Cataract Surgeon – James S. Lewis, MD
Serving Northeast Philadelphia, Phoenixville, Main Line, King of Prussia and Conshohocken
What is a Cataract?
A cataract is the clouding of the natural crystalline lens. Almost all of us start life with a clear lens. Cataract development is the normal aging change of this lens which occurs during our sixties, seventies, or eighties. Conditions like diabetes, steroid use, kidney disease, inflammatory disorders, ocular trauma, and prolonged sun exposure can hasten this process. A cataract usually develops slowly over years and gradually degrades your ability to drive at night, read small print and function in low light. Sometimes a cataract develops over several months. Rarely, a cataract appears to develop suddenly; this is often because a patient covers the good eye and suddenly recognizes he or she has been relying on the opposite eye. When the benefits of surgery outweigh the risks, cataract extraction should be considered. Years ago cataracts were described as “ripe’ but that concept ignores your visual needs and expectations.
Cataract surgery is nothing more than replacing your cloudy natural lens with a clear, customized manufactured lens (also called an implant, Intraocular Lens, or IOL). The implant lasts forever and requires no maintenance. Your implant is not visible to others and it is not subject to rejection.
How long does surgery take?
Seven minutes. Although you are not asleep, cataract patients are given sedation by a board-certified anesthesiologist relieving any anxiety and most recollection of the surgery. Most patients report seeing exotic colors in a dream-like state. There is no discomfort, in fact, almost all patients describe cataract surgery as a pleasant, relaxing experience.
When can I go back to work?
You can return to work the next day. You can lift and bend over but we prefer you avoid getting large amounts of water, dirt, or toxic fumes in your eye for at least one week. Safety glasses are always a good idea. Runners, weightlifters, and exercise enthusiasts can resume their activities on the first post-operative day. You can shower and wash your hair at any time.
Does it hurt?
No. Topical anesthesia in conjunction with intravenous sedation make this a painless procedure. Our Philadelphia, Montgomery County, Chester County, and Bucks County cataracts patients typically have no difficulties remaining still or keeping their eye open. At the conclusion of the procedure most patients insist they slept through surgery.
What is the Recovery Period?
98% of patients are legal to drive the next morning. You can start reading and watching TV immediately. Most patients recognize a significant visual improvement immediately after surgery. Your vision continues to improve for approximately one week. Updated glasses can be prescribed at any time.
Will I feel or see anything?
No. You see only colors and shapes. Your eye is anesthetized and there is no pain or unpleasant sensation.
Can I take care of myself alone?
Yes. Almost all patients are entirely self-sufficient after surgery. In fact, patients are usually more independent the day after surgery than the day before. It is usually a good idea to go home and get some rest after your operation. Even patients with only one good eye should be self-sufficient.
What are the risks?
Approximately 4.2 million cataract surgeries are performed in the United States each year and as many as 10 million worldwide. Naturally, with that many procedures there will be reports of almost every possible complication. Our data shows a complication rate lower than 0.5% with 99.5% patients having an excellent post-operative course and an excellent visual result. Infection occurs in less than 1 in 50,000 cases (because of our use of intracameral antibiotics) and retinal detachment occurs in less than 1 in 10,000 cases. Other complications including corneal decompensation, persistent macular edema, implant instability, power calculation errors, and glaucoma. All of these problematic cases add up to less than one half of one percent. In almost all of these cases further surgery, additional medications, or additional time results in recovery and a net improvement in vision. It is extremely rare for patients to end up worse than they started.
How safe are these implants?
Extremely safe. The development of the intraocular lens was the single most important development in the field of Ophthalmology over the last century. The refinements in lens design, materials, and manufacture since the 1940’s is one of the great medical success stories. Implants used since 1990 are safe, reliable, and effective. All of our Philadelphia lens implants patients receive IOLs that are FDA approved, from these manufacturers: Alcon, Bausch and Lomb, Zeiss, Staar Surgical, and Abbott. Premium lenses used by our practice include the PanOptix, PanOptix Toric, Light Adjustable Lens (LAL), and the Alcon Toric. These have entirely replaced our use of the Crystalens, Tecnis Multifocal, ReZoom, Array, ReStor, Symfony, and nanoFlex.
How long between eyes?
We can’t perform cataract surgery in both eyes on the same day. Several Canadian and English physicians have successfully performed thousands of same-day sequential bilateral cataract surgical procedures.
My preference is to perform the second cataract surgery anywhere from 3 days to 1 week later. This assumes a perfect result in the first eye with near total recovery of vision. This eliminates imbalance between the two eyes enhancing safety, minimizes followup visits, and reduces paperwork including referrals, medical clearance, and lab testing. Most patients also enjoy getting the entire process completed and find it easier to put post-operative drops in both eyes together rather than one at a time. Naturally, if a patient prefers or the surgeon recommends, it is never a problem to postpone the second procedure. Some patients, however, prefer to allow one eye to heal completely before having surgery on the other.
What can I expect after surgery?
Your vision will be brighter, colors will be enhanced, clarity will improve, and vision in low light will be normalized. Many patients described their operated eye as High Definition or 4K compared to their un-operated eye. Because a portion of your refractive correction (glasses or contacts) is “built into” your implant, your old glasses will need to be updated. If you select a Premium implant, your post-operative dependence on glasses will be reduced or eliminated entirely.
It can take some time to become accustomed to the brightness of colors. Within a week the other eye’s vision will appear dull with an amber cast. Rarely, there is a small amount of foreign body sensation that resolves within the first 24 hours.
Do I have to use drops?
Yes. We start pre-operative antibiotics and pre-operative anti-inflammatory drops four days in advance. Patients are asked to continue these medications for one week after surgery along with a topical steroid. Because suppressing inflammation is critical after cataract surgery we usually continue this steroid drop and another anti-inflammatory medication for as long as two months. This medication strategy has been found to be optimal for reducing post-operative complications.
No. After nearly 12,000 cases of Dropless™ Cataract Surgery, we no longer ask patients to use topical medications prior to the procedure. Despite the well-established success of this technique, we remain the only practice in the area to routinely utilize this advanced technique. We prescribe a low dose topical steroid and NSAID (non-steroidal anti-inflammatory drop) after surgery from your pharmacy. Because medication costs have skyrocketed, we provide a compounded version to our patients at our cost as an alternative.
A one-day follow up examination is required. Additional questions are answered and medication instructions reviewed.
Do cataracts come back?
No. Once the natural lens is replaced by the manufactured intraocular lens implant (IOL) a cataract can not return. Intentionally, we leave the posterior border of the natural lens (the capsule) to hold the implant. This initially clear capsule will opacify over time. Twelve weeks to twelve years after surgery a painless in-office 20 second laser procedure called the YAG capulotomy removes the central cloudy capsule. If you notice that your vision has degraded slightly several months or years after cataract surgery you might need a YAG. Contact your referring doctor or call us directly to schedule the YAG procedure.
A YAG laser is only needed once in each eye following cataract surgery.
Will insurance cover my surgery?
Yes, in almost all cases. Some companies require you pay some form of co-pay (usually $150 to $300) for the procedure. Patients with deductibles will have to satisfy that requirement as well. Unfortunately, many insurance companies have started to offer deductibles of $13,000 or more. In these situations we provide a reasonable cash pay option. High deductible plans are never a good idea in the cataract age group.
Who is my surgeon?
All surgery is performed by me, Dr. James Lewis. I see everyone pre-operatively and post-operatively along with Dr. Patrick McManamon, Dr. John Fabriziani, and Dr. Barry Fabriziani. I no longer train resident-surgeons and no portion of the procedure is handed off to a student. Our practice teaches pre-operative and post-operative management to hundreds of eye doctors in training. The surgery, however, is strictly personalized, private care by James Lewis, MD.
How can I be sure I have the right doctor?
I performed my first cataract surgery in 1983 as a resident at Duke University Eye Center. I continued my training as Senior Registrar and Corneal Fellow at Flinder’s Eye Center in Adelaide, South Australia. In 1987 I became the Director of Cornea Surgery at Hahnemann University and Chief Consultant in Cataract and Corneal Surgery at the Pennsylvania College of Optometry in Philadelphia. I have lectured for virtually all of the major Ophthalmic Surgery Companies including Alcon, Allergan, Abbott, Bausch and Lomb, Staar Surgical, Moria, Nidek, Zeiss, Panasonic, Ikegami, Harrow Health, Ivantis, and Stereo Optical. I published peer-review articles on surgical technique and contribute to trade journals and eye surgeon video teaching organizations.
I have performed approximately 72,000 cataract surgeries, 1500 corneal transplants, and 12,000 LASIK procedures. I have performed minimally invasive glaucoma surgeries (MIGS) since before the MIGS acronym was developed.
Because our practice uses a custom designed electronic medical record, our implant calculations are checked and double checked eliminating transcription errors. We have also developed our own algorithms for greater accuracy.
Finally, our practice prides itself on optimizing results for each patient. Compassionate doctors, technicians and office personnel make your experience a pleasant one. While we perform a large amount of surgery, we always have time to spend with our patients. We are on call 24/7/365.
What about astigmatism?
Leaving astigmatism unaddressed during cataract surgery is a lost opportunity. Several new and important options have been developed which can reduce or entirely eliminate astigmatism. Because residual astigmatism is dependent on ocular anatomy rather than your pre-operative spectacles, we will discuss astigmatism management at the time of your cataract evaluation.
What about premium implants?
Intraocular lens manufacturers have been laboring since the early 90’s to provide a premium option. The goal has been to address astigmatism, presbyopia (the need for reading or magnifying glasses), and the individual healing characteristics of each patient. Enormous progress has been made with the development of the Light Adjustable Lens, the PanOptix, and the TORIC. The suitability of these advanced technology implants will be discussed at your evaluation.
Because Premium Implants are not covered by any insurance company and they require a considerable out-of-pocket expenditure, we provide a no-interest financing program to help patients benefit from this once in a lifetime option.