All About Cataracts

Inside everyone’s eye is a lens. Just like with a camera, the lens of your eye helps you to focus on things whether they are nearby or far away. To work well, the lens must be clear. As you age, the lens of your eye gradually becomes cloudy. We call a cloudy lens a cataract. The word cataract comes from an old Latin word for waterfall. Waterfalls produce heavy mist that can blur your vision. Cataracts have the same effect—blurry vision. Looking through a cloudy lens is like looking through a dirty window—everything is blurred.

Everyone who lives into their 60s develops at least mild cataracts. Early on, the cataract process not only makes your lens cloudy, it also makes your lens swell a little bit. When your lens gets bigger, you become a little more near-sighted. So in the early stages of cataract, simply changing your glasses prescription will usually restore your sight.

But as you continue to get older, the cataract gets more and more cloudy, and eventually not even a change in your glasses prescription will improve your sight. At that point, the only way to restore your vision is to remove the cataract. Cataract surgery is the most common surgical procedure performed on adults in the United States. The procedure is performed on an outpatient basis, generally takes a half-hour or less, and recovery time is usually only a few days.

Cataract surgery is a two-step procedure—first the surgeon removes your cloudy lens, and second, a new lens implant is inserted into your eye. The cloudy lens is removed with a tiny instrument that enters your eye through a small incision—usually one-eighth of an inch or smaller—and gently breaks the cataract into tiny pieces that are then removed from the eye with a miniature vacuum cleaner.

Once the cataract is out, you will need a new lens in order to focus after surgery. Artificial lens implants—made of plastic-like materials—are used to restore your ability to focus after surgery. These implants come in many different strengths, like glasses, and before your cataract operation, your doctor will perform several measurements to determine the appropriate lens implant strength for your eye.

Once your cataract is out and your implant is in, the operation is over. Most people see better within a day or two after cataract surgery, but it is not abnormal or worrisome if your vision seems blurry for a few weeks after surgery as your eye heals. Your doctor will prescribe some eye drops for the healing period after surgery, and if you need new glasses after surgery, these will be prescribed for you once your eye is completely healed, usually about a month after surgery.

Cataracts cannot grow back, but sometimes a thin cloudy membrane grows behind the lens implant, making your vision blurry like the cataract did. This is not uncommon—it happens to roughly 40 percent of patients having cataract surgery. If it happens to you, a quick and simple laser treatment can be performed in the office to make a hole in the membrane for you to see through.

RISK FACTORS:

The number one risk factor for developing cataracts is age; in fact, if everyone lives long enough, all humans will eventually need cataract surgery.  The trust is that there are many other risk factors that influence cataract formation which, together with age, will determine when cataracts start to affect one’s vision.  These factors include sun (ultraviolet) light, smoking, excessive alcohol consumption, trauma, radiation/chemotherapy and other medications. 

Modern cataract surgery makes use of an amazing array of high-tech equipment and techniques. Gone are the days when cataract surgery required a two-week stay in the hospital, with your head immobilized with sandbags until you healed. Today’s cataract surgery is an outpatient procedure that takes a half-hour or less and lets you get back to your normal activity level within a few days.

One of the most dramatic advances in cataract surgery involves anesthesia for the procedure. Long ago, patients were put to sleep for cataract surgery. More recently, patients were given a shot behind the eye before surgery to numb it. But now, the vast majority of cataract surgeries are performed under topical anesthesia, with only a few numbing drops placed on your eye before the start of the procedure. This eliminates both the risks and discomforts of the shot. Also, the shot made the vision blurry for several hours after surgery—with just the numbing drops, some patients notice improved vision within minutes after the surgery is completed. The technique of cataract removal has also undergone major improvements. Once upon a time, the cataract was removed whole through an incision over a half-inch long. Modern cataract surgery is performed through an incision less than an eighth of an inch long. A small instrument is inserted through this tiny incision, and is used to break the cataract into many small pieces that are removed without the need for a large incision. There are many advantages to a smaller incision, including a faster recovery time, less need for glasses after surgery, and a smaller risk of infections after surgery. In addition, while the old incisions required many stitches to close up, modern cataract surgery can often be performed without any stitches, or with one stitch at most.

During cataract surgery, the cloudy lens of your eye is removed and replaced with a clear lens implant. In the old days, there were no implants, and patients had to wear thick glasses (“Coke-bottle glasses”) after surgery to see well. Now there are implants that are placed directly into the eye, reducing or eliminating the need for any glasses after surgery. The newest implants (called toric implants, and multifocal or presbyopia-correcting implants) can even provide sharp vision at both distance and up close, reducing or eliminating the need for any kind of glasses, including reading glasses, after surgery.

Antibiotic advancements also benefit patients undergoing cataract surgery. Cataract surgery is among the most successful operations in all of medicine, but complications can occasionally occur. One of the most severe complications is an infection in the eye called endophthalmitis. To reduce your risk of getting endophthalmitis, your doctor will prescribe antibiotic eye drops to use around the time of your surgery. New antibiotics developed in the past few years are more effective than ever at preventing eye infections during cataract surgery.

Routine cataract surgery is so well tolerated that it has become the most common surgery performed on adults in the United States. As a result of these many high-tech developments in all aspects of cataract surgery, the operation is more successful—and has a faster recovery time—than ever before.

The lens of your eye is an important structure. In order to see clearly at all distances (from up close to far away), your eye must be able to change its focus power. The lens of your eye is responsible for this change in focus—it changes its shape to bring whatever you’re looking at into clear focus. In your early 40’s, you start to lose the ability to see up close and require bifocals, or at least reading glasses. This is because, as we age, the lens hardens and cannot change its shape anymore, and in order to focus at different distances, more than one glasses prescription is required.

As we age even more, the lens becomes cloudy. This cloudiness of the lens is called a cataract. Cataract is a common problem among aging Americans, and cataract surgery is the most common surgery performed on adults in the United States. In cataract surgery, the cloudy lens is removed. In order for you to see clearly afterward, a new lens (called an intraocular lens implant, or IOL) must be inserted at the time of surgery.

Selecting the right implant for your eye is very important for your vision after surgery. Your doctor will take measurements before your surgery to determine how strong your lens is, so an implant with the same strength can be put in during the surgery. If you wear glasses, the implant strength can be adjusted to replace both your lens and your glasses.

Like your aging lens, the implant cannot change its shape to help you see both up close and off at a distance. Thus unique intraocular lens helps to correct the blurriness caused by astigmatism. But several options are available to help you minimize—or even eliminate—your need for any type of glasses after cataract surgery.

For instance, your doctor may place implants in your eyes with the appropriate strength for you to see well at a distance, and you can wear reading glasses when you want to see up close, such as for reading.

Another option is for your doctor to select the implant strength for you to see clearly off at a distance for one eye, and a different strength—the one for up close—for your other eye, so that you can see clearly at all distances without glasses after surgery. This works well for most people, but some people have trouble with depth perception when their two eyes are focused at different distances.

In recent years, several types of toric, bifocal and/or multifocal implants have been developed. These lenses allow you to see clearly at a variety of distances, effectively eliminating the need for glasses. Several manufacturers, including Alcon, Advanced Medical Optics, and Eyeonics, have recently received approval from the FDA for new technology multi-focal lenses following cataract surgery. It should be noted, however, that multi-focal lens technology is evolving rapidly and patients are encouraged to consult with their doctor about these offerings. Also, this technology is relatively expensive and is considered elective by Medicare and most insurance companies, thus the difference in price between a standard cataract IOL and the new technology must be paid by the patient.

Talk with your doctor about the various types of implants available, and their effects on your vision after surgery. You and your doctor will develop a plan that pairs you with the best type of implants for your eyes and your vision needs. The Acrysoft IQ ReSTOR® Multifocal Implant and the Crystalens® Accommodating Implant are two examples of the newest technology implants that help you to focus more clearly at distances, intermediate and near distances with less dependence on glasses or in many cases, eliminating your need for glasses all together.

The Acrysoft IQ ReSTOR®  is a multifocal (multiple focus points) one piece implant which bends the incoming light in a controlled way, allowing you to see at multiple distances. utilizes three different optical techniques (apodized diffractive, refractive and aspheric) in order to achieve this goal.

Apodized Diffractive Technology

Diffraction: The spreading of light that occurs when light passes through discontinuities (i.e., the steps or edges of a lens). In an optical system, light can be diffracted to form multiple focal points or images. involves the spreading of light as it passes through a lens. You'll notice that, on the AcrySof® IQ ReSTOR® IOL, the center of the lens surface consists of a series of tiny rings – this is known as an apodized diffractive optic.

Apodization: The gradual reduction or blending of varying diffractive step heights. The application of apodization to intraocular lenses is a patented process by Alcon and can only be found in the AcrySof® IQ ReSTOR® IOL. is the gradual tapering of different diffractive levels (or "steps") on a lens, creating a smooth transition of light between distant, intermediate and near focal points. This means is that the series of tiny steps in the center of the AcrySof® IQ ReSTOR® IOL work together to focus light, providing excellent near vision: The range of vision that includes focal points 16 inches or closer to your eyes. Items that typically fall within this range include books, newspapers and medicine bottles. Also known as "reading vision.", intermediate vision: The range of vision that includes focal points between 16 inches and 7 feet away from your eyes. Items that typically fall within this range include computer screens and car dashboards. and distance vision: The range of vision that includes focal points 7 feet or further from your eyes. Items that typically fall within this range include billboards, street signs and movie screens.

Refractive Technology

Refraction: Redirection of light rays as they pass through a lens involves the redirection of light as it passes through a lens. The outer ring of the AcrySof® IQ ReSTOR® IOL is a refractive region designed for excellent distance vision. This refractive area bends light as it passes through the lens, accurately focusing it on the retina: The transmitter located at the back of your eye that sends the images to your brain. for a crisp, clear image.

Aspheric Technology

Even healthy eyes still contain some imperfections, or "aberrations." Spherical aberration: An irregularity in the shape of the lens. As the eye ages, the lens gets thicker and rounder, causing image quality to deteriorate. Often associated with loss of contrast sensitivity and poor night vision., a type of imperfection common to cataract patients, can eventually lead to a reduction in visual acuity and function. Thankfully, with the addition of a proven aspheric optic: A type of lens designed to compensate for spherical aberration, resulting in improved image quality., the AcrySof® IQ ReSTOR® IOL can correct for these spherical aberrations, leading to enhanced clarity.

Astigmatism-Correcting Lenses

Astigmatism-correcting lenses such as AcrySof® IQ Toric IOL, are for patients with existing corneal astigmatism. Similar to monofocal lenses, these lenses usually give patients quality distance vision with less dependence on glasses. Most patients will still need to wear glasses for tasks such as reading or working at a computer.

The Crystalens®  Implant is an accommodating (focusing) implant. Crystalens® was modeled after the human eye.  Like the natural lens, it uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. The Crystalens® accomplishes this by utilizing tiny hinges attached to the sides of the implant positioned in such a way to take advantage of thenatural movement and flexing of eye muscle responsible for focusing.

See animation below.

Consult Dr. Mark Oberlander at Eye Associates of Pinellas to determine which implant would better serve your visual needs and lifestyle.

Click the Videos below to learn more about  ReSTOR® 

Click the Video below to learn more about the Crystalens®

Bioavailability of Lutein

It is confusing for patients when trying to purchase supplements for their eyes and their vision.  Lack of knowledge in the ophthalmic area is commonplace and consumers are easy prey for unprofessional and unethical companies whose only agenda may be corporate profit.

The end result can be loss of vision, which could have easily been prevented by appropriate specialized products.

There are potential problems with many of the ocular supplements available in retail stores.  Many products on the store shelves, especially in discount stores, contain a brand of lutein which may not be bioavailable or beneficial.

As a result, they will not be effective and patients will be at high risk of losing vision.

Ready to Order Lutein Supplements for Your Vision? Please Click Here!

Bioavailability simply refers to the amount of a nutrient that is actually absorbed from a supplement.

Lutein, zeaxanthin and mesozeaxanthin are vital nutrients for retinal health.  There are several different brands of lutein available for use in supplements and each brand has its own unique properties.  Lutein exists in two different chemical forms, esterifed and non-esterified molecular forms.

The majority of the research regarding lutein and vision has been done with FloraGLO® Lutein brand of lutein, a non-esterified form of lutein, which is the natural form found in nature.  It is extracted from the flowers of the marigold plant.

There are less expensive brands of lutein which have become available and the products using them are much cheaper, however, they may not be effective.  There are no evidence-based studies showing they are bioavailable or absorbable, which means they would not be effective and patients will lose vision needlessly.

Ready to Order Lutein Supplements for Your Vision? Please Click Here!

Lutein Esters Are Not Bioavailable

The lutein ester molecule is not bioavailable and cannot be absorbed.  Only free, non-esterified lutein can be absorbed and is the only form found in the blood.  Even if a product contains high levels of lutein esters, it may not be effective.

Non-esterified Lutein May Not Be Bioavailable

Several different brands of non-esterified lutein are also available, but they may not be effective either.  Most of them do not have clinical trials demonstrating they are bioavailable, or even get deposited in the macular area.  In fact, some have been shown to have very little bioavailability, and are therefore questionable if they provide any benefit.  In one study, FloraGLO® Lutein showed approximately five times the bioavailability over another non-esterified lutein brand.

¹ FloraGLO® Lutein is the only brand proven to be effective and that is why it is the Standard of Care for maintaining vision.

Lutein & Mesozeaxanthin

Bioavailability of lutein is also important because mesozeaxanthin is created in the macular area of the retina from the conversion of lutein.  Research has shown that some of the lutein that accumulates in the macular area is chemically converted into mesozeaxanthin, which only exists in the central macular area.

² If the brand of lutein used in a supplement has a low bioavailability, it will not accumulate in the macular area, and there will be a deficiency of mesozeaxanthin as well as lutein.  Therefore, lutein accounts for two out of the three carotenoids found in the macular area, so a highly bioavailable brand of lutein is doubly important.

Some brands of lutein are not bioavailable and cannot be absorbed, therefore they are not beneficial! Be sure your product meets the Standard of Care. Look for the FloraGLO logo on your supplement label!

Nutrients Are Not Required To Be Bioavailable Under FDA Rules & Regulations

When you take a supplement, if the nutrients are not absorbed by the digestive tract, they cannot produce any desirable effects.  The Food and Drug Administration (FDA) does not regulate or mandate that nutrients in supplements have to be bioavailable or functional.  This is a major concern with nutraceutical supplements.  This is why manufacturers can use cheap, non-functional ingredients which are not bioavailable, still meet label claims, but avoid any FDA regulatory actions against them.  This is unsettling news for consumers who are virtually helpless.  People buy products in good faith, believing they are safeguarding their vision, but unfortunately the products may not be effective and they will lose vision.

Reputable manufacturers will clearly state on their label what brand and/or molecular form of lutein is in their product.  If a product label simply indicates “Lutein”, it could be any brand and may not be effective.  The Age Related Eye Disease Study 2 (AREDS2), sponsored by the National Institutes of Health (NIH), is using 10 mg of non-esterified lutein per dose from FloraGLO® Lutein, which is the leading brand recommended by doctors, and is regarded as the Standard of Care for supplements.  Be sure and look for the FloraGLO® logo on your supplement label.

MEDOP INC.

MAXIVISION® and MAXITEARS®, manufactured by MedOp Inc, are specialized products guaranteed to meet or exceed the Standard of Care.  These products are designed and created by eye doctors and researchers to be the highest quality and the most effective products available.  They contain the same brand of nutrients that are being used in the ongoing National Institutes of Health Age Related Eye Disease Study 2 (AREDS2 study).  The MAXIVISION® product line contains products ranging from essential to comprehensive and MAXITEARS® is a high level omega-3 source with additional nutrients targeting dry eye conditions.

MedOp has established an irrefutable leading edge reputation by providing the most effective, highest quality professional products, with no side effects, no contraindications with systemic medications or smokers, and very cost effective prices.

Our office is proud to recommend these proven products for your ocular and overall health.  If you have any questions or need any information, please contact our office.

Ready to Order Lutein Supplements for Your Vision? Please Click Here!

The Areds & Areds2 Study

The Age Related Eye Disease Study (AREDS) was the first major National Institutes of Health study testing nutritional supplements for treatment of age-related macular degeneration (AMD).

It firmly established a therapeutic rationale for treating dry macular degeneration with supplements. The new ongoing Age Related Eye Disease Study 2 (AREDS2) is the second major study being conducted by the National Institutes of Health.

It is a clinical trial designed to assess lutein (10 mg/dose), zeaxanthin (2 mg/dose) and the omega-3 fatty acids EPA and DHA (1,000 mg/dose) as a treatment for age-related macular degeneration, cataract and moderate vision loss. Other study goals include the evaluation of eliminating beta-carotene and reducing zinc to 25 mg/dose compared to the original AREDS
formulation. AREDS2 is a major study and will provide new insights into treating AMD with supplements.

Lutein / Omega-3

Since the publication of the original AREDS, there have been several studies showing lutein is helpful in macular degenerative disease. One of the latest ground breaking studies, The Veterans Lutein Antioxidant Supplementation Trial (LAST Study), showed a therapeutic benefit for lutein in all stages of dry macular degeneration.

There have also been several studies showing that the omega-3 fatty acids EPA and DHA reduce the incidence and progression of age-related macular degeneration. In addition to visual health, the omega-3 fatty acids are also involved in overall health and especially cardiovascular health. The American Heart Association recommends 1,000 mg per day of the omega-3 fatty acids EPA/DHA. Many fish oil products on the market do not contain these higher concentrated levels of EPA and DHA.

Maximum Vision & Body Support - Evidence Based Rye Nutrients

• The Whole Body Formula and the Ocular Formula are the premiere supplements in the MAXIVISION® Product Line.
• They are the most comprehensive and progressive combination of nutrients, based on all relevant studies, providing the greatest benefit for patients.
• Whole Body Formula is a comprehensive multivitamin including the comprehensive evidence-based ocular nutrients.
• Ocular Formula is a comprehensive evidence-based ocular supplement.
• Recommended for patients with macular degeneration, but also useful for prevention and for patients with a family history of AMD.
• Both contain the highest amount of lutein (20 mg/dose) and zeaxanthin (4 mg/dose) of any product on the market.
• Both also contain CoQ10, Acetyl-L-Carnitine, Resveratrol, Boswellin PS, Green Tea Extract, Vitamin D3, Taurine and several others.

Therapeutic Options

Maximun treatment for age-related macular degeneration requires eating a healthy diet, an exercise program, no smoking and nutritional supplements. The most advantageous supplement protocol would include the components used in the AREDS, the AREDS2 and all other relevant studies. There are several levels of products on the market specifically targeting ocular health. MAXIVISION® is a product line commonly recommended by leading doctors across the country.

MAXIVISION® products are based on all current research and formulated by an Advisory Board composed of leading doctors and researchers. By combining important information from all relevant studies, MAXIVISION® provides the most advanced, progressive protocols available for maintaining overall health and maximizing visual function.

The most advanced therapeutic protocol for AMD includes a product like MAXIVISION® Whole Body Formula or Ocular Formula for the powdered nutrients plus MAXIVISION® Omega-3 Formula for the oily omega-3 fatty acids EPA and DHA. The combination of these products creates a synergistic effect providing the most comprehensive nutritional support for vision and overall health. The Omega-3 Formula contains 1,000 mg of the fatty acids EPA and DHA per dose.

The fish oil is encapsulated in enteric coated softgels which eliminate the annoying fish burp, fish taste or gastrointestinal distress often encountered with other fish oil capsules.