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Old 06-25-2014, 10:21 AM   #1
Doz
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Default Cataracts: Advancements improve eye surgeries

Wife was having some site issues and went to the eye Doctor. He told her she has Cataracts. She will eventually need eye surgery.


Most people don't notice they have developed cataracts until they can't pass the vision test for renewing their driver's license.

"Cataracts don't bother some patients until it starts affecting their central vision," said Dr. Lucian Szmyd, an ophthalmologist at Eyesight Ophthalmic Services with offices along the Seacoast including Portsmouth.

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging and less than 10 percent of people with cataracts are under the age of 65, Szmyd said.

A cataract can occur in either or both eyes.

What is a cataract?

The lens lies behind the iris and the pupil and works much like a camera lens. In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain.

The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as people age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. With time, the cataract may grow larger and cloud more of the lens, making it harder to see.

"Some people start noticing that they can't read things like the Red Sox ticker tape at the bottom of the TV screen," Szmyd said. "They may have trouble driving at night with glare and seeing halos around lights."

The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities.

"The colors are washed out," Szmyd said. "After cataract surgery, not only are patients amazed by their clarity of vision, but also at how colors like blues and purples are more vivid."

Cataracts are detected through a comprehensive eye exam that includes a visual acuity test, a dilated eye exam and tonometry (measuring the pressure inside the eye.)

What is cataract surgery?

The symptoms of early cataracts may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

The patient may not need cataract surgery for several years. With regular vision testing, the patient and doctor can discuss when and if surgery is needed.

If both eyes require cataract surgery, the surgery will be performed on each eye at separate times, usually two weeks apart.

The patient will be instructed to take antibiotic eye drops before and after the surgery to prevent infection.

During the surgery, the patient is given medication intravenously to put them in a state of conscious sedation.

The most common surgery to remove and replace cataracts is done by phacoemulsification. A small incision, less than a quarter-inch, is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The eye surgeon then breaks up the damaged cataract by ultrasound waves and removes it.

A new lens is then implanted. There is no need for stitches as this is a small, self-healing incision. The patient will be fitted with a patch and returns the next morning to have the eye checked.

"We recommend the patient wear sunglasses during the day and a patch for the first four to seven nights after the surgery to protect the eye from accidental rubbing," Szmyd said. "They can usually resume full normal activity after five days."

Excellent Vision Eye & Laser Center in Portsmouth is the only facility on the Seacoast offering laser cataract surgery. Dr. Richard Lasonde and Dr. Vasilios Lazos began performing laser surgery using the LenSx femtosecond laser in May 2013.

"During laser cataract surgery, a computer provides a precise image of the patient's eye called a tomography," Lasonde said. "Based on this detailed image, the surgeon is able to program a precise treatment for each patient's eye."

Lasonde said the laser is able to correct astigmatism in most cases. Astigmatism is a vision condition that causes blurred vision due either to the irregular shape of the cornea, the clear front cover of the eye, or sometimes the curvature of the lens inside the eye.

He added that in 99 percent of the surgeries, a surgical blade does not have to be used for cutting. The LenSx laser does the actual cutting of the lens, and because it is able to soften the cataract prior to removal, there is the potential to use less ultrasonic energy to extract the cataract material.

"We've done more than 200 (surgeries) since we started a year ago," Lasonde said.

Replacement lens choices

There are three types of replacement lenses patients can choose from and it is recommended that the patient talk with the surgeon or eye specialist in the office to decide which is the best option.

The basic cataract lens is a monofocal lens that will improve distance vision. But the patient will still need to wear glasses for reading. Most of the costs for basic cataract surgery are covered by Medicare or other insurance.

A second type of lens, called toric, is for patients with mild to moderate astigmatism.

The lens will reduce astigmatism to enhance distance vision and improve night vision without glasses. The patient may still need glasses for near tasks.

If needed, LASIK enhancement may be offered at a reduced price. In addition to insurance deductibles and co-pays, the cost for this type of lens is around $1,600 per eye. The cost may be worth it to the patient to have this type of correction to improve his or her quality of vision.

A third type is an accommodating lens. This may be the best option for patients who want to reduce their dependence on glasses.

Medicare and other insurance companies pay most of the costs associated with removal of the cataract and placement of these multifocal lenses. However, out-of-pocket costs can be around $2,500 per eye. Again, the cost may be worth it to the patient depending on his or her job or hobbies.

In addition, laser cataract removal is about $1,000 to $1,800 more out-of-pocket than the non-laser surgery.
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