Cornea Research Foundation of America

We Bring Hope

Cataracts

Cataracts are a clouding of the crystalline lens in the eye that naturally occurs with age. Cataracts impair vision in over half of people who are over 60 years old. Eventually everyone will develop cataracts if they live long enough. Cigarette smoking and extra exposure to UV light, including sunlight, can cause cataracts to form at an earlier age than normal.  Wearing UV blocking sunglasses during outdoor activities may help delay cataract formation.

The famous impressionist artist Monet (Figure Monet painting) developed cataracts and postponed having them removed, because cataract surgery was not as safe when he lived (1840-1926) as it is today. As his cataracts got worse, his paintings became darker and less colorful. After his cataracts were removed and he could see clearly again, he destroyed many of his paintings from those years with the cataracts clouded his vision.

Cataract Surgery

Once cataracts begin to impair your daily activities, such as reading or driving, an ophthalmologist can remove the crystalline lens and replace it with a small plastic intraocular lens (Figure) as an outpatient procedure. Lenses can be chosen that correct nearsightedness, farsightedness and astigmatism. Some lenses even provide good vision at near and far distances to avoid having to wear glasses.  Dr. Price routinely uses eye drops to numb the eye and performs cataract surgery without sutures or injections around the eye. 

What are your lens options after cataract surgery?

Until recently, everyone received a monofocal (single focus) intraocular lens (IOL) after cataract surgery.  Monofocal means that the IOL is designed to give you sharply focused vision at a particular distance.
Newer multifocal lenses are designed to give you sharply focused vision at 2 distances (like bifocal glasses). A multifocal lens divides incoming light into at least 2 distinct areas of focus, to provide distance vision as well as near vision. A multifocal lens increases your chances of being free of glasses after cataract surgery.

On the other hand, a monofocal IOL can provide the clearest, highest quality image, because it does not divide the incoming light. If you choose a monofocal lens, you will probably need supplemental glasses at least some of the time. If you choose to have monofocal IOLs optimized for distance vision in both eyes, you will need to use glasses for reading and near work. If you choose to have monofocal IOLs optimized for near vision in both eyes, you will need to use glasses for distance vision and driving. You may also choose to have “monovision” – this means that the monofocal IOL is optimized for distance vision in one eye and for near vision in your other eye.  If you choose monovision, you should use glasses for better depth perception and safety while driving, particularly at night.

The cost of a monofocal lenses is usually covered by your health insurance plan, whereas you usually have to pay an extra charge that is not covered by insurance or Medicare for a multifocal or accommodating lens. With multifocal IOLs, most patients experience a broader range of vision and greater independence from glasses and contact lenses than ever before.

Over the years, IOL designs have evolved to provide improved image quality. In older designs, the IOL surface had a uniform curvature, like a sphere, but a standard spherical lens causes aberrations in the image, so newer aspheric IOLs have been developed to minimize aberrations.

Recently, we’ve realized that when you are young, neither your cornea nor your natural lens is spherical, but they are usually balanced with each other to provide you with optimal vision. This delicate balance can be lost when your natural lens develops a cataract and is replaced by an IOL. Therefore, the Cornea Research Foundation is conducting a study in conjunction with Price Vision Group to determine if your vision can be optimized by carefully matching the IOL to your corneal measurements.

Cataracts and Astigmatism

If you have cataracts and astigmatism you may be a candidate for a toric IOL, which is designed to correct astigmatism. Typically you will need to wear reading glasses or bifocals with a toric IOL. If you prefer to have a multifocal IOL, you could have your astigmatism surgically corrected with corneal relaxing incisions or LASIK.[link to section on laser vision correction]

Our studies to improve your cataract surgery

The Cornea Research Foundation of America has participated in numerous clinical research studies to help make cataract surgery safer and better for you. We have evaluated

• A light adjustable lens that can be fine-tuned after it is inside the eye to provide optimal vision
• A intraocular lens that filters harmful light rays
• Eye drops to prevent pain associated with surgery
• New antibiotic eye drops to prevent eye infections
• A device to stabilize the lens capsule in high risk patients

Following is a story about one of our clinical research studies that resulted in approval of a device for use in high-risk patients:

TENSION RING for high risk cataract patients:

“Dr. Price was the Medical Monitor and the Cornea Research Foundation participated in the clinical trial that resulted in recent FDA approval of the tension rings for use in certain high risk cataract patients.”

Tension Ring Implant Surgery Video

**NOTE: If you are unable to view the animation below, you must update your Flash player to the most current player by clicking here.

Endocapsular Tension Ring

Click Images for Larger View

Most people develop cataracts, or clouding of the natural lens inside their eye, as they age. Treatment involves removing the natural lens and replacing it with a plastic lens. This is a relatively straightforward surgical procedure in most patients.

The natural lens sits inside a “capsular bag”. This bag hangs in the center of the eyeball, suspended by thin membranes, known as “zonules”. The zonules extend out from the capsular bag in a sunbeam pattern, attaching to the eyeball. In some people, some of the zonules are weak, loose or missing. In these patients there is a high risk of having the lens and capsular bag move out of position during or after cataract surgery.

Click Image for Larger View

To minimize the risk of cataract surgery in these high-risk patients, an Endocapsular Tension Ring can be placed inside the capsular bag. This ring helps distribute stress around the full circumference, allowing intact zonules to help carry the load for loose or missing ones. High-risk patients include those with:

• Pseudo-exfoliation syndrome
• High myopia
• Congenital aniridia
• Traumatic eye injury
• After vitrectomy surgery

Our Cataract and Intraocular Lens Publications

1. Richardson MR, Price MO, Price FW, Pardo JC, Grandin JC, You J, Wang M, Yoder MC. Proteomic analysis of human aqueous humor using multidimensional protein identification technology.  Molecular Vision 2009;15:2740-50.
2. Price MO, Price FW, Jr, Werner L, Berlie C, Mamalis N. Late dislocation of scleral-sutured posterior chamber intraocular lenses. Journal of Cataract & Refractive Surgery 2005; 31: 1321-1326. 
3. Price MO, Quillin C, Price FW. Effect of gatifloxacin ophthalmic solution 0.3% on human corneal endothelial cell density and aqueous humor gatifloxacin concentration. Current Eye Research, 2005; 30:563-567. 
4. Price. FW, Mackool RJ, Miller KM, Koch P, Oetting TA, Johnson T. US. Interim results of the United States investigational device study of the Ophtec capsular tension ring. Ophthalmology, 2005;112:460-465. 
5. Price MO, Price FW, Chang DF, Kelley KA, Olsan MD, Miller KM. Ophtec iris reconstruction lens United States clinical trial phase I. Ophthalmology, 2004, III; 1874-1852. 
6. Price MO, Price FW, Jr. Efficacy of topical ketorolac tromethamine 0.4% for control of pain or discomfort associated with cataract surgery. Current Medical Research & Opinion 2004; 20: 2015-2019. 
7. Parker DS, Price FW. Suture fixation of a posterior chamber intraocular lens in anticoagulated patients. J Cataract Refract Surg, 2003; 29:949-954.
8. Price FW, Dobbins K, Zeh WG. Penetration of topically administered ofloxacin and trimethoprim into aqueous humor. Journal of Ocular Pharmacology and Therapeutics 2002; 18(5):445-53. 
9. Zeh WG, Price FW. Iris fixation of posterior chamber intraocular lenses. J Cataract Refract Surg, 2000; 26(7):1028-34. 
10. Zeh WG, Price FW. Anesthetic and nonsteroidal agents in cataract surgery. Therapeutic Updates in Ophthalmology 1999; 2(3).
11. Price FW, Parker DA. Horizontal corneal diameter and its implications for implanting sulcus-fixated lenses. 1997; 23(8):1131-2.
12. Price FW, Wellemeyer ML. Transscleral fixation of posterior chamber intraocular lenses. J Cataract Refract Surg 1995;20:567-573. 
13. Lee DA, Price FW, Whitson, WE. Intraocular complications associated with the Dubroff anterior chamber lens. J Cataract Refract Surg 1994;20:421-425. 
14. Tilden ME, Price FW. Management of coincident corneal diseases and cataracts. Cur Opin Ophthalmol 1994,5;1:93-100.
15. Lee DA, Price FW. Management of concurrent corneal diseases and cataract. Cur Opin Ophthalmol 1993,4;1:97-101.
16. Coli AF, Price FW, Whitson WE. Intraocular lens exchange for anterior chamber intraocular lens-induced corneal endothelial damage. Ophthalmology 1993;100:384-393. 
17. Price FW, Whitson WE, Collins KS, Johns SK. Changing trends in explanted intraocular lenses: a single center study. J Cataract Refract Surg 1992;18:470-474. 
18. Price FW, Whitson WE, Collins KS, Johns SK. Explantation of posterior chamber lenses. J Cataract Refract Surg 1992;18:475-479. 
19. Price FW, Whitson WE. Suprachoroidal hemorrhage after placement of a scleral-fixated lens. J Cataract Refract Surg 1990;16(4):514-515. 
20. Mamalis N, Craig MT, Price FW. Spectrum of Nd:YAG laser-induced intraocular lens damage in explanted lenses. J Cataract Refract Surg 1990;16:495-500.
21. Price FW, Whitson WE. Natural history of cystoid macular edema in pseudophakic bullous keratopathy. J Cataract Refract Surg 1990;16(2):163-169.
22. Price, FW, Whitson, WE: Visual results of suture-fixated posterior chamber lenses during penetrating keratoplasty. Ophthalmology 96;8:1234-1240, 1989.
23. Apple DJ, Price FW, Gwin RT, Imkamp E, Daun M, Casanova R, Hansen S, Carlson AN. Sutured retropupillary posterior chamber intraocular lenses for exchange or secondary implantation. The 12th annual Binkhorst lecture, 1988. Ophthalmology 1989;96:1241-1247. 
24. Price, FW. A controlled method of removing the Stableflex lens. J Cataract Refract Surg 14:81-83,1988.
25. Price FW. Factors contributing to corneal decompensation with the Stableflex lens. J Cataract Refract Surg 14:53-57,1988.
26. Piest KL, Kincaid MC, Tetz MR, Apple DJ, Roberts WA, Price FW. Localized endophthalmitis: a newly described cause of the so-called toxic lens syndrome. J. Cataract Refract Surg 1987;13:498-510.
27. Tetz MR, Apple DJ, Price FW, Piest KL, Kincaid MC, Bath, PE. A newly described complication of neodymium-YAG laser capsulotomy: exacerbation of an intraocular infection. Case report. Arch Ophthalmol 1987;105:1324-1325.