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    An OD’s perspective on his own cataract surgery

    I had to make the same decisions I asked my patients to make


    Comparing procedures

    As a consequence of scheduling, each surgery was done in a different facility. The first surgery was done with a nerve block. The immediate results of the nerve block were absolutely frightening. Because the nerve block also affects the extraocular muscles and the orbicularis, I noticed, for hours after the surgery, very significant double vision. The diplopia was both horizontal and vertical, and I couldn’t close the operated eye to alleviate it. In addition, the image in the operated eye was tilted about 30 degrees. I think I remember being taught in optometry school that the human eye does not cyclorotate, but let me tell you, it sure seemed like it did.

    Related: Innovations in cataract and refractive surgery

    None of these phenomena occurred with the second eye, which was anesthetized with topical anesthetics only. In both eyes, there was no noticeable post-op pain and no significant difference in dry eye perception. If given a choice, I’d pick topical drops over nerve block any day.

    Femto also offers lowered retinal trauma risk, better capsulorhexis centration, and the ability to incorporate astigmatic keratectomy incisions. In the hands of a surgeon skilled with the laser, I’ve yet to hear a clear argument against it. If cost and access are not an issue, my advice to patients, now based on personal experience, will be to choose laser-assistance. 

    As an addendum, I should mention that because I opted for early intervention, there was no “a-ha” moment in which colors looked substantially more vivid, and background light looked substantially brighter. A patient with BCVA of 20/200 will have much more of a “wow” factor.

    Related: Comparing laser-assisted vs. conventional refractive cataract surgery

    Most people with aging eyes, even eyecare professionals, have a difficult time separating the visual disturbances caused by cataracts from those caused by vitreous opacities and irregularities. My floaters are even more apparent now. I plan to be a lot more diligent, going forward, in stressing to patients that they are getting a new crystalline lens, not a new eyeball. 

    So here I am, six months out from my cataract surgeries, functioning nicely with my new vision and pleased to know that this is one aging issue that I have already put to rest. If the others fix up this handily, I’ll be one happy old camper. 

    Click here to check out the latest news and advice on refractive surgery

    Charles Klein, OD
    Dr. Klein graduated from PCO in 1967. E-mail him at [email protected]


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    Optometry Times A/V