Cataracts are the most common problem reducing vision in the eye. Cataract surgery is the most common operation performed in the world & has the best post-operative results of any operation performed in the world. Perhaps the most important question about cataracts is when to have surgery? Dr Howell’s patients frequently ask if it is time to have surgery? He answer with the question, what do you want to do that you can not do because of your vision? Cataracts should not be removed just because they are present. Removal should be based on how much it bothers the patient’s vision & in the beginning, that answer is frequently is “not much”. The most common type of cataract causes the distance vision to fail long before the near vision is affected at all. However when the vision is poor in one eye, even though that may be covered up by the other, surgery is indicated in the poor eye. Because of this, every month or two after being told that cataracts are present, one should cover one eye & then the other to make both are okay. A good test is to make sure one can read the print on the TV, especially the trailers that run across the screen frequently. If you can read that then the vision is not bad. When you cannot, something might need to be done.
Dr. Howell your opthamologist in amarillo has been performing cataract surgery in Amarillo for many years. He joined the American Society for Cataract & Refractive Surgery as a charter member & became proficient in the insertion of intraocular lenses (IOL’s) after the cataract removal. This organization pioneered the use of IOL’s in America & the world. The use of IOL’s revolutionized cataract surgery. This eliminated the need for the thick cataract glasses which had been necessary to correct the vision after removal of cataracts in most patients. This new technique allowed the patient to have the same or better vision than they had before cataracts developed by changing the amount of glasses correction required after surgery.
In many instances a person who was very near sighted could be converted, by using the correct power IOL, to one who is much less near sighted or even need no glasses correction at all to see clear in the distance. The same would be true of some one who was far sighted. These individuals would need glasses for near vision however. Or for someone who wanted to be able to read without any glasses then that could be done in most of those people. But they would need glasses correction to see to see clearly in the distance. Because of this, research was done to change that situation.
This research developed a new IOL to correct that problem. For several years new types of intraocular lenses (IOL) have been available which are able to correct the vision for distance & reading by themselves, with no glasses or contact lens necessary. These lenses are called Premium Intraocular Lenses. There are two types of IOL’s that produce this correction. One is called an accommodative lOL which works somewhat like the eye does when one is young, before bifocals are necessary, to see near. This lens allows good vision at all distances, far away, intermediate computer distance & reading. Real fine print is the only short coming where about 40% of patients see that print well. About 90% can read magazine & newspaper size print & see a computer screen clearly however. This lens is called the Crystalens IOL & it was developed now sold by Bausch & Lomb Ophthalmic Company.
The other type of Premium IOL is the multifocal IOL. This lens has two different focal lengths in it, one for distance & one for near. The near focal length will correct somewhat for the intermediate or computer distance also. Because there are two focal lengths present the light for vision is split up between these two distances so that vision in dim light is diminished somewhat. Lights at night have halos around them & night vision in general is not as good as with a monofocal or accommodative IOL. Most patients become used to the halos or they go away. Some patients are not able to use the near vision portion as the brain has to learn how to recognize which is which. One of these IOLs is the Acrysof ReSTOR IOL sold by Alcon Ophthalmic Products. which I use some of the time. About 75% of the patients have satisfactory vision for near & distance. With the multifocal it is recommended that both eyes have this type IOL inserted while the accommodative IOL will perform if present in only one eye but is best when in both eyes.
At the present time Dr. Howell your eye doctor in Amarillo Tx will use either lenses when appropriate.
This is a picture of the Crystalens IOL which has extensions on both ends that can become attached to the peripheral capsule after it is inserted in the same place where the cataract was located. The muscle that allowed close focusing in the natural eye is attached to the capsule still by microscopic ligaments & pulling on these ligaments causes this IOL to move forward. This allows the near vision to come into focus. The eye does this natually but one must strengthening the muscle in the eye that does this by doing reading exercises.
If one is not interested in having vision without glasses or contacts, then doing the standard form of cataract surgery is available also. In most instances glasses will be necessary for distance or near & much of the time for both. Monovision is possible where one eye, the dominant one, is used for distance & the other is corrected for near. This is less expensive than the premium IOLs as insurance pays for most or all of the cost. This is described above in the second paragraph.
Dr. Howell is a eye doctor in amarillo who has performed thousands of cataract extractions, most with IOL insertion & is very competent in this surgery. Since when these statistics were started, 96% of the patients operated on by Dr Howell who is a eye doctor in Amarillo Tx has had a good visual results from cataract surgery. Of the 4% that did not, 3/4 of that 4% had some potential problem before surgery that turned out to be what prevented good vision post operatively. Therefore only 1% of the operated patients had an operative problem which prevented the vision from being good.
Click to view Pre-Operative and Post-Operative Instructions for Cataract Surgery>>>