Advanced Cataract Surgery. We Bring Life Into Focus

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1 Advanced Cataract Surgery We Bring Life Into Focus

2 What is a Cataract? Standard Cataract Surgery A cataract is the clouding of the normally clear lens of the eye, which prevents light entering the eye from being focused properly on the retina. Cataracts are a normal part of the aging process and can begin to affect the clarity of vision as early as age 50. In fact, it is said that most people will develop cataracts if they live long enough. Early changes may not disturb vision, but over time, cataracts will result in blurred or fuzzy vision, difficulty reading, and driving at night due to sensitivity to light and glare. People with advanced cataracts often say they feel as if they re looking through a waterfall, or a piece of wax paper. Early Symptoms of Cataracts LaserVue Eye Center offers two levels of cataract surgery: Standard and Advanced Laser Cataract Surgery. Standard Cataract Surgery involves creating a 2-3mm incision with a blade to enter the eye. The cataract is then removed using a high-frequency device (Phacoemulsification) that breaks up the cloudy lens into small pieces. These pieces are then Advanced Laser Cataract Surgery gently removed from the eye using suction. Next, a clear intraocular lens is inserted into the eye in the same location your natural lens occupied. Our Standard Cataract Surgery Option includes manual cataract surgery with a standard monofocal IOL. Currently, there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only way to achieve clear vision again is through cataract surgery. In your parents or grandparents day, cataract surgery was considered quite risky, required a lengthy hospital stay, and was usually postponed for as long as possible. Today, cataract surgery is a comfortable outpatient procedure that allows patients to avoid the inconvenience and expense of a hospital stay. In fact, most patients vision recovers well enough to see to drive as quickly as a few days after surgery. Cataract surgery is considered to be one of the safest and most successful procedures performed in medicine today. It involves creating a microscopic incision through which the cataract is removed and a foldable intraocular lens (IOL) is implanted to replace the clouded lens. This small incision seals itself naturally and allows for comfortable and rapid healing. Symptoms of Cataracts: Decreasing vision with age Blurred or double vision Seeing halos around bright lights Difficulty distinguishing colors Frequent prescription changes for glasses Difficulty reading Lens Natural Clear Lens Cataract Natural Lens with Cataract Causes of Cataracts: Age Eye trauma Diabetes Some medications including long-term use of oral steroids Smoking Glaucoma Advanced Laser Cataract Surgery refers to not only removing the cataract, but also performing additional procedures at the time of cataract surgery and/or replacing the cataract with an IOL that can reduce one s dependence on glasses or bifocals. For most cataract patients, life without reading glasses or bifocals is something they either experienced when they were very young or they just dreamed about for most of their lives. Advanced Laser Cataract Surgery provides advanced options and intraocular lenses (IOLs) to enhance your vision and provide you with decreased dependence on glasses. Specifically, Advanced Laser Cataract Surgery addresses presbyopia and astigmatism. These are the conditions that remain even after standard cataract surgery. Advanced Laser Cataract Surgery goes beyond standard cataract surgery by also managing astigmatism and/or replacing the cataract with an IOL to reduce your dependence on glasses or bifocals. It is important to note that insurance and Medicare covers standard cataract surgery, but they do not cover the testing or the advanced IOL options for Advanced Laser Cataract Surgery. Learning that you have a cataract can cause concern, but once you understand how your vision may be improved, you may actually have reason to be excited.

3 The Procedure Unlike other systems, the LENSAR Laser Cataract System is unique in that it is specifically designed for cataract surgery. It uses a proprietary, highresolution 3D CSI imaging device, which gives your surgeon a fully automated analysis of the cornea and lens surfaces, and couples that with an advanced femtosecond laser. These systems work together to deliver laser pulse placement, resulting in incredibly precise surgical incisions. Laser Cataract Surgery is performed in LaserVue s Medicare certified, AAAHC-accredited surgical facility and only takes 15 to 20 minutes. In addition to using the LENSAR laser to accomplish many of the surgical steps that were traditionally performed by hand, we use the latest innovations in cataract surgery, such as drops only anesthesia (no shots), and sutureless small-incisions through the clear cornea. Foldable, intraocular lenses are chosen to match your vision needs. The precise, reproducible steps performed by the LENSAR laser mean better lens positioning, less trauma to the eye and more predictable visual results, which are especially important if you want to reduce or eliminate your dependence on glasses. The procedure begins with the laser creating an opening called a capsulorhexis in the thin capsular membrane that surrounds the natural lens. This opening provides access to remove the natural lens. In order to remove the cataract, the lens must be softened in preparation for removal. This critical step is also performed by the laser, which makes the procedure gentler and reduces the amount of ultrasound energy needed to break the lens into manageable pieces for removal from the eye. Studies have shown that laser treatment requires 45% fewer surgical movements to remove cataracts compared to manual surgery that means greater precision and greater safety. After the natural lens is removed, the IOL of your choice is positioned inside the eye. Because we use self-sealing incisions, the eye is sealed without the need for sutures. Manual Blade Incision Laser Incision Manual Capsulorhexis Laser Capsulorhexis Manual Lens Division Laser Lens Division

4 Astigmatism Presbyopia Correcting IOLs Nearsightedness and farsightedness are common forms of visual distortions that we are familiar with. Astigmatism is another form of visual distortion that often occurs simultaneously with nearsightedness and farsightedness. Astigmatism is typically caused by the cornea (clear window of the eye) being shaped more like a football than a basketball. This causes images to focus at different points on the retina, resulting in blurry or double vision. Astigmatism can also be caused by similar irregularities in the shape of the natural lens inside the eye. Astigmatism can usually be corrected with glasses or contact lenses but can also be treated at the time of your cataract surgery to reduce your need for glasses postoperatively. correcting astigmatism with laser cataract surgery correcting astigmatism with toric IOLs Our Advanced+ Cataract Surgery Option includes Laser Cataract Surgery and the insertion of a Toric IOL that corrects higher levels of astigmatism along with pre-existing nearsightedness or farsightedness. Dr. Bansal will discuss the best method of correcting your astigmatism prior to your surgical procedure. Presbyopia is a condition most people over the age of 40 experience that results in difficulty seeing up close without the aid of bifocals, trifocals, or reading glasses. This age-related condition is believed to be caused by a hardening of the natural lens inside the eye, making it difficult for the eye s muscles to change its focus. Many people realize they have developed presbyopia when they find themselves having to push reading materials further and further away to focus. Patients, who undergo cataract surgery with a standard monofocal IOL, will experience the same visual effects as presbyopia because standard monofocal IOLs can only focus at one distance. However, by choosing Laser Cataract Surgery with a presbyopia correcting Multifocal or Accommodating IOL, patients will realize a decrease in dependence on glasses, contacts, or bifocals at all distances for most of their daily activities. We refer to this option as our Advanced+ Premium Cataract Surgery Option. Many people describe their vision with this option as being able to see young again. There are a number of advanced presbyopia correcting IOLs that we make available to our patients. Which one is best for you will depend on the unique characteristics of your eye, as well as your lifestyle needs. The Laser Cataract Surgery procedure gives Dr. Bansal the ability to reduce mild amounts of astigmatism with the accuracy and precision of the LENSAR laser. Microscopic corneal incisions are made in the outer margins of the cornea to reduce astigmatism which is yet another important benefit of Laser Cataract Surgery. These incisions reduce the curvature of the steeper axis of the cornea so that it brings images to focus on one point of the retina instead of several. For patients with mild astigmatism, our Advanced Cataract Surgery Option will provide the best distance vision with a standard monofocal IOL. The laser may also be used to correct astigmatism with our Advanced+ Premium Cataract Surgery Option that uses presbyopia correcting IOLs. After Cataract Surgery without Astigmatism Corrected Astigmatism Corrected with a Blade After Cataract Surgery with Astigmatism Corrected Astigmatism Corrected with Laser Monofocal IOL Presbyopia Correcting IOL

5 Refractive Lens Exchange Are your cataracts not quite so severe, but you still want to see without glasses? Refractive Lens Exchange (RLE) may be the solution for you. RLE corrects nearsightedness, farsightedness and astigmatism, and when coupled with a presbyopia correcting IOL, it is often the procedure of choice for patients over 50 who wish to reduce their dependence on glasses or contacts in a more permanent way. It is also an excellent alternative for those individuals who may be showing early signs of developing cataracts or that have corneas that are too thin to correct their vision with LASIK or PRK. Millions of eyes have received intraocular lens implants when undergoing cataract surgery, using the same highly successful surgical techniques used in RLE. The primary difference between cataract surgery and RLE is that cataract surgery is performed to remove a patient s cloudy lens, and Refractive Lens Exchange is performed to reduce one s dependence on glasses or contact lenses. RLE, with a presbyopia correcting IOL, along with Laser Cataract Surgery can provide patients with exceptional visual acuity for near, intermediate and distance vision. In fact, the majority of our patients who select this option find they rarely need glasses for most of their activities. Natural Clear Lens Replacement IOL Choosing the IOL that Best Fits Your Lifestyle NEAR: INTERMEDIATE: DISTANCE: ASTIGMATISM: Multifocal IOLs can provide a full range of vision from near, to intermediate to distance. Pros: They can eliminate the need for glasses for most activities. Multifocal IOLs may also be available that have the ability to correct astigmatism (Multifocal Toric IOLs). Cons: They can create rings around lights at night which usually diminish over time. Toric IOLs are monofocal IOLs that correct higher levels of astigmatism. These monofocal IOLs usually provide excellent distance vision for patients with pre-existing astigmatism. Pros: They are ideal for patients who want clear distance vision without glasses. Cons: Because they are monofocal lenses, patients will still need glasses for near and intermediate vision. Standard Monofocal IOLs can provide clear distance vision for patients without pre-existing astigmatism. Pros: Their costs are typically covered by Medicare and other insurance. Cons: Most patients will need glasses all the time for clear vision. *Individual results may vary.

6 Preparing Ask our Doctors If you re considering cataract surgery, here are a few questions you may want to discuss with our eye doctors: For The Procedure Which type of IOL is best for my needs? How much does cataract surgery cost? What payment options are available? How can I prepare my family or caregiver to help me throughout the surgical process? Will any of the prescriptions I m taking complicate the surgical or recovery process? Will any of my pre-existing medical conditions affect the surgery? What kinds of risks are there? How can I minimize them? During your preliminary appointments at LaserVue Eye Center, our doctors and staff will review your medical history, including any pre-existing condition and medication you might be taking. You may also be asked to get medical clearance from your primary physician. As your surgical date approaches, our surgical team will walk you through the final preparations for the procedure when to arrive, what to wear, which medications to take, etc. You may be asked to begin administering prescription antibiotic and anti-inflammatory eye drops a few days before the procedure. Here s a step-by-step overview of the procedure: The skin around your eye will be wiped with disinfectant, and medicated eye drops will be applied. These drops prevent infection and inflammation, and will keep your pupil fully dilated during the procedure. THE SURGERY: Quick but Complex The typical cataract surgery procedure lasts 20 to 30 minutes, although some cataracts are more difficult to remove and may require more time. During these initial appointments, make sure you understand and feel comfortable with the entire surgical process before, during and after. Clear up any questions you have about the time line, side effects or complications. Depending on the type of anesthesia Dr. Bansal will be using in your particular case, you may need to fast the night before surgery. The day of the procedure, you should plan to arrive at least an hour before the operation the entire process usually takes less than two hours. You ll also need to arrange for someone to drive you home afterward. To ensure you feel no pain during surgery, your eye will be anesthetized with topical drops or a local injection depending on Dr. Bansal s preference with your case. You won t be put to sleep for the procedure, but you ll likely receive a mild sedative, so that you stay relaxed and comfortable throughout. After making a tiny incision (2-3mm) in your cornea, Dr. Bansal will use either a femtosecond laser or a manual probe the size of a pen tip to break apart the old lens. The fragmented lens is then suctioned out. Cataract Removal After making a small incision in your eye, your surgeon will insert a probe to break up and remove the cloudy, cataract-affected lens. Once the old lens has been removed, Dr. Bansal will insert the replacement intraocular lens (IOL) of your choice into your eye. Typically, the IOL is rolled up into the tip of an injector tool, so that it can be inserted through the same tiny incision. Once injected, the IOL unfolds perfectly into place. Lens Insertion The flexible IOL is folded up and inserted into the lens capsule, at which point it opens, and its haptics, or arms, unfold to keep it in the proper position. Because of the small incision, you probably won t require stitches your eye should heal itself naturally. And that s it! All you have to do now is rest up, and get ready to enjoy the benefits of improved vision often even better than before the cataract developed. Vision Restored With the cataract removed, and the IOL in place, light can once again travel unimpeded to the back of your eye for clearer, more youthful vision.

7 Free and Clear Life After Cataract Surgery and Your New Outlook Okay, the hard part s done. And really, it wasn t all that hard! After a brief, virtually painless procedure, it s time to rest up and enjoy the benefits of your newly restored vision. You may be a little worried about the recovery process following cataract surgery we are talking about your only set of eyes, after all. smooth healing is up to you Although state-of-the-art surgical techniques and technology certainly help the recovery process, a good deal of credit goes to the amazing resilience of your eyes. The eye recovers and adapts with surprising speed and you can aid in this process by carefully following our postoperative instructions. Every patient and every eye is different we will develop a personalized recovery time line and specific instructions to best suit your needs. Still, to give you an idea of the recovery process, here s an example of a time line of what you can expect in the hours and days following a typical cataract surgery procedure: once the surgery is completed After the procedure, Dr. Bansal will usually apply some antibiotic and anti-inflammatory drops. For the first hour or so, you may feel slightly groggy from the local anesthetic and sedation this will pass. Before you leave, you ll receive instructions in how to care for your eye. A loved one or caregiver must be on-hand to drive you home, so you can rest up. Rest assured, however thanks to highly perfected techniques and tools, recovery from cataract surgery is usually quick, with a low rate of complications. Best of all, though, are the amazing results for the vast majority a return to clearer more youthful vision within a matter of days! The days to follow The day after the procedure, you will need to return to our office for a follow-up visit, just to make sure your eye is healing properly. Additional check-ups are usually scheduled for a week and a month after the surgery. For the first week, your eye s health will depend on you more than ever. Make sure you stick to your our postoperative instructions, avoid strenuous activities and administer your medications as prescribed. Be careful not to rub or place pressure on your eye. During the first week, you may experience some mild A Whole New Perspective The day after cataract surgery, most patients find they can resume many everyday activities watching TV, reading, even some light chores. Then, within a week, you ll likely be ready to take on a new world of enhanced vision you can drive, go back to work, and much, much more. After the procedure, colors may seem more vibrant, your vision clearer, more in focus maybe for the first time in years. Think about how this new outlook will change your life. aftereffects from the procedure, including itching, discharge and vision fluctuations. These are normal, and tend to subside quickly. Sensitivity to light can be common; sunglasses help. If you experience any discomfort, talk to your doctor about taking an overthe-counter pain reliever. Although complications are generally uncommon, contact our office immediately if you experience severe pain, swelling, redness, bleeding, loss of vision or double vision. These problems are usually treatable if dealt with right away. Restored vision often motivates patients to pick up the tasks and hobbies that their cataracts once prevented them from doing you might even be inspired to take up some new ones. And why not? Cataract surgery doesn t just improve your vision it opens up a whole world of possibilities.

8 YAG Capsulotomy Cloudy Capsule Following Surgery At some point following cataract surgery, most people eventually experience some clouding of the capsular membrane that holds the IOL in place. It typically will cause blurry vision and many patients actually think their cataracts are growing back, but this is not what is happening. The clouding can happen weeks, months, even years after your cataract surgery. If you notice a change in your vision, contact your eye doctor. Which of These Options is Right for You? It is likely that any of our Advanced Laser Cataract Surgery options will reduce your dependence on glasses or contacts. However, every eye is different, everyone has different visual needs, and individual results may vary. Your first step is to have a thorough eye examination to determine the health of your eyes so that we can make a recommendation based on our examination and your visual needs. Even with advanced diagnostic testing and meticulous surgery, there is no guarantee that you will have 20/20 vision or never wear glasses again. YAG Capsulotomy A procedure called a YAG Capsulotomy can restore your personal best vision. It is a simple, outpatient laser procedure performed in LaserVue Eye Center s AAAHC-accredited surgical facility. The YAG procedure takes only a few seconds and there are no restrictions on activities. If you would benefit from a YAG Capsulotomy, it is considered a medically necessary procedure, which is typically covered by your health insurance plan. About Dr. Bansal Jay Bansal, MD, Medical Director of LaserVue Eye Center is a nationally-recognized Cataract and Refractive Surgery specialist. Dr. Bansal is certified by the American Board of Ophthalmology. He received his medical degree from the University of Nebraska and received his Fellowship in Cornea and Refractive Surgery from the Hermann Eye Center, University of Texas Medical Center. Cataract surgery was one of the best decisions I ever made. I didn t just regain my vision I got my whole life back! It was worth every penny... Kathy A. Dr. Bansal was among the first eye surgeons in California to perform the LASIK procedure and one of the first surgeons in the country to offer Laser Cataract Surgery with the femtosecond laser. His career is dedicated to the research, teaching, and practice of advanced vision correction techniques. He has performed over 20,000 successful cataract and vision correction procedures. As a renowned San Francisco Bay Area ophthalmologist, Dr. Bansal lectures frequently on vision correction surgical techniques both nationally and internationally. Your Clear Choice Schedule your consultation with the North Bay s most experienced laser cataract surgeons at LaserVue Eye Center today. Call LASER45 or to schedule your appointment and ask to speak to a Patient Care Counselor for more information. You can also visit our website at

9 3540 Mendocino Ave., Suite 200 Santa Rosa, CA Phone: Toll-Free: LASER Patient Education Concepts, Inc

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