Comments for About Eyes and Lens Replacement Surgery by Cataract Expert

Comment on It Slices. It Dices. It Even Treats Glaucoma… by Jay Hamilton

Jay Hamilton — Tue, 14 Jul 2009 20:55:28 +0000

Thank you for this amazing wealth of information. Your blog has been very helpful to me and I plan to talk to my doctor about this at my next visit.

Comment on Our Contributors by drdavid

drdavid — Sat, 09 May 2009 18:33:38 +0000

Dear Vivian,

I am happy to hear that you are pleased with you vision after surgery with a monofocal IOL. The vast majority of my patients choose monofocal IOLs and are very happy with that decision. I offer all of my patients information regarding all of the available options but am quick to point out the limitations of each technology. To date, either the technology is not up to meeting most patients’ expectations or I am a very bad salesman (likely both) as only 5-10% of my patients choose multifocal IOLs. Those who do chose them tend to be very pleased with their vision but (and I emphasize this) they were informed prior to surgery of the limitations of current technology - complete spectacle freedom should not be expected.

I believe that I should offer the available IOL technologies to my patients. That being said, I consider my role in choosing an IOL to be more along the lines of an advisor than an advocate of any particular IOL technology. Ultimately, my goal is a happy patient with improved vision. Whether that involves a monofocal or multifocal IOL is customized to each of my patients’ goals, desires, and expectations.

Sincerely,
David Richardson, MD

Comment on Our Contributors by vivian mower

vivian mower — Sat, 09 May 2009 17:31:55 +0000

As a former cataract patient who turned down the sales pitch for multifocal IOLs, I have been researching the topic ever since. I am aware that Crystalens may be better than ReZoom/ReStor, but I find myself agreeing with doctors such as Douglas Koch at Baylor and Neil Friedman at Stanford, that there are still too many problems with multifocal IOLs. So these are the two issues that bother me as a patient–1. the aggressive marketing by many ophthalmologists of the multifocal IOL. In my case, most of the selling and discussion was done by technicians–then the Dr. tried to close the sale by recommending ReZoom/ReStor for my eyes. He didn’t even mention monofocal. I can’t believe what excellent vision I have with monofocal–I can even read my grocery list. 2. Seond issue goes back to above statement about problems with multifocal IOLs. Even one explant is too many, and there have been quite a few, even on patients who were considered ideal candidates. Monofocal patients, on the other hand, aren’t asking for explants. Dr. Richarson, you appear to be very ethical. Of course, I do not know how you present information about IOLs to your patients. Thanks for listening. Vivian Mower

Comment on My eyes can’t be dry. They tear constantly. by Blueman

Blueman — Sat, 28 Feb 2009 22:37:04 +0000

How do you diagnose dry eyes ?

What exactly do you mean by foreign body sensation ?

Thanks.

Comment on Why your friend didn’t really have his or her cataract removed with a laser by eyemdla

eyemdla — Sat, 21 Feb 2009 20:03:03 +0000

Cold phaco is very good. It allows for efficient removal of the cataract with minimal risk of wound burn (one of the disadvantages of earlier phacoemulsification technology). It is true that laser technology continues to be researched, but as ultrasound technology continues to improve there simply is not a convincing reason for most cataract surgeons to learn a new platform (with all the unknown risks of new technology). In general, surgeons are gadget freaks, but we also tend toward the conservative side when choosing for our patients.

Comment on Why your friend didn’t really have his or her cataract removed with a laser by blueman

blueman — Sat, 21 Feb 2009 17:05:43 +0000

How good is this “cold phaco” ? I guess it is not particular good, since cataract surgery is the most common surgery.

I have heard of a research project, where they will use laser to almost remove all of the cataract, which should avoid operation for 10 more years. I don’t remember the name, but something about femto-nano-second laser (very short bursts of laser).

Comment on A NuLens design for presbyopia correction by eyemdla

eyemdla — Mon, 16 Feb 2009 20:50:55 +0000

Agreed. Most likely we won’t see this IOL technology before 2015. One thing is certain: the options available for patients with cataracts are going to explode over the next decade - just in time for the baby boomers.

David D. Richardson, M.D.
Medical Director
San Gabriel Valley Eye Associates, Inc.

Comment on A NuLens design for presbyopia correction by blueman

blueman — Mon, 16 Feb 2009 20:47:37 +0000

Given the lack of public information from Nu-lens, I would be surprised if it was ready during next year, but 3 years for FDA to approve is probably right.

I really hope there will be some information soon.

Comment on A NuLens design for presbyopia correction by eyemdla

eyemdla — Mon, 16 Feb 2009 18:34:05 +0000

That’s correct. These lenses have been implanted in patients with macular disease in order to measure the ability of the IOL to accommodate. Assuming the manufacturer can get the IOL ready for prime time in the next year I would think it would take at least three years for the FDA to approve it for general use. Mind you, that’s just a guess and it could take even longer than that but I would be amazed if this IOL was available in the US prior to 2013.

David D. Richardson, M.D.
Medical Director
San Gabriel Valley Eye Associates, Inc.

Comment on A new paradigm in IOLs - The Synchrony by eyemdla

eyemdla — Mon, 16 Feb 2009 18:30:07 +0000

Yes, these initial results are impressive. To give you an idea, someone with 20/40 uncorrected distance vision would be able to obtain a driver’s license in California without spectacles.

The issue with effective lens position (at least for the Synchrony) is that it is a dual optic system with the lenses moving relative to each other. As such, it is difficult to calculate where the lens actually sits in the eye (from the perspective of a ray of light). If the effective lens position (ELP) is more toward the front of the eye (anterior) than anticipated the eye will be myopic (nearsighted); if further toward the back of the eye (posterior) the eye will be hyperopic (farsighted). Without knowing the true ELP a surgeon cannot accurately calculate the proper power to implant in the eye.

The issue of ELP is present for all lenses but is exacerbated by the dual-optic system. Additionally, eyes that are either longer or shorter then average can change the ELP in such a way that the standard lens calculations are thrown off.

David D. Richardson, M.D.
Medical Director
San Gabriel Valley Eye Associates, Inc.