Cataract

How are cataracts treated?

Once a cataract has formed, the most effective way to restore vision is to remove the cloudy cataract and replace it with a plastic lens implant (Intraocular lens or IOL). With recent advances in cataract surgery equipment and techniques, vision can be restored safer and faster, allowing patients to resume normal activities within hours after surgery (some activities may be limited during healing). Using these state of the art techniques, cataract surgery has a success rate greater than 98%.

Standard Intraocular Lens Implants (IOLs)

Intraocular lens implants (IOLs) were first developed over 50 years ago and have been used routinely to correct vision after cataract surgery since the 1980’s. Traditional lens implants, whose costs are covered by health insurance, do an excellent job for many people in restoring vision after the removal of their natural lens. These implants provide good focusing at one specific distance (Monofocal) usually resulting in excellent distance vision and pretty good intermediate vision. To be able to also have excellent reading or near vision, reading glasses are usually required.

Toric Lens Implants

Blurred or distorted vision due to an irregularly shaped cornea is called astigmatism. In some cases astigmatism can be corrected during cataract surgery but this is not an option for all patients. Toric IOLs effectively eliminate astigmatism and may be a better option for many people.

Multifocal Lens Implants

For people with more demanding lifestyles, new multifocal lens implants provide much greater visual freedom. Multifocal lens implants offer a more complete range of good vision, day and night, from distance to near reading vision, without cumbersome or unsightly reading glasses or bifocals.

 

How Multifocal Lens Implants Work

Multifocal IOL’s with multiple optical zones have a series of concentric focusing rings extending from the center of the lens to the lens periphery. Each ring selection has its own focusing power and corresponding focal point. With these lens designs distant vision is very good right after surgery but intermediate and near vision may be blurry during the healing period. Over a short adjustment period the brain learns to “look” through the best area of the lens to provide good distant, intermediate or near vision as required by the object of attention.

 

AcrySof ReSTOR Multifocal IOL

The AcrySof ReSTOR IOL, marketed by Alcon, has been approved for use in the US since 2005. These multifocal lens implants feature a patented "apodized diffractive" design that optimally distributes light to distance, intermediate and near focal points, depending on the amount of ambient light available. This optimizes image quality in all lighting conditions, according to Alcon.

For example, in low-light conditions, as the pupil dilates, more light is distributed to elements in the lens required for clear distance vision. This improves a driver's vision of the road ahead at night, the company says. But this also means near vision may not be as crisp with the ReSTOR lens in low light as it is in bright light conditions.

AcrySof IQ ReSTOR multifocal IOLs also feature aspheric optics to reduce a specific type of higher order aberration called spherical aberration. This reduces halos around lights at night and improves image quality for enhanced visual clarity, the company says. More than 93 percent of people who have had AcrySof IQ ReSTOR multifocal IOLs implanted in their eyes during cataract surgery have said they would do it again, according to Alcon.

TECNIS Multifocal IOL

The Tecnis Multifocal IOL, marketed by Abbott Medical Optics (AMO), has been approved for use in the U.S. since 2009. The fully diffractive surface of the Tecnis Multifocal IOL provides advanced image quality at all distances under any lighting conditions and regardless of pupil size, according to AMO. Nearly 9 out of 10 people who have had Tecnis Multifocal IOLs implanted in their eyes enjoy freedom from eyeglasses after cataract surgery.

Crystalens hinged IOL

The Crystalens IOL, marketed by Bausch + Lomb, uses a different lens design to achieve a more complete range of vision than standard Monofocal lenses. The Crystalens IOL uses the eyes zonules and ciliary body muscles to move the lens either forward or backward to adjust the focal point for good vision. With this lens design distant vision is good right after surgery, and over time, the brain learns how to manage the zonule and ciliary muscle combination to control the movement of the Crystalens IOL and provide good distant, intermediate or near vision as needed.

TRULIGN Toric IOL

For those patients with cataracts and astigmatism the TRULIGN Toric IOL, marketed by Bausch + Lomb, is a premium IOL that can treat both. The TRULIGN Toric IOL works the same as the Crystalens hinged IOL with the additional ability to improve or correct astigmatism.

Are You a Good Candidate for Multifocal IOLs?

Perhaps the most important factor in determining if you are a good candidate for multifocal IOLs is your willingness to honestly assess whether you're willing to accept some compromise in the clarity of your distance vision for the convenience of being less dependent or computer glasses and/or reading glasses after cataract surgery.

 If you're not willing to accept this type of compromise, or your occupation requires the best possible distance vision at all times or excellent night vision — for example, if you are a pilot or someone who spends a lot of time driving in unfamiliar areas at night — then you are probably not be a good candidate for multifocal IOLs. You likely will be better served with standard monofocal IOLs for optimal distance vision — even though this means you will need bifocals, progressive lenses, or reading glasses to see clearly up close.

Also, if you have a pre-existing visual condition other than cataracts that affects your vision in one or both eyes (macular degeneration, for example), you typically will be happier with standard monofocal IOLs rather than multifocal IOLs, which require good visual capability in both eyes for best results.

Dr. Lum can evaluate the health of your eyes during your comprehensive eye exam prior to surgery to determine if you have any non-cataract-related eye problems that may affect your vision after cataract surgery.

Glaucoma

A combination of eye drops, medication, laser treatment and conventional incisional surgery is used to treat glaucoma. New micro-incisional glaucoma surgical (MIGS) techniques are currently being developed. Treatment is concentrated on lowering the pressure inside the eye to prevent damage to the optic nerve.

Dr. Lum is trained and performs many different glaucoma surgeries. Each patient is carefully evaluated to determine which surgical procedure is best suited to each individual.

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is an advanced type of laser treatment to manage patients with open-angle glaucoma. SLT selectively stimulates or changes only specific pigmented cells to activate increased fluid drainage and reduce intraocular pressure (IOP). SLT results in a biological response that increases aqueous drainage without burning tissue.

 SLT is performed in our office and only takes about 15-20 minutes. Use of the SLT in treating glaucoma may reduce the need for lifelong use of expensive eye drops or other medications. Because there is no damage or scarring from the SLT laser, the SLT may be repeated.

iStent accompanying Cataract Surgery

Patients with mild-to-moderate glaucoma and cataracts may benefit from an iStent implant accompanying cataract surgery. The iStent Trabecular Micro-Bypass Stent is the world’s tiniest medical device and the first Micro-incisional glaucoma surgery (MIGS) that has been FDA-approved. For patients with glaucoma, over time the eye’s natural drainage system becomes clogged. iStent creates a permanent opening though the blockage to improve the eye’s natural fluid outflow. By improving the outflow of fluid in the eye, iStent is designed to lower and control the pressure within the eye.

Trabeculectomy Surgery

Trabeculectomy is a tried and true method of lowering IOP in patients with glaucoma. In this surgery a drainage canal is made to help shunt the fluid from inside the eye to a protected area outside of the eye.

Ex-Press Mini-Glaucoma Shunt

The Ex-Press is a new permutation of the trabeculectomy surgery. Instead of making the drainage canal out of the patient's tissue, a small stainless steel shunt is place to allow a controlled and reproducible drainage canal. Dr. Lum is one of the first and most experienced surgeons implanting the Ex-Press mini-glaucoma shunt.

Ahmed Glaucoma Valve

The Ahmed Valve is the most commonly implanted valved glaucoma shunt device. The Ahmed utilizes a Venturi valve to regulate the flow and prevent the pressure from dropping too low in the immediate post-operative period.

Baerveldt Glaucoma Shunt

The Baerveldt implant is used in more difficult to control glaucoma cases. It utilizes a tiny silicone tube to bypass the non-functioning drain in the eye. The tube shunts the eye fluid to a silicone reservoir which sits on the eye wall, underneath the muscles.

Endocyclophotocoagulation

Endocyclophotocoagution (ECP) is a technique where a tiny endoscope is used to LASER ablate the ciliary body of the eye. This structure makes the fluid in the eye. By decreasing the function of the ciliary body, less fluid is made and the pressure is lowered. This ten minute surgery is very effective in patients with difficult or refractory glaucoma or those who have already had an Ahmed or Baerveldt implant surgery.

Canaloplasty

The innovative technique of canaloplasty is a less invasive way of controlling the intraocular pressure. In this technically demanding surgery, a small catheter is threaded into Schlemm's canal (the drainage canal of the eye) to improve the outflow of fluid. Less invasive than many other surgeries, it has recently fallen out of favor, but is still a viable alternative in some patients.

LASIK/PRK

Laser-assisted in situ keratomileusis (LASIK) and Photorefractive Keratectomy (PRK) are common refractive surgery techniques to eliminate or reduce the need for contacts or glasses. These procedures are very quick, usually less than 15 minutes for a bilateral procedure. The results are excellent with 98+ percent of patients able to function without glasses postoperatively.

 

Visian Implanted Collamer Lens

For patient with high myopia (nearsightedness) or who are poor candidates for LASIK and PRK, the Visian Implanted Collamer Lens (ICL) is a great option. The visual success is even higher than LASIK surgery. In this short procedure a tiny collamer lens is implanted inside the eye to correct nearsightedness. Dr. Lum is certified to implant the ICL.

 

Eyelid Sugeries

Dr. Lum performs many eyelid surgeries, including blepharoplasty (eyelid lifts), cancer removal surgeries and eyelid repair surgeries.

 

Corneal Transplant

The cornea is the clear window or the eye. When it becomes cloud, or there are growths on the cornea, it can obstruct the vision. Corneal transplant (from a deceased donor) can be performed to restore vision. A full thickness transplant is called a penetrating keratoplasty (PKP). If only a layer of cells needs to be transplanted, a partial thickness corneal transplant can be performed (DSAEK). These and other corneal surgeries can be performed by Dr. Lum.

 

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Ventura Ophthalmology

3088 Telegraph Road
Suite A

805.648.6891

Lum Glaucoma Care Centerof Santa Barbara

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