Cataract Surgery and Implant Options

Cataract Evaluation

If you have been previously diagnosed with a cataract or if you feel you are experiencing blurry vision, a comprehensive eye examination is important.  The examination can determine if the cataract is the source of your visual complaints.  If the cataract is the source of your complaints, we can complete a cataract evaluation and discuss with you the options.

Most people develop a cataract as they get older.  Surgery is recommended when the cataract is interfering with your day to day activities.  Patients may experience difficulty driving especially at night or in the rain and bright sunlight.

Examinationcataract surgery | Alaina Kronenberg MD

A comprehensive eye examination involves checking your visual acuity, refracting to see if new eyeglasses can improve your vision, a slit lamp examination and a dilated examination.  Dr. Stanley Grandon and I will also take a comprehensive medical history.  This is done to assess for any conditions that would increase the risk of a problem during surgery.

If  the cataract if the cause of your visual complaints, Dr. Stanley Grandon and I will discuss with you the risks and benefits of surgery as part of the cataract evaluation.  We will take the time to discuss implant options with you.  For example, if you have astigmatism you may be a candidate for a toric implant to correct the astigmatism.  If you have a desire to be less dependent on glasses for near activities, you may be a candidate for a presbyopic implant that allows some vision for near and intermediate activities.

Cataract Surgery Implants

When I first trained, monofocal intraocular implants were primarily used.  Most patients still required glasses after their surgery due to either astigmatism and/or near vision needs.

Many patients have astigmatism and benefit from a toric intraocular implant.  I discuss the option of this implant with all patients who have corneal astigmatism.  It reduces the dependence on glasses after surgery.

Multifocal implants can help correct vision both at distance and for near activities.  These intraocular implants can work well for patients who wish to be less dependant on glasses for both distance and near and intermediate vision.   To determine which implant is best for you, it is important to understand your visual needs.  For example, do you wish to have better intermediate or reading vision?  Are you willing to accept that you may have decreased contrast sensitivity or some halos at night?

The extended depth of focus implants (Symfony) corrects vision provides more of a continuous vision by using an extended range of focus technology.  This lens will be a good option for patients who have a desire to be less dependent on glasses for all activities.  You may still need a low power reading glasses for some up close activities.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan


What is Monovision?

What is Monovision?

Monovision is a method of optimizing both distance and near vision.  It is a method that we often use during Lasik, contact lens fittings and during cataract surgery.  We use the dominant eye for distance activities and the non dominant eye for near activities.  The goal of monovision is to optimize both distance and near vision.

Why Do You Need Monovision?What is monovision? | Eye Surgery Institute

Presbyopia is term that refers to difficulty focusing up close with age.  We all develop presbyopia as we age and it usually starts around age 40.  Presbyopia gradually becomes worse as we age.  It can be frustrating to no longer be able to see up close objects such as your cell phone, computer, a menu or a book or magazine.

If you are frustrated by the onset of presbyopia, Dr. Stanley Grandon, Dr. Cindy Wang and I can discuss your options with you.  We will perform a complete eye examination and provide you with the options that best meet your needs.

What Are My Monovision Options?

If you are interested in Lasik eye surgery, we can perform a laser correction and allow your dominant eye to see well for distance activities and your near activities.  Dr. Stanley Grandon, Dr. Cindy Wang and I can also perform a contact lens fitting with monovision

We often aim the near eye for more intermediate vision activities rather that very fine print.  This makes  it easier for you to adjust to the difference between the two eyes.  You will likely still need reading glasses for fine print.

What If I Need Cataract Surgery?

A cataract is a clouding of the natural lens in your eye.  We may recommend cataract surgery if your are experiencing blurry vision from a cataract and it is interfering with your day to day activities.  At the time of cataract surgery, Dr. Stanley Grandon and I will chose an implant power to place inside your eye.   We will discuss with you what options best meets your needs.  We can provide the option of monovision at the time of cataract surgery.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


Blurry Vision After Cataract Surgery

Secondary Cataract Causes Blurry Vision

Most patients decide to have cataract surgery because their vision is blurry.  The purpose of your cataract surgery is to correct your blurry vision.  Sometimes, months or years after cataract surgery the vision can become blurry again.  We call this a secondary cataract.

You may worry that the cataract grew back.  This is not the case.  Once the cataract (the cloudy lens in the eye) is removed, it cannot grow back.

When the cataract is removed, an intraocular lens implant is placed into the capsular bag that the cataract previously sat inside.  Up to 50% of the time after cataract surgery, the back of the capsule can become cloudy after cataract surgery.  Some people call this a secondary cataract.  This can occur months or even years after cataract surgery.  A secondary cataract is extremely common.

Symptoms of Secondary Cataractsecondary cataract causes blurry vision

You may notice increased in blurry vision or an increase in glare and mistiness of the vision.   You may notice halos around lights.  It is important for your comprehensive ophthalmologist to perform a comprehensive eye examination to determine the cause of your blurry vision.

Symptoms of a secondary cataract are very similar to the symptoms of having a cataract.

If I feel the blurry vision is due to opacification of the capsule (in layman’s terms a secondary cataract), I will discuss the risks, benefits and alternatives of the the treatment plan.

Yag Laser Capsulotomy

A Yag Laser Capsulotomy is a relatively simple procedure typically performed in my office.  The laser procedure is painless and only takes a minute or two.  No anesthesia is required and you can drive yourself home.

I will give you drops to dilate the pupil and numb the eye.  After, I will place a lens on the surface of the eye.  I will use a laser to make an opening in the capsule.   The purpose of the procedure is to improve your vision.

After a Yag Laser Capsulotomy

Your vision may be blurry for an hour or so after the procedure because of ointment used in the eye during the procedure.  I will give you a drop to use for approximately 5 days.  I will check you in my office 2-3 weeks after your procedure.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


When Do I Adopt New Technology?

Changes in Intraocular Implants

As a comprehensive ophthalmologist, my primary surgery is cataract surgery.  The methods and technology used for cataract surgery are constantly evolving.  For example, in the past, patients had to wear very thick eyeglasses after cataract surgery.  This is no longer necessary since intraocular implants became available.  When I completed my residency training, almost all intraocular implants were monofocal.  This means they only correct vision for one distance.  If the intraocular implant is corrected for distance, the patient still needs glasses for computer and reading.  Over the years, much new technology has been developed.

New TechnologyCataract Surgery | Intraocular Implants

It is important that I stay educated on new technology that is developed.  I focus on technology that is relevant to my practice.  I educate myself by reading peer reviewed journal articles, articles regarding experiences of other doctors, and attending local and national conferences.  I also discuss with colleagues their experiences.

I use the information I learn to gather my own opinion on the value of the new technology.  It is important that I feel it is safe for my patients and that it will offer an improved outcome.  I often wait a few months after the technology is approved by the FDA to learn from the real world experience of other ophthalmologists.

Initially when I implement a new technology, I may try in in a very select group of patients.  I evaluate the results before proceeding with a larger group of patients.

Cataract Surgery Intraocular Implants

When I first trained in cataract surgery, monofocal intraocular implants were primarily used.  Most patients still required glasses after their cataract surgery due to either astigmatism and/or near vision needs.

Many patients have astigmatism and benefit from a toric intraocular implant.  I discuss the option of this implant with all patients who have corneal astigmatism.  It reduces the dependence on glasses after cataract surgery.

Multifocal implants can help correct vision both at distance and for near activities.  These intraocular implants can work well for patients who wish to be less dependant on glasses for both distance and near.  I am cautious about recommending these intraocular implants due to the potential for decreased contrast sensitivity and difficulty with night driving.

The Symfony implant corrects vision provides more of a continuous vision by using an extended range of focus technology.  This lens will be a good option for patients who have a desire to be less dependent on glasses for all activities.  It does not run the same risk of halos and glare.

Staying Educated

It is important that I continue to learn and evolve the technology that I utilize.  This will provide my patients with the best outcomes possible.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


Risks and Benefits of Cataract Surgery

Possible Benefits of Cataract Surgery

Most people develop a cataract as they age.  Cataract surgery is indicated when you feel your day to day activities are limited due to poor quality vision.  Many patients notice trouble with driving initially when a cataract begins to interfere with their vision.  You may notice improvements in some of the common symptoms of cataracts listed below:risks and benefits of cataract surgery

  • to improve the quality of your vision
  • to decrease halos
  • to decrease glare
  • to decrease light sensitivity
  • to improve contrast sensitivity
  • to improve night vision
  • to make images brighter/less dull
  • to decrease dependence on glasses

Risks of Cataract Surgery

In general, cataract surgery is a relatively low risk surgery to your overall health.  Most patients have successful cataract surgery with no complications.  No surgery is free of possible risks.  The possible risks of cataract surgery are primarily within the eye.  These risks include but are not limited to the items listed below.

  • risk of an eye infection
  • risk of needing a second operation to completely remove the cataract, possibly performed by the cataract surgery or possible performed by a retinal surgeon
  • risk of swelling in the central vision (cystoid macular edema)
  • risk of swelling of the cornea that may be persistent
  • risk of a retinal detachment
  • risk of a leaky wound
  • risk of blindness (rare)
  • risk of needing to exchange the lens implant
  • risk of needing glasses for distance, intermediate and near activities after surgery
  • risk of halos and trouble driving at night especially if certain implants are used
  • risk of difficulty tolerating the difference in the glasses prescription between the two eyes, especially if surgery is intended on only one eye

Dr. Stanley Grandon and I will have a lengthy discussion with you regarding the potential risk and benefits of your cataract operation.  We will spend the time necessary to answer all of your questions.  You will need to sign an informed consent prior to your cataract surgery.

If you have additional questions or concerns about the risks and benefits of cataract surgery feel free to leave a comment.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


What to expect with cataract surgery

What to expect with Cataract Surgery

Now that you are ready to have cataract surgery what can you expect?

Cataract surgery is an outpatient operation often performed at ambulatory surgical centers.  Dr. Stanley Grandon and I perform ours at the Dearborn Surgical Center. cataract surgery

Preparation for Cataract Surgery

We ask you to instill drops for the 3 days prior to your surgical date.  One of the drops is an antibiotic and the other is an anti inflammatory drop.  You typically cannot eat or drink for several hours before the operation.  When you arrive at the Dearborn Surgical Center, we ask that you bring a driver with you.

When you arrive at the surgical center you will be asked to change into a gown.  You will receive medication to dilate the pupils and be seen by the anesthesia staff.  During the operation you will feel no pain.  You will receive sedation to make you comfortable.  In most cases, surgery is performed without a numbing injection.  Surgery usually takes less than 20 minutes.

After your Cataract Surgery

After your cataract surgery you can expect the vision to be a bit blurry as the eye heals and adjusts.  Most of the time cataract surgery does not require a bandage.  It is normal to feel a scratchy or foreign body sensation in the eye.  Dr. Stanley Grandon and I will have you continue the antibiotic drop, the anti inflammatory drop and we will add a steroid drop.  It is very important to continue to use these drops as directed after your operation for the eye to heal properly.

Post Op Visits

You can expect to come in for a check up to our office the day after your operation.  We ask you to bring your drops with you for that visit.  Most day to day activities can be resumed immediately.  You will then return to our office approximately one week after your operation and then at one month.  If necessary, we can perform surgery on your other eye 1-2 weeks after the first eye as long as the first eye is healing well.  A prescription for new glasses (if necessary) will be given at your one month post op visit.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


Cataract Evaluation

Cataract Evaluation

If you have been previously diagnosed with a cataract or if you feel you are experiencing blurry vision, a comprehensive eye examination is important.  The examination can determine if the cataract is the source of your visual complaints.  If the cataract is the source of your complaints, we can complete a cataract evaluation and discuss with you the option of cataract surgery.

Most people develop a cataract as they get older.  Cataract surgery is recommended when the cataract is interfering with your day to day activities.  Patients may experience difficulty driving especially at night or in the rain and bright sunlight.

Examination

A comprehensive eye examination involves checking your visual acuity, refracting to see if new eyeglasses can improve your vision, a slit lamp examination and a dilated examination.  Dr. Stanley Grandon and I will also take a comprehensive medical history.  This is done to assess for any conditions that would increase the risk of a problem during cataract surgery.

If  the cataract if the cause of your visual complaints, Dr. Stanley Grandon and I will discuss with you the risks and benefits of cataract surgery as part of the cataract evaluation.  We will take the time to discuss implant options with you.  For example, if you have astigmatism you may be a candidate for a toric implant to correct the astigmatism.  If you have a desire to be less dependent on glasses for near activities, you may be a candidate for a presbyopic implant that allows some vision for near and intermediate activities.

Scheduling Cataract Surgery

If you decide to schedule the cataract operation, we will take measurements to determine the implant type and power to use.  The entire cataract evaluation can take approximately 2 hours time.  You will read and sign informed consent paperwork.  Our surgical schedulers will provide prescriptions for drops to be used before and after cataract surgery.  They will go over all of the details of what to expect the day of your operation.  You will need to have a driver bring you to the Dearborn Surgical Center on the day of your surgery.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126