Vision is a critical part of sports performance.  At the elite level of sports, the athletes tested have been found to have above normal visual acuity.  It is not only acuity but the entire visual system including association areas in the brain dealing with the visual response which are special.  When a pitcher delivers a pitch at 90 miles an hour, the batter must react almost immediately.  The interesting factor is that once the eye sees the release of the pitch, it takes two-tenths of a second for that visual information to arrive at the visual cortex at the back of the brain.  By the time the brain perceives the pitch, the ball has already traveled 25 feet toward the batter.  Ofcoarse, the same considerations apply to reaction time on the tennis court. There is no doubt that there are numerous immeasurable clues that the batter or tennis player processes in order to get to the ball.  One physical finding that is readily measurable is the visual acuity of the professional baseball player.  Many of the outstanding batters have acuity which is far better than 20/20.  A batter with 20/10 acuity can see the stitches on the baseball as it is released by the pitcher.  This enables him to predict the type of pitch (curveball, slider) that is coming his way.

If there is an athlete in your family, he or she should have their visual acuity measured and the examiner should not stop at correcting the vision to 20/20 but should attempt to correct the vision to the very best that is possible.  A nearsighted baseball player might require the smallest amount of additional power in the eyeglasses or contacts to get to 20/15 and this could make all the difference at the bat or on the tennis court.  Of coarse here in Miami where the glare is so intense, any residual refractive error can enhance the glare as well.

I take this same approach with the senior sportsman/sportswoman who are coming to cataract surgery at Miami Eye Center.  Whether they are avid golfers, tennis players, sports anglers or pilots, these folks need an optimum visual outcome.  This means selecting the best intraocular lens for that individual, meticulously obtaining the most accurate preoperative measurements on that person’s eye and delivering an outcome which exceeds the patient’s expectations. 

A professional fishing guide needs optimum contrast sensitivity and minimum glare.  While it would be nice to offer a multifocal lens in order to eliminate glasses, this would not be the best choice; rather an aspheric lens would fulfill the guides requirements.  And if there is any astigmatism, that must be addressed.

If you are an up and coming athlete or a more seasoned veteran, have your visual acuity optimized, it will make more of a difference than you might think.

Here in Miami and probably elsewhere, about half of my patients having cataract surgery also have dry eyes or eye allergies or various types of inflammation of the eyelids.  It is amazing to me how this problem can reduce the good results of well done cataract surgery (LASIK surgery as well).  In many cases the condition is only slightly bothersome prior to surgery, however, when you have cataract surgery with one of these ocular surface diseases present, there appears to be a surprising diminusion of the visual outcome.  If you have chosen to make a significant “lifestyle enhancement” with a multifocal lens insertion at the time of cataract surgery you want to maximize the result and achieve the ultimate potential of this new technology. 

During the preoperative examination at Miami Eye Center, we look at the tear film using new technology and are able to determine if you have a deficiency in the water component of the tear film or if your tears are evaporating too fast.  When found, patients are treated with artificial tears preoperatively and the surgery itself is performed in a way which protects the surface of the cornea.  If we find an inflammatory problem causing a tear film deficiency we treat that with a course of cortisone eye drops before the surgery.  We might also use Restasis to decrease inflammation. In cases of eyelid inflammation a round of oral antibiotics as well as antibiotic eyedrops over a period of several weeks can improve the tear film.

The take home message here is that there are subtle issues which can impact the outcome of your eye surgery that are beyond just having a good procedure and your surgeon needs to evaluate these factors and discuss them with you.

Now that you have a visually significant cataract, that is, a cataract that is interfering with activities that you enjoy doing or those that you must do, the choice is no longer “should you do the surgery,” rather “how should the surgery be done.”  Needless to say, this decision must be made during a consultation with an ophthalmologist with whom you feel  comfortable.  Keep in mind that this is the last and best opportunity to not only remove your cataract but to correct other problems such as nearsightedness, farsightedness presbyopia and astigmatism.

To help with the discussion, the lens options fall into several classes; MONOFOCAL LENSES will deliver good vision at a single point in space, ie, distance or near.  A modern variation on this lens is the ASPHERIC LENS which has a curvature which neutralizes the curvature of the cornea and thus reduces glare and other types of distortion.  A TORIC LENS will correct astigmatism at the same time that it corrects nearsightedness or farsightedness and it has recently been manufactured in an aspheric form.  Then there are the MULTIFOCAL LENSES which are in many instances, aspheric as well.  These lenses correct for distance and near vision.  There is the Restor lens from Alcon Labs, the ReZoom lens and more recently the Tecnis lens from AMO.  In addition, the Crystalens from Bausch and Lomb which is somewhat different from the other lenses but ultimately yields a similar outcome.

The issue is that there are numerous lenses to place in the eye at the time of surgery. The lens must be matched to the patient’s visual needs, not the other way around; one lens does not fit all.  On the one hand, an 80 year old with macular degeneration and cataracts who does not mind wearing reading glasses would fair best with a lens that provides only distance vision and perhaps it should be an ASPHERIC LENS which minimizes glare and maximizes distant vision.  The opposite situation might occur in a 50 year old who needs distance vision, computer vision and reading vision and would be willing to wear reading glasses occassionally.  The latter case would call for a MULTIFOCAL LENS of which there are several. 

It must be said that every style of lens has different advantages and disadvantages and these must be reconciled with the patient; that is my job.  I must find out what you expect and want from the procedure.  What are the tasks that you want to do without glasses and which are you willing to occassionally put the glasses on in order to perform. 

Remember that cataracts come with having birthdays and perhaps this year’s present might be good vision and possibly no glasses to achieve that end.

I performed my first cataract surgery in 1973, while a resident in training at the Medical College of Virginia.  The patient was admitted to the hospital on the evening prior to the day of surgery.  The surgery took about an hour and the patient was returned to the hospital bed.  On the patient’s second hospital day, she inhaled an orange peel and had a respiratory arrest which resulted in  brain damage.  It was my belief that had she been at home in familiar surroundings that this never would have occurred. 

As chief resident in Virginia, I began a crusade to shorten the length of hospital stay for cataract surgery.  The best that I could do was to reduce it to two days.  From Virginia, I moved on to Bascom Palmer Eye Institute.  In the mid-seventies the same policy was adhered to; in-patient hospitalization for cataract surgery.  I was able to get folks home on the day following surgery but still not good enough.  Ultimately, I went into private practice at the old Victoria Hospital.  This was the infancy of the HMO movement in Miami.  One of my early patients was in AvMed HMO and on the first day following cataract surgery I got a phone call from the president of the HMO advising me that it would be a good idea to discharge the patient that day.  That was the incentive that I needed and I sent the patient home on day one much to the chagrin of my colleagues.

Fast forward to this week.  I operated ten cataract patients at Miami Eye Center which does not even have a postoperative bed in which to put patients; there are lounge chairs.  The surgery takes ten minutes, there are no preoperative shots, no stitches, no patches and the patient is on his/her way home after a fifteen minute recovery.  How is all this possible?  In 1973, I was operating with magnifying glasses to see the surgery.  The wound was 3cm and it was closed with silk suture.  The entire cataract was frozen (intracapsular cataract surgery) and removed in a large piece through this large wound.  Occasionally the sutures broke and the wound opened leading to serious complications.  In general, the trauma to the eye left it quite inflamed.  Today the surgery is performed with the aid of an operating microscope which allows for microscopic management of the details of the surgery.  The wound is 2.6mm long and no stitches are necessary.  The cataract is removed via this tiny bloodless incision by breaking the lens into a soupy material and aspirating from the eye (phacoemulsification).  The wound is secure so folks can become quite active on the next day.  Very sophisticated antibiotics and anti-inflammatory drugs reduce inflammation to the point that patients rarely feel any discomfort.  And most importantly, patients have the opportunity to come away from the surgery with little or no need for eyeglasses.

If you are in need of cataract surgery, step up to the twenty-first century advances.  The experience will amaze you.

I am asked this question on a regular basis, “are my cataracts ready for surgery?”  The answer to this question is not a “one size fits all.”  Since cataracts develop slowly in most cases, the change in vision is subtle.  Very often, the only way to know that you have developing cataracts is to be told by your ophthalmologist during a routine examination.  In any case, the earliest symptoms are often glare while driving at night, glare during the day, dim vision in low light or double vision.  In all cases this is a painless process.  The symptoms will be different depending on the location of the cataract change in the lens of the eye.

Cataracts which are found in young individuals are often associated with using steroids (cortisone) for extended periods or following eye trauma.  This type of cataract is located in the back of the lens (posterior subcapsular cataract).  Because it is closest to the retina, the impact on vision is most profound; a small cataract can cause substantial loss of vision.  These cataracts tend to develop quickly.  The more common type of cataract is called a nuclear cataract and is the typical age related lens change.  This cataract grows slowly sometimes taking ten or twenty years to become a problem.  There is also an anteriorly located cataract known as an anterior cortical cataract seen quite often in diabetics.  Because it is further forward in the eye and away from the retina, it has less of an impact on vision.

The over-riding factor that determines when it is appropriate to intervene with surgery is the lifestyle of the individual.  Depending upon your line of work or your recreational interests, you will have different visual needs.  I have performed cataract surgery on commercial airline pilots who had only a slight loss of vision with only a small amount of glare.  Their complaints would probably not bother most of us.  But when attempting a landing at night there is an exquisite need for sharp vision and these young pilots were in need of help.  I have operated a number of recreational fisherman whose complaints were not being able to see into the water or see the markers at night.  Golfers ofter complain that their friends can follow the ball and they can not.  At the other end of the spectrum is an elderly inactive person whose only interest is to sit in front of the T.V.  This individual can just move closer to the screen and defer surgery indefinitely.  I hasten to add that I have seen amazing changes come over debilitated folks (who might also have hearing problems and possibly Alzheimers Disease) following cataract surgery and the resumption of good vision.

Most of us are somewhere between the pilot and the elderly infirmed T.V. watcher.  It is for that reason that routine exams are recommended and once cataracts are diagnosed, continued followup is important.  Cataracts are not a disease, they are a normal part of having birthdays.  These days we are all hoping to live well as long as we can and often early intervention with cataract surgery can put spring back in your step.

It is my pleasure to open the BLOG section of this website.  I hope to give the reader an opportunity to obtain up to the minute information about the newest technologies offered at MIAMI EYE CENTER as well as the greater ophthalmic community.  I encourage those with an interest to become involved with questions or comments.

This evening, I was reviewing the chart of patient C.B. who is a very young 72 years.  He had R.K. (radial keratotomy) surgery in Columbia 15 years ago.  He was quite pleased with the outcom of that surgery until recently when became bothered by nighttime glare while driving.  He consulted an optometrist who diagnosed cataracts and referred him to this office.

I began performing radial keratotomy surgery for myopia in 1982, PRK in 1996 and LASIK in 2000.  Now that many of my patients from those days have “grown up” they are developing cataracts.  Cataract surgery in folks who have had prior RK, PRK or LASIK presents a unique challenge to ophthalmic surgeons but one which I have managed incorporating the newest technology.  The challenge facing the surgeon is in selecting the proper intraocular lens to place in the eye at the time of surgery.  For patients who have not had prior refractive procedures, the selection process is routine.  However, the standard computer programs used for the average patient do not work for people who have had prior RK, PRK or LASIK.  If the incorrect lens is utilized, the patient will be nearsighted or farsighted following the surgery.

In the clinic today, I measured the power of C.B’s eye as one would for making eyeglasses.  I then inserted a special diagnostic contact lens and repeated the process.  This yielded the true power of the cornea and that data was used in two additional programs to yield the power of the intraocular lens to be inserted at surgery.  These mathematical manipulations have been evolving over the past several years and I have found them to be quite accurate.

The goal of modern cataract surgery is not only to achieve excellent vision for the patient but excellent vision without glasses.  This goal can be achieved for many patients even in complex cases as outlined here.