Refractive Cataract Surgery
What is Refractive CATARACT Surgery?
Refractive surgery is a set of surgical procedures that correct common vision problems such as nearsightedness, farsightedness, astigmatism, and presbyopia. Patients receive refractive surgery in order to reduce or eliminate the need for glasses and contact lenses. The most common type of refractive surgery is LASIK.
What is Cataract Surgery?
A cataract is clouding of the eye lens. Cataract surgery involves removing the eye’s natural lens in order to remove the clouding. Before 2005, cataract patients were perfectly content having their cataract-clouded lens or lenses removed, and then replaced with standard synthetic lenses. This is still how vision is corrected in standard cataract surgery. However, new technology allows ophthalmologists to replace the cloudy lens with an intraocular lens implant, IOL, as well as reduce or eliminate astigmatism by performing laser cataract surgery. Using the Femtosecond laser, Dr. Sondheimer can perform some steps in cataract surgery more accurately than with other techniques.
“Dr. Sondheimer is outstanding! He gave my Mother her independence back and another lease on life. He is one of the Top Doctors in the country for a reason. He is very humble and very patient centric. The best choice for anyone needing cataract surgery.” -Jana
What is Refractive Cataract Surgery?
Refractive cataract surgery, a relatively new term, describes the merging of traditional cataract surgery with modern refractive eye surgery techniques. The first part of refractive cataract surgery is the same as standard cataract surgery. Additionally, refractive cataract surgery corrects astigmatism and presbyopia. Refractive cataract surgery enables patients suffering to lose the clouded vision and to greatly reduce or eliminate the need for corrective eyewear.
If cataracts are present patients may experience one or more of the following symptoms.
- Cloudy vision
- Double vision in one eye
- Frequently changing eyeglass prescription
- Interfering glare
- Pale color vision
- Poor night vision
- Trouble seeing to drive or reading during the night or day
- Trouble seeing with bright lights
Am I a candidate for refractive cataract surgery?
With Traditional Cataract Surgery, most patients with nearsightedness, farsightedness, astigmatism, presbyopia require glasses or contact lenses after cataract surgery to see at near, far, and/or both. Dr. Sondheimer uses Extended Focus or Multifocal Lens Implants (IOL’s) , Monovision (one eye for near and eye eye for far), Toric (astimagatism) correcting Lens Implants, and Laser Cataract Surgery to rehabilitate many of his patients with Cataract Surgery so that they can see clearly without the need for glasses or contact lenses while reading, computer, and driving.
What is the difference between cataract surgery and refractive cataract surgery?
Refractive cataract surgery with Dr. Sondheimer begins with Traditional Cataract Surgery to remove the clouded lens. Dr. Sondheimer can replace the cloudy lens with a Multifocal or Extended Focus IOL, which corrects vision at near, intermediate and distance vision. He may correct one eye to see well in the distance and the other to see at near. Many patients choose to have each eye corrected for only distance vision and use glasses at near and computer distances.
Astigmatism is often corrected with special Toric lens implants or the Laser. Rarely, patients choose to see well to read without glasses and use glasses to see in the distance. Patients can choose to have their eyes corrected to suit their desires. Sometimes, the ORA (Interoperative Aberrometer is used to further improve the quality of vision.
Refractive Cataract Surgery Options
Typically, ophthalmologists perform cataract surgery on one eye at a time. This is because cataracts can develop in each eye at different rates. However, if patients correct only one eye their eyes can stop working as a team. This leads to patients electing for surgery on the second, now worse, eye. The choice to have surgery on one or both eyes depends on the eye health and the patient’s preferences. There are some advantages of choosing cataract surgery for both eyes including rehabilitating both eyes at one time as well as allowing the eyes to match in clarity and function.
In addition, patients who choose to have cataract surgery on both eyes can have one eye corrected for distance vision and one eye corrected for near vision. This use of IOLs is called monovision.
Types of Refractive Cataract Technology
Over the past decade, multifocal IOLs, toric IOLs, and laser cataract surgery advances have given Dr. Sondheimer the ability to also address refractive problems such as astigmatism and presbyopia. The following are some refractive cataract surgery technologies we use in our office.
Presbyopia-correcting IOLs and Monovision
At a certain age patients begin to lose their ability to focus on objects that are up close. This is called presbyopia and results in the need for reading glasses to see things such as books or computer screens. In order to fix this, patients elect for multifocal IOLs or monovision surgery. About 70% of patients will are able to adjust to monovision.
Toric IOLs and Laser Cataract Surgery
In order to solve astigmatism, where the cornea is shaped more like an oval than a sphere, vision at certain distances impossible. Toric IOLs or Laser Cataract Surgery improves astigmatism in Refractive Cataract Surgery.
ORA Intraoperative Aberrometry, Verion Registration, and OPD Registration
In many patients, Dr. Sondheimer uses Intraoperative Aberrometry to measure power and guide best placements of IOLs. He also uses Verion and OPD instruments along with laser cataract surgery treatment to achieve precise astigmatism correction.
How do I prepare for refractive cataract surgery?
Preparing for refractive cataract surgery is the same as for cataract surgery. About a week before your surgery, Dr. Sondheimer will perform tests to measure the size and shape of your eye. Dr. Sondheimer will help you pick the rehabilitation goals of your cataract surgery to allow you to see independent of glasses after cataract surgery, if you wish. Alternatively, some patients prefer to use corrective eyewear after cataract surgery.
Other patients who have other eye problems, such as retinal problems are best off not trying to see without corrective eyewear. Each treatment plan is customized to meet the needs of each individual patient.
What is the process for laser refractive cataract surgery?
Dr. Sondheimer uses minimally invasive, small-incision, no-stitch cataract surgery known as phacoemulsification (phaco) surgery. He utilizes the femtosecond laser for greater precision and accuracy, in many cases. Here’s how it is done. In the office Dr. Sondheimer, maps the astigmatism in your eye with Cassini or Version topographers. This information is registered with the Lensar or LenSx femtosecond lasers, to guide the laser to make an incision in your cornea to reduce astigmatism.
The laser procedure starts with the creation of a 3D image of your eye for guidance. Next, the femtosecond laser creates the corneal incisions to reduce astigmatism and accurately incises the front capsule of the lens. This gains access to the cataract-clouded lens. Next the laser makes a series of cuts in the cataract-clouded lens. An instrument is then inserted in the eye and delivers ultrasound energy that breaks up the cloudy lens. At the same time, the probe uses suction to gently remove the small lens pieces. The earlier scoring of the lens reduces the amount of ultrasound energy needed to break up the cataract lens.
The next step of the surgery is to insert the artificial intraocular lens (IOL). For some refractive improvements, a Multifocal and/or Toric IOL may be inserted. It is folded and inserted through the same small incision through which the original lens was removed. Sometimes, accuracy is improved with the ORA, Interoperative Aberrometer. The small incision size usually doesn’t require any sutures; it will heal on its own.
Cataract Surgery Consultation
Dr. Sondheimer meticulously examines and advises each patient before cataract surgery in order to help the patient choose the rehabilitation plan that best serves their needs. Dr. Sondheimer is one of the few cataract surgeons who is also an expert in refractive surgery. As a result, he can use his expertise in reducing the need for glasses through refractive laser procedures when treating his laser cataract surgery patients.
Refractive Cataract Surgery
Dr. Sondheimer is at the forefront of refractive cataract surgery with a combined 22,000 surgical procedures performed to treat cataracts and refractive vision issues. Rather than a standard synthetic IOL, Dr. Sondheimer prefers to place a multifocal IOL to correct presbyopia and a toric IOL to correct astigmatism. Cataract surgery often takes as little as 15 minutes. It may take longer if the lens is very hard or if patients choose to correct their astigmatism at the same time.
What will my results be after refractive cataract surgery?
Although every patient is unique, Dr. Sondheimer’s goal with every patient is to remove the cataract-clouded lens and to address your refractive errors as much as is possible, reducing or eliminating the need for corrective lenses. Together you will have selected your choice of IOLs and vision correction goals. Multifocal lenses and Monovision enable patients to see at distance, intermediate, and near, so many patients see well without using corrective lenses.
Dr. Sondheimer uses the femtosecond laser, Toric IOL’s, and special measurements in Surgery (Interoperative Aberrometry) to correct for astigmatism. The goal is for your final vision to be cataract-free and completely clear, perfect or near perfect in refraction, and to not need to use eyeglasses for up close vision such as when reading. These changes are permanent.
Recovery from Refractive Cataract Surgery
Traditional and refractive cataract surgeries have the same recovery. At first, you may experience blurry vision or irritation but that should improve rapidly for most patients. An eye shield needs to be worn for a few days following surgery, including during sleep. In addition, Dr. Sondheimer will prescribe eye drops to reduce inflammation, prevent infection, and control eye pressure. Patients have reported clear vision within hours of surgery, however, it may take additional time for others.