Seeing Eye To Eye

Why Cataract Surgery in the 58 year old?

Written By: Mujtaba Qazi | April 2, 2012

Most of us think that one has to be older to develop a cataract.  This makes sense as cataract formation is generally age-related.  A cataract is a cloudy natural lens inside the eye that distorts light entering the eye.  However, a number of factors may accelerate cataract formation.  Cataracts can develop at an earlier age due to trauma to the eyes, from medical conditions such as diabetes, or from spending more time outdoors without wearing sunglasses to block UV light.  Earlier cataracts are also seen in patients who use steroids chronically, such as with Prednisone pills, asthma inhalers, allergy nasal sprays, or steroid eye drops.

During the early phase of cataract formation, patients will note subtle changes in their vision.  They will report that their vision with their present glasses or contacts is not as sharp as when they first received the glasses.  They will need more light to read.  Street signs at night will be more difficult to see until they are very close to the signs.  There may be more glare from oncoming car headlights.

These symptoms are initially treated by updating the glasses or contact lens prescriptions.  As the cataract clouds, a different glasses prescription is needed to bend the light around the new cloudy areas that have developed since the previous glasses prescription,  In a sense, this means that patients with early cataracts face the challenge of trying to catch up the progressing clouding.  Hence, patients wonder if a more permanent solution to their vision problems makes more sense than updating their glasses every 6 – 12 months while struggling in between.

An alternative treatment for symptoms related to early cataract formation is consideration of cataract surgery.  The advantages of cataract surgery in these patients are that surgery: (1) permanently removes the clouded natural lens; (2) is generally a 1 time procedure; (3) replaces the cataract with an artificial, clear lens or implant that further improves the vision because glasses prescriptions can be built into the implant (as if the glasses were permanently placed inside the eye); and (4) provides long-term stable vision as the artificial implant does not change over time, as long as the health of the remainder of the eye remains the same.  For these reasons, patient even in their 50s and 60s are considering cataract surgery as a safe, effective, long-term treatment to improve their ability to drive and read without “filmy,” “hazy,” “ghosting,” or “glary” vision.

Are You Suffering From Computer-Vision Syndrome?

Written By: Jay Pepose | October 25, 2010

A recent article in The Wall Street Journal asks whether we are becoming a “squinter nation”. Computer screens, I-Pads, smart phones, and a litany of other hand held devices are all typically viewed between 18 to 40 inches away. This intermediate distance is often the “black hole” in between the clear distance and near focus of typical bifocal glasses. The National Institute of Occupational Safety and Health says that 30% of people who spend 3 or more hours a day on computer experience the symptoms of computer-vision syndrome or “CVS”.

The symptoms of CVS include headaches, fatigue, blurred vision and neck pain. The blink rate drops when we stare at computers, contributing to dry eye and blurry vision. (Lowering the screen and using artificial tears may help). For those of us experiencing the loss of near (presbyopia), the eyes may fatigue from trying to accommodate for long periods of time, just as muscles would fatigue during an isometric exercise. Looking off to the distance every few minutes to relax the muscle and applying heat or a warm washcloth to the eyes may reduce these findings. Neck strain often relates to trying to utilize the near segment of the bifocal glasses by tilting the head back in an unnatural position when looking at the computer.

Some people resort to multiple powers of reading glasses for computer or closer objects, but it becomes evident that these blur distance vision if you look across the room. Others have tried multifocal contacts or trifocals or specialized occupational progressive glasses with a large upper portion for intermediate (i.e. computer range vision) and a lower area for close-up, with no correction for distance.

For patients with cataract, a new life-style enhancing intraocular lens implant called Crystalens has been shown to deliver good distance and intermediate vision in the same eye. This may be a good solution for patients who want to maintain good uncorrected distance vision and also to be able to see their computer and Kindle. If you are suffering from computer-vision syndrome, I recommend seeing what options may be available for you by making an appointment online or calling us at 636-728-0111.

Update from Hawaii

Written By: Jay Pepose | January 18, 2009

This week, I have been invited to lecture at the Hawaii Ophthalmological Society Annual meeting in Honolulu. I am teaching the local doctors on the mechanism of action of the Crystalens lens implant for patients with cataracts, who desire both near and far vision. In addition, I have brought surgical tapes that demonstrate important points in achieving good success with this lens.

From there, I have been invited to speak at the Royal Hawaiian Eye meeting in Maui. This meeting has over 1000 ophthalmologists from both the US and abroad. Among the 3 lectures that I am giving at this meeting, is a presentation on new accommodating lens implants, to give the audience a snapshot of what may be on the horizon over the next 10 years. Since Pepose Vision Institute is involved in many clinical trials, we are very aware of technology under development. We are excited about participating this year in a clinical trial of a new lens implant that can change power postoperatively by application of a special wavelength of light. This allows the surgeon to fine tune the power of the lens after it has been implanted and wound healing changes have already occurred—similar to going to a tailor to have a suit or dress custom-fit.

In addition, we will be participating in a trial of a new infrared laser system, in the initial studies on a bifocal treatment of the cornea, which will not require creation of a LASIK flap. I will be going to Bogata this spring to meet with engineers, scientists and clinicians to further study this new technology.

Happy New Year!

Written By: Jay Pepose | December 31, 2007

This past week at Pepose Vision has been very busy, as many LASIK patients are taking advantage of their flexible spending accounts this year and next. These patients, who were tired of wearing contacts and glasses, have scheduled laser vision correction surgery to reduce this need. Some of our patients with cataracts, who want to have clearer vision, have scheduled to have cataract surgery. At Pepose Vision, not only do we perform laser vision correction and cataract surgery, but provide general eye care as well. We are able to meet the visual needs of every age and phase of life.

The diverse interests and occupations of LASIK patients always makes the surgery day interesting for me. This week I operated on an accountant, a judge, a marketing director, as well as a college student on break hoping to get into Vet school. Our delighted patients commented on the day after their procedure that my job was a lot like Santa’s, and I guess this is around the right time of year for that!

I would like to wish all of our patients and their families a happy, healthy and joyous New Year from all of us at Pepose Vision Institute. We appreciate your confidence in placing your trust in us.

- Dr. Pepose
www.peposevision.com