Sharing Experience: Cataract Surgery with Two Distinct Intraocular Lens Replacement in a Single Day
“The doctor had everything planned out. He is highly experienced and knows what I need most.”
Cataracts are a common age-related eye condition that can cause blurred vision, making everyday activities like reading challenging.
Cataracts are most commonly treated with a surgical procedure called phacoemulsification. This minimally invasive technique uses ultrasound to break up and allow the removal of the cataract to make room for the implantation of an artificial lens. While some patients may understandably fear cataract surgery due to concerns about blindness, it's a safe and effective procedure with a high success rate. Panida Sae-Tan, who discovered she had cataracts unexpectedly, didn't hesitate to undergo surgery. Read her story in this issue of Patient Story to learn more about her experience.
Cataracts and glaucoma, detected through eye checkups, place me in the risk group.
“In my late fifties or early sixties, I experienced a sudden and intense itch in one eye. Unfortunately, the itch worsened when I rubbed my eyes unknowingly. This prompted me to schedule an appointment with an ophthalmologist. While I anticipated needing just eye drops, a comprehensive examination revealed a different story. The thorough checkup identified cloudiness in my lens, a potential indicator of cataracts. In addition, the ophthalmologist discovered narrow angles between the cornea and iris, along with ocular hypertension.”
While my findings appear to be in the early stages, neglecting treatment could lead to complications. Over time, the affected lens may swell and thicken, potentially causing angle-closure glaucoma.
“The diagnosis naturally raised concerns. Having pre-existing hypertension (my blood pressure typically ranged from 130-150 systolic and 90 diastolic) and a slightly elevated HbA1c (6.2) meant I was more susceptible to cataract development. Furthermore, the identified ocular hypertension could, if left untreated, progress to glaucoma, another potential complication associated with cataracts.”
While the initial cause of the itch was diagnosed as an allergy requiring prescription eye drops, Panida's vigilance paid off. Aware that these drops, containing steroids, could potentially affect her intraocular pressure, she ensured strict adherence to the doctor's instructions. Regular follow-up appointments were scheduled. This proactive approach led Panida to research cataract treatment options. Determined to address the issue, she sought out Assoc.Prof.Dr. Prin Rojanapongpun, a renowned ophthalmologist specializing in cataract and glaucoma surgery at MedPark Hospital.
Panida's confidence was further bolstered when she learned her chosen ophthalmologist, Dr. Prin Rojanapongpun, was internationally renowned. Even an overseas friend’s ophthalmologist recommended him for cataract surgery if my friend returned to Thailand. During their consultation, Dr. Prin provided clear and concise explanations about her condition and treatment options, alleviating any anxieties Panida might have felt.
During their initial meeting, Dr. Prin conducted a thorough examination, including visual field testing, anterior chamber angle measurement, and intraocular pressure checks. He also took a comprehensive medical history, inquiring about Panida's lifestyle, including her work status, reading habits, computer use, and driving frequency. This detailed approach allowed Dr. Prin to tailor the treatment plan personalized to Panida's needs.
Personalized intraocular lenses
“You need lens replacement surgery,” said Dr. Prin. He explained the mixed IOL approach, involving the implant of distinct intraocular lenses for each eye -- “mono-focal lens” for the right eye and “multifocal lens” for the left. The doctor scheduled Panida for bilateral lens replacement surgery on the same day.
“I had surgery for both of my eyes in one sitting. Some suggested I should have surgery one eye at a time so that I can still see and take care of myself, and when the operated eye regains its function, go for the other one. They asked me if I was scared of undergoing surgery for both of my eyes at the same time, lest one of them got infected. I told them I was not afraid because the doctor had everything planned. I trusted in him. He is highly experienced and knows what I want the most.”
The advantage of a mono-focal lens is excellent clarity for distance vision, However, you might still need reading glasses for close-up tasks like reading. On the other hand, a multifocal lens is like a progressive lens, offering clear vision across a range of distances, from near to intermediate and distance viewing.
“Motorcycling is a big part of my life – I even use it to run errands like grocery shopping in my neighborhood. Dr. Prin was incredibly considerate. He explained that during the first few months after surgery, I might experience glare or halos, especially at night. This could be distracting, particularly while riding a motorcycle. So, before the surgery date, we had a dedicated appointment to choose the most suitable intraocular lens for me. He carefully selected one that would best accommodate my needs and lifestyle.”
Is phacoemulsification scary?
Phacoemulsification, a minimally invasive surgical technique, utilizes ultrasound waves to break up the cloudy lens in the eye. This emulsified lens material is then gently removed, allowing for the implantation of a pre-customized intraocular lens (IOL).
“Surgery day arrived, and I made sure to be meticulously prepared. I washed my hair and face extra carefully, following the pre-operative instructions to the letter. Shortly before being wheeled into the operating room, the staff kindly administered eye drops. Once settled, the doctor gently applied a retractor to keep my eyelids open. Even though I was aware of what was happening throughout the surgery, I couldn't see a thing – just darkness. However, the sounds around me were clear, and most notably, Dr. Prin! He crooned while performing the surgery. Despite the seriousness of the procedure, the ambiance felt surprisingly light and relaxed.”
“Fifteen minutes flew by, and I barely noticed – that must mean the surgery on my left eye was a success! Dr. Prin then switched to my right eye, working with the same calm efficiency. Once both surgeries were complete, a gentle nurse placed a gauze pad and eye shields on each eye before carefully wheeling me to the recovery room.”
“After a short while, the nurse returned and gently removed the gauze pads, leaving the eye shields in place for protection. The nurse explained they were crucial to prevent me from accidentally rubbing or pressing on my eyes while they healed. She also began a regimen of eye drops, instilling them one at a time in each eye every few hours.”
Following the surgery, Dr. Prin scheduled a series of follow-up appointments to monitor my recovery, which took place one week, one month, three months, six months, and one year after surgery. At each appointment, I underwent a comprehensive evaluation to assess my visual field, intraocular pressure (IOP), and the anterior chamber angle.
“I would like to encourage everyone over 40 to have a regular eye checkup. It's a reminder that our bodies, including our eyes, change with age. Honestly, if it hadn't been for that intense itch in my eye, I might not have had my eye examination. Thankfully, that led to the discovery of cataracts. Today, while I sometimes wear reading glasses to ease the strain from watching hours of live streams, the real difference is clear – literally! My distance vision with my old farsighted glasses is incredible. Thanks to my new IOLs, I'm beyond happy with the results.”
Panida's positive experience with cataract surgery has inspired others to consider the procedure themselves. Her radiant smile and sparkling eyes, reflecting a newfound sense of joy, truly embody the saying, “The eyes are the windows to the soul.”
Cataract surgery can be performed early if it answers the needs of a patient
Traditionally, ophthalmologists performed cataract surgery when the cataract matured with significant lens clouding. However, advancements in technology allow for earlier intervention. Sophisticated eye analysis tools and advanced techniques like digital systems and wavefront laser technology enable doctors to perform accurate and efficient cataract surgery, optimizing vision quality and addressing individual patient needs. You don't necessarily have to wait for complete lens opacity before seeking treatment.
Don't wait until cataracts worsen to seek treatment! Seniors experiencing lens degeneration should consult an ophthalmologist to discuss their options. Early intervention can significantly improve your quality of life. Imagine being able to read a book, watch TV, use your smartphone, or go about your daily activities without constantly relying on eyeglasses.
Assoc.Prof.Dr. Prin Rojanapongpun, a renowned ophthalmologist specializing in cataract and glaucoma surgery, emphasizes the importance of tailoring treatment to individual needs. Intraocular lens implants offer a wide range of options, and Dr. Prin recommends considering your lifestyle and visual requirements to determine the best fit for you.
“Effective communication is key to understanding a patient's needs and tailoring the treatment plan accordingly. Ms. Panida, for example, lives in Phuket and frequently rides a motorcycle on various terrains, including flat and hilly roads, both lit and unlit. To ensure her safety, we needed to address issues like brightness and varying light contrasts, allowing her to see clearly under all conditions. With Google Maps becoming an essential tool, Ms. Panida related a need to see her phone screen clearly at close range but preferred to avoid wearing glasses altogether. Considering these factors, a solution combining mono-focal and multifocal lenses emerged as the optimal approach. A mono-focal lens in one eye would provide excellent distance vision for safe motorcycle riding, whereas a multifocal lens in the other would offer both near and far focus for daily activities like using her phone. Selecting the right model for each eye is crucial to ensure the best possible outcome for Ms. Panida's unique lifestyle.”
Surgical technology and the personal experience of an opthalmologist are important
Beyond understanding a patient's lifestyle and vision needs, ophthalmologists rely on their intricate knowledge of intraocular lenses (IOLs). A thorough eye examination combined with in-depth knowledge of each IOL type allows them to recommend the most suitable option for each patient. This personalized approach ensures optimal visual outcomes. Finally, successful cataract surgery hinges on precision. Skilled surgeons and advanced technology work to ensure a safe and effective procedure.
MedPark Hospital prioritizes patient outcomes by utilizing cutting-edge technology throughout the cataract surgery. Diagnostic tools play a crucial role in ensuring precise treatment planning and execution. This equipment includes advanced equipment like auto keratometers, IOLMasters 700, and ANTERION systems, which meticulously measure the 3D corneal curvature. In addition, Anterior Segment Optical Coherence Tomography (OCT) and Pentacam technology provide detailed cross-sectional images of the front part of the eye, allowing for a comprehensive evaluation.
Furthermore, MedPark Hospital leverages cutting-edge intraoperative wavefront aberrometry for real-time data that helps the surgeon refine the pre-operatively chosen IOL power and calculates its ideal placement inclination within the lens capsule during surgery, significantly enhancing surgical precision, minimizing the risk of errors and maximizing potential visual outcomes for patients.
“We're confident in recommending this treatment plan, engendering by years of experience treating patients with a wide range of eye conditions. We have a deep understanding of the strengths of each type of IOL, and a proven track record of successful outcomes. We believe this approach will be highly effective.” added Assoc. Prof. Dr Prin.
The advantages of simultaneous bilateral cataract surgery
Patients can undergo cataract surgery for both eyes simultaneously. The procedure is not as worrying as one thinks. However, it depends on how prepared the hospital, doctors, and medical staff are. Most importantly, a support team must be constantly ready when something happens to a patient.
“Simultaneous bilateral cataract surgery has been around for over a decade and good reason. It offers several advantages that can make the entire process smoother for you.
Firstly, undergoing both surgeries at once means a shorter overall recovery time. This translates to less time spent adjusting to your new vision and a quicker return to your daily activities. Secondly, it can significantly reduce anxiety for some patients by completing both procedures in one go.”
“Financially, there can also be some cost savings compared to having separate surgeries. This is because you'll only need one set of preoperative evaluations and postoperative medications. Finally, convenience is a major benefit. With a single surgery, you'll eliminate the need for multiple appointments and the burden it places on you and your family.”
Patients should know it takes time for the brain to adjust to a new intraocular lens. Dr. Prin explained:
“When you have different types of lenses implanted in each eye, your brain needs time to adjust to the new way of seeing, a phenomenon called neural adaptation. We encourage patients to use both eyes as much as possible after surgery. The good news is, for Ms. Panida, this adjustment period was quite short. However, it can vary for everyone. The reason? Each treatment plan is tailored to the individual's needs, and that can influence how quickly the brain adapts.”
