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Cataracts Treatment & Surgery

About Cataracts

The only treatment for cataracts is surgical intervention. In just a few short years, the rapid advances in microsurgery and the Intra-ocular lens implants have enabled us to restore eyesight in cataract patients more easily and successfully than we ever dreamed possible. Dr. Walman has long been involved in researching improved methods of removing cataracts and replacing them with intra-ocular lens implants. In fact, through his research on intra-ocular lens implants, he holds patents on two types of flexible intraocular lens implants.

In ancient Greek times, the term “cataract” referred to a waterfall. If one is relaxing by the rushing, falling waters of a waterfall along a mountain stream, one may observe that the normally clear water is gray and opaque in color. In a similar fashion, a cataract is a cloudiness in the natural lens of the eye. This cloudiness will blur one’s vision no matter how great a pair of glasses may be in focusing. If the well-focused light, even through glasses, cannot penetrate through the cloudiness of the cataract, the vision will still be blurry.

Other prominent symptoms may include difficulty with glare during the day or at night. A normal street light at night may look hazy and grow streaks. The difficulties in driving at night are compounded by the cataract problems.

Causes of Cataracts

Cataracts may have any number of causes such as:

• Injury to the eye
• Inflammations of the eye
• Eye infections
• General systemic diseases – such as diabetes
• Certain medications – such as cortisone
• Metabolic imbalances – such as kidney disease
• Long term solar (UV) damage
• Family history
• Association with glaucoma

Most cataracts, however, will occur for no known reason. It is believed that the natural lens fibres of the eye simply wear out in time. At present, there is no medication or diet that will cure a cataract. There is no way to polish clean the cloudy lens. The only treatment involves surgery.

Treatment of Cataracts

When a cataract is surgically removed, the eye loses its natural focusing component. In years gone by, we had to replace the lost focusing power with thick heavy cataract glasses that looked like Coke bottles. In this old method, severe distortion of vision was present because of the thickness of the glasses. Peripheral vision was very poor. Even if central vision was clear and you could see a stop light in front of you, you might fail to notice the little child running out onto the street in your peripheral field of vision.

An alternative to replacing the lens with the thick heavy cataract glass was the use of contact lenses. This alleviated the distortion problems, but the patient had to be committed to a lifetime of contact lenses and all the problems that this would entail. Contact lenses are not always what they are cracked up to be!

In 1949, a British Ophthalmologist, Harold Ridley, was the first individual to think about using an implant. Dr. Ridley was an Ophthalmologist looking after pilots in the Royal Air Force. The doctor observed that while many pilots sustained eye injuries from the plane’s windshield during dogfights, there was a surprising absence of any reaction to this foreign material by the eye. These windshields were made of a plastic called “Perspex” (or Polymethylmethacrylate – PMMA). He decided that utilizing this material in the shape of a lens to replace the lost natural lens in cataract patients might indeed work well. Dr. Ridley’s first experimental procedures failed miserably — mainly because of problems manufacturing the implant. However, the idea was born, and over the next several decades, designs and technologies of intra-ocular lens implants gradually improved.

Dr. Walman’s Invention: A New Intra-ocular Lens Implant

In the early 1980′s, after Dr. Walman had completed residency training and had started his practice in Arizona, it occurred to him that implants could be improved by increasing the flexibility of the supporting haptics. He proceeded to design a unique style of intra-ocular lens implant that had significantly more flexibility for greater comfort and better post-op vision results. Dr. Walman was granted a patent on the design with the U.S. Patent office. This style of intra-ocular lens implant has been used extensively throughout the world.

Premium Implants – Achieving the dream of vison far and near without glasses

Classically, in traditional intraocular lens implantation – the implant that has been used is a monofocal implant – that is, one can focus on distance vision, but the individual is dependent on reading glasses for near vision.

In the last few years, the FDA has approved the new technology implants; these newest implants can correct astigmatism, far distance, and near vision without the need for dependence on glasses. Ask us to discuss with you if this implant would be suitable for your individual circumstances.

No Stitch, Micro-incision, Foldable Implants

The main reason for the rapid improvement in visual results and the rapid return to normal activities is primarily a factor of the tiny incision that is utilized. Through a high powered microscope, the incision is so tiny that no suture is necessary to seal the area. Implants are now made of very flexible foldable materials that can be manouvred through the tiny micro-incision and then unfold only after they are in the correct position when internally placed in the eye.

The Experience of Modern Day Cataract Surgery with Implants

The surgical treatment of cataracts is presently considered one of the most successful types of surgery known. Individuals afflicted with visual problems no longer have to wait for a “white cane” before improving their vision through modern technology.

After the decision is made to proceed with treatment, careful measurements of the eye with ultrasound are made. This information, as well as other parameters, are put into a computer, which then produces the correct power of intra-ocular lens implant for that individual.

The surgery is generally done as an outpatient in one of our state and Medicare certified surgicenters. An intra-venous is started, through which relaxing medication is administered (to the patient, not the doc). The region around the eye itself is then gently numbed so that the patient is comfortable. During the procedure, the patient cannot see any details of what is occurring. He or she is simply relaxing, under the influence of the medication as well as relaxing music. The patient sees nothing, does not have to worry about not moving, and should experience no more than perhaps an occasional vague pressure sensation.

When the procedure is over, the patient is able to get up under his or her own steam and go home the same day to activities that are pretty close to normal. No stitches are necessary. Often, even a patch is unnecessary. Normal activities can be resumed rather quickly. Patients can generally be back to work or on the golf course 1 to 2 days after surgery.

After the procedure, patients are often pleasantly surprised at the rapid improvement in vision. Although nobody should guarantee results, we are pleased to be able to assure people that excellent results (assuming pre-existing healthy eyes) can be achieved in over 95% of people.

YAG Laser for Secondary Membranes After Cataract Surgery

Many people have the misconception that Lasers are used for cataract treatment. Cataracts, in fact, are removed by ultra-sound; but if scar tissue forms behind the implant sometime after surgery, the ‘YAG’ laser is used to effectively remove the scar tissue.

With this technique, a procedure that required surgery 2 decades ago, can now be relatively easily performed without surgery and allowing the patient to return to normal unrestricted activities immediately. We can comfortable say that no pain at all is associated with the procedure. Vision that was previously blurred as a result of this cloudy membrane that grows behind the implant, usually improves remarkably within 1 to 2 hours after the laser procedure.