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CATARACTS & CATARACT SURGERY
INTRAOCULAR LENSES TO CORRECT
DISTANCE & NEAR VISION
WITHOUT THE NEED OF GLASSES
Dr. Howell has been performing
cataract surgery in Amarillo since 1964. In the 70's he
became proficient in the additional insertion of
intraocular lenses (IOL's) after the cataract was
removed. The use of IOL's revolutionized cataract
surgery. This eliminated the need for the thick cataract
glasses which were necessary to correct the vision after
removal of cataracts in most older patients. This new
technique allowed the patient to have the same or better
vision than they had before cataracts developed. Dr
Howell is a charter member of the American Society for
Cataract & Refractive Surgery which pioneered the use of
IOL's in America.
For several years a new type of intraocular lens (IOL) has
been available which is able to correct the vision for distance & reading
by itself, with no glasses or contact lens necessary. These lenses are called
Premium Intraocular Lenses. There are two types of correction. One
is called an accommodative lOL which works somewhat like the eye does when
one is young, before bifocals are necessary to see near. This lens allows
good vision at all distances, far away, intermediate computer distance & reading.
Real fine print is the only short coming where about 40% of patient see
that print well. This lens is called the Crystalens IOL. The other
type of Premium IOL is the multifocal IOL. This lens has two
different focal lengths in it, one for distance & one for near. The
near vision will correct somewhat for the intermediate or computer
distance also. Because there are two focal lengths present the light
for vision is split up between these two distances so that vision in dim
light is diminished somewhat. Lights at night may have halos around them
& night vision in general is not as good as with a monofocal or
accommodative IOL. This IOL is called the
Acrysof ReSTOR IOL in my hands. There are several companies that
make multifocal IOL's. About 85-90% of the patients have
satisfactory vision for near & distance. With the multifocal it is
recommended that both eyes have this type IOL inserted while the
accommodative IOL will perform if present in only one eye but is best when
in both eyes. Both of these IOL's are available through our office.
In large studies 80% of the recipients who had both eyes operated did
not wear glasses at all for vision, neither distance nor near. Of those
who remained 15% wore them some of the time & 5% wore them much of the
time. Certain conditions must be met to be a candidate for this IOL which
will be discovered in the examination prior to surgery. One must be
prepared to have both eyes operated the same way to obtain the best
results.
The IOL itself is much more expensive than the monofocal IOL which is
generally used & Medicare will not & private insurance may not pay the
difference. In those situations, it will be the responsibility of the
patient to pay that difference. Preparation for the surgery by the doctor
& staff is more complicated for this type surgery which Medicare will not
& insurance may not pay. Again this additional expense will be the
responsibility of the patient. There is no more risk in the surgery itself
than regular cataract surgery but more measurements & decisions must be
performed. To be as accurate as possible, these measurements must be
repeated at least twice & frequently more which is time consuming on the
staff. Much time is required to determine the power of the IOL &
more surgery may be necessary to achieve the goal.
If one is not interested in Premium IOL's but wants good distance or
near vision or to correct the distance in one eye & near in the other
(monovision) & this is very important to that individual, extra care can
be taken to insure this. This may require the use of a toric IOL to
correct astigmatism which is frequently present. Of course this IOL
can be used to correct the distance vision in both eyes also. In
that situation, the patient would need to wear reading glasses. The same extra time
is necessary repeating several of the measurements at least
twice & taking more time evaluating this information. Again Medicare
will not pay for the extra time taken & would be the responsibility of the
patient. The cost of this IOL is not as much as the Premium IOL but more
than Medicare pays & this & the extra charge by the surgeon is the
patient's responsibility.
If interested in Premium IOL's to correct one's vision completely, call
358 7558 for an appointment. Each patient is an individual & a
complete medical eye exam is necessary to reveal all information to make
an informed decision.
Dr. Howell has performed thousands of
cataract extractions, most with IOL insertion & is very
competent in this surgery. Since 1990 (when these
statistics were started), 96% of the patients operated
on by Dr Howell have had a good visual result from
cataract surgery. Of the 4% that did not, 3/4 of that 4%
had some potential problem before surgery that turned
out to be what prevented good vision post operatively.
Therefore only 1% of the operated patients had an
operative problem which prevented the vision from being
good.
Patients frequently ask when they
need cataract surgery. The answer; surgery is indicated
when the patient can no longer see to do the things that
they enjoy doing. If reading the print on the TV screen
or street signs is difficult, that is a good reason for
surgery. When reading the newspaper or magazines is a
chore, surgery is indicated. Surgery is indicated when
one can no longer follow the flight of their golf ball
or not see down the barrel of their shotgun to enjoy
hunting. Many older persons stop doing the things they
enjoy because of poor vision rather than questioning why
that is necessary. Older patients in poor physical
health frequently can only enjoy the things they can see
to do.
Age is seldom a reason for not having
surgery. Cataract surgery today is about like going to a
dentist's office & having a tooth pulled. It is not
something to look forward to; however, it is not a
terrible experience, Many of our patients tell us that
they did not have one pain during the entire process. In
most instances, normal activities can be resumed only a
few days after surgery.
If you, a friend, or someone you love
is having difficulty seeing to do the things that are
enjoyable, call 358 7558 or 800- 658- 6462 & make an
appointment for an examination at Amarillo Eye Care
Center. Most health insurance & always Medicare pays the
major portion of the bill. We are happy to file any
insurance or Medicare forms for our patients.
The following are our pre- &
post-operative instructions to our patients including
instructions about post-operative activities.
PRE-OPERATIVE INSTRUCTIONS FOR CATARACT SURGERY
Pre-admit on Monday or Tuesday (the week of surgery) at
the hospital between 8 AM and 5 PM.
START THE DAY BEFORE THE SCHEDULED SURGERY
- Maxidex eye drops -- use one drop in the operated eye four times
daily.
- Vigamox eye drops -- use one drop in the
operated eye four times daily.
- Nothing to eat or drink starting at midnight.
ON THE DAY OF SURGERY
- Take early morning medication with only a
sip of water.
- Continue all of the above.
- Go to the hospital at hour you were told.
- Bring the Vigamox, &
Maxidex drops to the hospital with you.
- Be sure to make plans for someone to drive
you home from the hospital.
- If there is anything you do not understand, call
358-7558.
POST-OPERATIVE INSTRUCTIONS FOR CATARACT SURGERY
ON THE DAY OF SURGERY
- Do not remove the patch from your eye and
therefore no drops will be put in your eye until after you are
seen by the doctor.
- If pain occurs try Tylenol or aspirin (two
tablets) for relief. If pain persists and is severe, call the
office number, 358-7558. Dr Howell will prescribe something
stronger.
- Return to the Amarillo Eye Care Center the next day at the hour assigned
to be seen by Dr Howell.
In the morning bring with you the sack of medication
and other things that will be sent home with you
today.
BEGINNING THE DAY AFTER SURGERY
- When you leave please make an appointment
to be seen on the date told by Dr. Howell.
- Use the Vigamox drops four times daily until all gone. Wait five
minutes between the drops that are used at the same time.
- Use Xibrom drops twice daily until all the drops are gone.
- Use the
Maxidex drops in your
operated eye four times daily.
When you
run out of this medication switch to the Vexol drops in the case
and use it four times daily until it is gone; then you need
no more.
- Your vision may or may not be very good. If it is not, do not be
alarmed about your vision as a needed change of glasses may be the
problem.
- Wear your old glasses during your waking
hours. Cover your eye at bedtime with the shield. Use tape
sent from the office. It is not necessary to use a gauze patch
under the shield.
- If you have any problems, call the office
(806-358-7558) and speak with Rosella Curry, the
office nurse. If necessary you may be asked to come
in for an additional examination.
POST OPERATIVE ACTIVITY INSTRUCTIONS
DO NOT RUB YOUR
OPERATED EYE. DO NOT BUMP OR HIT YOUR OPERATED EYE. DO
NOT SQUEEZE YOUR EYES CLOSED TIGHTLY FOR THE FIRST TWO WEEKS.
You should have
something for protection in front of your eye at all times, either glasses
or the protective shield. When you go outside during the daylight
time, you must wear the special dark glasses that are provided.
You may perform any
activity you wish if you follow the instructions above. Bending over
or performing heavy
physical activity will not damage your eye; however excessive
reading, watching TV, or any physical activity may cause discomfort in
your eye for the first few days after your surgery. This is NOT
causing any damage to your eye. It is normal because of the recent
surgery. After a few days, the pain will not be a problem.
Bending over or
picking up heavy objects will not harm your eye. It is permissible
to sleep with your head turned to the operated eye if you do not press
your eye into the pillow. It is not necessary to sleep on more than
one pillow.
If you wish to have
your hair done at the beauty salon, wear the protective shield over your
eye while there. You may go anytime you wish after surgery.
DO NOT RUB YOU
OPERATED EYE. DO NOT BUMP OR HIT YOUR OPERATED EYE. DO NOT
SQUEEZE YOU EYES CLOSED TIGHTLY FOR THE FIRST TWO WEEKS.
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