What are Cataracts?
CATARACT/LENS IMPLANT SURGERY
CATARACT/LENS IMPLANT SURGERY
Cataract/lens implant surgery is Dr. Shaaf’s and Prendiville’s main specialty and they have performed combined about 23,000 “no-needle and no stitch” cataract/lens implant surgeries. In 1997, Dr. Prendiville was chosen by Staar Surgical to be the first ophthalmologist in Arizona to implant a toric intraocular lens for the correction of astigmatism.To add a new question go to app settings and press "Manage Questions" button.
WHAT ARE CATARACT?
A cataract is a significant degree of opacification or cloudiness in the crystalline lens of the eye which occurs naturally as a result of aging. Also, many cataracts occur naturally at a young age and occasionally result from corticosteroid medication or trauma, etc. Cataracts can lead to cloudy or blurry vision for driving and watching TV or reading, or glare with night driving, etc. Cataract surgery is usually considered when a person experiences adverse visual effects from the cataract in the course of daily living. Occasionally, cataract/lens implant surgery is performed for refractive purposes, only. Prior to cataract surgery, we perform measurements in our office and utilize advanced intraocular lens implant calculation formulas to ensure accuracy in the selection of power of the intraocular lens to be implanted. Utilization of advanced intraocular lens implant calculation formulas are especially helpful in ascertaining the correct power of intraocular lens to be implanted in long, short, and post-refractive surgery eyes. Cataract surgery is typically performed under intravenous sedation with monitored anesthesia care and with powerful anesthetic eye drops and other agents to ensure comfort, and takes about an average of 12 minutes or a little longer when combined with ORA and/or implantation of a glaucoma drainage device for pressure lowering in glaucoma patients. The incision is self-sealing and very small at 2.4 mm thus resulting in no need for stitches.
We enjoy and look forward to taking the necessary amount of time discussing the visual needs and desires of each of our cataract surgery patients and understanding their lifestyles. It is helpful for us to know your hobbies including activities such as golfing, computer use, and reading, etc, how much you drive at night, and how spectacle independent you may wish to become. We apprise each patient of the various options for vision correction which is part and parcel of each cataract surgery; cataract surgery is refractive surgery. These options include, but are not limited to, excellent distance vision for each eye resulting in a requirement for reading glasses postoperatively or vice versa for near vision, various degrees of mono-vision including blended vision, etc, and multifocal vision (seeing both distance and near without glasses). Many of our happiest postoperative patients simply have a very small amount of near-sightedness in one or both eyes resulting in very good distance vision in each eye, ability to see the computer screen very well, along with some functional reading vision, all without glasses or premium services. We, also, advise you of how much astigmatism is present and whether or not it would require correction in order to achieve more spectacle independence, and the best method of correcting it. In many cases, excellent vision and freedom from glasses for many activities can be achieved without having to purchase any premium services whatsoever. After a thorough discussion of visual desires and expectations, and understanding whether the patient has an interest in purchasing premium services, we can make recommendations for a treatment plan that will be in the best interest of the patient. Our goal is to continue communicating and taking the extra steps necessary to ensure that we are providing the best and most appropriate care for each of our patients in order to achieve the best and most satisfying outcomes for each of our patients. As with any surgery, there are possible complications which we will apprise you of; fortunately, serious complications are rare.
The vast majority of our cataract/lens implant surgeries are performed at El Mirador Surgery Center in Palm Springs, CA in very close proximity to Desert Regional Medical Center. El Mirador Surgery Center is dedicated mostly to eye surgery and has excellent eye surgery equipment and staff. We, also, offer cataract/lens implant surgery at Dolores Hope Outpatient Surgery Center in Rancho Mirage on the Eisenhower Medical Center campus. For our patients who may be interested in premium services and advanced technology intraocular lenses, we are pleased to be able to offer a comprehensive array of premium services. All of these following premium services are entirely optional, are not paid for by any health insurances, and therefore require out-of-pocket patient expenditures:
OUT - OF- POCKET PATIENT EXPENDITURE
FLACS, available at El Mirador Surgery Center, is a more controlled way of performing certain parts of the cataract surgery and assists in the following ways: a) performs a perfect anterior capsulorrhexis which is an essential step in cataract surgery and which the surgeon does manually otherwise, b) softens up the nucleus of the cataract and divides it into 4 or 6 sections to make it a little easier, safer, and gentler to remove, and c) in some cases, performs peripheral arcuate corneal incisions for astigmatism reduction/elimination to achieve clearer vision without glasses after cataract surgery. By softening up the cataract prior to removal by phacoemulsification, FLACS tends to decrease the amount of “cumulative dissipated energy” (CDE) used during phacoemulsification removal of the cataract which may result in a gentler and safer surgery. Also, the perfectly round and centered capsulorrhexis may help to optimize “effective (intraocular) lens position” (ELP) which may confer visual benefits in some cases compared to manual capsulorrhexises. The actual time for the laser to perform FLACS is only about 13 to 20 seconds. We tend to correct smaller amounts of astigmatism, from 0.50 up to about 0.75 to 1.0 diopter, with FLACS; over that amount, we tend to recommend toric intraocular lenses for it’s elegance and accuracy. Additionally, FLACS may be extremely helpful in cases of complex cataract surgery posed by white or intumescent cataracts and/or weak or torn zonules which are microscopic fibers which attach to and stabilize the capsular bag of the cataract.
Toric intraocular lenses are recommended for patients who desire better vision without glasses and contact lenses, and need corrections of about 1.0 or more diopters of corneal astigmatism. These lens implants, including Tecnis toric and Alcon toric, are available to us in various strengths to correct the precise amount of astigmatism present in any given patient. We perform several various measurements of astigmatism in every cataract surgery patient to accurately determine the precise magnitude and direction of corneal astigmatism. Toric intraocular lenses are not indicated for all types of astigmatism. Astigmatism refers to a corneal shape that is not perfectly round like a basketball; rather, the cornea is shaped a little like a football. Most of us have at least a little corneal astigmatism. A very small amount of astigmatism is usually not visually significant. However, more than a little contributes to blurred vision when not wearing corrective glasses or contact lenses. When toric lenses are implanted, the goal is almost always excellent vision primarily for distance without glasses and contact lenses. However, it is anticipated that reading glasses would oftentimes be needed postoperatively, especially for small print. Toric lenses can also be targeted for excellent unaided near vision in which case glasses would be needed for distance vision. Toric lenses obviate the need for, and use of, corneal relaxing incisions, and are thus a more elegant way of correcting astigmatism. Moreover, when combined with ORA, they tend to be very accurate resulting in an increased chance of excellent distance (or, near) vision without glasses. Also, as of very recently, toric multifocal lenses are now available for implantation which can provide excellent vision in patients with astigmatism for both distance and near.
3- OPTIWAVE REFRACTIVE ANALYSIS
Optiwave Refractive Analysis (“ORA”), available at El Mirador surgery Center, is an ”in-surgery” adjunctive diagnostic device which provides the following information and guidance during surgery: a) correct power of intraocular lens to be implanted, b) correct magnitude of toric intraocular lens to be implanted to fully correct the patient’s astigmatism, c) proper meridional alignment of the toric intraocular lens after implantation, and d) additional analysis on peripheral arcuate relaxing incisions made at the time of FLACS. We use ORA to perform at least three refractive analyses on the eye prior to intraocular lens implantation, and again immediately after toric intraocular lens implantation to ascertain correct meridional alignment of the lens. Although ORA is generally recommended for most cataract surgery patients who can comfortably afford it, we especially recommend it for patients who have undergone prior refractive corneal surgery such as PRK, LASIK, or radial keratotomy, etc due to the higher degree of difficulty in ascertaining true corneal dioptric power in some of these eyes preoperatively. Using the ORA only adds a few minutes to the surgical procedure.
4- MULTIFOCAL INTRAOCULAR LENSES
These lenses, including Alcon Active Focus (shown above), Tennis Symphony and multifocal, and others, are most suited to our cataract surgery patients who prefer to be as spectacle independent as possible. The newer multifocal lenses have significantly less negative impact on contrast sensitivity and are now additionally available in a variety of toric powers for correction for astigmatism. Multifocal intraocular lenses correct both distance and near vision and can be tailored to the patient’s visual needs including computer versus up-close reading or both. Certain optical aberrations such as halos around headlights may result from implantation of these lenses. Therefore, we fully apprise and counsel patients who may be interested in multifocal lenses to ascertain their appropriateness and suitability. The vast majority of patients who have multifocal lenses implanted in both eyes can function spectacle free either all the time or most of the time.
5-Laser Vision Correction or Intraocular Lens Replacement Surgery
Following cataract surgery, in occasional cases where the patient does not achieve their desired refractive outcome or objectives, or just desires more “fine-tuning” of their refractive result, we offer and can easily perform either intraocular lens replacement surgery or laser vision correction. Our preferred method of laser vision correction is “PRK” (photorefractive keratectomy) and LASEK which gently and very precisely reshapes the cornea to correct any postoperative cataract surgery ametropia. Typically, in these cases after cataract surgery, the amount of correction required is small which leads to a very precise refractive outcome and a highly satisfactory result. Dr. Prendiville is very experienced in PRK and performs this procedure at a local laser vision correction facility. Following most premium cataract surgeries, we do not charge for either intraocular lens replacement surgery or PRK; however, facility fees may apply. Our experience is that patients are very satisfied and appreciative when we take this extra step, when needed, to achieve an excellent outcome.
- Diagnostic modalities including comprehensive eye exams with gonioscopy and intraocular pressure measuring, visual fields testing, optic disc photos, and optical coherence tomography (“OCT”) testing of the optic nerve and angle
- Intraocular pressure lowering eye drop medication prescriptions
- Surgical services including selective laser trabeculoplasty (“SLT”), iStent placement at the time of cataract surgery, trabectome, and Express minishunt filtering procedures
OCULOPLASTIC SURGERY SERVICES
- Ectropion and entropion repair
- Benign eyelid tumor removal
- Malignant eyelid tumor removal using frozen section control; reconstruction
- Blepharoplasty for mechanical ptosis and cosmetic blepharoplasty
- Blepharoplasty and ptosis repair by advancement of levator aponeurosis for myogenic ptosis
- Diagnostic modalities including comprehensive eye exam, fundus photos, optical coherence tomography (“OCT”) of the macula, fundus photography, and fluorescein angiography to rule out and monitor various conditions such as macular degeneration, diabetic retinopathy, and retinal vein occlusions, etc.
- Anti VEGF (vascular endothelial growth factor) medication injections for certain retinal conditions including exudative macular degeneration, diabetic retinopathy, and retinal vein occlusions
- Laser treatment for diabetic retinopathy, retinal vein occlusions and retinal tears
- Referrals to Retina Specialists
CORNEAL AND REFRACTIVE SURGERY
- Pterygium removal with adjunctive use of Mitomycin C and amniograft
- Photorefractive keratectomy (“PRK”) for correction of refractive errors
- Femtosecond peripheral arcuate incisions for correction of astigmatism generally in conjunction with cataract surgery
SERVICES WE DO NOT OFFER
- Except in unusual circumstances, we do not dispense prescriptions for glasses and contact lenses. We refer to a number of excellent optometrists throughout the Coachella Valley for these services.
- Glasses and contact lens dispensing; we do not have an optical department in our office.
COMPREHENSIVE EYE CARE
- Diabetic eye care including laser surgery
- Dry eye syndrome
- Eye emergencies
- Macular degeneration care including eye injections
- Cataract surgery including laser assisted cataract surgery, and use of premium laser for cataract refractive surgery
- Glaucoma management
Including surgery and laser
- Pterygium surgery
Eye lenses surgery including excision of tumors