed for your comfort.
Are there any other restrictions after cataract surgery?
 —  You should try not to rub your eye for the first few weeks after cataract surgery.
 —  Do not expose your eye to immersion in baths, hottubs, swimming pools, or lakes for 2 weeks after cataract surgery.
 —  Do not wear makeup that involves rubbing the eye (eye shadow, etc.) for one week after cataract surgery. Light non-waterproof mascara is acceptable.
 —   No impact water sports, boxing or karate for one month.
 —   Avoid dusty and dirty or sun and wind environments.


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