New Lens Implants Can Correct Astigmatism after Cataract Surgery

Cataracts are a clouding of the natural lens in the eye. The lens becomes yellow or opaque preventing light and images from reaching the retina. They most frequently affect older patients, but may appear in younger individuals as well. While the most common type of cataract is age related trauma, oxidative stress caused by drugs, poor diet, environment, and disease or congenital issues may precipitate lens opacities in younger folks. Over the years, surgery to correct this common vision problem has evolved in several dramatic ways.

Early surgical cataract procedures involved the affected lens being removed, and the patient had to wear very thick eye glasses in order to see. This posed several optical problems which were then best corrected with contact lenses. As time passed, the first intraocular lens implant was developed. This early lens was placed in front of the iris, (colored part of the eye), and replaced the natural lens in power to refract light on to the retina. It soon became apparent that vibrations in this implant damaged the inner most layer of the cornea called the endothelium. On occasion this in turn resulted in an opaque cornea and the need for a corneal transplant.

This problem was solved by the next generation of lens implants that were placed behind the iris, and were called posterior chamber implants. They were secured far enough away from the cornea, so that they had no impact on it. These early lens implants were fairly large, and required a large incision to remove the natural lens and implant the new one. As time progressed, Phacoimulsification became the procedure of choice for cataract surgeons. This revolutionized the procedure. A small incision was required, and as a result fewer sutures were needed. Along that time, foldable implants came along that could be inserted into the eye through that small opening.

The next big advancement was removing the cataract, and inserting the implant directly through the cornea. This approach did not require any sutures, and thus healing time was even further reduced as was patient discomfort. The nagging issue that plagued cataract surgeons was to be able to eliminate the need for eye glasses after the surgery. To that end, stronger implants have been developed, multi focal, UV absorbing IOLs and many other options have been employed. Some have worked well, while others have failed. A most troublesome residual problem has been how to correct astigmatism after this surgery. At first, eye glasses had to be worn to correct the uncorrected astigmatism. Then some surgeons advocated making incisions in the cornea to reduce or eliminate the astigmatism post surgically. While this therapeutic approach was fairly successful, most patients did not want an additional procedure if note needed.

Recently, the astigmatic problem has now been solved. The STAAR Toric IOL is now available, and can correct up to 3.50 diopters of corneal astigmatism. That means that most people that have astigmatism before surgery can choose to have this new IOL implanted at the time of surgery, and have their astigmatism corrected resulting in no need for distance eye glasses after the procedure. The implant works similarly to a toric contact lens. When seen in the eye, there are peripheral markings to evaluate the positioning of the lens. The results thus far have been very good with only a few patients complaining about glare. These implants are not covered by most insurance companies and there fore must be paid for by the patient.

Always ask your surgeon about the options for implants before surgery to see if there is something that will best suite any visual needs.

Dr. Jay B Stockman is a contributing editor for VisionUpdate.net, and a practicing doctor for New York Vision Associates, http://newyorkvisionassociates.com.

Cataracts – Cataract Symptoms, Treatment and Surgery

Cataract, a term given to the misting or hazing of the lens in your eye, tells many people that their time is slowly edging by.

Cataracts lead to poor vision and blindness, but in most cases can be easily remedied by a fairly minor operation. For most people, Cataracts are emergency bells that ring in each one’s lives, hinting that they need to complete their duties in the world and get ready to face that last lap of their lives.

Cataract Symptoms
When you develop a cataract in your eye, your vision slowly becomes more and more misty. You may see haloes around lights, and may find vision worse in bright sunlight. As dazzled as you might be in more easily by bright lights, you might also notice that your color vision may not be as good as it was initially. Of course there is not way really that you might want to change the situation as it is inevitable, there are means to push it even further.

Prevention is the best option for your eyes as it is not possible to correct the problems caused by cataracts by just getting a new pair of spectacles. In fact, the first you know about it may well be when the optician tells you that you have cataracts when you go for a routine eye test.

Causes of Cataract
Most cataracts are caused by ageing of the eye. Like the degeneration of a machine, the body also starts giving way with age and time. It is said that some degree of cataract commences its tour in all of us if we are destined to live long enough. Typically, though, this may be noticed from 50-60 years and onwards. Certain other conditions of the eye that cause inflammation and eye injury might lead to cataracts occurring earlier in life. There are still other conditions that affect your system as a whole for e.g. diabetes, that are linked with a higher risk of developing a cataract. Certain drugs, including steroids, if not administered accurately may make you more likely to develop cataracts early.

Excessive exposure to the sun as well as to radiation increases the risks of developing cataracts. Smoking and alcohol add fuel to the fire. There are some rare conditions leading babies to be born with cataracts. If this occurs it is very important that it gets detected early for the baby to get rid of the cloudy lens as the development of normal vision relies on the eye being able to see in the early months and years.

Diagnosing Cataract
Cataract is usually diagnosed by your doctor or optometrist, although other professionals my well point this condition out to you. They will usually use a hand held torch with a lens (ophthalmoscope) or at times an even more elaborate apparatus called a slit-lamp for examining your eyes. The lens, which starts off as clear at birth; may have areas that are cloudy or may even be generally milky in appearance. Sometimes the cataract makes it difficult to see the back of the eye properly. It is important to note that your doctor needs to arrange for you to see a specialist (usually the ophthalmologist), if he doesn’t then you can be sure that you are not in safe hands.

Cataract Treatment and Removal
The only effective treatment for cataracts is to remove the cloudy lens. This is not done with a laser, but by a tiny probe that goes into the eye and dissolves the lens using very fast sound waves (ultrasound), a process known as phacoemulsification. Usually a tiny plastic lens is put in to the place where the natural lens was at the same procedure. The whole process, thanks to technology today is very quick, often taking only 15-20 minutes.

Cataract Eye Surgery and Complications
Most times the Cataract operation is done while you are awake, with local anesthetic. In fact, even the most nervous of people seem to find this very easy to go through. It’s best to mutually discuss the possible complications with your specialist before you undergo the operation. The most common complication, which occurs in up to one person in five within two years of the Cataract operation, is for the posterior layer of the clear pocket, which rests the lens lies becomes cloudy. This is dealt today with laser treatment that completely removes this cloudy layer. You will have eye drops given to you to use after the operation. These contain a steroid to reduce inflammation, and an antibiotic to prevent infection getting in to the eye.

Cataract Prevention
The Khejara tree found in most part of Rajasthan, India has leaves that are endowed with a fluid, which when cleaned and purified can be used as eye drops. These drops are also known as "Khakra" in the Indian local language and can primarily act as an anti-ageing agent by preventing the formation of cataract. Of course you can not stop yourself getting cataracts by any specific changes to your lifestyle, but it does make sense to try to reduce the risk factors.

Probably the most important of these that are known are:

* If you smoke, stop smoking.
* Avoid bright sunlight, wearing broad brimmed / peaked headwear and using sunglasses which cut out UVA and UVB.

The eyes are the mirror to your soul, its best if you keep them as transparent as possible!