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What are the Treatments for Cataracts?

Surgery is usually recommended for people who cannot see well because of their cataracts. The surgery is performed at our state of the art outpatient surgery center. Mineral Surgery Center is an outpatient surgery center that deals exclusively with eye procedures.

Different type of Surgery for Cataract Treatments

Advanced Phacoemulsification

Phacoemulsification uses ultrasound vibrations to break up the damaged lens of the eye. Your surgeon will make a small incision of about 3-5 mm on the side of the cornea, and insert a device to break up and suction out the lens. The lens will be replaced by a man-made lens. The incision heals on its own and does not require any eye-patch or stitches. This surgery takes less than 30 minutes.

Micro incision Cataract Surgery (MICS)

Micro incision cataract surgery (MICS) is minimal invasive cataract surgery, performed by making an incision of less than 1.8 mm. The lens is removed by the phacoemulsification procedure and is implanted with a MICS intraocular lens. MICS is associated with decreased postoperative complications such as corneal aberrations (scratch on the corneal surface) and corneal astigmatism (irregular curvature of the cornea).

Secondary Lens Implantation

Complex cataract surgery or injury can sometimes make it difficult for the surgeon to immediately replace the damaged lens with a plastic lens in your eye. You may have to wear prescription lenses until your eye heals. Following this, your doctor will suggest a second surgery for lens implantation. This is called secondary lens implantation. Your surgeon will make a small incision in the white part of your eye (sclera) and insert a lens implant. The implant is stitched to the sclera and the incisions are closed with small stitches.

Small-incision Cataract Surgery (SICS)

Small-incision cataract surgery (SICS) involves an incision of around 6-7 mm made in the form of a tunnel through the sclera and cornea. The lens is removed and replaced with a rigid lens implant through this tunnel. No sutures are needed as the tiny incision will heal naturally. It is a low-cost procedure compared to phacoemulsification and ensures good post-operative outcomes.

The surgeons of Associates in Eyecare implant every type of FDA approvedlens category including the light adjustable lens, multifocal lenses,extended depth of focus lenses and toric lenses. Every eye is unique andevery patient has individual vision goals so a customized plan is developedbefore every cataract surgery. During your consultation, we will takemultiple maps and measurements of your eye to help develop your customizedtreatment plan. Together we will decide which lens is the best option.

New Light Adjustable Lens

We are excited to be one of the first surgical practices in Denver to offer new light adjustable lens with cataract surgery. For the first time ever, we have the ability to fine tune the power of the lens (and how well you see without glasses) AFTER surgery with a painless UV light treatment in our office. The videos below will help to explain this exciting new technology.

Technology

We are committed to offering our patients all of the latest technology thathas been shown to improve patient outcomes based on peer-reviewednon-industry sponsored studies. We offer all of our patients pre-operativetesting that looks at the health of your eye and assesses how your uniqueeye shape and health impacts which lens design and power will best serveyou. Cataract surgery was once a last resort for vision that was extremelydegraded and has evolved to become refractive cataract surgery, helping ourpatients achieve their goals for their vision even without glasses.

Examples of our technology include the following:

  • IOL master 700 – The industry standard for biometric measurements helping us chose the appropriate lens
  • Pentacam testing for corneal astigmatism and baseline corneal health
  • I-Trace – This advanced eye imaging device uses ray tracing and aberrometric technology to show us the unique characteristics of your eye vital to the selection of the correct lens design and power

Experience

Dr. Kruger and Dr. Kokx have both performed over 5000 cataract surgeries. All this experience has translated into a team that has a much lower complication rate than most cataract surgeons in the area based on internally published data from the surgery centers in Denver. We are also specialists in eyes that have had previous refractive surgery and complicated pre-existing conditions such as Fuchs' Dystrophy and pseudo-exfoliation syndrome. We are proud of our extremely low complication rate and look forward to working with you to achieve your goals.

Description

Surgery is usually recommended for people who cannot see well because of their cataracts. The surgery is performed at our state of the art outpatient surgery center. Mineral Surgery Center is an outpatient surgery center that deals exclusively with eye procedures.

Patients are normally awake but sedated for the procedure. You will receive local anesthesia (numbing medicine) for pain control and a sedative to relax you. These work extremely well to make you comfortable.

Looking through a microscope, the doctor will make a small incision in the eye. The surgeon then removes the cloudy lens. Cataract removal involves the use of instruments and a machine that uses sound waves (ultrasonic energy) to break up the lens and suction it out. This is called phacoemulsification. A man-made lens, called an artificial intraocular lens (IOL), is placed next. It will help improve your vision.

The surgery usually lasts about 10 minutes. One eye is done at a time. If both eyes need cataract removal, your surgeon may recommend waiting a few weeks before having cataract surgery on the other eye.

To watch a video of our surgeons performing and narrating a real case of cataract surgery, see our video:

Below is a video of cataract surgery where Dr. Kokx narrates routine cataract surgery.

Dr. Kruger enjoys sharing his advanced cataract surgery techniques with other cataract surgeons. If you are interested in seeing these videos, please see Dr. Kruger's YouTube channel.

Cataract Patients With Glaucoma

Our doctors are experienced with a variety of combined procedures called MIGS (minimally invasive glaucoma surgery) including the iStent and goniotomy to help treat your glaucoma the same time as the cataract surgery.

What is the iStent Implant?

The iStent is a tiny titanium implant device measuring about 1 mm in length that is inserted into the eye from an injector system during a minimally invasive glaucoma surgery to treat mild to moderate open-angle glaucoma. The iStent is the tiniest implantable device in the world that has been approved for use in the human body. A study conducted in the US concluded that about 68% of people who underwent iStent implantation were able to manage their glaucoma successfully without medication for about a year.

Glaucoma is an eye condition characterized by damage to the optic nerve, which transfers the pictures we see from the eye to the brain, due to increased intraocular pressure (IOP) or internal eye pressure. The increase in eye pressure is a result of accumulation of eye fluid (aqueous humor). This may be due to the production of too much fluid in the eye or the inability of fluid to drain out properly from the eye. If left untreated, glaucoma can lead to progressive vision loss and ultimately blindness.

How Does the iStent Work?

The iStent device functions similar to stents used to treat narrowed or blocked arteries (blood vessels) to prevent strokes and heart attacks. When arteries get blocked or clogged, a stent provides access for the free flow of blood. The iStent device works in the same way. When you have glaucoma, your eye’s natural drainage system gets clogged over time. The iStent works by creating a permanent opening to facilitate the outflow of accumulated fluid, thereby reducing intraocular pressure to maintain optimum pressure within the eye.

iStent

Indications and Contraindications of iStent Procedure

The iStent procedure is mostly indicated for use in conjunction with cataract surgery to reduce intraocular pressure in individuals with cataract and mild to moderate open-angle glaucoma.

However, the iStent is contraindicated for use in individuals with:

  • Primary or secondary angle-closure glaucoma, including neovascular glaucoma
  • Retrobulbar tumor
  • Thyroid eye disease
  • Sturge-Weber Syndrome
  • Any other conditions causing elevated episcleral venous pressure

Preparation for iStent Procedure

Preoperative preparation for the iStent procedure will involve the following steps:

  • A thorough eye examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You should refrain from using makeup or lotion around the eyes a few days prior to the surgery.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for iStent Implantation

The iStent implantation is mostly performed under local anesthesia, where your doctor inserts the iStent device into the eye through a surgical procedure. The surgery involves the following steps:

  • Your surgeon will first numb your eye with anesthetic eye drops.
  • An eyelid holder will be placed on your eye to prevent the eye from blinking.
  • A small incision is made into the cornea to properly place the device.
  • Utmost care is taken to place the stent into the eye through the trabecular meshwork, a filter-like tissue located in the anterior chamber of the eye, where the eye fluids normally drain.
  • Once the stent is in place, it facilitates an exit between the anterior chamber of the eye and Schlemm’s canal.
  • This enables the eye fluid to bypass the clogged and damaged drainage system of the eye and exit into the deeper tissues of the eye, thereby lowering intraocular pressure.
  • The incision is then closed, and a protective shield is placed over the eye to complete the operation.

Postoperative Care and Recovery

In general, postoperative care and recovery after iStent implantation involve the following:

  • Arrange for someone to drive you home.
  • You should wear a protective eye shield for at least a week at night or while napping to protect the eye from rubbing in your sleep.
  • Keep both eyes closed and rest as much as possible during recovery.
  • You may experience sensitivity to light, blurred vision, or tearing.
  • You may notice some eye pain or discomfort for the first few days for which your doctor will prescribe medications as needed.
  • Steroid and antibiotic drops, as well as artificial tears, are prescribed to minimize the risk of infection, dry eye, and inflammation.
  • Limit reading and watching TV for the first few days.
  • Do not swim or use a hot tub, spa, or whirlpool for at least 2 weeks to reduce the risk of eye irritation and infection.
  • Do not apply eye makeup, cologne, lotions, or aftershave for one week.
  • Avoid strenuous activities and heavy lifting for a week so that there is no stress on the eye as it heals.
  • Wear sunglasses while outdoors to prevent discomfort from sun exposure and dusty environment.
  • You may need to take off from work for at least a week or two to facilitate recovery.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Advantages of iStent Procedure

Some of the advantages of the iStent procedure over other traditional glaucoma surgeries include:

  • Easy to perform
  • Faster recovery
  • High safety profile
  • Speedy recovery
  • Less expensive
  • Minimal damage to eye tissue
  • Reduces the side effects or inconvenience of using eye drops
  • Avoids or delays the need of more risky surgical interventions

Risks and Complications of iStent Procedure

The iStent implantation is a relatively safe procedure; however, as with any eye surgery, there are potential risks and complications that may occur, such as:

  • Bleeding
  • Infection
  • Inflammation
  • Retinal tears
  • Retinal detachment
  • Corneal edema
  • Corneal abrasion
  • Stent obstruction
  • Stent dislocation
  • Failure to improve eye pressure