By Drs. Barry Drucker and Elizabeth Kim
It’s pretty obvious that patients desire an ideal result after cataract surgery. Who wouldn’t want perfect vision: no glare, no discomfort and the ability to see far and near without using glasses. When approaching cataract surgery in our practice, we always shoot for perfection.
I believe all other surgeons also strive for these ideals; however, sometimes a surgeon has limitations in his or her level of skill, preventing such a blissful result. Other times, the state of the patient’s eyes prevents perfection, or an unforeseen problem found during surgery gives less than absolute visual nirvana.
Patient limitations, preventing perfection
There are patients, particularly the elderly, who do not have a perfect “20/20 potential vision” due to ocular problems other than cataracts. For example, macular degeneration or other diseases may limit the results of fine surgery. Your surgeon should be able to predict what level vision is attainable post operatively by the use of a simple test. If there is some question as to the expected results of cataract surgery, we use a “potential acuity meter,” known as a “PAM,” that is safe and rapid.
Surgeon limitations preventing perfection
We have seen many unhappy patients who come to us after cataract surgery with a complaint of blurred vision from an inaccurate IOL implant power, which leaves large amounts of near or farsightedness. Often the two eyes do not jive and cause headaches or double vision.
This problem can be avoided by more accurate measurements and frequent calibration of machinery to prevent such inaccurate results. A comparison of each eye during the measurement will also put up a “red flag,” telling the ophthalmologist to remeasure with the ultrasound scan or a laser-guided device that determines the necessary power of the implant.
While all machinery has its limitations, the results should be within tolerable limits. Another problem is pre-existing astigmatism, which leaves the patient eyeglass-dependent, post operatively. This can be obviated by specially placed corneal incisions, at the time of surgery, to reduce astigmatism. Not all surgeons have the skill to do this. Yours should.
Please note that this procedure is not covered by Medicare and most other insurances. Occasionally, the use of implants that correct astigmatism can be used; however, these have some inherent problems in and of themselves, such as unwanted post-operative rotation.
Complications preventing visual perfection
The most common complication of cataract surgery is a tear in the posterior capsule of the lens. This fine capsule is usually left behind to support the implant. If the procedure is done with skill, the incidence of this capsular break should be rare.
Note that there are some predisposing situations that greatly increase the chance of this complication. These include poorly dilating pupils, short eyes as seen in high hyperopia, lax supporting ligaments of the lens and very dense hard cataracts. When the capsule breaks, lens material can fall down toward the retina, necessitating a second operation for its removal.
The broken capsule also increases the risk of swelling of the macula and even infection. Obviously, prevention of this complication is the best treatment. Your surgeon should have the experience and the knowledge to deal with the predisposing factors to limit such problems.
While many things can lead to a less-than-perfect result, cataract surgery remains one of the most common procedures and one of the safest. Choose your surgeon carefully. Not all eye surgeons are created equal.
Dr. Barry L. Drucker is a board certified ophthalmologist and a Fellow of the American College of Surgeons. He has been practicing ophthalmology in Bayside for more than 20 years. Dr. Kim has completed a corneal fellowship at Mt. Sinai Hospital and a glaucoma fellowship at Cornell University. She is board certified. They can be reached at 718-224-5500 or at their Web site: www.baysideeye.com.