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CataractPhiladelphia

Cataract Surgery Philadelphia

  • Cataracts
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Cataract Surgeon – James S. Lewis, MD

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


Animation Explaining Cataracts

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What is a Cataract?

A cataract is a clouding of the natural lens. Almost all of us start life with a clear natural lens. Cataract is a normal aging change of this lens occurring at any time from inception to our nineties. Conditions like diabetes, steroid use, kidney disease, inflammatory disorders, ocular trauma, and prolonged sun exposure can hasten cataract development. A cataract usually develops slowly over years and gradually degrades your ability to drive at night, read small print, and achieve excellent distance, intermediate, and near vision with glasses and/or contact lenses. Sometimes a cataract develops over several months. Rarely, a cataract appears to develop suddenly; this is usually 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, a cataract is considered “ripe”.

Cataract surgery is nothing more than exchanging your cloudy natural lens for 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, it is not subject to rejection, and it may reduce your dependence on glasses and contact lenses. The vast majority of Dr. Lewis’ Philadelphia cataract surgery patients achieve 20/20 vision following cataract surgery.

How long does surgery take?

Five 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 experience.

When can I go back to work?

You can go back 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 postoperative day. You can wash your hair at any time.

Does it hurt?

No. Extremely potent topical anesthesia in conjunction with intravenous sedation makes this a painless procedure. Our Philadelphia, Montgomery 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 themselves 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 about one week. If patients want or need glasses they 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 sleep after your operation. Even patients with only one good eye should be self-sufficient.

What are the risks?

Approximately 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 .5% with 99.5% patients having an excellent post-operative course and an excellent visual result. Infection occurs in less than 1 in 5000 cases and retinal detachment occurs in less than 1 in 3000 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 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.

What is the Van Service?

No.

How safe are these implants?

Extremely safe. The development of the intraocular lens was the single most important development in the field of Ophthalmology and Optometry over the last century. The refinement 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 implants that are FDA approved.

How long between eyes?

We can’t perform cataract surgery in both eyes on the same day. Although several Canadian and English physicians have successfully performed thousands of bilateral cataract surgery procedures.

My personal preference is to perform the second cataract surgery anywhere from 3 days to 3 weeks later. This assumes a perfect result in the first eye with total recovery of vision. This eliminates imbalance between the two eyes, cuts out some 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, and clarity will improve. Many patients described their operated eye as High Definition compared to their un-operated eye. Because your refractive correction (glasses or contacts) is “built into” your implant, your old glasses are no longer necessary. Often, all that is needed is a pair of over the counter reading glasses or some thin prescription glasses.

It takes some time to become accustomed to the brightness of colors. Within a week the other eye’s vision appears to have a yellow cast. Rarely, there is a small amount 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 10,000 cases of Dropless™ Cataract Surgery, we no longer ask patients to use topical medications prior to the procedure. We prefer a single drop, twice a day, for comfort.

A one-day follow up examination is standard. 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 aspect of the natural lens (the capsule) to hold the implant. This capsule often opacifies with time. Twelve weeks to twelve years after surgery a painless in-office laser called the YAG removes the 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. Some patients never require a YAG.

The implant remains stable after the YAG procedure. In fact, with the modern very small incision cataract surgery implant stability is outstanding.

Will insurance cover my surgery?

Yes, in almost all cases. Some companies require that you pay some form of co-pay (usually $150 to $200) for the procedure. Patients with deductibles will have to satisfy that requirement as well. Those with secondary insurance, Medicare, Medicaid, HMO’s, PPO’s, and indemnity coverage are usually very well covered.

We make it a policy to guide patients to affordable insurance programs. We are almost always successful in obtaining good coverage for this surgery for our patients without insurance. In the rare case in which no medical insurance is possible, our costs for the cash paying patient is kept low.

Who is my surgeon?

All surgery is performed by me, Dr. James Lewis. I see everyone pre-operatively and post-operatively along with Dr. Patric McManamon. 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, Bausch and Lomb, Staar, Moria, Nidek and Stereo Optical. I published peer-review articles on surgical technique and contribution to trade journals and eye surgeon video teaching organizations.

I have performed approximately 75,000 cataract surgeries, 1000 corneal transplants, and 10,000 LASIK procedures. I have performed minimally invasive glaucoma procedures 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 virtually eliminating errors. Furthermore, our clinical results are easy to monitor. Staar Surgical, a major IOL manufacturer, used our computer database to optimize implant lens power calculations for all surgeons using their latest and most popular intraocular lens, the nanoFlex.

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?

Most regular astigmatism can be treated at the time of your cataract surgery. This usually involves special incisions (RLI’s: Relaxing Limbal Incisions) made in the peripheral cornea. I have been doing this for patients, without cost, for over a decade. In patients with very large amounts of astigmatism, outside the range of RLI’s, we can use special implants (some have additional cost) and post-cataract excimer laser treatment to help you achieve spectacle independence.

What about premium implants?

Congress has permitted implant manufacturers to add a surcharge for Premium Implants. This can cost as much as $3500 extra per eye. These are an excellent option for patients with the resources. Premium lenses like Tecnis Multifocal, ReStor, and ReZoom are called multifocal lenses because they split the light between distance and near. Patients can usually see well in the distance and close without spectacles. The trade-off is that patients usually get used to some dysphotopsias, especially are point sources of light. Most patients tolerate this very well.

Crystalens is the only lens recognized by the FDA in the accommodative category. Crystalens does not cause glare, halos, or starbursts but is often only moderately successful at producing excellent intermediate and reading vision. The Crystalens mimics the natural lens by changing focus. Unfortunately, this lens is more effective in some patients than others.

The PanOptix and the AcrySof IQ Vivity are a new class of implant with the best features of multifocal and accommodative lenses.  These EDOF, extended depth of focus or enhanced range of vision implants are rapidly becoming the lens of choice for maximal spectacle independence.

CALL FOR AN APPOINTMENT

(215) 886-9090

RxSight Light Adjustable Lens

Select uncompromised clarity with an IOL that matches your visual requirements

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PanOptix Trifocal dominates Cataract Philadelphia

Enjoy a glasses-free life, with the most advanced multifocal IOL.

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AcrySof IQ Vivity

Designed to deliver an extended focal range and a monofocal-like visual disturbance profile

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Dropless and Less Drops Cataract Surgery

Choose safer surgery and save $100 to $300 per eye

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Hydrus MicroStent: Cataracts and Glaucoma

Stop your glaucoma drops with the Hydrus MicroStent.

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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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CALL FOR AN APPOINTMENT

(215) 886-9090

8380 Old York Road
Suite 110
Elkins Park, PA 19027

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