Come see at any of our Ohio locations: Canton, Canfield, or Alliance
Femtosecond Laser Cataract Surgery (FLACS or LCS)
In 2011, femtosecond Laser Cataract Surgery (FLACS) was introduced and is now promoted in many centers. The doctors at RVI have extensive experience with FLACS, in fact Dr. Roholt was one of the first in the area to use this technology (we will perform the surgery upon patient request). FLACS is performed with a laser such as the LenSx™, Catalyse™ or others, which are used to make the incisions, open and soften the cataract, but has not been shown to improve the result of cataract surgery. As time passes and the laser technology improves, benefits may become more clear. Because the extra cost is significant, and since Medicare and Insurance do not pay, almost all patients opt for the traditional, gentle ultrasonic PE method. A new benefit of the more traditional method is the ability to use ZeptoTM which is explained next.
One of the most important steps in cataract or lens replacement surgery is the capsulotomy or capsulorrhexis. The natural human lens, or cataract, is enclosed by a thin, saran-like sac. This “capsular bag” must be entered and peeled away to remove the lens. Currently, there are three ways to accomplish this: 1) the traditional method uses small instruments to peel it away, 2) FLACS capsulotomy, and the latest innovation, ZeptoTM.
The ZeptoTM uses an electronic pulse to instantly create a perfectly round capsulotomy, which helps in intra-ocular lens centration. The edge of the capsule is congealed for increased strength, which helps in avoiding complications such as tearing of the capsule edge. The ZeptoTM is even stronger than the traditional method, which itself is stronger than a FLACS capsulotomy. It is also less costly to the patient than FLACS.
The lens implants used by RVI doctors are high-tech, FDA approved designs. The most common material for lens implants since 1953 is derived from a hard plastic called polymethylmethacrylate (PMMA). Now foldable PMMA (or acrylic) implants are used. Foldable silicone lens implants are also used and are safe and effective (this is not the same type of silicone used in breast implants). The doctors will take various factors into consideration when deciding which implant to place in your eye. Roholt Vision Institute uses the Humphrey-Zeiss IOLMaster™ and Lenstar™ and the iTraceTM eye analyzer, which is a first in NE Ohio. These technologies enable eye measurements for lens implant which are more accurate than those used previously. For more information, visit the Zeiss, Haag-Streit or Tracey <http://www.traceytechnologies.com/index.html> website.
Now you must consider your choices for lens implants – to help in your decision, ask yourself:
“Do I want to be less dependent upon glasses or is wearing glasses ok?”
1. Basic Implant
This lens is a single vision intra-ocular lens, which gives excellent vision. You will need reading glasses and possibly distance glasses. Medicare and insurance pay for basic implant surgery subject to coinsurance and deductible.
2. CustomCorrection I™
This is for patients who prefer to be less dependent on glasses. All the CC surgeries use the ZeptoTM technology to help improve safety and accuracy. Extensive testing is used to maximize crisp, glasses-free vision. The implants used generally are calculated to reduce spherical aberration, often giving better night vision. (Click Here) Roholt Vision Institute was the first center in Ohio to use advanced software for custom lens implant matching for spherical aberration. You would need reading glasses, unless you elect a monovision blend (one eye for distance, one for near). Sometimes a secondary treatment (LASIK, PRK, CK or others) is required to reduce the eyeglass dependency, included in CustomCorrection I™. Medicare or insurance will not pay for CustomCorrection™, only what they would pay for basic cataract surgery.
3. CustomCorrection II™
Symfony™, Tecnis™ Multifocal, Crystalens™, Restor™
The above lens implants are multifocal lens implants which allow patients to achieve both distant and near vision without eyeglasses. Each type has unique characteristics, and the doctors at RVI are skilled at implanting all. Dr. Roholt was one of the first implant surgeons in the Midwest involved in multifocal lens implant research in the early 90’s as an investigator in the Storz TruVista™. Now the new advanced designs offer opportunities for glasses-free vision, and the Symfony™ Toric and Crystalens Trulign™ even correct for astigmatism. The disadvantage of the multifocal lens is a possible slight decrease of clarity in low contrast, or glare with night driving, compared to single vision implants. There is an additional charge that is not covered by Medicare or Insurance with the election of one of these lenses. For more information on these lenses visit: Tecnis Symfony™, Tecnis Multifocal™, Acrysof Restor™, or www.crystalens.com.
4. CustomCorrection A™
A special “Toric” or astigmatism-correcting lens implant (Acrysof™, Tecnis™, or Crystalens Trulign™) is used to achieve the same results as in CustomCorrection™ for individuals who have moderate to severe astigmatism. Medicare or insurance will not pay for this, only for the basic amount of the surgery.
YAG Laser and Secondary Cataract (After-Cataract)
A secondary cataract, or cataract re-growth, is a frequent occurrence after lens implant, lensectomy, or cataract surgery, and can occur within weeks after the original operation. This occurs even with a perfectly performed eye surgery. A YAG laser (Yttrium-Aluminum-Garnet) is used to open the wrinkled or fogged membrane behind the lens implant. This laser procedure takes five minutes and is painless. The secondary cataract will usually not recur. Performance of a YAG laser is more common with Multifocal implants (CustomCorrection MFTM). With CC-MFTM the YAG may be performed prior to a focusing procedure such as LASIK, PRK, or CK. Dr. Roholt’s practice was the first in NE Ohio to use the YAG laser. This treatment is NOT included in the cost of CustomCorrection™ and is billed separately to insurance or Medicare.
Focus Defects and CustomCorrection™
Myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (warped cornea) are all focus defects that can be improved by lens implant surgery with CustomCorrection™. The eyeglass lens power needed for the eye is incorporated into the lens implant. Astigmatism is caused by a distorted “spoon shaped” cornea. This visual defect can be reduced or eliminated using a toric lens implants as in CustomCorrection ATM, or through LASIK or other CustomCorrectionTM techniques. As physicians specializing in refractive surgery (correction of focus defects), the Drs. at Roholt Vision are uniquely qualified to help you attain the best vision possible.
The incision into the eye is generally very small and is self-sealing, creating a “No-Stitch” incision. However, sometimes for safety’s sake, one or more sutures are placed to close the incision and, therefore, the “One-Stitch” procedure is used. In general, the surgery is tailored to the individual.
The cataract/lensectomy surgery is performed using anesthetic placed around the eye area and/or adjacent eyelids, or strong eyedrop “topical” anesthesia which causes complete loss of pain sensation. A short-acting sedative is also used to eliminate anxiety or discomfort.
Roholt Vision is one of the first centers in Ohio to offer the EZ-Drop™ method of antibiotic/steroid prophylaxis after cataract surgery. This greatly reduces the number of drops that need to be instilled. The risk of infection is also reduced compared to the conventional methods of multiple eyedrops.