ADVANCED CATARACT SURGERY

ABOUT CATARACTS:

 

The human eye is born with a natural crystalline lens which sits behind the iris and aids in our eye's focusing capability. As we age, this lens will eventually, unavoidably, become cloudy in a slowly progressive manner. When this lens becomes cloudy, we call it a "cataract."

Cataracts are a natural part of the aging process, so it is easy to see why cataracts are a very common condition in Western society as we appreciate greater and greater longevity. In fact, today, cataract surgery is the most common outpatient procedure performed in the United States.

Of course, other events can cause cataracts to progress more quickly or in a younger patient, including a congenital condition, an injury or trauma, other eye surgery, topical steroid usage, and sun exposure, to name a few.  In our office, Dr. Singh and Dr. Soni have decades of experience with cataract surgery, and currently operate with the latest technology with renowned outstanding results.  

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Because Dr. Singh is a corneal specialist in addition to being an accomplished cataract surgeon, he has uniquely qualified expertise and abilities when performing careful, and even modified, cataract surgery for patients who have corneal pathology in addition to needing cataracts removed.  For instance, Dr. Singh has significant experience performing cataract surgery behind any type of corneal transplant, or for patients with other corneal pathology (i.e., keratoconus, pterygium, Fuch's dystrophy, etc.) or those who have had previous corneal surgeries (LASIK, PRK, RK, etc.) or planning for those who may need corneal surgery in the future (Fuch's patients).

ABOUT THE PROCEDURE:

Cataract surgery is a painless procedure performed in the outpatient operating room under "twilight" intravenous sedation. In addition to the IV sedative, cataract surgeons also use topical (eye drop) anesthetic; furthermore, Dr. Singh is a unique surgeon because he also believes in injecting a local nerve block to numb the entire region before surgery. This is performed because Dr. Singh strongly believes in complete patient comfort as a top priority during and after surgery.  

The procedure can be performed one of two ways: manually with a scalpel, or by a precision laser called LenSx.  

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MANUAL CATARACT SURGERY:

Both cataract surgeons at Eye Specialists of Texas, Dr. Gurpreet Singh and Dr. Ruhi Soni, have been performing manual cataract surgery (with a scalpel) for many years, and still successfully perform dozens of cataract surgeries with this technique every single week. The procedure involves a thin 2.5 to 3 millimeter incision made in the cornea (the front window of the eye). The surgeon then reaches the cataract through the dilated pupil and manually cuts a hole in the front of the membranous capsule that holds the cloudy lens (cataract). Then, the cataract is broken up and removed with an ultrasonic micro-vacuum ("phacoemulsification"), leaving the rest of the membranous capsule intact.

Then, the intraocular lens implant ("IOL"), which starts tightly rolled, is inserted and made to unfold in good position and proper orientation inside the capsule. 

 

LenSx LASER CATARACT SURGERY:

As seen in the video above, the LenSx Laser provides advancements in the cataract surgery procedure: it uses an image-guided computer to calibrate cornea and the cataract position, then it allows Dr. Singh or Dr. Soni to use precise laser energy to perform a few of the steps of the operation that they would otherwise do with a scalpel. The LenSx Laser makes the incisions on the cornea, opens up the front of the membranous capsule (capsulorhexis), and breaks up the cataract for efficient extraction from the eye. Benefits of this method include precise incision sites on the cornea, a neat and perfect capsular opening, and minimized phacoemulsification energy with easy removal of the cataract material. After the cataract is removed, the surgeon will still inject the rolled IOL into the capsule in the same manner as with the manual procedure, ensuring its proper position and orientation. We are proud to have the LenSx option for our patients during their cataract surgery.

ORA TECHNOLOGY:

As a surgical procedural option (with or without use of the LenSx Laser), we can also offer our patients access to ORA technology. The purpose of this technology is to verify that the power for the IOL that will be implanted in the eye is the proper prescription, at the proper axis, to fully correct the patient's vision, eliminating the need for glasses after surgery (see IOL options below). The ORA instrument is the only technology that allows the surgeon to verify the pre-operative measurements of the IOL prescription power (taken in the office before the cataract is removed) against the refractive data of the eye once the cataract has already been extracted in the operating room. In a sense, it is a "double-check" to ensure that the IOL power choice is perfectly optimized to correct the patient's vision.

 

ABOUT THE INTRAOCULAR LENS (IOL) IMPLANT CHOICES:

We offer all the latest technology in the industry when it comes to options for IOL choices with your cataract surgery.  

Specifically, when the cataract is removed and the IOL is implanted in the eye, we can calculate and choose an IOL prescription power that provides vision correction, eliminating the need for glasses or contacts, in patients whose ocular health is otherwise appropriate.

 

Thus, patients who have lived their entire lives near-sighted, far-sighted, or with astigmatism can now have their prescription completely corrected during cataract surgery.

The IOL options include:

1) Mono-focal lenses, which provide one prescription power. This lens is always an option for patients, though patients may still need reading glasses for small print up close, or may need glasses to correct the astigmatism if they have any.

2) Astigmatism lenses, which provide custom astigmatism power for each eye, oriented to the proper axis within the eye by Dr. Singh  or Dr. Soni during surgery.

3) Multifocal lenses, which allow previously near-sighted, far-sighted, and astigmatic patients the opportunity to see at distance, intermediate, and near without the use of glasses. We carry the latest technology in multifocal IOLs, and are currently experiencing great success with the PanOptix IOL and Vivity IOL, which provide a full range of vision while reducing the night-glare symptoms that were common in multifocal IOLs of yesteryear.

4) Monovision correction, using a combination of the above lenses, depending on the patient prescription. Monovision is a popular type of correction where one eye is used exclusively for distance viewing and the other eye is used exclusively for intermediate/near viewing.

 

Visit our office for a cataract evaluation and see which lenses for which you may be a candidate!

COMBINING TREATMENT FOR GLAUCOMA: iSTENT

 

For patients who need cataract surgery and are diagnosed with glaucoma, there is a small stent that can also be placed during the cataract surgery procedure.  This stent can aid in lowering the eye pressure. See more about the iStent and more information about treating glaucoma here.

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