We are happy to announce that February, 2017 marks our 20th consecutive year of operation. In the 1990’s, Dr. Schulze Jr & Sr recognized the need for a venue for affordable, convenient, and high quality surgery for our cataract and refractive surgery patients.
Prior to that time, all eye surgeries were performed in the hospital, and while quality was good, the size and bureaucracy of the hospitals did not lend themselves to efficiency, and costs to the patient were roughly double (and, in some documented cases, up to ten times as high) what was spent on facility fees in the ambulatory surgery center setting. Although Dr. Schulze, Sr. had long wanted to build a surgery center, Georgia state law prevented him from doing so, mainly because the powerful hospital lobby was against any competition for their services. After all, they had a government sponsored monopoly on surgery, and could essentially charge whatever they wanted for their services.
But the laws changed in the mid ’90’s, and Dr. Schulze, Jr and Sr teamed up to build the first outpatient surgery center specializing in eye surgery in coastal Georgia. Construction took place in 1996, and we opened our doors for our first surgeries in 1997. Since that time, we’ve had the opportunity to serve tens of thousands of #cataract and #LASIK patients, saving our patient base millions of dollars in the process as compared to what they would have spent in the hospital setting. More importantly, however, we have been able to provide first class care to an entire generation of patients, and we look forward to carrying on these traditions of quality and innovation for generations to come.
The Holy Grail for eye surgeons would be to have an implant that would provide for simultaneous far and near vision–and everything between–after cataract surgery. Although multifocal intraocular lenses have been in common use now for over 20 years, they are not for everyone. Specifically, certain conditions such as astigmatism, retinal or corneal disease, and dry eye can make vision after multifocal implants less than optimal.
Last year, the Symfony intraocular lens, made by AMO, was approved by the FDA. This is the first so called extended depth of focus lens to enter the marketplace, creating a longer range of clear vision as compared to previous multifocal designs through improved optics which correct not only spherical aberration, but also chromatic aberration. Although Symfony patients might not be able to read the very smallest lines of print after surgery, we are finding that they tend to have a more effective range of vision than traditional multifocal IOl patients. Specifically, we’re finding that Symfony patients tend to excel without glasses in real world situations like seeing the dashboard while driving a car and reading a cell phone, tablet, or computer screen, whereas older designs that had more magnification at near tended not to see well with intermediate tasks.
Moreover, the Symfony lens is now available in a toric version that corrects for astigmatism at the same time as it corrects far and near vision. This enables patients who previously were not candidates for multifocal lenses to have an extended range of vision.
Is the Symfony lens the Holy Grail for cataract surgery? Well maybe not quite, but it appears to be the closest thing to it we have at our disposal today. The smiles and happy faces I see the day after surgery, with patients asking, “can I have my second eye done tomorrow” appear to be proof that this technology works.
This is a common question I get in my daily practice. Why is it that when we reach the age of about 40, our near vision tends to slip?
A typical story is that patients will come to us with a history of excellent vision for both far and near earlier in life followed by gradually diminishing near vision in late middle age. As presbyopia worsens, you have to hold objects farther and farther away in order to read, until finally you are no longer able to read without the aid of reading glasses, bifocals, or contact lenses (multifocal or monovision). Lots of patients will say, “Doc, my arms aren’t long enough anymore.”
Why does this happen? Understand that the reason you have excellent vision for both far and near in the early stages of life is because of the elastic properties of the human lens. Being elastic, the lens has the ability to change shape, and hence change focus, for objects both far and near in a seamless fashion through a process called accommodation. You don’t have to think about it; it just happens because of reflexes that are hard wired into your nervous system. As we get older, the lens loses its flexible properties and thus its ability to change shape to focus for far and near. Typically, once the lens loses its elasticity, the eye becomes locked in to a focal point for distance and then you become dependent upon reading glasses and bifocals for near vision.
What can we do to treat presbyopia? The simplest solutions include reading glasses and bifocals. Readers have the virtue of being inexpensive, available universally at any drug store for just a few dollars. Start with a lower power (around +1.25 or +1.50) early in life and understand that every few years you will need to increase the power. There is no right or wrong power; whatever works is the one for you. Realize that higher powers will shorten your working distance and bring things closer to you whereas lower powers will lengthen your working distance and push things farther away. Thus you may want different powers for different tasks; e.g., a higher power for reading close up or a lower power for looking at something farther away like a computer screen.
Surgical corrections for presbyopia are available, although these are not for everyone. The ones that work best depend upon your particular situation and age, and these include LASIK for monovision and Refractive Lens Exchange utilizing either a Multifocal IOL or monovision strategy. Older surgical strategies on the cornea such as LTK (Laser Thermal Keratoplasty) and CK (Conductive Keratoplasty) ultimately proved to be only temporary in effect and have been abandoned. Some newer corneal strategies have recently been developed but these typically improve near vision at the expense of far vision and have yet to be proven. Finally, there are eyedrops for presbyopia under development but there are not yet FDA approved.