Refractive Eye Surgery At Its Best

A Happy Patient Is An Informed Patient

watch-informed-consent-001You might ask, “What are possible temporary side effects after cataract surgery?”   To answer this question and to help you prepare when you talk with your surgeon, here are frequent questions and concerns patients ask about after surgery.

BLURRED VISION:  what are common causes of blurred vision after cataract surgery?

  • Dropless cataract surgery is routinely performed at The Harman Eye Clinic, and causes black dots in the vision for at least day or two after surgery.  Patients are instructed to sit upright for at least a few hours when the get home to help the medicine settle to the bottom of the eye, like a snow globe.
  • Dilation lasts for at least a day or two after cataract surgery and commonly causes blurred vision.
  • PCO or posterior capsular opacification occurs 10-20% after routine cataract surgery.  It causes glare at night, but is curable by a simple YAG laser procedure that takes 2 minutes to perform, but an hour and a half for the paperwork!
  • CME or cystoid macular edema occurs about 1% of the time after routine cataract surgery.  It causes difficulty reading and even distance vision.  Risk factors include diabetes, ERM (epiretinal membrane), prior retinal surgery and possibly cigarette smoking.  It often can be cured with topical steroid and anti-inflammatory eye drops.
  • Residual refractive error may cause blur until new spectacles are prescribed.  If a monofocal lens is chosen for best distance vision, then near vision will be blurred (so called presbyopia) until readers are used.
  • Dry Eye syndrome is a life long condition, that may cause fluctuating vision, and may be worse at least temporarily after cataract surgery.  It is often exacerbated by prescription eye drops (especially generic drops such as ketorolac), but we are seeing much less dry eye problems since switching to dropless surgery.
  • ARMD (age related macular degeneration) or ERM may also limit vision due to aging changes in the retina.

DYSPHOTOPSIAS are unwanted visual phenomena occurring after routine cataract surgery.

  • Negative dysphotopsia are likened to “horse blinders” with a shadow or dark crescent on the side and usually subside within days or weeks. They are thought to be more common in square edged lens implants, but have been reported in all types of lens implants, however they are not dangerous.
  • Positive dysphotopsia are less common, and are often described as an arc of light under certain lighting conditions.

REBOUND IRITIS IS INFLAMMATION that occurs usually 2 to 3 weeks after cataract surgery.

  • It is thought to be a result of the dropless medicine wearing off, especially found in darkly pigmented patients.  It happens in less than 10% of patients who have dropless surgery and is treated with topical steroids.  This is the best reason for patients to keep their 3-week postoperative appointment after surgery.

For more information.  download a free copy of our Cataract Surgery Patient Workbook, here.

Or take time to read, A Patient’s Journal – Cataract Surgery

 

 

Second Surgery, Day One – A Journal VI

I had my one day post op after my second surgery. My vision was pretty blurry due to a bit of swelling on the cornea, so I’ve waited to share.

Needle and threadNow when you decide on having a “lifestyle lens,” you really have to think about how you spend your time and what your particular vision needs are. Myself, I work on a computer and interact with patients. Ok, that’s 40 hours of my week. Typically, I’m awake about 122 hours in a week, so that accounts for 1/3 of my time. Driving: an hour a day. Family time includes reading, watching television, board games. Weekends are your typical housekeeping chores. Hobbies? Making quilts! Accurately measuring, cutting, sewing and pressing. Hand sewing the bindings on finished quilts. For me, being able to thread a needle and follow a line of stitching was vital.

Quilting

These Symfony lenses have the ability to let you see for reading, computer and driving. But super fine like I wanted required either cheaters (non-prescription magnifying glasses you find in a drug store) or, choosing a power for the implant that would provide that. Choosing that option may require glasses for driving. That is the choice I made.

Right now, I’m threading needles and hand sewing along that line of stitching!

My advice to those of you considering a Lifestyle lens? Evaluate your life! What are your visual needs? Communicate this to your surgeon. You may be an avid outdoor enthusiast, golfer, pilot or ham operator! Reading may be your passion. There’s as many lifestyles as there are people, each one unique and important.

I still have a couple weeks for my vision to stabilize, but right now I have what I can only describe as “normal” vision. I’m seeing what I want to see. How awesome is that?!?

 

 

One Week & 2nd Eye Surgery – A Journal V

One week later. Scheduled for a one week post op and second surgery. Depending on how your eye heals, your personal preference and the difference between your eyes, surgeries can be scheduled 1-3 weeks or further apart. I was fortunate to be 1 week.

I have noticed a lot of struggle between my new eye and the other one this past week. It felt like the new eye was doing about 90% of the work and the old one was trying to keep up. Those floaters from the medication last week? They were gone 3 days after surgery. What was really cool was turning on my side to read in bed without my glasses getting in the way!

The halos are much smaller around lights, more something I observe but not causing any difficulty, All in all, it’s been a great week between surgeries!

My one week check up was great. Healing well, seeing 20/20 without correction. My biggest hobby is sewing quilt tops, so I’ve asked my surgeon to set my lens power for reading or “near” vision to help me with my hand sewing.

My surgical experience was every bit as good as the first time. I even slept a bit before and during! I still don’t remember a great deal of what went on in the OR… and I can say that because I know what happens since I work there! The medication in my eye this time is more like a cloud over the outside half of my vision. I had a foreign body sensation which I knew was the incision from surgery, and artificial tears took care of that.

I’ll check in again tomorrow and let you know how I am with the dilation gone. I’m still ecstatic with my surgery. I’m very proud to be a part of the Team at The Harman Eye Clinic. It’s a blessing to help others with improving their vision, and I’m one of many staff members who have experienced the benefit of various procedures we can do. iLASIK, Refractive Lens Exchange, Cataract surgery with an assortment of lens options. It’s all good!

Second Surgery, Day One – A Journal VI

Cataract Surgery Day – A Journal III

Surgery Day. Must admit, I’m a bit anxious. Tossed and turned all night.

No coffee or breakfast this morning. Just a couple meds with a sip of water. Brushed my teeth and rinsed my mouth out, being careful to not swallow any of that tasty toothpaste!

My co-workers learned I’m not as perky when I am caffeine deprived! But I took a couple Tylenol with my meds to keep the headache minimized and made it through to admission time.

The staff are fantastic! I don’t think I was ever alone. Super supportive, keeping me informed of what was happening along the way. There were a bunch of eye drops that got easier each batch because there was always a numbing drop first. IV, monitors placed for heart rhythm, SAT and a blood pressure cuff. You know, surgery stuff! I was a bit chilly and a hand warmer and the heated chair were perfect. Even got a bit of a massage from the chair.

Seemed like no time at all and I was fitted with O2 tubing and being escorted into the Operating Room. Normally there are 4 folks in the OR with a patient: the Surgeon, Anesthesia, Scrub Tech and Circulator. As I said, never alone.

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There was a little shuffling around to get comfortable in the chair and after that I really don’t remember much! I do remember seeing a really cool pattern (like a beautiful wallpaper), some colored lights, the surgeon saying we were going to do a final test, doing that and then being told the lens was in. Then the slight sensation of the medication being placed in my eye and we’re done!

Out to the post op area with another great staff member who recorded vitals while I had a cup of coffee and a “continental breakfast.” With strong vitals and me feeling good, time to disconnect the IV and head home.

Now this dropless medicine manifests differently for everyone. For me it’s like oil on top of a bowl of water being swirled around. At first it looked like mountain ranges, later it was bubbles, and even later just a patch of black dots! I was told to go home and rest in an upright position for a couple hours so that the medicine could settle to the bottom of the eye.

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Headed home, noticing my eye felt a bit scratchy as the numbing wore off. Laid down with a bunch of pillows to keep my head elevated and took a short nap, woke up feeling great. My husband and I picked up our grandson and went to Taekwondo; back to normal except no driving today.

What a great experience! From checking in to checking out, the staff are very caring, friendly and professional. Yes, I work with them every day, and from a patient perspective, I’m proud to say GREAT JOB!

Tomorrow, back to work and I’ll see the doctor for my first follow up visit and I’ll keep you posted as I continue this journey and the second surgery next week.

My biggest WOW right now it how bright white is with my new eye! The old eye looks like someone turned the dimmer switch down. This is exciting!

Tap here to read A Journal IV

Cataract Surgery – A Journal II

Joyce Bowley

Joyce Bowley, ASC Patient Surgery Coordination

Getting ready for surgery day. I’m between the age of 60-65 with no health issues, so I was able to have the need for my MD to clear me for outpatient surgery deferred. After the schedule was set, the nurse sat and explained my pre-op instructions to me: morning meds with a sip of water, nothing to eat or drink past midnight, the need for a driver. They will start an IV, so I’ve got to drink lots of (hydrating) fluids the day before to ensure the best veins.

Now, since I work in the Surgery Center, I volunteered to work until it was time for me to be admitted. The only problem I can foresee is a caffeine headache when my body realizes it’s not getting its daily dose. I went for years eating one meal a day, so I don’t see a problem with not eating until after surgery. I certainly don’t want to risk being nauseous while my eye is being worked on!

I have been approved for what’s called “dropless” surgery. This means I won’t have to pick up any prescriptions for a set of eye drops (antibiotic, steroid & NSAID) to use before and after surgery. Instead, the medication will be placed in the back of my eye at the time of surgery. Thank goodness! While I’ve figured out the best way to put drops in my eye, remembering to do so 4 times a day would probably require hiring a personal assistant!

Am I nervous about having surgery? Well, I am fortunate to know this team of surgeons and staff and be familiar with the entire process from A-Z. I have total faith in my surgeons skill. In the back of mind, I know that any surgery comes with risks and possible complications. I choose not to dwell on negatives. What would be the point? I will pray for the surgeon and his team and let God do the worrying. (This is what got me through my two children doing 8 tours with the Army in Iraq & Afghanistan without a nervous breakdown.)

My surgeon has told me I’ll need to be diligent in taking care of my dry eyes. For me, the hours I spend staring at computer screens has led to dry eyes. Seems I forget to blink! I do take fish oil every day as he’s recommended, which has certainly helped. But surgery will disturb the surface of my eye, so I will stock up on Preservative Free artificial tears for use after surgery. Plus, years ago I did have an injury to my left eye that has caused what is called “recurrent corneal erosion.” I used to have yearly flare ups, but since I started with the fish oil I haven’t had any problems. I’m aware this problem is ever present and I need to be responsible for constant care.

Other than that, I think I’m ready!

Tap here to read A Journal III

Cataract Surgery – A Journal

Joyce Bowley

Joyce Bowley, ASC Patient Surgery Coordination

Joyce Bowley joined The Harman Eye Clinic in 1995.  Patients have happily passed through our surgery center under her warm, professional guidance. Now Joyce has discovered that cataracts have affected her lifestyle.   By writing her experience as it unfolds, it is her hope that she can reach out to those who are undecided and yet concerned about their vision impacting daily life activities.

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Cataract surgery. When I was growing up in the 60’s, I don’t remember hearing about it all that much, but I do remember “old” people with thick, coke-bottle glasses. If asked, they would tell you they’d had eye surgery and it was quite a big deal: in the hospital, sand bags to immobilize their head, no bending over or lifting. Surgery was a big deal.

Now, here we are 50 years later. So many changes. Cataract surgery is now an outpatient procedure. Clear Cornea surgery means smaller incisions & easier recovery. Intraocular implants mean no coke-bottle glasses and now can offer correction for astigmatism and provide multi focal vision.

I’ve been a witness to many of these advancements during the last 22 years working with the Surgeons at The Harman Eye Clinic.

Recently, I’ve started to notice that lights aren’t bright enough while I do hand sewing on my quilts. I’ve found myself avoiding driving at night because oncoming headlights almost blind me. (When you start and stop your work day in the dark, that’s a challenge!). When I looked at lights, they all had a starburst effect. A couple times during the day the sun would hit just right and I’d be momentarily blinded.

So, time for my eye exam! I’ve had “baby” cataracts for a few years. I’m only 61, but I’ve seen many, many patients my age and younger coming in for surgery. So the possibility of qualifying for surgery was the only concern. Well, turns out I did.

So now I’m on the schedule for both surgeries. I’m thrilled that I’ll be able to have the Tecnis Symfony lens implant.  This will allow me to be less dependent on glasses, probably only needing readers to see fine print.

My hobbies are sewing, genealogy and reading. I’ve also been seen driving around Washington State with my camera, photographing the fantastic scenery, flowers, wildlife and quirky things that catch my eye. My job is computer work and face to face. The ability to do all this without glasses is perfect!

I’ll be sharing my personal experience of surgery and the adjustment to Symfony lenses in further posts. I’m not one to put my personal life online for all to know, but this is dear to my heart with my job, that I love.

Read more:  Cataract Surgery – A Journal II

 

 

Imagine iLASIK working for you.

The Harman Eye Clinic, in Arlington, Washington, invites you to stop in for a free, brief screening and meet-up with one of our surgeons.  There is no pressure or obligation to have surgery.  We are here to help you decide what type of vision lifestyle is best for you and whether you want to research further.  No one is the same and we do not expect to treat you like everyone else.

When you are ready either stop in (903 Medical Center Drive, Arlington WA) or call us at 360-474-2561 or 800-755-3937 and ask for a free screening.  Make the most of your lifetime!

Showtime with Pam!

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Live Facebook ,  (tap here), is quickly becoming our newest path of communication for the Pacific Northwest community.  Pam Miller, Refractive Consultant, connects with our staff and patients for a glimpse of what goes on in the background of The Harman Eye Clinic, in Arlington WA, before visiting our center.

Join us!  Get notifications of upcoming Live Talks with Pam by “liking” us at The Harman Eye Clinic Facebook page  Patients tell us these are the best eye surgeons in the Pacific Northwest for  iLASIK, Cataract surgery, and Lifestyle Lens Implants with cataract surgery!

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What is an extended depth of focus lens? TECNIS SYMFONY®

 

An extended depth of focus lens is an integral part of the Lifestyle Premium lens implant menu at The Harman Eye Clinic in Arlington WA.

In 2016 the Food and Drug Administration approved two new types of intraocular lenses for use in cataract surgery—the and TECNIS SYMFONY® toric lens implants.

The Symfony® intraocular lens is the option of choice that I can offer my patients to improve their vision following cataract surgery, especially those who have difficulty focusing on objects at near distances because of presbyopia,” said Dr. Bajenova.

The Symfony® lens improves intermediate (and in many cases near vision), thereby treating presbyopia. The Symfony® toric lens not only corrects presbyopia, but also astigmatism.

“Many of my patients live very active lifestyles and want to see clearly at all distances, and without glasses if possible,” said Dr. Ballon. “With the Symfony® lens, I can give patients the freedom to enjoy the activities that matter to them, while wearing glasses less.”

Traditional Cataract Surgery compared to an Extended Depth of Focus lens
During cataract surgery, the natural lens of the eye is removed, and an artificial lens, called an intraocular lens, or IOL, is inserted into the eye. Many patients still believe the only IOL available to them is a traditional monofocal lens, which only allows the person to see at a distance, with closer objects being out of focus.

“We take extra time during a patient visit to explore IOL options,” said Dr. Wietharn. It takes more time with staff and myself to introduce new concepts but we think every patient should be aware before surgery, whether or not they wish to take advantage of state-of-the-art technology.”
In contrast to the traditional, standard IOL, the Symfony® lens was specifically developed with features to improve both the range and quality of vision.

The Importance of Pre-Surgical Discussions with your Surgeon
“There is nothing as good as the original equipment from the manufacturer when you are a teenager,” says Dr. Ballon. “That said, the Symfony® lens is the best addition to our lens inventory to date.”

Symfony® lens is successful because it provides a continuous range of focus for both distance and intermediate (computer) vision. Patients who continually require absolute fine detailed vision, such as accountants or those who like to read paper, small-print books in bed without glasses may appreciate a comparison discussion over Technis multifocal lens and Symfony®. These patients who have the Symfony® lens may choose over the counter reading glasses (+1.50 cheaters) for fine print. Others who require fine-print access leave behind need for reading glasses by using their computers, smart phones and pads, to do their reading in bed and fine print projects. It is important to discuss comparison options before surgery by sharing your lifestyle and vision expectations.

The Symfony® lens also offers excellent quality of vision without loss of contrast sensitivity. Some patients who may not be a candidate for the Tecnis Multifocal lens due to, say, an epiretinal membrane (wrinkle in the macula) which may decrease contrast sensitivity, for example, may still be a candidate for the Symfony® lens. Presently, it is the only lens on the market that corrects chromatic aberrations, a feature that improves reading ability. The rings are larger than the Tecnis Multifocal lens, so that halos at night are much less prominent. Patients under the age of 60 tend to tolerate the Symfony® lens much better than multifocal lenses. Although the Symfony® lens is designed for bilateral implantation, patients with a cataract in just one eye seem to tolerate the Symfony® lens well, but the full benefits of reading are best when it is implanted bilaterally.

A LifeStyle Worksheet is available for our patients so that they can prepare. Many patients come for cataract surgery consultations with little or no information about what we call LifeStyle lens implants. The Symfony® is one such lens. Much of the senior population have come to accept that glasses are a part of their life. Some will even say that they like wearing glasses. That is fine, if true. Patients who were eligible and chose to have a LifeStyle lens implant continue to tell us how grateful they are to get up in the morning, look out the window, read the time on their smart phone, and remember how good it is to see with little or no dependence on glasses.

TAKE AWAY POINTS:

  • Extended depth of vision was approved by the FDA in 2016
  • Symfony® and Symfony® toric lenses can extend depth of vision: far, intermediate, and near
  • Symfony® and Symfony® toric lenses can offer quality of vision without loss of contrast sensitivity.
  • The traditional lens implant for cataract surgery is a monofocal lens (vision for one point of vision). Reading glasses and glasses for intermediate vision is expected after surgery.
  • To proceed with confidence, prepare by listing your lifestyle vision requirements and expectations before meeting your cataract surgeon.

Download our latest, comprehensive Patient’s Guide to Successful Cataract Surgery, or request an appointment for a cataract evaluation and your surgeon will be able to address your questions on an individual manner after your eyes have been examined with an overall evaluation of your health, life-style and vision potential. Call The Harman Eye Clinic in Arlington today, the first step to life without cataracts.