Andrew Cies, M.D., F.A.C.S. - Welcome to Newport Center Laser Center!

How does the eye work?

Light enters the eye through the clear outer dome, the cornea, and goes through the pupil.
The lens is just behind the pupil: it transmits and focuses images on the retina, which is like film in a camera.

Cataract

The macula is the central receptor site of the retina and provides our sharp vision for tasks such as reading and driving. The retina sends the image via the optic nerve to the brain for processing.

What is a cataract?

A cataract is a progressive clouding of the human lens inside the eye. The lens is a small oval like structure and consists of a thin capsule (like saran wrap) enveloping a bag of protein.
The protein is crystal clear and colorless at birth but discolors and clouds with age: first yellow, then brown, and finally cloudy.

Whitish pupil shows the cataract.

When the lens becomes cloudy and interferes with vision, it is called a cataract.
The lens no longer transmits or focuses light clearly. A cataract is not a growth, a "skin", or a disease. It is usually not a sign of eye or systemic disease.

Clear lens - Cloudy lens.

When should you have surgery?

Cataract surgery is elective: It is done only when the person wants and needs it. Everyone has a different personality and different needs.

Choose to have surgery when you cannot see to enjoy or perform to your satisfaction in jobs, hobbies, driving, athletics or outdoor activities.

How does a cataract affect vision?

Initially the cataract changes the focusing power of the eye, and a change of glasses can satisfactorily improve vision. Gradually, clarity drops so that visual tasks become increasingly difficult, despite the best possible glasses.

Cataract1

Current Cataract Technology:

Cataract surgery is usually fast, comfortable, and quite successful. Surgery is performed at an outpatient surgical center, not a hospital. Anesthesia consists of minimal sedation and eye drops for comfort. The surgery usually takes less than 15 minutes.

All surgical work is done through a self-sealing (sutures are usually not used) opening into the eye that is about the size of a pen tip. Sutures are usually not necessary.

The cloudy lens is removed with an instrument that loosens the cloudy lens protein (emulsifies) and gently vacuums it out of the eye. The instrument is called a phacoemulsifier and is not a laser.

Vacuums

Phacoemulsifier vacuums the
cloudy lens material from the eye.

Once the cloudy lens is removed, a lens implant is necessary to restore the focus of the eye. The lens implant is folded and inserted through the same tiny opening into the eye.

Phacoemulsifier removing cloudy lens material.

Lens implant positioned through pupil and behind the iris.

Laser Assisted Cataract Surgery (LensSx):

LenSx cataract surgery is a new development to assist with greater control and accuracy in cataract surgery. Basically there are several incisions made in traditional surgery by hand. With LenSx a laser makes these incisions. The overall approach to cataract surgery is otherwise the same.

Lens Implants

When the cataract, the cloudy lens, is removed, the haze is eliminated.

Lens implant size.

However, the focus of the eye must be restored. Intraocular lens implants are made of a type of plastic or silicone.

The lens implants can be folded to permit placement inside the eye through the tiny incision already made for cataract removal. The power of the lens implant is calculated to give the best distance vision possible without glasses. This approach is called the standard lens implant strategy. Bifocals may be necessary to sharpen vision for fine near tasks.

Lens folded to be placed on eye.

Lens Unfolded

Unfolded lens implant.

Specialty Lenses

A new approach for lens implants is called specialty lens implant technology. This new technology can give the patient distance, intermediate and near vision. There are two different approaches to specialty lens implants. One, the Crystalens, looks like a standard lens implant but can focus near objects through the muscle effort that we all use to see near objects. The other approach,ReStor , uses a multifocal technology, much like sophisticated progressive eyeglass correction. Both approaches can result in significant or total freedom from glasses.

Lens Folded

Insertion of lens implant into eye.

Lens Unfolded

Postoperative appearance of eye
With lens implant in proper position
in lens capsular bag.

Laser:

From several months to several years after successful cataract surgery, a cloud may develop behind the lens implant.

This is called a secondary cataract and will blur vision much as the original cataract did.

YAG laser opens hole in cloudy
capsule behind lens implant.

The YAG laser is used in the treatment of secondary cataracts. The YAG laser makes a small opening in the cloudy membrane behind the lens implant. This requires 2 minutes and usually results in immediate vision improvement. The YAG laser is not used for the original cataract surgery.

Before

Before

After