Cataract News Archives | The Princeton Eye Group

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iStent – New Glaucoma Treatment for Cataract Surgery patients

So your doctor has told you that it’s time for cataract surgery. You are also being treated for glaucoma. There is now an exciting new technology that is available that may help either reduce your need for eye drops or improve your eye pressure on the eye drops your are currently taking. The Princeton Eye group is proud to be among the first in this area to offer this exciting new technology to its patients. It’s called the iStent Trabecular Micro-Bypass Stent. The iStent is the smallest implantable device in the human body, measuring 0.3 mm by 1.0 mm in size and it helps to allow fluid trapped inside the eye to get out more easily. The best part is, it can be done at the same time as your cataract surgery without causing any significant increase in the risk of your cataract surgery.

Glaucoma is one of the leading causes of irreversible blindness in the US today and it can come on gradually without any symptoms until the later stages of disease. It is often characterized by an increase in the pressure of the fluid inside your eye but some patients develop it even with normal eye pressure. In all cases, lowering the eye pressure can help to slow down or even stop this loss of vision from occurring. Current treatment modalities include drops, laser, or a more invasive form of glaucoma surgery known as a trabeculectomy. Trabeculectomy is a surgery for more advanced or severe cases of glaucoma where the drops are not working or the chance for severe vision loss is high. While effective in these patients, it is not appropriate for more mild cases cases of glaucoma due to its risk profile.

The iStent however, works to help allow fluid from inside the eye to drain out of the eye more efficiently, thus helping to lower the pressure. Imagine you had a drain in your shower and in order for the water to get our of the shower, it first needed to pass through a sponge. You can imagine that this would slow the outflow of water. If you took a straw however, and poked it through the sponge, the water would now have a direct path out of the shower and into the drain without having to pass through the sponge. This is exactly how the iStent works, allowing aqueous fluid (the water in the eye) to pass through the trabecular meshwork (the sponge) and out of the eye through Schlemms canal (the drain). The end result in US clinical trials were that 68% of patients at one year post-operatively were able to reduce their glaucoma medicines by one drop. With typical glaucoma copays of $50 or more per month, the savings could be hundreds of dollars per year not to mention the reduction in side effects and the worry of taking a drop everyday.

It is important to realize that not all patients will be able to reduce their drops but given it’s tremendous safety profile, it’s high efficacy rate and the fact that most medical insurances cover its insertion, it has become a highly desirable treatment for those who are about to undergo cataract surgery and who also have glaucoma.

To find out if this exciting device is appropriate for you or to schedule a consultation for cataract surgery in combination with the iStent, please call our office at 609-921-9437. Let our schedules know that you have a cataract and glaucoma and they can help you make a consultation with a surgeon in our group who does both vision saving procedures.

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intraocular lenses for cataracts

Advances in Intra-Ocular Lenses Achieve Higher Satisfaction

While the main purpose of cataract surgery is to replace a clouded lens with a clear one, thereby improving visual potential, an additional benefit is the ability to re-focus the eye in the process. A new generation of intra-ocular lenses (IOLs) imparts tremendous optical benefits without adding any medical risks to the operation. Today’s IOLs can be folded and inserted through very small incisions and are made of inert material that is never rejected and is intended to last a lifetime, as there are no moving parts.

The ReSTOR IOL can increase range of vision

The ReSTOR intra-ocular lens has become the world’s most popular multi-focal IOL, by combining both refractive optics (focusing by bending light rays) and diffractive optics (focusing by constructive interference).

The Princeton Eye Group is proud to say they were on the forefront on the research that brought this lens to market and are viewed as key opinion leaders in the industry regarding proper use of this technology. All lenses can be considered light gathering devices, and the focus point is that distance at which the majority of light rays are gathered from. The ReSTOR IOL creates two major focal ranges, about 20 feet and 16 inches. This provides excellent distance vision and adequate close focus to create a range of vision referred to as ‘casual near ability.’ This casual near ability makes all the difference in the world in day-to-day living, when you’re on the go. For the most part it gives one the ability to see your cell phone, price tags when shopping, and your food when eating and cooking. It gives you enough near vision that you don’t feel you ‘need reading glasses for every picky little thing,’ which is the complaint of many patients who are over 55 years old or have basic monofocal IOLs set for distance. The ReSTOR lens works better when inserted in both eyes, and in many instances, patients spend their lives basically free from spectacles.

Toric IOLs can neutralize astigmatism

Another tremendous advance is the toric intra-ocular lens, which is designed to correct corneal astigmatism. Astigmatism is a focusing issue whereby two focal points are created by the cornea, which is the clear flexible dome in the front of the eye. This comes about when the cornea is bent more tightly in one direction than the other, like a spoon or the side of a football. That extra bend is called toricity.

The basic concept is that this extra bend can be measured, and applied to the surface of the IOL. When the surgeon inserts the IOL, he/she merely places the extra bend of the IOL perpendicular to that of the cornea, so that the toricities cancel out each other. There is no added medical risk in inserting the lens.

The features of the ReSTOR and Toric IOLs have been combined

Considered the most scientifically advanced IOL, the ReSTOR-Toric IOL combines the features of previous technology and addresses all three components in one’s prescription: the sphere for near-sightedness or far-sightedness, the astigmatism or toricity, and the near power of presbyopia. The doctors at the Princeton Eye Group were involved in the clinical studies and presentation to the FDA to garner approval of this special IOL.


Intra-ocular lenses do not match nature. Owing to the fact that the IOL is smaller than a natural lens, the edge of all IOLs can cause glare. The diffractive aspects of a ReSTOR IOL can cause rings around light sources such as headlights from oncoming cars. These symptoms most often dissipate over time and represent a small trade-off compared to the enhanced near vision. Some patients with the ReSTOR feel they need brighter light for the reading aspects to work well. Simple over-the-counter reading glasses alleviate this mild problem.

One cannot guarantee spectacle independence for distance. Very precise measurements are taken before the surgery and that information is inputted into very precise theoretical formulae to choose the power of the IOL. However, the final to-and-fro position of the IOL cannot be predicted as this depends upon healing, and this could cause one to not obtain the refractive goal. If so, this information is used as a fudge-factor when choosing the IOL power for the second eye and ultimately, good bilateral vision results. It is important to note that you ‘see with your brain, and not with your eyes,’ and even if each eye is slightly different, good vision is achieved. But keep in mind that if the final refractive result is less than desired, the fallback position is merely mild eyeglasses or LASIK surgery on the cornea. It is important to emphasize the concept that ultimately the measure of success is restoring the health of the eye.

Butterfly with cataracts and astigmatism

Vision affected by cataracts and astigmatism

butterfly with a traditional IOL and astigmatism

Vision after cataract surgery with a traditional IOL and astigmatism

Butterfly with ReSTOR or Toric-IOL

Vision with ReSTOR or Toric-IOL


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Lens Implants Provide a Full Range of Vision to Cataract Patients–Even Those with Astigmatism

Cataract patients have something to celebrate!

Not only has the AcrySof® ReStor® Intraocular Lens (IOL) revolutionized the visual acuity after cataract surgery – AcrySof® Toric IOLs now offer the same outcome for cataract patients with pre-existing astigmatism.

The Princeton Eye Group remains in the forefront of this evolving lens technology. Each of our ophthalmologists is trained to implant these advanced lenses. In fact, Dr. John A. Epstein was the first ophthalmologist in New Jersey to implant AcrySoft’s Toric IOL. As mentor and teacher, Dr. Epstein trains doctors in the art of cataract surgery at Wills Eye Hospital in Philadelphia.

Alcon, the manufacturer of ReStor and Toric IOLs has enlisted the participation of eight ophthalmologists throughout the United States to serve as clinical mentors. These eye care specialists work with Alcon to produce more effective solutions to today’s eye care issues. Our own Dr. Michael Wong is one of these eight chosen specialists.

Having participated in clinical trials for Alcon, Dr. Wong has been providing data, clinical reports and patient feedback on these IOLs for several years. He was the first in New Jersey to implant the ReStor lens. In his present capacity as clinical mentor he provides recommendations for improvements to enhance focal points and to safeguard the implant procedure. He is also one of the ophthalmologists recommended by Alcon to consult on difficult cataract surgery cases.

The results of cataract surgery with the ReStor and Toric IOLs are astonishing to ophthalmologists who can now provide better overall vision to patients who were dependent on glasses or contacts prior to developing cataracts. This new generation of IOLs provides distinct optical advantages over their predecessors with improved focal points and reduced glare. Patients with myopia, hyperopia, astigmatism and presbyopia can enjoy a full range of vision after cataract surgery without the use of glasses.

The AcrySof® Toric IOL utilizes advanced technology to correct the cataracts clouding
your vision and the corneal astigmatism that distorts your vision. Astigmatism is
characterized as a refractive error caused by an uneven curvature of the cornea. Where a normal cornea would have a curvature much like a soccer ball, the cornea with astigmatism would have a curvature more like a football. The AcrySof® Toric IOL is a foldable, single piece lens that is implanted during cataract surgery that’s designed to reduce or eliminate corneal astigmatism and significantly improve uncorrected vision.

The AcrySof® ReStor® lens is the first and only IOL that uses apodized diffractive technology to provide cataract patients with and without presbyopia a quality range of vision. It is designed to respond to how wide or small the eye’s pupil might be to provide near, intermediate and distance vision. The ReStor lens is somewhat flat near the edges, or aspheric, to improve contrast sensitivity and provide improved night vision.

Cataract surgery/IOL implantation statistically has one of highest success rates of all surgeries. The IOLs mentioned here are specialized lenses and all cataract surgeons may not be trained to implant them. Here, with The Princeton Eye Group, all of our ophthalmologists are trained to implant these advanced lenses and they share the benefit of being one of the practices at the forefront of this technology since its beginning – during the clinical trials. Talk to us about your aspiration after cataract surgery. There’s no need to settle for the monovision provided by the traditional lens implant. With today’s technology, and by working side-by-side with our doctors to choose the IOL that’s right for you, you can experience vision like never before.

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New Treatment Options for Cataracts and Presbyopia

FDA approval of special high technology intraocular lenses such as the ReStor, ReZoom, or Crystalens can often provide a full range of vision , allowing decreased dependence on glasses for both distance and near tasks for cataract patients who also suffer from presbyopia.

Intraocular Lenses are surgically implanted to replace the eye’s natural lens. With multiple focusing zones, these lenses provide patients with clear near, intermediate and distance vision. Most patients will no longer require the use of glasses to improve their near or far vision.

Postoperative glare and halos have been significantly reduced through the use of the ReStor, ReZoom and Crystalens IOL. This new generation of IOL allows your doctor to custom tailor a lens choice specific to your visual needs.

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