Optima Ophthalmic Medical Associates, Inc.

What is an Implantable Contact Lens? The implantable contact lens is also known as a phakic IOL. The word “phakos” is Greek for lens of the eye. “IOL” is an abbreviation which stands for “intraocular lens.” An IOL is a lens that is placed inside the eye. The term “phakic IOL” means an artificial lens that is placed permanently inside a the eye to correct nearsightedness and astigmatism without removing the natural lens. The implantable contact lens is made of a proprietary material called Collamer. It consists of collagen and a similar material contact lenses are made out of. The material has built in UV protection and is biocompatible with the eye for long term vision correction. Choosing the EVO ICL for Vision Correction EVO ICLs are designed for nearsighted and nearsighted plus astigmatism for patients who desire reduced dependence or (possibly) elimination of glasses or contact lenses. Patients elect to have the EVO ICL because it does not cause dry eye syndrome and it is an additive technology so no corneal tissue,( the clear front part of your eye), is removed to correct vision. Patients also like the peace of mind that it is removable, so their eye is still their eye. In some cases patients may not be candidates for LASIK due to the anatomy of the eye, but they may be great candidates for the EVO ICL. Who Would Be a Good Candidate for This Procedure? Patients who are nearsighted, with or without astigmatism, and/or those patients who have corneas which are abnormal with respect to being too thin, too flat, or irregularly shaped, would likely be good candidates for the EVO ICL. Also patients considering PRK, but do not want the longer recovery time, might be great candidates for the EVO ICL. The only way to know if you are a candidate for the EVO ICL is to come in for a consultation with your surgeon. We will do a complete analysis of your eyes to determine which vision correction procedure is best for you and your vision goals. What Are the Alternatives to the EVO ICL? The alternatives to correct high amounts of nearsightedness and astigmatism include: Glasses, which are the time tested, tried-and-true method with the highest degree of safety. Contact lenses are also safer than any form of surgery, although there is a small risk of developing a sight-threatening infection and contact lens-related dry eye. Corneal surgery such as LASIK, PRK, LASEK and EPI-LASIK. However, in patients with high degrees of nearsightedness and astigmatism in combination with a thin or flat cornea, it may be impossible to safely achieve full correction of the nearsightedness and/or the astigmatism with corneal surgery. Additionally, the quality of vision with respect to visual acuity as well as contrast acuity may not be as good in the higher degrees of nearsightedness with LASIK, PRK, LASEK or EPI-LASIK as it is with the EVO ICL procedure. What Can I Expect During the EVO ICL Procedure? The procedure for the EVO ICL is performed in our Federally certified ambulatory surgery center in Hayward. This ensures that the highest quality surgery is performed in the safest and most controlled setting using our dedicated surgical team. The surgery itself is quick. Typically, the patient is back in the room for half an hour, but the procedure itself take between 5 to 10 minutes. It is virtually painless and the patient is awake, but relaxed. After using numbing the eye with drops, a small opening is made where the white meets the colored portion of the eye. Additional tiny openings are made to secure the lens safely into position. The lens is then placed through the opening and positioned in the eye. The patient is then observed post-operatively at the center to ensure that the lens is in proper position and that the pressure in the eye is not elevated. Most patients experience an immediate improvement in vision that will continue to improve over the next 24 to 48 hours. What Can I Expect? The data submitted to the FDA for the STAAR EVO ICL lens was based on the results of a multi-center U.S. clinical trial which included 629 eyes followed for up to 6 months. The data showed patients experienced a significant improvement in distance vision. On average patients had a -7.62 refraction and by one month most did not have any remaining refraction and it was stable out to 6 months. In a global survey, 99.4% of patients said they would have the EVO ICL again. With over 2,000,000 implanted worldwide the technology is both safe and effective. What If My Best Possible Vision Before Surgery Is Not 20/20? The FDA studies showed that a small percentage of patients actually enjoyed better vision without glasses than they had with glasses before the procedure. However, one must understand that for most patients the best one can expect is vision without glasses to be the same as the vision with glasses before the procedure.

Correct focusing of images in the eye is determined by the focusing power of the cornea and the lens of the eye in relation to the length of the eye. Either the cornea or the lens or both can be changed to correct errors of focusing (called refractive errors) such as nearsightedness, farsightedness, or astigmatism. A “cataract” is a clouding of in the eye’s natural lens. Modern cataract surgery involves removing this clouded lens and replacing it with an artificial lens called a lens implant. Exactly the same operation can be done when the lens is not clouded in order to change the power of the lens as a way to correct farsightedness with or without associated astigmatism. This is called Refractive Lens Replacement also known as custom lens replacement. For a relatively high amount of farsightedness (hyperopia) refractive lens replacement is, in our opinion, the only good surgical choice at this point in time. Depending on individual considerations, it may be the best procedure for any degree of hyperopia and astigmatism. Refractive lens replacement / custom lens replacement is less likely to produce side effects such as starburst, glare, halos, and decreased night vision than any of the corneal procedures. Most patients have none of these side effects after refractive lens replacement, but they remain possibilities… especially if a multifocal IOL (lens) is inserted at the time of surgery. Since refractive lens replacement requires surgery inside the eye and not just on the cornea, it can be associated with some potentially severe complications which are rarely if ever seen following any of the procedures that only involve the cornea (e.g., LASIK or PRK). These include, but are not limited to: Infection inside the eye (endophthalmitis). We estimate the probability of this to be less than 1 in 3,000, but if it occurs it is very serious and can cause loss of vision or blindness if unsuccessfully treated. Retinal detachment. We estimate the probability of this to be about 1 in 1,000 cases in hyperopic patients, but considerably more likely in myopes and especially high myopes where it may reach a likelihood of as high as 4 to 5 in 100. Retinal detachments tend to occur in high myopes even if they have no surgery. The probability of retinal detachment increases if a capsulotomy (see “6” below) is needed. A capsulotomy is necessary in 30% to 50% of young patients who undergo lens replacement. Some retinal detachments can be successfully treated, but not all, and this can result in severe loss of vision or blindness. Cystoid Macular Edema. This is a swelling in the layers of the center part of the retina that can occur after any type of surgery inside the eye, including refractive lens replacement. It seems more likely with increasing age. It may occur to some degree in several out of every 1,000 eyes. Fortunately it usually gets better with time, but it can delay the return of good vision and sometimes does not get better and can result in permanent decreased vision. Damage to the iris or pupil. This is not likely, but can occur. It if does, it can interfere with the best possible vision, and produce severe glare, light sensitivity, and a cosmetically displeasing appearance to the eye. Eye pressure. There is commonly some fluctuation of the eye pressure following refractive lens replacement in the first few days or weeks following surgery. Rarely the pressure can remain elevated and result in the eye condition called “glaucoma.” Need for capsulotomy. In about 1 out of 3 eyes following refractive lens replacement the “capsule” behind the implant becomes clouded to some degree. This is usually very easy to correct using the YAG laser, but having the capsule opened is felt to increase the risk of cystoid macular edema and retinal detachment. Effect on accommodation. (See “Presbyopia” section). The ability to focus at different distances automatically in young people is done by the natural lens of the eye. Following refractive lens replacement, this ability is gone and the resulting effect must be understood. In patients near or over 40, this changing focus ability is already decreased or lost and is not generally much of an issue. It is, however, an important consideration, especially in younger people. This surgery creates “instant presbyopia” and unless it is compensated for by monovision the implantation of a multifocal implant, there will be a need to use glasses for near tasks such as reading. If you are a candidate for Refractive Lensectomy, you will be given a separate booklet to study. Schedule a Consultation Today During a comprehensive consultation, Your surgeon will go over all of the details of the refractive lens exchange procedure, including the risks and benefits, and he can answer any questions you may have. If you are considering refractive lensectomy, consult with the professional eye surgeons at OPTIMA Ophthalmic Medical Associates. Call us today at 510-886-3937.

The LASIK alternative …PRK, …is known as a “surface procedure.” The LASIK alternative procedure of choice is PRK. PRK is performed for patients who are not good candidates for the LASIK procedure and for the occasional patient who would otherwise be a good candidate for LASIK, but requests an alternative instead. The main indication for a LASIK-alternative procedure is a cornea which is too thin to safely undergo a LASIK flap, or a cornea with relatively normal thickness but which has a mildly abnormal configuration such that it may not be safe to perform LASIK. Additionally, some patients in high-risk occupations or with high-risk hobbies where they are likely to incur a physical eye injury with potential damage to the flap, may be better suited for PRK. Procedure Overview For PRK , the excimer laser is programmed the same as for the LASIK procedure, but because the laser is applied directly to the surface of the cornea, there can be no flap complications such as microfolds, or intra-operative or post-operative flap trauma. The disadvantage of this is that it may take up to 4 weeks for the patient’s vision to become clear. Therefore, unlike LASIK, most patients elect to have PRK in just one eye at a time. A corrective contact lens is worn in the unoperated eye until the vision is clear enough in the operated eye and then the second eye undergoes surgery. This is typically 3 to 5 weeks after the first eye. If a patient does not wear contact lenses, then the unoperated eye can be corrected with a spectacle lens while clear glass can be placed in the spectacle over the operated eye during the healing process. Associated Risks Most of the risks and complications of the PRK procedures are the same as for the LASIK procedure. Therefore, patients must view Dr. Mandel’s web video on this website and read the outlines on the complications on LASIK prior to undergoing PRK. The additional complication that can occur following PRK, but not in LASIK patients, is the potential for scarring on the surface of the cornea. This scarring, if left untreated, can significantly decrease visual acuity and quality of the vision. It may also induce regression back toward nearsightedness and/or astigmatism. Possibility of Scarring In order to diminish the possibility of scarring, your surgeon has been performing PRK with the intra-operative use of Mitomycin-C. Although not FDA approved for this procedure, it is common and standard practice among experienced refractive surgeons. Mitomycin-C is a cancer chemotherapeutic agent, which, in this case, is used to prevent scarring of the surface of the cornea following PRK. We have not observed nor are we aware of any complications that result from the off-label use of intra-operative Mitomycin-C in the concentrations and for the time periods for which we use it in refractive surgery. Post-Operative Enhancement Like all corneal refractive procedures, after PRK a certain percentage of patients require an enhancement for overcorrection, under correction, or induced astigmatism. Your probability of needing an enhancement is based on many factors such as your degree of nearsightedness, farsightedness and/or astigmatism, as well as individual healing factors that cannot be predicted. If you require an enhancement, this is usually performed 6 to 8 months after your initial PRK procedure to ensure that the refraction is stable. If an enhancement is required, a repeat PRK with Mitomycin-C will be performed. Complications Haze and/or scarring of the surface of the cornea may occur following PRK. However, it is rare with lower degrees of nearsightedness (less than 5.00 diopters). In all patients undergoing PRK I briefly place a small sterile sponge with a medication called Mitomycin-C on the surface of the treated cornea. This substantially decreases the chances for scarring or haze following PRK. However, if scarring occurs, it can permanently decrease vision. This occurs in less than 0.5% of cases in our hands. About 13% of LASIK or PRK patients may require a retreatment (enhancement or touch-up) for undercorrection, overcorrection and/or induced astigmatism. Retreatment is more common in patients who are highly myopic, highly hyperopic, or who have a lot of astigmatism. With either PRK or LASIK regression and undercorrection is very uncommon with less than 3.00 diopters of myopia or hyperopia, or 2.00 diopters of astigmatism. Irregular astigmatism (i.e., a “wavy” corneal surface) due to decentration of the laser optical zone or uneven healing is uncommon with both procedures (less than 1%). Loss of best correctable (i.e. with glasses) vision worse than two lines on the vision chart is about 0.5% to 2% for both LASIK and PRK.

Due to advances in medical technology, we now have a number of choices for the type of lens implant which will be placed in the eye. Below is a summary of the choices. The physicians and staff at Optima are here to help you make the choice, but ultimately, the choice is up to the patient and the family. BOTH EYES ADJUSTED FOR DISTANCE VISION. The power of the intraocular lens for both eyes is adjusted for distance vision. Patients will need glasses for reading and for intermediate tasks such as the computer, dashboard, cell phone, and wristwatch, and other near and intermediate tasks. Because of how each eye heals, even those patients whose eyes are adjusted for distance vision may still need distance glasses for functions such as driving, T.V., movies, and golf. ONE EYE ADJUSTED FOR DISTANCE AND THE OTHER EYE ADJUSTED FOR NEAR (MONOVISION, BLENDED VISION). By using different implant powers for each eye, we can adjust the vision in one eye for distance and in the other eye for near tasks such as reading or using a computer. Some people currently achieve this with contact lenses. Even with this option, patients may still need glasses for distance vision, (especially night driving), and possibly for near. Most, but not all, patients can get used to having one eye adjusted for distance and the other eye adjusted for near. If you have high astigmatism, we can also use the toric lens to achieve monovision. FOR PATIENTS WITH HIGH AMOUNTS OF ASTIGMATISM. Astigmatism is when the eye is shaped more like a football than a basketball. There is a lens implant option called the “toric” IOL. This lens has the astigmatism incorporated into the implant (like your glasses). The advantage to this lens upgrade is that, because it significantly reduces the astigmatism, people are often much less dependent upon glasses following surgery for distance vision. However, unless we do monovision with the toric lens, glasses will be required for using a computer and reading. MULTIFOCAL IMPLANTS. Since 2003, we have been using multifocal implant lenses. This is the latest in implant technology. With this option, each eye receives a multifocal lens. The goal is that when looking at a distant object, patients can see well in the distance with both eyes. Also, patients can see well with both eyes when viewing intermediate targets such as the dashboard, a cell phone, a computer, or a wristwatch. Often, near targets such as menus and the newspaper can also be seen more clearly than with the standard lens implant. However, for small print, reading glasses will be necessary. Although most patients with these implants are glasses-free most of the time, it is important to realize that these lenses are not perfect. Occasionally distance and/or near glasses are required. This is the best option for patients who wish to have as “natural” vision as possible. Although we strive for glasses-free vision, these lenses and the healing of the human eye are never perfect and occasionally the use of glasses or corrective laser surgery may be necessary. More light maybe required while reading and some patients may see glare, halos, or starbursts while driving at night. LIGHT ADJUSTABLE LENS. The most high technology lenses available today are called the Light Adjustable Lens (LAL). Approximately four weeks after surgery, using an ultraviolet light delivery system, we fine-tune and micro-adjust the lens power to the patient’s visual needs. We typically leave the dominant eye for the full distance and the non-dominant eye slightly near such that patients are able to see distance, computer, cellphone, dashboard and near without glasses. Also, because of the technology, glare and halo is exceptionally rare. Although this lens works exceptionally well for everyone, this is absolutely the best choice for patients who have had prior LASIK or PRK and some patients with prior RK. ORA – Optiwave Refractive Analysis After the cloudy lens (cataract) has been removed, you can elect to have an additional confirmatory measurement with a real-time wavefront analyzer to assess and refine the exact measurements of the eye to ensure the most accurate lens implant power. This helps us to hit the target implant power more accurately without the cataract impeding the measurement. This leads to a better opportunity to refine and customize the implant power to your individual eye. PRIOR CORRECTIVE SURGERY. Patients who have had prior LASIK, PRK, or RK will require additional pre-operative testing, measurements, and computer programs to determine the power of any lens implanted at the time of cataract surgery and also the use of the intra-operative ORA test to help refine our implant measurements which helps us to better achieve our visual target more accurately.

What Is a Cataract? A cataract is a clouding or opacification of the normally clear lens inside the eye. This clouding causes blurred or foggy vision or glare. It is not a visible film or growth over the outside of the eye. The word “cataract” actually means “waterfall” — as if one were looking through a waterfall. There are two basic types of cataracts: The slower growing “nuclear” type in which the entire lens turns yellow-brown, and the faster growing “subcapsular” type which affects younger people, those with diabetes, and patients taking cortisone. How Do I Know If I Have a Cataract? You will probably notice a decrease in vision and/or glare and halos around lights. You may be unable to see clearly to perform the tasks that you need or want to do. Changes in your eyeglass prescription will no longer improve your vision. A thorough eye examination by your optometrist and our surgeons can detect the presence of a cataract, as well as other conditions that also may be causing altered vision. Other reasons for visual loss in addition to the cataract may involve problems with the cornea, the retina, the blood vessels in the back of the eye, or the optic nerve. If these other conditions are present in addition to the cataract, you will likely experience an improvement in vision, but not perfect vision following cataract surgery. We will explain to you and your family the details of your situation after a thorough exam. Patients with cataracts may notice one or more of the following symptoms: a painless decrease in vision light sensitivity or glare decreased vision in sunlight decreased vision from oncoming headlights frequent eyeglass prescription changes double vision in one eye needing brighter light to read poor night vision with glare halos, or starbursts fading or yellowing of colors How Is a Cataract Treated? Surgery is the only way that a cataract can be treated. There are no pills or drops, vitamins, exercises, or lenses that have been shown to prevent or cure cataracts. However, if symptoms from a cataract are mild, a change of glasses may be all that is necessary for you to function more comfortably as the cataract progresses. Protection from excessive sunlight may help prevent or slow the progression of cataracts. Sunglasses that screen out ultraviolet (UV) light rays or regular eyeglasses with a clear, anti-UV coating offer this protection. If surgery is required, it is comforting to know that cataract surgery is safe and extremely effective in restoring vision. In fact, cataract surgery has one of the highest success rates of any surgery. About 2 million people a year have cataract surgery in the United States. Our surgeons are among the most experienced in the country. Why Cataract Surgery with the Surgeons at Optima Is the Best First Step Imagine life with less dependence on glasses or contacts; everything in clear, bright, vibrant color. Activities like driving, reading, hiking, biking, swimming and golf are much more convenient. At Optima, this freedom and comfort is precisely what we strive to achieve every day for the people who have chosen to trust their eyes to us. The center you choose for vision correction should offer advanced technology and experienced surgeons. Our surgeons hold leadership roles in the development of new vision correction technology giving them early access to the latest advances. Our patients often benefit from next-generation technology before it is available anywhere else. The latest technology is important and it can affect your level of satisfaction with the procedure. However, it’s the surgeon and dedicated staff behind the technology that truly makes the difference. The surgeons and surgical team at Optima have been recognized as leaders in the field, and are continually setting the standard of care that other eye surgeons follow. As you consider any type of vision correction, you can be confident in our commitment to be there every step of the way to make the process comfortable, and above all, safe and successful. What Can I Expect From Surgery? At Optima, cataract surgery is performed under local anesthesia at our Federally certified ambulatory surgery center located within our office. Our center was the first outpatient surgery center in the United States to be certified by Medicare and has been in continuous operation since 1981. Because our center specializes only in eye surgery, our highly-trained staff is dedicated to ensuring the highest level of care. We use only state-of-the-art equipment in our warm and comfortable environment.

Vision Care Is Our First Priority Whether your vision needs are just a complete exam, LASIK laser refractive surgery, or anything in between, we promise to provide you with exceptional care as we work to maintain or enhance your vision. Below are just some of the many procedures and services we regularly provide to our patients – with a gentle touch, and stunning results. Your vision is our first priority! If you have any questions, concerns, or would like to schedule an appointment, please contact us today. We look forward to providing you with the personal care you deserve. Contact us today to schedule your FREE LASIK consultation! Monovision – Presbyopia Treatment If you have normal distance vision (either with or without lenses, or after refractive surgery), as you reach 42 to 45 years of age, presbyopia develops. There are no exceptions to this rule. Presbyopia is the loss of ability to accommodate. Accommodation is the ability to focus up close. Each year it gets worse. If you are presbyopic, you either need bifocals or a separate pair of reading glasses to see what you normally could see up close when you were younger. By the time you are 60 you will have lost essentially all of your ability to focus closer than 3 feet. So, all close objects will be blurred. The use of one eye for distance vision and one eye for near vision is referred to as monovision and is one of the options to consider as part of your refractive surgery decision. This is primarily applicable to those 40 years and older. Monovision has been used successfully for many decades with contact lens correction and with various types of refractive and cataract surgery. By correcting one eye to focus in the distance and one eye to focus for near, the vision part of our brain tends to suppress or filter out the image from the eye that is not in clear focus. The patient is not bothered by the eye that is not in focus. We create monovision using the laser such that the dominant eye focuses at distance and the non-dominant eye at near. One of the best ways to define monovision in the context of refractive surgery is that you can aim to have each eye corrected to a natural focus at any distance you choose. How well it will see at other distances depends upon how old you are. For example, if you are 30 and we correct each eye to excellent distance vision, then you will have good vision at almost any distance because, due to your young age, the eye will be able to accommodate (adjust focus) from far to near. If, on the other hand, you are over 40 and we correct each eye to excellent distance vision, you will not see well at a typical reading distance and will need reading or near vision glasses. This change in accommodation (focusing ability) will generally begin to be noticed about age 40 and will usually get worse quite rapidly over the next few years (presbyopia). This loss of ability to change your focusing distance from far to near will occur whether or not you have refractive surgery. At any age, if you have the vision in one eye corrected to a natural focus for near tasks such as reading, you will not see clearly with it farther away as the ability to change focus only goes from far to near. The brain adjusts to each eye being focused at a different distance within 6 to 8 weeks. You do not need to consciously make any adjustments. There is no right or wrong answer to the question of whether to have monovision. This information is to help you make this decision. In our experience, most people over the age of 40 to 45 who try monovision and take a few months to become accustomed to it, like it and find it very useful. Those who have monovision will be able to generally see well enough both at distance and near to do most things at any age without corrective lenses. Depending on the exact result obtained (as is true for everyone having refractive surgery) there might still be some situations when the very best vision or the maximum visual comfort might require wearing glasses (or possibly contacts). Night driving and prolonged reading are two examples that are mentioned frequently, as well as vision at “intermediate” distance (between 3-10 feet). However, glasses may be required for anything for which you feel the need or desire to have the sharpest possible vision. It is probably helpful to realize that without a specific cure for presbyopia once you are past the 40-year age range, all refractive corrections involve compromise. If you have both eyes corrected for good distance vision, you will need glasses for close vision. If you have both eyes corrected for close vision (not a common choice) you will need glasses to clearly see everything far away. If you choose monovision, although your vision may work well for almost all purposes, you might feel it is less than perfect.