Light Adjustable Lens Implant for Cataract Surgery with Dr. Steven Tersigni
After watching his father improve the lives of others as a general surgeon, Dr. Steven Tersigni became interested in medicine himself. In medical school, he fell in love with ophthalmology because it allowed him to have an immediate impact on the lives of others. There are many different ways to do this in the ophthalmology profession, but cataract surgery is one of the most important.
What is Cataract Surgery?
Cataract surgery is one of the most common surgeries done in the US today, and it is also one of the safest. This surgical procedure, also called lens replacement surgery, is usually done to remove a cataract and allow the patient to see clearly again. During this surgery, the natural lens inside the eye (which contains the cataract) is removed. A new intraocular lens is then inserted in its place, allowing the patient to see well again.
What does Cataract Surgery Cost?
Based on the most recent estimates, cataract surgery in the US costs around $3500 per eye. This does not include specialty lenses such as torics, multifocals, or light adjusted lenses, which we’ll learn more about in a bit. This cost is the average out-of-pocket for standard monofocal lenses that allow you to see at one distance (usually far away). Medicare or other private insurance will usually pick up some of the cost of cataract surgery, depending on the circumstances and the intraocular lens selected.
What is the Recovery Time for Cataract Surgery?
Thankfully, the recovery after cataract surgery is usually quite short and easy. You may be able to see well right away, and usually within a few hours of the procedure. Of course, procedures like this come with swelling and inflammation that can take a bit to calm down, but overall it’s an easy recovery. After your surgery, you’ll be seen the next day by your eye doctor, and then usually a few weeks after.
Make sure to continue taking any prescribed medications, such as antibiotics and anti-inflammatory eye drops. This will allow your eye to properly heal and do it within the right time frame.
How to Prevent Complications from Cataract Surgery
One of the best ways to prevent complications post-surgery is to take care of your eyes beforehand. Eyelid hygiene helps to keep the eyes clean and free of microorganisms before the surgery, and it also helps prevent blepharitis and dry eye, which can be problematic for cataract surgery if they’re not under control. Follow this simple routine:
Remove your makeup every night and wash your face with a tea tree soap to ward off demodex eyelash mites
Use a warm compress if you find it makes your eyes feel comfortable
Cleanse the eyelids and lashes with hypochlorous acid, a solution made naturally by the body to fight microorganisms. This cleanser should be used twice daily, especially leading up to the surgery
There are other things your cataract surgeon may suggest post-surgery in order to prevent complications. This may include:
Using all medications as prescribed and until finished
Avoid rubbing your eyes after the surgery and until healed
Avoid strenuous activity such as heavy lifting and intense housework or yard work
Avoid hot tubs and swimming pools until healed, to prevent infection
Consider wearing goggles or wrap-around sunglasses outdoors to prevent contact with dust, debris, and allergens
What are Light Adjustable Lenses?
Light adjustable lenses for cataract surgery are a new technology that allows the surgeon to do things they’ve never been able to before. This intraocular lens is placed inside the eye as any regular intraocular lens would be, but this type actually allows the surgeon to adjust the power of the lens as needed. This is incredibly important because, most of the time, there is no great way to adjust the power if someone is unhappy (aside from having refractive surgery on top of the cataract surgery).
Usually, it’s common to see 90-95% accuracy of regular intraocular lenses used during cataract surgery, but there are many factors that come into play which can affect how well a person sees. This may include corneal conditions, previous LASIK, or other refractive surgeries. Sometimes, patients are left with more prescription than they thought they would be, and that’s where light adjustable lenses are so great.
Light adjustable lenses are made of silicone, and have macromers embedded in the lens which change their position in response to UV light. They’re selected and placed just like regular lenses, and the patient is allowed to heal for an appropriate amount of time. Then, if there is any unhappiness with the prescription, the surgeon is able to use a light delivery device which works to reshape the lens inside the eye. This can effectively change the prescription of the lenses and ultimately make the patient more happy.
How does one determine suitability for a light adjustable lens?
Suitability for these lenses is determined similarly to any other cataract procedure. The patient needs to have a realistic vision goal, and some patients may just have expectations that are unreasonable with any lens. Patients who often do well with these lenses are those for whom it’s uncertain how they’ll heal. Patients who have had previous LASIK or RK surgery are also great candidates because their vision can be fine-tuned much more easily. Aside from these patients, normal patients do quite well with these lenses also.
What are contraindications of a light adjustable lens? What are risks?
Just like with any cataract surgery, there are risks. This can include any of the following:
Retention of pieces of the cataract inside the eye
Dislocation of the intraocular lens
Specifically for light adjustable lenses, contraindications have more to do with the UV light delivery device than the actual lens. Patients with moderate to advanced macular degeneration, herpetic infections, and those who take certain medications may be contraindicated.
What is the Cost of a Light Adjustable Lens Implant?
Every surgeon will have their own pricing, and cataract surgery can vary widely in cost. Medicare will usually pay for traditional, simple intraocular lenses with minimal technology as long as certain criteria are met. If you’d like to have perfect vision without the need for reading glasses, bifocals, or distance lenses, there will be an upcharge for more specialized lenses.
Light adjustable lenses are one of the most expensive intraocular lenses because they require so much doctor and technician time and precise care afterwards. Because of this, they tend to be more expensive than even multifocal or toric options. Each insurance plan and every office is different, so make sure to discuss the costs with your eye doctor.
Individual Questions - Lightning Round
15:45 - Can the lens shift after cataract surgery?
18:11 - What are the different lenses used for cataract surgery?
21:05 - How do lens implants work?
22:25 - Can a lens implant be redone?
24:50 - What are the disadvantages of cataract surgery?
26:50 - How do you know when it's time for cataract surgery?
When it comes to professionalism and experience, Dr. Tersigni is unrivaled. He is a fellowship-trained refractive surgeon who graduated cum laude from the University of Oregon, and he obtained both his medical degree and a master’s degree in public health at Tulane University School of Medicine in New Orleans. He completed an internship at Sacred Heart Medical Center in Spokane, Washington, followed by his ophthalmology residency training at the Ira G. Ross Eye Institute in Buffalo, NY. Dr. Tersigni then completed a fellowship in corneal and refractive surgery under the mentorship of world-renowned vision correction surgeon, Dr. Y. Ralph Chu, at the Chu Vision Institute in Minneapolis, MN. Here, he was trained in the full spectrum of vision correction solutions.
In addition to being a surgeon, Dr. Tersigni is an educator and researcher. He has been published in national journals and has authored and edited content for numerous medical educational publications and websites. He has been an investigator on nine U.S. FDA trials involving advanced technology lens implants, corneal treatments and investigational therapeutic medications, among other studies. He is a member of the Refractive Surgery Alliance, a global organization of the top vision correction surgeons from around the world, as well as the American Society of Cataract and Refractive Surgeons, and the American Academy of Ophthalmology.
Dr. Tersigni enjoys spending time with his wife, Kayla, and five children. Outside of work and family, he enjoys the outdoors, athletics and playing music. He also speaks fluent Vietnamese.