FAQs

• Cloudy, fuzzy, foggy vision or a feeling of looking through wax paper – that cannot be corrected with glasses or contacts
• Glare around car lights that lead to trouble driving at night
• Frequent changes in your glasses prescription
• Trouble doing daily activities such as reading, threading a needle, watching TV, etc.

The most common cause of cataracts is aging; however, there are other disease processes that can cause cataracts as well. The most common is diabetes mellitus. Some medicines such as oral predisone (taken for inflammatory diseases such as arthritis) can cause cataracts after prolonged use. Trauma to the eye is another possible cause of a cataract. If you have a cataract in one eye, you usually have a similar grade cataract forming in the other eye.

Your local eye doctor or Dr. Stewart can find out if you have cataracts by doing a physical exam and asking questions about your symptoms and health history. When a patient in their 60’s or older is experiencing blurry vision that cannot be corrected with glasses, cataracts top the list of possible diagnoses. A cataract is usually seen after your pupil is dilated using special dilation drops (lasting for a few hours). You may need other tests to make sure you have a cataract or to rule out other conditions that may be causing vision problems. Cataracts are graded from 1+ to 3+ in severity. In rare cases, a cataract can be so severe that it is white and the patient can only visualize light or dark.

Surgery is the only way to correct vision loss caused by cataracts. Dr. Stewart is an expert in topical, no-stitch, no-patch cataract surgery.

Just because you have a cataract does not mean you must have cataract surgery. Insurance companies such as Medicare require that a cataract must be causing a decrease in vision of 20/40 or worse (with additional symptoms affecting daily life activities).  Cataract surgery is always an elective surgery which means you should make the decision when and if you would like to improve your vision.  Every surgery carries with it a certain degree of risk, including infection and worsening vision after surgery. Although these postoperative complications are extremely rare, they can happen.

Dr. Stewart was one of the first new-age ophthalmologists to perform topical, clear cornea, no-stitch (self-healing), no-patch cataract surgery.

In the 'old days' of cataract surgery, a very long needle was inserted behind the eye to anesthetize and paralyze the eye muscles. This injection has been linked to lingering pain, bleeding behind the eye, and damage to the eye or the muscles that control the movement of the eye. After the eye was anesthetized, a large incision was made to deliver the cataract from the eye. The cataract was pulled out in whole. The resulting wound would be over 10 millimeters and needed to be closed using tiny silk sutures.

Dr. Stewart eliminated the use of the retro-bulbar needle in 1999, and began using topical anesthetic drops and an intravenous sedative to help patients relax during the 5-minute surgery. Dr. Stewart now uses a relatively new form of cataract extraction. This particular form of cataract removal enables Dr. Stewart to create a small incision that is less than 3 millimeters. The cataract is broken into small manageable pieces inside the eye, and removed via a vibrating and irrigation system known as phacoemulsification. The benefits of this new technique is that the wound does not need to be sutured and it seals itself right after the procedure. This leads to less inflammation after surgery and a faster recovery time.

Many years ago, patients who had cataracts removed where given thick 'coke bottle' glasses or hard contacts to help them see. Later cataract surgery was revolutionized by the introduction of the IOL (intraocular lens).  Today, all of Dr. Stewart's patients receive an IOL after cataract surgery. (Not every surgeon uses the new IOL technology.) Dr. Stewart was one of the first surgeons in the country to start using the new technology IOL. The traditional IOL could be custom fit to the patient’s eye, to help decrease their use of glasses after cataract surgery, even if they wore glasses before they developed cataracts. The traditional IOL can help patients see better in the distance with less dependency on glasses, but they cannot treat astigmatism or help patients read up close. The New Technology IOL that Dr. Stewart uses in his practice, help patients achieve the distance and near vision after cataract surgery. Only recently has Dr. Stewart been able to treat cornea astigmatism with a new Toric IOL that helps treat preoperative astigmatism.

Dr. Stewart uses the LenSx femtosecond laser system. This system has laser data entry at left, a joy stick control and an OCT screen, which offers the surgeon all-important guidance during laser-assisted cataract procedures.

Principal laser-based surgical systems that are either FDA-approved or still in development for laser cataract surgery:

• LenSx - The LenSx (Alcon) was the first femtosecond laser system to receive FDA approvals for cataract procedures. The approvals involve three aspects of cataract surgery: creating the anterior capsulotomy that involves making a circular incision within the eye, fragmenting the cataract and making laser incisions on the corneal plane.
• LensAR - The LensAR Laser System (LensAR, Inc.) so far has FDA approval for creating an anterior capsulotomy and laser-based lens fragmentation within the eye.
• Catalys - The Catalys Precision Laser System (OptiMedica) also has FDA approval for capsulotomy and lens fragmentation.
• iFS - Abbott Medical Optics received FDA approval for its iFS Femtosecond Laser to create bow-shaped or curved arcuate incisions in cataract surgery. The device had already been used for several years to create the flap in all-laser LASIK.
• Victus - The Victus Femtosecond Laser Platform (Technolas Perfect Vision in partnership with Bausch + Lomb) was launched in Europe in September 2011 and received FDA approval in August 2012. The Victus is a multiple-use femtosecond laser system and is cleared for anterior capsulotomy during cataract surgery and corneal flap creation during LASIK surgery or other treatment requiring initial lamellar resection.
• Femto LDV Z6 - This device by Ziemer Group has received FDA approval for certain eye surgeries, but not yet for laser cataract surgery.

It is important to put this new technology into proper perspective. Traditional cataract surgery is very effective and successful. People who do not want to invest out-of-pocket money in laser cataract surgery can still feel confident about the traditional approach. But for those who want the best possible vision, the laser approach is appealing. A more accurate incision, capsulotomy and astigmatic correction will help to achieve their goal of less dependence on glasses after cataract surgery.

Keep in mind that even though the early results of laser cataract surgery are promising, this is newer technology that deserves in-depth research and discussion with your doctor so that you can make the best possible decision for your situation.

Refractive laser-assisted cataract surgery costs more than conventional options. Extra costs associated with refractive laser cataract surgery are unlikely to be covered by Medicare or private health insurance. Fees vary from one cataract surgeon to another, but it is likely you would pay a few hundred dollars extra per eye out-of-pocket for a laser-assisted procedure.

Cataract surgeons who use lasers say that their advantages are especially evident when it comes to high-tech, premium implants such as presbyopia-correcting multifocal IOLs and accommodating IOLs. The advantages can include better lens placement and therefore more accurate visual outcomes.

Especially with advanced intraocular lenses that provide good vision without glasses after cataract surgery, it is important that the surgery results in minimal astigmatism. Examples of these advanced lenses are presbyopia-correcting multifocal IOLs and accommodating IOLs.

Because astigmatism involves the cornea being more curved in one axis than the other (like a football shape), incisions can be used in the more curved axis to reduce the astigmatism so the cornea has a rounder shape (like a basketball). The procedure is called astigmatic keratotomy or AK.

Surgeons perform AK free-hand with a diamond blade, and it is quite effective in reducing astigmatism. During refractive laser-assisted cataract surgery, the OCT image can be used to plan the AK incisions in a very precise location, length and depth, and then the laser accurately creates them. Since the laser minimizes the variables involved, the AK procedure becomes more accurate and reproducible.