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CataractPhiladelphia

Cataract Surgery Philadelphia

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Astigmatism and Cataracts – James S. Lewis, MD

Serving Philadelphia, Northeast Philadelphia, Phoenixville, Conshohocken, Main Line and King of Prussia


Almost half of the eyeglass and contact lens wearing patients have been told they have astigmatism. It is rarely explained well. Astigmatism is the lack of radial symmetry of the eye’s visual system. That means an optical solution (glasses, contacts, LASIK, cataract surgery) must bend light differently in each meridian to allow parallel light from a distant object to focus perfectly on the fovea, the visual acuity center of the retina. In other words, a perfectly “spherical” system only requires a simple, spherical pair of glasses, contact lenses, LASIK surgery or Cataract Implants. The “astigmats”, however, need a more sophisticated solution.

During cataract surgery the cloudy natural lens is removed and replaced with an implant. Most astigmatism is produced by asymmetric curvature of the cornea and the natural lens. Once the lens is removed only the corneal astigmatism remains. Special implants can be used to eliminate the residual corneal astigmatism. There are two astigmatism-correcting implants on the market, one by Staar Surgical and the other by Alcon. Both are excellent and extremely effective for reducing or eliminating astigmatism following cataract surgery.

Sometimes all of a Philadelphia cataract patient’s astigmatism is produced by the natural lens. When this happens cataract removal alone removes all astigmatism so a Toric implant is not needed. Sometimes a patient with no pre-operative astigmatism will manifest corneal astigmatism after cataract surgery. Those patients can undergo special procedures to resolve their astigmatism.

In all of our cases, we aim to reduce the patient’s astigmatism following cataract surgery. Sometimes that is done with special relaxing corneal incisions for smaller amounts of astigmatism. Others require an Toric Implant. Still others require both modalities. There is an additional cost for some Toric IOLs and we will tell you if they are recommended in your case.


Intraocular Lens (IOL) introduction

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Toric IOLs

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Rarely, large degrees of astigmatism remain after cataract surgery. When this happens we have the luxury of an excimer laser in-house. A LASIK-like correction can be performed following cataract surgery if the patient does not have adequate uncorrected distance visual acuity. Sometimes, this too incurs an additional cost.

Irregular astigmatism, a more rare type of astigmatism often associated with corneal disease, trauma, or hard/RGP lens wear, does not respond to relaxing incisions, LASIK and Toric implants. These patients still benefit from cataract surgery but require a customized approach to their astigmatism.

Astigmatism correction with cataract surgery, either by relaxing limbal incisions, toric implants, or LASIK is an important advance in the eye surgery. As Corneal Specialists, we pride ourselves in our success with these cases.

Cartoon Cataract Surgery
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(215) 886-9090

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Full compliance with all guidelines 😷 related to the Coronavirus crisis

Lewis LASIK
Our practice will start seeing patients again on M Our practice will start seeing patients again on Monday, May 11th in full compliance with all local, state, and federal guidelines. This includes masks, social distancing, and the disinfection of all common surfaces. Elective surgeries are also being rescheduled. Care will be taken to avoid office congestion and minimize exposure to COVID-19.

We require: ➡️ You do not have fever, chills, shaking, muscle pain, headache, sore throat, or a loss of taste or smell ➡️ You have not had exposure to anyone with a flu-like illness within the past two weeks ➡️ You wear a mask or equivalent facial covering over both your nose and mouth ➡️ You agree to maintain social distancing ➡️ You avoid touching your eyes, nose, mouth, and face ➡️ You enter the office alone if possible

Expect to hear from our staff shortly. You may contact us at your convenience from links at jameslewismd.com
Chorioretinal folds are a known finding following Chorioretinal folds are a known finding following penetrating glaucoma surgery, as in these two cases who underwent Ahmed valve tube shunt placement. Prevalence is estimated between 10-50% of incisional glaucoma surgeries.

Pic 1.) several linear chorioretinal folds throughout the posterior pole. Intraocular pressure was 4mmHg at the time of this photo. The fundus and visual acuity returned to baseline within a week as IOP leveled at 10mmHg.
Pic 2.) Small choroidal folds can be seen distributed temporal to the macula. This image also demonstrates a large hemorrhage consistent with ocular decompression retinopathy.
Pic 3.) shows complete resolution of the choroidal folds and hemorrhage after 4 weeks in patient 2.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #eye #oculardisease #optometry  #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity #glaucoma #glaucomasurgery #retina #chorioretinalfolds
Inflammation of the anterior chamber can create fi Inflammation of the anterior chamber can create fibrin plaques that are readily seen within the pupil. The second and third images demonstrate an almost completely occluded pupil with synechia formation. The fourth image demonstrates an ultrasound biomicroscopy image of a patient in angle closure following complete pupil occlusion from fibrin (blue arrow). Aggressive corticosteroid therapy can ‘melt’ the fibrin and cycloplegics can mechanically disrupt it. Nd:YAG laser can also instantly disrupt total occlusion.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #eye #oculardisease #optometry #ocularinflammation #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
Descemet stripping endothelial keratoplasty (DSEK) Descemet stripping endothelial keratoplasty (DSEK) is a corneal transplant procedure that replaces only the innermost cells of the cornea. It is readily combined with cataract surgery to improve refractive outcomes. This is a one day post operative visit of a DSEK showing faint edema and remaining air bubble. The air bubble will typically dissolve over the first 48-72 hours.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #corneatransplant #dsek #fuchsdystrophy #endothelium #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
Ocular surface disease is a complex state that rep Ocular surface disease is a complex state that represents a poorly performing pre-corneal tear film. It can frustrate many patients and can be challenging for clinicians. No two cases are alike.

In this case, a young patient without evidence of desiccation or inflammation had persistent physical symptoms. Biomicroscopy revealed clear lid margins, no conjunctival injection, and no corneal epitheliopathy. Meibography (imaging the meibomian glands) provides insight into the cause. A previous course of oral medication that acts on sebaceous glands has likely impacted his meibomian glands as well. The gland dropout is easily seen as truncation and atrophy. The final video demonstrates a noninvasive tear-breakup time where the red squares are regions with early loss of tear film stability.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #dryeye #ocularsurfacedisease #OSD #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
Iris cysts are benign. If suspected, they should b Iris cysts are benign. If suspected, they should be imaged with ultrasound biomicroscopy (UBM) to confirm the diagnosis and rule out other causes of iris elevation.
#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #ubm #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
There are various types of cornea transplantation There are various types of cornea transplantation procedures and each is best suited for different patients based on diagnosis and other factors. This is an MDALK (maximum depth anterior lamellar keratoplasty) that retains the innermost layer of cells and membrane, but replaces as much diseased tissue as possible. It has excellent clarity and comparatively good visual outcomes. 
#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity #mdalk #corneatransplant
Corneal infection! This series of images highlight Corneal infection! This series of images highlights a case of pseudomonas aeruginosa microbial keratitis (corneal infection) related to contact lens wear. Keep in mind the cornea is about 0.5 millimeters thick! Not much room to allow an infection to move deeper.
Pic 1. The resultant scar after the infection cleared.
Pic 2. At presentation, the eye is injected (red) with a large central infiltrate (immune response) and necrotic stromal tissue (dying cells). Pic 3. There was extensive inflammation in the anterior chamber including fibrin strands
Pic 4. Note the presence of a hypopyon (accumulation of white blood cells at the bottom of the anterior chamber).
Pic 5. This is two days after initiating treatment with fortified antibiotics. The pupil is intentionally dilated (for comfort) and anterior chamber inflammation is improving. There is a small unrelated fiber present that was subsequently removed.
Pic 6. A closer look at the scar and the shadow it casts. These scars disrupt the vision permanently. Fortunately this patient has achieved good acuity, yet blur, glare and haze can be persistent.
(Sorry for poor photo quality in pictures 2/3/4)

It is important to work quickly to identify the organism responsible for these infections to tailor treatment appropriately. If left untreated infection can spread to devastating results.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #microbialkeratitis #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
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At the Philadelphia, Pennsylvania cataract surgery offices of Dr. James S. Lewis, patients are assured the highest quality treatments and impeccable care. Dr. Lewis and his team use the latest surgical technologies and techniques to deliver the best possible results. CataractPhiladelphia offers a wide range of premium IOLs, including PanOptix, Vivity, Toric and Light Adjustable Lens. Dr. Lewis also treats patients with both cataracts and glaucoma through an enhanced range of micro-invasive glaucoma surgical options.

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* currently only PanOptix, Vivity, Toric, and the Light Adjustable Lens patients qualify for ONCE AND DONE.

 
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(215) 886-9090

8380 Old York Road
Suite 110
Elkins Park, PA 19027

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