CATARACT SURGERY IS OUR PRIMARY AREA OF FOCUS. OUR GOAL IS TO MAKE YOUR SURGERY AS COMFORTABLE AND SUCCESSFUL AS POSSIBLE.
Once the need for surgery has been determined by the doctor, you may arrange your surgery date with our schedulers. Our physicians perform surgery at Wills Eye Surgery Center in Plymouth Meeting, Wills Eye Hospital, and at Chestnut Hill Hospital Outpatient Surgical Center. They use the most advanced surgical method, called clear corneal incision phacoemulsification. This means the cataract is removed using a type of ultrasound. Stitches are usually not required and recovery time is brief. You can resume your normal activities almost immediately after surgery. Our surgeons are experienced in using the standard intraocular lens implants (IOLs) as well as the newer premium intraocular lens implants (such as Crystalens, ReStor, ReZoom, and Toric).
With all the advancements and options in today’s procedure, the information presented to you during your appointment can be somewhat overwhelming. Below is some information to review so that you can start to think about what you would like to gain from the procedure.
TYPES OF CATARACT PROCEDURES
Our surgeons at Wills Eye Physicians Thorp Bailey Weber use some of the most advanced approaches to the procedure (advanced technology intraocular lenses, laser-assisted surgery). As a patient, you will have decisions to make regarding the type of technology used during your procedure. We offer three different types of cataract procedures:
Standard Cataract Surgery
The Standard Cataract Procedure will render improved vision to any patient who has cataracts. During the surgery, your doctor will remove the cloudy lens (cataract) from within the eye and replace it with an artificial lens implant. These lens implants are very effective, safe and have stood the test of time. With the basic procedure, the patient can expect improved vision, but in most cases the patient will still require prescription eyeglasses for distance and/or near. The patient who chooses the Standard Cataract Procedure will only be responsible for deductible or co pays that are not covered by Medicare or insurance.
The Standard Procedure is an excellent choice for many patients, and at Wills Eye Physicians Thorp Bailey Weber we have been providing wonderful results this way for years (and continue to do so). Advancing surgical technology now allows us to provide our patients with reduced dependence on glasses after surgery. For some, this is an important priority, and in that case we offer the options below. Our pre-operative testing, and your visual needs, help us determine if you are a candidate for either. Please remember that your medical insurance does not consider reduced glasses wear a “medical necessity.” It is classified as a “refractive” portion of the surgery, and thus is elective and not covered by your medical insurance.
Astigmatism Correcting Cataract Surgery
The Astigmatism Correcting Procedure is the type of procedure that will offer a patient the clearest distance vision with minimal dependence on glasses. Astigmatism is a type of refractive error (like nearsightedness or farsightedness) that many people have, and is not correctable with the standard lens implant. It is correctable with either glasses or surgery. With the Astigmatism Correcting Cataract Surgery, most patients will only need non-prescription reading glasses after the procedure. Patients will be responsible for co pays, deductibles, and an additional fee per eye that covers additional measurements, and more sophisticated technology, including a toric lens implant or laser-assisted surgery.
Presbyopia Correcting Cataract Surgery
The Presbyopia Correcting Procedure is the type of procedure that will offer a patient the greatest range of vision. Presbyopia is the age related decrease in near vision that happens to almost everyone, and it is the reason why people need reading glasses and/or bifocals as they age. The goal of the Presbyopia Correcting Surgery is to neutralize this and give the patient the ability to read, drive, and perform his or her day to day activities with as little dependence on glasses as possible. This is achieved with presbyopia correcting lens implants. The surgeons never can guarantee that a patient may not need glasses for some visually challenging functions like threading a needle, or doing an extensive amount of reading, but the lens will give a patient the greatest chances of the most independence from prescription eye wear. Please know that your surgeon will not perform this procedure unless you are an excellent candidate. With the Presbyopia Correcting Procedures, patients are responsible for co pays, deductibles, and an additional fee per eye that covers additional measurements, and more sophisticated technology, including a presbyopia correcting lens implant and/or laser-assisted surgery. Your doctor will discuss advantages and disadvantages of these implants during your evaluation.
Not all patients’ needs or eyes are the same. The mix of technology and measurements used are left to the discretion of the surgeon in order to provide you with the best outcome. Our surgeons have a large arsenal of technology at their fingertips, and will use the ones which best suit your eye. Please see below for further details.
LENSAR and Catalys Laser Systems
Image guided laser incisions help with astigmatism reduction and certain portions of the cataract extraction
ORA Intraoperative Measurement
Measures the eye immediately before lens implantation to guide selection of the proper lens
Toric Lens Implants
Neutralizes the eye’s astigmatism
Alcon Wavefront Toric
AMO Technis Toric
Presbyopia Correcting Lens Implants
Neutralizes the effect of presbyopia
AMO Technis Multifocal
Baush and Lomb Crystalens
Again, it is important to know that not all patients are candidates for Astigmatism and Presbyopia Correcting Cataract procedures. The Evaluation will help you to understand what you are a candidate for, and the benefits of each type of procedure. In many cases they are not necessary to help you obtain your clearest vision, and your doctor will only consider them if they will be helpful.
SPECIALTY CATARACT/LENS SERVICES
Dropless Catarct Surgery
A new, but non-FDA approved, method of administration of medication associated with cataract surgery is available. This involves the placement of a compounded mixture of a cortisone medication (Triamcinolone) with an antibiotic (Moxifloxacin) into the eye during the surgery, ie Tri-Moxi. This mixture has been intensively tested for sterility and potency. A special cannula, is used to infuse the mixture into the middle part of the eye (the vitreous). It is your choice whether to use this method or medication administration, or to use traditional eye drops
Advantages and Benefits
Reduced or eliminated need for using eye drops after surgery. Without Tri-Mox, three different eye drops are used 2-4 times a day for 4 weeks.
Less cost to the patient since no drops will need to be purchased. Usually the cost of drops are $100 or more.
Prevents the patient from trying to instill drops themselves or have someone do it.
Disadvantages and Risks
Because of the medication particles in Tri-Moxi, the patient may notice floaters or swirls in their vision for the first few days. Vision may not be as clear initially until the Tri-Moxi is absorbed into the body, causing the floaters to go away.
You may still need some drops if, during your healing phase, the doctor thinks your eye appears inflamed or prone to infection.
In certain patients, especially those with glaucoma, the cortisone part of the medicine may cause your eye pressure to increase for a short time. It may be necessary to be placed on a pressure lowering drop or, in extreme cases, surgery to lower the eye
No peer reviewed studies have yet been done to identify all of the side effects, risk, nor the degree of effectiveness of this medication.
Implantable Miniature Telescope
The Implantable Miniature Telescope is implanted inside the eye to improve the vision of those in the most advanced End-Stage of Age Related Macular Degeneration (AMD). The pea-sized device is placed in one eye to provide central vision while the other eye provides peripheral vision. Patients are a candidate for the lens if they have cataract and dry AMD. Patients who are still receiving injection or laser treatment for AMD are not candidates. For more information on the Implantable Miniature Telescope, visit their website here.
Laser Assisted Cataract Surgery
Cataract surgery is a refined, safe, and technologically advanced surgery. It is a far cry from the days when a patient was hospitalized with sandbags on either side of their head. Recent advances now include the use of a laser to assist your surgeon during certain parts of the procedure – Femtosecond Laser Assisted Cataract Surgery (FLACS). The femtosecond laser is the same type of laser used for LASIK surgery, and has an excellent track record. Our surgeons are certified on two systems, the LensAR and the Catalys, and have been involved in clinical research and training with the lasers at Wills Eye Hospital and Surgery Centers. For some patients, the laser may enhance their vision after surgery, reducing the need for glasses or contacts. It is indicated for patients with astigmatism or those receiving certain types of intraocular lenses (IOLs). For others, the laser is no better than the standard method of surgery. Only your surgeon can make this determination. FLACS is considered a refractive procedure. This means it is elective, and the laser portion of the procedure is not covered by your insurance. If you are a candidate for FLACS, but chose not to pursue it, you will still have an excellent visual outcome; you may simply need glasses more often. There are also other options that your surgeon may recommend, such as an astigmatism-correcting or toric IOL, which can achieve the same outcome. Each patient and each eye is different, and your surgeon will review all of your options and recommend the best for you. Visit our YouTube page and check out this informational video on Laser Assisted Cataract Surgery featuring Dr. Wisner.
iStent is a great option for patients with Cataract and mild to moderate Open-Angle Glaucoma on a glaucoma medication. This tiny device is carefully implanted in the eye during cataract surgery to safely lower intraocular pressure. In some cases, patients may be able to eliminate the use of glaucoma drops after the procedure. Your surgical experience is similar to standard cataract surgery. The iStent is so small, you will not be able to see or feel it. Visit their website for more information.
The doctor calculates the power of the lens implant to be used. Prior to surgery the length and shape of your eye will be measured in our office. The tests are painless and the measurements are accomplished using the most precise and accurate technology available. At this visit, we will also explain more about your surgery and give you post-operative instructions. You will have an opportunity to discuss your surgery and ask any questions that you may have.
Cataract surgery is an outpatient procedure. You will be lightly sedated, very relaxed but still awake. You will not see anything coming toward your eye during the surgery. A gel is used to numb the eye. The incision made to remove the cataract and insert the lens implant is so small that stitches are usually not required. You will return home after surgery with a clear shield over your eye. This protects your eye and allows you to see.
Your post-operative checkup will be scheduled for the day after surgery. At this visit, your doctor will tell you if you may resume driving. Most patients are able to do so at this point. You may return to most normal activities (such as showering, washing hair, exercising) shortly after surgery. Our dedicated Surgery Department staff are available to help guide you through the pre- and post-operative processes.
Our Surgery Department manager is Susan E. Boone, RN, BSN, CRNO (Certified Registered Nurse in Ophthalmology). She is a graduate of Chestnut Hill Hospital School of Nursing and LaSalle University and has been with our practice since 1986.
We encourage you to bring a friend or loved one along with you to help ask questions and take in information.