Eye Surgery


Eye Surgery

Cataract Surgery

What is a cataract?

A cataract is the clouding of the natural lens inside your eye.  The lens is located behind the iris (color part of the eye) and works like a focusing lens of a camera.  Symptoms of cataracts include blurry vision at distance and/or near, poor night vision, problems with glare, need for brighter light to read, dulling of color. At this time, eye drops and medicine cannot prevent or treat a cataract. The best way to treat a cataract is with surgery that removes the cloudy lens and replaces it with a new artificial lens. 

Cataract surgery is one of the safest and most successful procedures performed. More than 1.8 million people have cataract surgery each year in the US and more than 95 percent of those surgeries are performed with no complications.  Surgery is usually performed as an outpatient procedure under local or topical anesthesia with little discomfort.  The goal of the operation is to break apart the old cloudy lens, removed the pieces from the eye, and insert a replacement lens.  A microscope and ultrasound machine is used to aid the surgeon in these steps.  

 

With cataract surgery, your ophthalmologist removes the cataract-diseased lens of your eye. The ophthalmologist then replaces your natural lens with an artificial one.

The Procedure

This outpatient procedure is generally safe and takes less than an hour. Your ophthalmologist will dilate your pupil with eye drops and administer local anesthetic eye drops. You may also be prescribed a sedative to counter anxiety.

Once your eye surgeon has made a small, self-sealing incision in the eye, he or she performs a step called phacoemulsification. During this step of the procedure, the ophthalmologist inserts a thin probe into the cataractous lens and uses ultrasound waves to break it up, before suctioning out the pieces.

Once your eye surgeon removes your cataract, he or she implants an intraocular lens (IOL). IOLs come in a wide variety of materials and functions. Some help with both near and distant vision, similar to bifocals. Others block ultraviolet light. You and your doctor will discuss the best type for you.

If you need cataract surgery in both eyes, your doctor will likely recommend doing one at a time, with a healing period in between.

Recovery

Usually, you can go home on the day of your surgery. However, you’ll need to arrange for somebody to drive you home from the surgical facility. You might also need help around the house, as your doctor may restrict bending and lifting for a few days.

Expect mild discomfort, light sensitivity, fluid discharge and itching for a few days after surgery. For a short period of time after surgery, you may need to wear a patch or eye shield while sleeping or take medications that control eye pressure.

Your eye doctor will schedule follow-up visits to monitor your progress. Once healed, you’ll get a new prescription for eyeglasses, if necessary.

After surgery, some people develop a secondary cataract, also called posterior capsule opacification. Eye surgeons can usually treat a secondary cataract with a quick, painless outpatient procedure.

Risks

Cataracts are usually treated safely and successfully. However, risks — while uncommon — do exist. These include swelling, infection, inflammation, retinal detachment, glaucoma and loss of vision. People with serious medical conditions or other eye diseases are at increased risk of complications.

If you suspect you need cataract surgery, call us today to discuss your options.

Laser Cataract Surgery

Lawrence Eye Care surgeons are now offering the newest technology in cataract surgery!

The new Alcon LenSx laser performs many of the initial key steps of cataract surgery that were previously perfomed using a blade.  The LenSx laser uses high resolution images and measurements to customize certain steps of cataract surgery that can lead to more precise and accurate results.  This is especially important when a patient selects a premium intraocular lens to help them become less dependant on glasses after cataract surgery. 

Conventional Surgery versus Laser Assisted Cataract Surgery

Conventional cataract surgery uses a blade to make the corneal incisions to allow the instruments to be inserted into the eye to remove the lens.  A bent needle is than used to make an opening in the capsule that surrounds the lens.  The ultrasound machine is than used to remove the cataract lens.  The new LenSx laser can now be used to make the corneal incsions without a blade, makes the opening in the capsule to reach the cataract and helps break the cataract into pieces before the ultrasound machine is used.  The LenSx laser can also make additional corneal incision to help correct astigmatism.  Astigmatism is an irregular shap of the eye that causes blur at distance and near if not corrected. This can be corrected with glasses but the laser correction during cataract surgery allows patient to be more independant from glasses after surgery. The LenSx laser can also provide more accurate results with implantation of a premium intraocular lens such as a multifocal IOL or Toric IOL. 

Intraocular Lenses (IOL)

Monofocal lens: intraocular lens that gives clear vision at one distance, either for reading/near or for driving/distance.  You will still need to wear glasses for either reading or driving depending on the distance the IOL is selected to correct. 

Toric lens: If your astigmatism is larger than what can safely be corrected by the LenSx laser, a toric lens is specially designed to correct your amount of astigmatism when it is implanted in the eye during cataract surgery.  The lens allows vision to be clearer without glasses at one distance.  You will still need reading glasses for near work.

Multifocal lens: This lens has several rings of different powers built into the lens. This allows patient to have the potential of good vision at near, intermediate, and distance.  This may allow patients to be independant from glasses after cataract surgery.  Patients may, however, have more problems with glare or halos due to the different power rings in the IOL. 

Other Services at Lawrence Eye Care:

Glasses and Contacts:

·         Evaluation and eye testing

·         Large selection of glasses

·         No charge for glasses adjustments

·         No-Hassle warranty replacements

Surgery:

·         State-of-the-art cataract surgery and lens implantation

·         Laser treatment of secondary cataract

·         Laser treatment of diabetic retinopathy

·         Diagnosis and treatment of glaucoma

·         Blocked tear duct surgery on infants

·         Strabismus eye muscle surgery for crossed or drifting eyes in children and adults

·         Eye injury treatment 

Refractive Surgery

Lawrence Eye Care is now offering LASIK laser vision corrective surgery! Call now for a free evaluation!

 

LASIK

LASIK surgery is a procedure that corrects abnormalities in the eye to improve your vision. LASIK can correct conditions such as nearsightedness, farsightedness and astigmatism. With LASIK surgery, many of our patients walk away with 20/20 vision and all of the conveniences that come along with better sight. Never worry about forgetting your glasses or needing to maintain proper hygiene with your contact lenses again. At Lawrence Eye Care, we are happy to be able to give you back control of your sight.

LASIK surgery is one of the safest and most comfortable procedures you can undergo. Due to this, and its high success rate, LASIK is the most common procedure used to correct vision. In refractive surgeries, the laser reshapes the surface of your eye, improving the cornea so that light is properly focused on the retina. This allows you to see without using glasses or contact lenses. Each eye is done separately, and the procedure takes around five minutes for each eye. You will be asked to look directly into the laser for the length of the procedure, but it will be entirely painless; you may only feel some mild pressure on the eye. You can expect hazy and blurry vision immediately after receiving LASIK, but your vision will begin to improve almost immediately. LASIK in itself is a simple procedure, and it has a simple recovery to match. In most cases vision is corrected in only a couple days after surgery, and the recovery is very simple; we recommend that you rest as much as possible to allow the eye to heal quickly, but you will be able to return to your routine a day or two after having the procedure done. This simple procedure can have an enormous impact on your life. Consider LASIK surgery at Lawrence Eye Care as a means to correct your vision and improve the way you see the world.

 

PHOTOREFRACTIVE KERATACTOMY or PRK

PRK, which stands for Photorefractive Keratectomy, is a laser correction surgery very similar to LASIK that is more beneficial for those who have very thin corneas.

While traditional LASIK cuts a flap into the cornea, the PRK procedure simply removes only the outermost layer of the cornea (called the epithelium) before using the same excimer laser used in LASIK to sculpt the cornea and correct refractive error. Altering the shape of the cornea allows light entering the eye to be properly focused on the retina for clear vision. While both procedures will result in corrected vision, some prefer LASIK for the faster healing times and others prefer PRK for its extra safety as the original laser surgery for vision correction. PRK is a safer procedure for patients with thin corneas since more of the cornea is left untouched during the procedure than in LASIK. Unlike LASIK surgery, there is no risk of corneal flap complications because the cornea does not need to be cut. Like most other refractive surgeries this procedure only takes 5 minutes per eye, and most people only feel a little pressure. You will be awake during the procedure but your eyes will be numbed with a topical anesthetic. Your surgeon will have you look into a target light while the laser uses pulses of light to reshape your cornea. As an additional benefit, patients experience less dryness in the eyes following PRK surgery. However, PRK does have a slightly longer recovery time than LASIK surgery as the outer layer of the cornea has to repair itself. After the procedure, you will have a corneal abrasion that will take 3-5 days to heal. The body is an amazing thing, and the cornea is able to repair itself without sutures or much interference from your surgeon. During the healing time you will wear a soft contact lens that acts as a bandage to minimize pain, promote healing, and protect the cornea. After the cornea has healed, your surgeon will remove this bandage lens for you. As a PRK patient, you will likely experience mild discomfort during the healing process. Expect some blurry vision initially; it is very normal for several weeks to pass before vision is clear and stable! Your vision will continue to improve and you will achieve excellent sight and minimal disruption to the cornea with PRK laser correction surgery.

 

Cornea Transplantation Surgery

Lawrence Eye Care is now offering cornea transplantation surgery and cornea care exclusively in Lawrence!

Cornea transplantation replaces the diseased layers of the cornea to create an optically clear window for your eye for better vision. Different types of cornea surgery are indicated based on the cornea problem. Please see below for more detail.

What is the cornea?

Your cornea is the outermost part of your eye and covers your iris, pupil, and anterior chamber. It is often called the windshield of your eye since it covers the front of your eye and needs to be clear for good vision. The cornea helps to refract light and focus it onto the back of the eye to help you see, and it makes up for two-thirds of your eye’s total optical power. If the cornea loses its clarity due to various processes like Fuchs’s dystrophy, keratoconus, infections, swelling, or scarring, then it is like seeing through a cloudy windshield and worsens the vision.

What is cornea transplantation?

Cornea transplantation is replacing the diseased, cloudy layers of the cornea with a new clear cornea. Depending on the cause, a full thickness or partial thickness cornea transplantation is performed to replace the damaged layers with healthy ones. The new corneas are supplied by the local eye bank.

Corneal transplants are very common in the United States; over 50,000 are performed each year. While success rates may vary due to pre-existing conditions in your eye, technological advancements have increased your chance of success. Approximately 90% of corneal transplants are successful, and the new cornea will stay healthy for an average of 10 years. In the unlikely event that your surgery is not successful, or if your cornea does become cloudy again, you can always receive another transplant.

Full thickness cornea transplantation (PK)

If all layers of the cornea are cloudy or damaged, then a full thickness transplant called a penetrating keratoplasty (PK) is needed. During the corneal transplant surgery, Dr. Farhat will remove about an eight-millimeter central portion of the cloudy or damaged cornea and replace it with a new, clear one. Your new cornea will often come from an eye bank after being screened for suitability and infectious diseases. Your surgeon will place the brand new cornea in the opening left from removing the old cornea and secure it in place with a very fine suture. These tiny sutures will remain in your eye for a few months while the eye heals, and then will be removed easily and gradually during visits to our office.

Your surgeon will prescribe you eye drops to use after surgery to help your eye heal and to prevent infection. Your vision will be blurry at first due to stitches and post-operative swelling, but most people are able to return to work and daily life about a week after surgery. Full visual recovery can take up to a year, and it is vital that patients take their medication as directed, keep follow-up appointments and pay close attention for any increased redness, discharge, sensitivity to light, pain or blurring. This can be an indication of transplant rejection and should be reported to our office immediately so that we may be able to reverse the condition.

Partial thickness cornea transplantation

If only specific layers of the cornea are damaged, then we often only need to replace specific layers of your cornea, which longterm decreases the risk of rejection and potentially better vision. Three types of partial thickness cornea transplantation exist including DSAEK, DMEK, and DALK.

Endothelial Keratoplasty (EK/DSAEK)

Endothelial Keratoplasty (EK), also known as Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), is a newer method of corneal transplantation and only involves replacing some of the posterior or inner layers of the cornea, instead of its full thickness as in standard corneal transplantation. For this reason, if your disease affects the full thickness of the cornea, you are not a candidate for EK.

While EK is a relatively new surgery, and therefore hasn’t been studied as thoroughly as the standard procedure, there are many advantages. Compared to the standard transplant procedure, your surgeon can make a smaller incision in the eye so fewer stitches are needed. Your recovery is drastically shortened with the eye healing in 3-6 months, as opposed to a year. Your eye will have less chance of injury during surgery, and with fewer stitches there is less chance of infection.

Descemet Membrane Endothelial Keratoplasty (DMEK)

A Descemet membrane endothelial keratoplasty (DMEK) is very similar to DSAEK, except that the implanted donor tissue does not include any stromal tissue. A DMEK is an exciting option to treat decreased vision and swollen cloud corneas, such as in Fuch’s dystrophy, and it is a pure replacement of endothelium. There are three generations in the evolution of corneal transplantation and DMEK is the third and newest. DMEK is the most anatomical repair of the three generations of corneal transplantation with just one cell layer and a thin membrane, all of which is only 15 to 20 microns thick.

During DMEK surgery, the diseased innermost layer of the cornea is removed and the thin layer from a healthy donor cornea is put in its place. The transplant is then held in place by only an air bubble. Patients will be required to lay flat on their backs with their faces directed upwards immediately after surgery to float the bubble into place. DMEK has been shown to offer patients the best chance to see 20/25 and resume their daily activities quickly.

Deep Anterior Lamellar Keratoplasty (DALK)

Deep Anterior Lamellar Keratoplasty (DALK) is an additional newer method of corneal transplantation. It only replaces the superficial layers of the cornea, so there is less risk of damage to the eye. You are a good candidate if you have a disease that only affects the outermost layers of the cornea, like keratoconus. Because this procedure is extremely technical, the success rate is approximately 75%. Fortunately, if the cornea does not divide optimally at the time of the procedure, a full-thickness keratoplasty remains an option to rehabilitate vision. The advantages to DALK include greater structural integrity of the eye and decreased chance of rejection.

Eyeglasses have been a traditional solution for correcting vision problems for many centuries. When contact lenses arrived on the scene, they offered a new practical solution for restoring vision. Now an increasing number of eye surgery options have displaced glasses or contacts as the only solutions for healthy vision.


Eye Surgery Evolution

Advanced technology has made it possible to reshape eyes and restore vision to healthy levels for many people from all walks of life. Surgical techniques and tools have rapidly evolved over the past two decades to create procedures that are both safe and helpful.

Corrective surgeries for eyes now include everything from using lasers to reshape the cornea surface to inserting artificial lenses. These procedures correct how light entering the eye is processed – leading to much sharper vision in patients.

The state of the cornea is a determining factor in these surgeries. Thinner corneas with a high degree of myopia, for example, usually require a more invasive surgery to reshape the eye surface enough to improve vision.

Types of Eye Surgeries

Laser correction surgeries offer a snapshot of evolution in eye surgeries. Photorefractive Keratectomy (PRK) became the first successful surgery to change the shape of the cornea through removing tissue. The FDA approved PRK in 1995 and it is still widely used early in the 21st Century. With PRK, it only takes a few days for vision improvements to be realized.

LASIK followed on the heels of PRK. It involves cutting a thin flap in the outer covering of the eye to reshape the cornea. Unlike PRK, it only takes a few hours to gain sharper vision with LASIK surgery. There is some risk of suffering dry eye and other complications such as halos around bright lights until the flap fully heals. At Lawrence Eye Care we will be preforming LASIK with a femtosecond laser for flap creation and an excimer laser for reshaping the cornea with customized wavefront technology that measures how light hits the eye.

Some eye surgeries require implanting new artificial lenses to produce vision improvements. Implantable lenses similar to contact lenses can correct more severe levels of nearsightedness. These artificial lenses go permanently over the natural lens on the eye. Refractive Lens Exchange (RLE) takes it a step further and replaces the natural lens with an artificial lens of a different shape. RLE is done to correct extreme farsightedness.

Eye Surgery Considerations

Our eyes change as we age, so some corrective surgeries are not a good option for everyone. People under 18, for example, are not good candidates for laser eye surgeries because their eyes change rapidly as their bodies are growing.

Health also factors into eye surgeries. If you have diabetes or other medical conditions that impact eyesight, certain eye surgeries may pose serious risks.

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