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Cataract Surgery at San Antonio Eye Institute


What is a Cataract?

The eye functions somewhat like a camera. Inside the eye is a lens. When we are young, the lens is clear and works to focus light on the retina. A clear lens lets light pass without degrading the image. In this instance, we have clear, sharp vision. As we get older, the lens slowly becomes cloudy. This process can begin in our 30’s or 40’s, but doesn’t significantly affect our vision until our 50’s, 60’s, or 70’s. We call a cloudy lens a “cataract“. This occurs as a consequence of oxidation. When images you see pass through this cloudy lens, the images are degraded and causes images to appear blurry. In the clinic, we sometimes use the example of the headlights on a new car being clear when you first buy it. However, as the car ages, the headlights can become cloudy. The clouding of the headlights on a car also progresses because of oxidation.


Symptoms include:

  • Difficulty driving
  • Difficulty seeing at night
  • Difficulty viewing a computer screen, a phone or tablet
  • Colors appear dim and faded
  • Frequent changes in glasses prescriptions


What is Presbyopia?

In the early stages of cataract formation, the lens may not be very cloudy, but it’s becoming stiffer. This stiffening of the lens is called presbyopia. In an eye with presbyopia, the natural lens has increasing difficulty focusing on intermediate and near objects. Light fails to reach a single point on the retina when viewing objects up close and instead focuses on a point behind the the retina.

Symptoms include:

  • Losing your ability to read up close
  • Cloudier or fuzzier vision at near distance
  • Difficulty viewing a computer screen, a phone or tablet
  • Needing reading glasses or biofocals
  • Holding objects further away to read


What can I do About Cataracts?

Many studies have been done looking for ways to slow the progression of cataracts. Antioxidants and protecting the eyes from UV light with sunglasses have been investigated, but do not significantly slow or stop the formation of cataracts. Recently, Dr. Kang Zhang, an ophthalmologist at the University of California-San Diego, discovered an enzyme called lanosterol. This enzyme appears to clear cloudy lens cells in Petri dish studies, but is yet to be studied in humans. This research could lead to the development of an eyedrop that may slow or reverse the development of cataracts, but these studies are currently in their infancy.


Will Glasses Help If I Have Cataracts?

The first test performed after checking the vision of a patient with cataracts is a refraction. This is a test to determine if glasses will sharpen the vision despite the presence of cataracts. In many cases, glasses may sharpen your vision to a point where surgery may not be indicated. 


What Determines If I Need Cataract Surgery vs. Glasses?

There are two criteria that must be met for an individual to become a candidate for cataract surgery.

1.) The best corrected vision must be 20/40 or worse on the eye chart
2.) The decrease in vision must affect the individual’s activities of daily living (ADL’s). That means that the patient’s activities, i.e. driving, reading, using a computer, watching TV, etc., must be affected.

If a patient has vision that is 20/40 or worse and they feel that they can do all the things that they want to do, then they do NOT need surgery. New glasses may be prescribed or the patient may continue with the same glasses if a new prescription would not make a significant difference in their vision.


I Need Cataract Surgery. What Should I Expect? 

Cataract surgery is a procedure to remove the cloudy lens from your eye and replace it with an artificial lens. Cataract surgery is performed by a medical doctor who specializes in diseases and surgery of the eye (ophthalmologist). It takes place in an outpatient surgery center, which means you do not have to stay in a hospital after surgery. Your eye will be anesthetized prior to surgery so that you do not experience any pain. An anesthesiologist will provide intravenous sedatives to help you relax during the procedure. The eye is numbed with anesthetic eye drops and a small incision is created. Through this incision, additional anesthetic medication is placed inside the eye to “deeply put it asleep”. The average cataract surgery takes 15-20 minutes (sometimes less). The entire visit to the surgery center from check-in to check-out typically takes a couple of hours.

After surgery, a clear, plastic shield will be taped over your eye for protection. Your vision may be better the first day when you return for a follow-up exam. However, unlike LASIK surgery, the vision after cataract surgery may take a few additional days to clear. You may still need to wear glasses to obtain the very best vision, although new surgical devices (like the LensAR femto-second laser for laser cataract surgery) and new lens technologies (like the ReSTOR or Symfony IOL’s) make it possible to reduce your dependence on glasses. Cataract surgery is very common and is generally considered a proven and safe procedure.


What Are My Options? 

Option 1: Manual Cataract Surgery with Monofocal IOL

In manual cataract surgery, the entire surgery is performed “by the hand of the surgeon”. This is in contract to using a femtosecond laser to perform important parts of the surgery and to correct corneal astigmatism (up to 2 diopters). First, let’s be clear, studies have shown no significant difference in safety or ultimate outcomes between manual cataract surgery and femtosecond laser cataract surgery. One major difference to note is that manual cataract surgery does NOT correct corneal astigmatism. In addition, when we use monofocal intraocular lenses (IOLs), the vision can only be grossly corrected at one distance (distance or near). There is a good chance that you WILL need glasses to obtain the very best vision after manual cataract surgery with a monofocal intraocular lens. Again, the vision will be no less than someone who undergoes laser cataract surgery with a “premium” intraocular lens (see below). The patient will simply be more dependent on glasses to obtain their best vision. Lower costs is one of the biggest benefits of this option, as the patient would only be responsible for covering their insurance related costs.

Watch this video to learn more about traditional, manual cataract surgery. 


Option 2: Femtosecond Laser Cataract Surgery with Monofocal IOL

With this option, the patient will undergo cataract surgery with the LensAR fetmosecond laser. This laser performs some of the key steps of the surgery and creates incisions on the cornea to treat astigmatism (see image below). Some studies have shown that surgery performed with use of the laser allows the intraocular lens to center more precisely in the eye. If a monofocal lens is used, the vision can be corrected for distance or near (on a rare occasion, a patient will choose the monovision option where the dominant eye is corrected for distance and the non-dominant eye is corrected for near). If a patient has both eyes corrected for distance, they will certainly need reading glasses for near work and vice versa if they choose to set the lens power for near (they will need glasses for distance). There is additional out-of-pocket costs associated with femtosecond laser cataract surgery with astigmatism correction beyond the standard insurance related costs.




One additional bonus of upgrading to Option 2 or 3 is the availability of the ORA intraoperative aberrometer (see the video below). Normally, we take measurements for the power of the lens to be used in the clinic, prior to surgery, with the cataract still in the eye. This offers excellent results in most cases. However, when we are aiming for a more precise clinical outcome, we use the ORA to take real-time measurements during the surgery after the cataract has been removed from the eye. This allows us to refine the power of the lens that will implanted and gives the surgeon added confidence that the most precise lens power for your eye is being used. This ensures the best vision for the patient after surgery.

Watch this video to learn more about laser cataract surgery with LensAR.

Watch this video to learn more about the ORA System with Verifeye+ Technology.


Option 3: Femtosecond Laser Cataract Surgery with Premium IOL

The final option is femtosecond laser cataract surgery with a “premium” intraocular lens (3 options detailed below). This option gives the patient the best opportunity to be free of glasses after their cataract surgery. Again, the surgery would be performed using the LensAR femtosecond laser. The lens options include the Symfony IOL, Symfony Toric IOL, ReSTOR IOL, and standard TORIC IOL. The lens that works best for each individual varies and will determined by you and your surgeon after your eyes have been thoroughly examined. Again, Option 3 includes the use of the ORA real-time, intraoperative “IOL power measuring” device.



Symfony (Corrects Presbyopia)
Symfony Toric (Corrects Presbyopia and Astigmatism) 

The TECNIS® Symfony Logo Extended Range of Vision IOL delivers a continuous, full range of high-quality vision with incidence of halos and glare comparable to a monofocal IOL. The lens is available in both a Non-Toric version and a Toric version for patients with higher levels of astigmatism. See the video below for more information.



ReSTOR (Corrects Presbyopia)

ReSTOR® intraocular lenses use apodization and refractive and diffractive technology to interpret the amount of light entering the eye and focus it on the appropriate part of the retina. ReSTOR® IOLs allow patients to see clearly at any distance – 4 out of 5 patients who receive ReSTOR® lenses do not need glasses or bifocals. ReSTOR will soon release a TORIC version of this multifocal lens. See the video below for more information.


3.) Standard TORIC (Corrects Astigmatism)

TORIC intraocular lenses are used specifically to treat astigmatism in cataract patients. This new development has helped many patients reduce the amount of astigmatism after cataract surgery resulting in better vision. The standard TORIC lens is a monofocal lens and does not allow a patient to see at all distances. Therefore, most patients still need glasses for near. See the video below for more information.


Who Performs the Cataract Surgery and Lens Implant?

All cataract surgeries and lens implant procedures at the San Antonio Eye Institute are performed by Relief Jones, III, M.D. Dr. Jones is Board-Certified in Ophthalmology by the American Board of Ophthalmology. He has over a decade of experience performing cataract surgery. He received his education and training at some of the world’s best institutions, including Stanford, Duke and Harvard.

As a Glaucoma Sub-Specialist, he has special expertise and experience dealing with some of the most complicated types of cataracts, i.e. mature cataracts, pseudoexfoliation cataracts, and traumatic cataracts. Dr. Jones has performed cataract surgeries for patients from all over the globe. He’s taken care of other physicians and their parents, lawyers, engineers, farmers, ranchers, pilots, executives, and individuals from practically all walks of life. We make our patients feel comfortable irregardless of their race, religion, nationality, gender, or sexual orientation. What Dr. Jones likes most about San Antonio is the diversity of the community and clinical scenarios he sees on a daily basis. His personal, one-on-one approach is what patients enjoy most and that is why they continue to refer friends and family.


Surgery Risks & Safety

While cataract surgery is one of the safest procedures available in medicine with a high rate of success, rare complications can arise.

  • Complications can include pain, infection, inflammation, bleeding, swelling of the retina, retinal detachment, need for further surgery, loss of vision, or even loss of the eye. Fortunately, modern day cataract surgical techniques and medications make these complications extremely rare.
  • In most cases, you will be referred to your primary care provider for pre-operative clearance.
  • Antibiotics and anti-inflammatory medications are typically started before and continued after surgery.
  • Blood thinners like aspirin, coumadin, plavix, vitamin E, and fish oil (just to name a few), rarely have to be stopped before modern cataract surgery.
  • Patients should not eat or drink anything 6-8 hours before their surgery.
  • Patients should plan to arrive one hour before their surgery time.
  • Transportation from the surgery center will need to be pre-arranged prior to arriving at the surgical center. Because sedation is administered, operating a motor vehicle is prohibited immediately after surgery.
  • You will be seen within 24 hours after surgery, 1 week after surgery, and 1 month after surgery. If you require glasses to obtain the best vision, they will be prescribed at the 1 month post-operative visit.


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