A cataract occurs when the normally clear lens in the eye becomes cloudy and the amount of light reaching the retina is diminished. As the cataract develops and grows, less and less light reaches the retina causing vision to worsen.
The lens of your eye is located just behind the pupil and is responsible for the focusing of light on the retina. It is about the size of an ordinary pill and made up of a strong, transparent outer capsule filled with a transparent flexible gel. When you focus on a near object, the focusing muscle around the lens contracts, causing the lens to become thicker. This mechanism, called accommodation, enables the eye to focus on both near and far objects.
When light enters the eye, it passes through the cornea (the eye’s clear front window) and then through the pupil and the lens, which focuses the light rays onto the retina at the back of the eye. The retina changes the light images into electrical impulses and sends them to the brain via the optic nerve.
A cataract occurs when the lens becomes cloudy. As the cataract grows, it blocks light coming through the lens, preventing light rays from focusing properly onto the retina. This makes it difficult to see and even causes blindness over time.
Cataracts mainly occur due to aging, appearing first when a person is in his or her 40s or 50s, but usually not affecting vision until after age 60. Since it is a slow, progressive deterioration of vision, some people may not even be aware they suffer visual loss from cataracts. On the other hand, others have a noticeable cataract and cannot see well enough to perform tasks of daily living such as driving, watching television or reading. Cataract surgery can restore vision to people and allow them to return to activities that may have been put on hold.
Cataract surgery can help patients regain clear vision when cataracts interfere with daily tasks such as driving, watching televsion and reading. Modern cataract surgery involves removing the lens with the cataract and replacing it with a clear artificial lens, known as an intraocular lens (IOL). It has become the most common vision procedure in the United States, with over one million cataract surgeries performed each year.
The cataract removal procedure is performed at a surgery center on an outpatient basis. The eye is numbed with anesthetic drops. Using an operating microscope, Dr. Feinerman makes a small incision in the cornea. The incision is about 2.4 millimeters in length and is created at the junction of the cornea and the sclera. An anesthetic is then administered inside the eye through this incision.
The front part of the lens envelope, known as the lens capsule, is delicately opened so that the unwanted lens material can be removed. A thin ultrasound probe is inserted into the eye and uses ultrasonic vibrations to dissolve (phacoemulsify) the clouded lens, vaporizing the hardened and yellow proteins that make up the cataract. As the cataract is vaporized, a vacuum (through the same ultrasound prob) is used to remove the tiny particles from the eye. Once the cataract is removed, Dr. Feinerman places an artificial lens into the capsular bag that the cataract previously occupied. This new lens allows the patient to see clearly after surgery.
Laser cataract surgery is performed using a laser to create incisions in the eye, as opposed to the blade used in traditional cataract surgery. This improves accuracy, and also serves to make cataract surgery easier.
Laser cataract surgery automates the first steps in the cataract surgery procedure: the initial incisions (including additional incisions for correcting astigmatism, if necessary); the capsulotomy, which is the opening of the lens capsule; and breaking up of the cloudy natural lens in preparation for removal. These steps, performed with hand-held blades and ultrasound probes in the traditional procedure, are performed by a fast, extremely accurate, computer-guided laser. This leads to improved precision, which can be consistent with better surgical outcomes for patients.
Dr Feinerman has been performing laser assisted cataract surgery since 2009 with the LenSx laser. Technology has improved and Dr Feinerman currently uses the Ziemer Z8 laser for his laser cataract procedures. The Ziemer Z8 uses an incredibly fast sequence of low-energy laser pulses, which provides a higher level of safety and precision. The unrivaled precision, speed, and safety of laser-assisted cataract surgery are pointing the way to a new era in cataract surgery.
What is the Light Adjustable Lens (LAL)?
The RxSight™ Light Adjustable Lens is the fi
rst and only intraocular lens (IOL) that can be customized after cataract surgery. The Light Adjustable Lens is made of a special photosensitive material that can be adjusted in response to ultraviolet (UV) light. This optimization is done by your eye doctor in the weeks following lens implantation through a series of non-invasive light treatments that take only a few minutes each. You will have the unique ability to adjust and preview your vision until it meets your personal desires and lifestyle requirements. The Light Adjustable Lens delivers superior vision outcomes that non-adjustable IOLs cannot match.
The Light Adjustable Lens Procedure
The Light Adjustable Lens is made of a special photosensitive material that changes the shape and power of your implanted lens in response to ultraviolet (UV) light. Light treatments are delivered in your doctor’s office with the Light Delivery Device (LDD) after your eye has healed.
To customize your vision, you will preview and compare possible vision outcomes with your doctor based on your unique preferences and lifestyle requirements before electing a prescription for your adjustable lens. Your doctor will then apply a proprietary light treatment that precisely reshapes your implanted lens based on the visual correction that is needed to target your custom prescription.
With your doctor’s input, the LDD noninvasively delivers UV light to your Light Adjustable Lens to adjust your vision to the desired target. The system gives your doctor the flexibility to make adjustments and refinements to meet your specific criteria.
A minimum of two light treatments—each lasting approximately 90 seconds—are required. The total number of light treatments is based on achievement of the desired visual outcome that you and your doctor selected. Once you have achieved your final optimal vision, the lens power is permanently locked with a final light treatment to prevent any further changes. When you experience the results of your adjustments, you will better understand
the value of adjusting and customizing your vision after your surgery
UV Protective Glasses
Exposure to indoor and outdoor sources of UV light can cause uncontrolled changes to the Light Adjustable Lens until all light treatments are completed. To prevent this, patients must wear special UV protective glasses provided by RxSight during all waking hours (from time of lens implantation until 24 hours after the final lock-in light treatment is completed).
The clear pair of protective glasses must be worn indoors, and the tinted pair must be worn in all bright sunlight conditions. The glasses may be removed when sleeping, and may be temporarily removed when showering, washing the face, or applying eye drops as long as the patient is not exposed to direct sunlight.
Unprotected exposure to UV light during this period can result in unpredictable changes to the Light Adjustable Lens, which might necessitate removal of the lens.
The natural lens in the eye can vary its focus from distance to near for people who are younger than 45 years old. This process is called accommodation. As people age, the natural lens contained within the eye begins to lose its flexibility and becomes unable to focus on objects up close. This condition, called presbyopia, is why reading the newspaper or a menu in a restaurant gets harder as people get older. Fortunately, there is a new alternative to cumbersome reading glasses. The crystalens is a lens implant that may reduce your dependency on reading glasses, and it is offered by Newport Beach, Orange County doctor Gregg Feinerman.
Crystalens is the only FDA approved accommodative IOL (intraocular lens). It works by bending to focus on near objects, mimicking the eyes natural accommodation mechanism. It restores youthful vision to our Orange County residents suffering from presbyopia and cataracts.
Crystalens is designed for patients with an active lifestyle, who want to decrease their dependence on glasses and contact lenses. Dr. Feinerman was the first surgeon in Orange County to perform crystalens after it was FDA approved in 2003. He has performed the most crystalens surgeries in California.
The Trulign Toric IOL combines the benefits of crystalens, cataract surgery, and reduces or eliminates your astigmatism. If you have a cataract and astigmatism, then the Trulign Toric IOL may be a great choice for you. “Toric” means the IOL corrects astigmatism. The Trulign Toric IOL is basically the same lens as the presbyopia treating crystalens, with the added benefits of astigmatism correction.
If you lead an active lifestyle, then chances are you don’t have time to deal with the inconvenience of cataracts or astigmatism. If you experience any of these signs or symptoms, schedule a visit to Feinerman Vision Center for an eye exam. Treatment is fast, convenient, and safe, so you can soon be back to living your life on your own terms.
In the past, cataract surgery could only correct vision at one distance, typically for driving, and watching television; but people would still need reading glasses after surgery. Now, people can choose a trifocal intraocular lens (IOL) to correct vision at distance, intermediate (computer vision), and near.
If you are considering cataract surgery and want decreased dependence on glasses after surgery, you should consider trifocal IOLs. These implants are designed to provide more range of vision than can be obtained by traditional cataract surgery. Most patients who choose trifocal IOLs are completely independent from glasses or use them only occasionally after surgery.
Many people with cataracts also have astigmatism, which can cause blurry vision. The shape of a normal eye is round, but many people are born with an oblong-shaped eye which alters the pathway of light coming through the lens, causing a distorted image. Traditional cataract surgery involving standard monofocal intraocular lenses (IOLs) did not treat astigmatism, making eyeglasses necessary even after cataract surgery. The toric IOL now makes it possible to treat both cataracts and astigmatism with a single implant.
Toric IOLs require extra care on the part of the surgeon since the IOL must be placed so that the axis of additional power lines up exactly with the location of the astigmatism in the patient’s eye. Dr Feinerman is trained and highly experienced in the use of toric IOLs, such as the EnVista Toric, Tecnis Toric, Acrysof Toric and Trulign IOLs. He has at his disposal the most advanced diagnostic and surgical equipment. Dr Feinerman uses a technology developed by Carl Zeiss, called Callisto, that transfers the patient data to his operating microscope so he can precisely correct astigmatism during surgery.
If you lead an active lifestyle, then chances are you don’t have time to deal with the inconvenience of cataracts or astigmatism. If you experience signs or symptoms of cataracts or have astigmatism, schedule a visit to Feinerman Vision Center for an eye exam. Treatment is fast, convenient, and safe, so you can soon be back to living your life on your own terms.
Vivity is a first-of-its-kind, non-diffractive extended depth of focus IOL with Alcon’s proprietary non-diffractive X-WAVE™ technology, which stretches and shifts light without splitting it. Vivity delivers high quality distance (far) with excellent intermediate (at arm’s length) and functional near vision (up close).
Symfony is another extended depth of focus IOL intended to improve your range of vision. Both Symfony and Vivity are available at Feinerman Vision Center. Feel free to ask Dr Feinerman which IOL would be best for you by booking an appointment at our Orange County California eye center.