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AcrySof® ReSTOR® Introducing a breakthrough in vision surgery. Now there's a revolutionary new way to potentially leave your glasses behind – introducing the AcrySof® ReSTOR® intraocular lens (IOL), a breakthrough in vision surgery. AcrySof® ReSTOR® has been uniquely designed to improve vision at all distances – up close, far away and everything in-between – giving cataract patients their best chance to live free of glasses.  
Conditions of the Aging Eye As we grow older, our bodies mature and change naturally. Within the aging eye, these changes often develop into conditions that impact the quality of your vision. But if you're experiencing age-related visual problems, don't give up – with successful treatment, it may be possible to have clearer, brighter and sharper vision than you've had for a long, long time. Some common problems with aging eyes Cataracts – A cataract is a change in the clarity, or a "clouding," of the lens in your eye. Your crystalline lens, which is made mostly of protein and water, can become clouded enough to prevent light and images from reaching the retina. A cataract can be the reason sharp images become blurred and seeing things at night becomes more difficult. More than half of all Americans age 65 and older have a cataract¹, and cataracts are the leading cause of treatable blindness. For more on cataract treatment, read about cataract surgery. The Procedure Cataract surgery is an outpatient procedure that will only take a few hours. When you arrive, your eyes may be treated with eye drops and anesthetic to minimize any discomfort during the operation. During this routine operation, a small incision is made in the eye. Your surgeon will use a tiny instrument (about the size of a pen tip) to remove your clouded lens. This can be done with either an AquaLase®* device, which uses gentle pulses of fluid to wash away your cloudy lens, or an ultrasonic instrument that breaks up and gently removes your cloudy lens (called phacoemulsification). Once this is accomplished, your surgeon will insert an artificial intraocular lens (IOL) into your eye. After Cataract Surgery After the procedure, you'll be given a short time to rest. Then, the very same day, you can go home. Within the next 24 hours, your doctor will probably want to see you for an evaluation. Drops will be prescribed to guard against infection and to help your eyes heal. For a few days, you may need to wear a clear shield, especially at night, to prevent you from rubbing your eye. Crystalens®
Unlike multifocal or defractive lens designs, the crystalens® Vision Enhancement System offers a whole new dimension in vision restoration after cataract extraction. At the heart of the system is a unique intraocular accommodative lens design called the crystalens®. The crystalens® reacts to the eyes natural accommodative response by providing a single point of focus that moves more anterior for intermediate and near vision, and posterior for distance vision. The patient perceives a true sense of accommodation throughout a full range of vision. 
The Vision Enhancement System also includes a step by step process for optimizing the accommodating amplitude of the crystalens®. Absolute accuracy in pre-operative biometry, keratometry and refraction are required to optimize the capabilities of the accommodating crystalens®. Achieving these standards requires the doctor and his/her clinical and surgical staff to focus on precision, predictability and personalized patient care.
In a healthy eye, the lens, situated behind the pupil, bends light and focuses it on the retina. The light is converted to signals that the brain processes and organizes into the images we see. When the lens loses its transparency, the clouded tissue is known as a cataract. Initially, cataracts cause a reduction in vision that can usually be corrected partially with eyeglasses or contact lenses. As the opacification of the lens progresses, however, vision is increasingly and profoundly impaired. About 50% of Americans between the ages of 65 and 74 and 70% of those over 75 have some stage of cataract development. About 1.3 million cataract operations are performed each year in this country, and cataract removal is the most frequent surgical procedure performed in patients 65 or older. As the crystalline lens ages, it becomes harder and less flexible, and less able to change shape for near vision (accommodation). This process becomes clinically apparent at about age 40 and continues until accommodation is lost, typically by age 65. Loss of accommodation of the lens is a normal aging process, known as presbyopia. Stronger reading glasses are necessary to compensate for the loss of ability to focus up close. About 90% of all cataracts are age-related and start developing after age 40. Usually, there is no other demonstrable cause. Cataracts may develop in newborns and adolescents as well. While congenital cataracts do not impair vision, if the opacity is significant, cataract surgery in the first days of life can prevent otherwise irreversible visual impairment. Amblyopia (lazy eye), which results from damaged retinal cells that depend on adequate visual stimulation for development, can be avoided only if recognized early. At present, despite numerous over-the-counter remedies, there is no proven nonsurgical treatment to cure or retard the development of any form of cataract, in children or adults. However, those who focus on the relationship between dietary patterns and various diseases see evidence that people whose diets are rich in antioxidants (vitamin A and carotene) may be less likely to develop cataracts. It is unlikely that one can benefit from taking multivitamin supplements in the face of diet lacking in fruits and vegetables. On the other hand, people who eat spinach and broccoli for carotenes are sure to benefit from the other nutrients and fiber that these vegetables contain. Prolonged exposure to ultraviolet light may play a role in the formation of cataracts. Studies have also shown that people who smoke cigarettes face up to twice the risk nonsmokers have of developing cataracts. Since couching was developed in the Middle Ages, probably no medical procedure has seen more technological advancement than lens removal. Cataract surgery today is done with microsurgical instruments under the high magnification of an operating microscope. Under topical anesthesia (no needles), an incision of 3mm or less allows ultrasonic phacoemulsification, or liquification, of the lens. Attached vacuum tubing removes the cloudy material, leaving a clear capsule. A foldable artificial lens implant, specifically chosen for the proper correction of near-sightedness (myopia) or far-sightedness (hyperopia), is positioned in this exact location, permanently replacing the natural lens. The incision is designed to seal without stitches.
Laser Surgery In open angle or chronic glaucoma, laser trabeculoplasty may be used to lower intraocular pressure. Controlling glaucoma is usually accomplished with topical medications taken throughout one's lifetime. When medications are insufficient, vision can be protected with the application of argon laser treatment to the drainage system of the eye, allowing eye fluids to flow out more freely. Surgery may be avoided and medications may be reduced or eliminated. A small percentage of glaucoma patients develop a rapidly moving, painful type of glaucoma, called narrow angle or acute glaucoma. The eye pressure quickly rises and can progress quickly to blindness if the pressure is not reduced. The treatment of choice is laser iridotomy, a simple procedure in which an ophthalmologist uses a laser to create a tiny hole in the iris, avoiding emergency surgery.
Laser Surgery Ophthalmology was one of the first medical fields to embrace laser technology, and after more than 25 years, ophthalmologists remain among the leaders in laser applications. Lasers are used in virtually every aspect of ophthalmology from diagnosis to treatment. Were it not for lasers, many of the disease stricken could go blind. The word laser stands for Light Amplification by Stimulated Emission of Radiation. A laser is a concentrated beam of light, created when an electric current passes through a special material. Lasers may either be hot (like soldering) or cool (like a knife). After Cataract Membrane Laser machines for cataract surgery have recently been approved by the FDA. Manufacturers and designers are modifying these devices to allow entrance into the operating suite in the near future. Applied in a similar fashion within the eye, whether these devices will improve upon current technology will be determined over time. Currently, in the most advanced techniques, ultrasound probes are used to emulsify the lens and vacuum the resultant liquid from the eye. Cloudy natural lens material is removed from within its clear capsule. An intraocular lens implant is then inserted into this clear capsular bag to provide good vision. The lens has a cellophane-like outer lining called the capsule. The most common method of cataract surgery leaves the back or posterior part of the capsule intact after the rest of the lens is removed. The back part of the capsule may be used to support the intraocular lens implant (IOL), usually inserted at the time of cataract surgery. The posterior capsule is normally clear. Weeks, months or years later, this lens capsule may lose its transparency or wrinkle, causing a reduction in vision. It is not necessary to remove the capsule, but only to make an opening in the center to allow the clear passage of light rays. When this happens, a noninvasive laser procedure creates a small opening in the capsule, clearing the vision. The capsule, and its cloudy membrane, are under tension, so Ophthalmologists use a shock wave generated by a “cool” YAG laser to rupture the membrane. As it ruptures, the capsule snaps back to the edges of the opening, no longer obscuring the vision. The procedure is done in an outpatient setting using topical anesthetic drops for comfort. Laser capsulotomy is painless and takes but a few minutes. Results are prompt. Retinal Detachment Years ago, retinal detachment meant blindness. The retina is the sensitive nerve tissue which lines the posterior surface of the eye. It receives light energy and sends the vision message to the brain for interpretation. Detachment usually occurs after a retinal tear allows ocular liquid to flow under the retina, detaching it from the eye wall. Unattached retina does not function. Ophthalmologists can use laser power to spot weld the retinal tear, solving the problem, usually with minimal or unnoticeable change in vision. Diabetes Estimates of 16 million Americans suffer from diabetes. Almost a million new cases are diagnosed every year. Many will develop diabetic retinal disease. Two forms of the disease are amenable to laser therapy: growth of abnormal vessels and macular edema. National trials have been completed and guidelines for appropriate candidates for laser treatment have been developed. Once a statement of impending blindness, diabetic retinopathy is commonly managed with a variety of laser photocoagulation techniques. Since treatment is so successful and readily available, annual eye examinations are critical to the prevention of vision loss. Age-Related Macular Degeneration Many older people develop macular degeneration as part of the aging process. There are two common forms of ARMD: dry and wet. Ninety percent of all people with ARMD have the dry form. Recent studies suggest that dry ARMD is caused by the aging and thinning of the tissues of the macula. Over time, there is a gradual reduction in vision that can interfere with reading, writing or, even, driving a car. Although there is no proven treatment for dry macular degeneration, the National Eye Institute is sponsoring studies that evaluate the possible benefit of nutritional supplements for the condition. Although only ten per cent of people with ARMD the “wet” type, it is a much greater threat to vision. With the wet form of the disease, rapidly growing, abnormal blood vessels begin to hemorrhage, leaking blood and fluid that can destroy the macula. While laser surgery is an option for a small percentage of patients, the heat generated by the treatment can be as harmful to vision as the disease itself. Wet macular degeneration can cause severe loss of central vision. The FDA has recently approved laser photodynamic therapy (PDT) as an alternative option to laser photocoagulation. With PDT, a light-reactive dye is injected intravenously and concentrates in the abnormal blood vessels near the back of the eye. About fifteen minutes later, a special laser is focused on these vessels, activating the dye to destroy the targeted vessels, minimizing damage to adjacent healthy, functioning retina.
Tearing In some people, tears well up in the eye because too many tears are produced or because the tears are not draining properly. Excess tears give the eye a moist appearance, and can collect along the border of the lower lid and overflow onto the cheek. Small glands, located in the surface tissue on the white of the eye and lining the eyelids, constantly produce small quantities of tears to keep the eye healthy and lubricated. The lacrimal gland, a larger gland located in the upper eyelid, responds to emotion or eye irritation by producing larger quantities of tears. After bathing the eye’s surface, tears enter a small opening in each lid (the punctum), drain through a small canal (cannaliculus) into the lacrimal sac and down the nasolacrimal duct into the nose. This explains why we have a runny nose when we cry, since the excess tears reach the nose through the normal tear drainage system. Improper tear drainage and overflow tearing can be caused by malpostioned eyelid or punctum; faulty blinking; orbital injury; birth defects; infections; and complications of burns or radiation therapy. Excess tear production can be caused by: superficial foreign bodies; wind, smoke and fumes; infections, allergic reactions; glaucoma; eyestrain; emotion; and dry eyes. Surprisingly, people with dry eyes often complain of tearing. Even though the underlying problem is too few lubricating tears to keep the eye moist, the large lacrimal gland often reacts by producing an excessive amount of tears. Instead of draining normally, the excess tears will run down the cheeks. A thorough examination by an ophthalmologist is necessary to determine which of these problems is causing excessive tearing. An attempt may be made to irrigate fluid through the tear drainage system and into the nose. Other tests such as measuring tear production or recovering tears from the nose may also be performed. Treatment depends on the exact cause. If excess tears are caused by an in-turned eyelash, the offending eyelash is removed. Abnormalities of the eyelid or eyelid position may require surgery. If the tear drainage system is blocked, surgery to open or bypass the blockage may be necessary. Occasionally, the exact cause cannot be determined. In such cases, the patient may have to learn to live with the problem. Styes and Chalazions The upper and lower eyelids contain oil glands called meibomian glands. The glands are oriented in a vertical fashion, like a piano keyboard. Meibomian glands secrete oils at the lid margin to smooth the optical surface, to retard the evaporation of tears, and to seal the lids while asleep. For undetermined reasons, sometimes related to a chronic inflammatory lid disease called blepharitis, a gland may become clogged and inflamed. In its acute stage, the gland may swell to many times its original size, producing pain and redness. This is called a stye or hordeolum. Most times, such a lesion spontaneously resolves without therapy. Other times it remains tender and unsightly. The pain and redness of a stye may resolve, leaving the enlarged gland as a firm cyst, or chalazion. The management of styes and chalazions is focused on allowing the gland to drain, returning to its normal anatomy and function. This is accomplished through the systematic use of hot compresses. Hot compresses induce expansion of the lesion until it drains. To properly do hot compresses, water from a sink should be turned on to hot only. A clean washcloth should be soaked and, when the temperature is tolerable, applied to the closed affected eye for thirty seconds. The cloth should be remoistened and reapplied for a total of 3 minutes, three times a day. This remedy may induce mild redness around the eye, often focused on the lesion. A tube of antibiotic-steroid ointment will be prescribed to treat this irritation. Surgical drainage of these lesions is rarely necessary. Surgery may be considered once a stye has evolved into a chronic chalazion, unresponsive to therapy. Incision damages the gland and increases the likelihood of recurrence. Therefore, compresses remain the treatment of choice, however, perseverance is necessary as it may take days to weeks to achieve resolution. Pterygium (Carnosidad) A pterygium is fleshy tissue that grows over the cornea (the clear front window of the eye), like a callus. It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs at the inner corner of the eye, but can appear on the outer corner as well. The exact cause is not well understood. Pterygium occurs more often in people who spend a great deal of time outdoors, especially in sunny climates. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important causal role. A dry eye may contribute to pterygium. When a pterygium becomes red and irritated, eyedrops or ointments may be used to help reduce the inflammation. If the pterygium is large enough to threaten sight, grows excessively, or is unsightly, it may be removed surgically. Despite proper surgical removal, the pterygium may return, particularly in young people. Surface radiation or medications are sometimes used to help prevent recurrences. Protecting the eyes from excessive ultraviolet light with proper sunglasses and avoiding dry, dusty conditions and use of artificial tears may also help. A pinguicula is a yellowish patch or bump on the white of the eye, most often on the side closest to the nose. It is not a tumor, but an alteration of normal tissue resulting in a deposit of protein and fat. Unlike a pterygium, a pinguicula does not actually grow onto the cornea. A pinguicula may also be a response to chronic eye irritation or sunlight. No treatment is necessary unless it becomes inflamed. A pinguicula does not grow onto the cornea or threaten sight. If particularly annoying, a pinguicula may on rare occasions be surgically removed, but the postoperative scar may be as cosmetically objectionable as the pinguicula. |
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A number of attempts have been made to design a functional bifocal or multifocal/defractive intraocular lens. Unfortunately, the multifocal and defractive properties of these lenses produce significant visual aberrations and the technology has not become popular with patients and cataract surgeons.
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