Cataract surgery is now really more like refractive surgery in that we are trying to minimize the need for glasses postoperatively. Cataract surgery is simply a lens exchange. The old, cloudy lens is removed, and it is replaced by a new intraocular lens (IOL). The new IOLs all look alike but vary in power. Thus, every eye needs a slightly different power based on the length and the shape of the eye. Every piece of information available is helpful in hitting the postoperative target whether it's good distance, good near, or good for both distance and near. Besides the multiple preoperative calculations done in the office , ORA is an extraordinary precise tool that helps to hit that target. After the old, cloudy lens is removed, the ORA takes multiple measurements in just a few seconds to help me decide the power of the IOL that I insert into the eye.

ORA Cataract Surgery Dr. Brad Elkins
Encino, Ca Cataract Surgeon

ORA is very helpful in straightforward surgeries, but it's most helpful in eyes that have previously had refractive surgery (LASIK, PRK, and RK) as well as in astigmatism patients. Previous LASIK patients usually have demanding expectations because they have been independent of glasses after their LASIK surgery. Unfortunately, the preoperative calculations are challenging because of the corneal shape changes created by the previous refractive surgery. The cataract surgery is identical in these patients, but it's just hitting the prescription target that can be tough. Whereas I can hit my refractive target (+/- 0.5D) in about 90% of eyes that have never had previous refractive surgery, I can only hit my refractive target in about 60-70% of previous refractive surgery eyes. Remember, this target is ONLY based on how close to perfect without glasses the end result is and has nothing to do with the success of the surgery!

ORA Cataract Surgery for Astigmatism

The other situation in which ORA is most helpful is in treating astigmatism patients with toric IOL's. About 1/3 of the population has enough astigmatism to benefit from a toric IOL. Astigmatism is a curvature problem of the cornea. A basketball shaped cornea has NO astigmatism whereas a football shaped cornea has a large amount of astigmatism. When we do modern LASIK surgery, the excimer laser treats the cornea based on trackers that utilize iris imagery to make sure that the football shaped laser treatment is aligned with the football shaped cornea. When treating astigmatism at the time of cataract surgery, I have to align the football shaped IOL with the football shaped cornea. ORA helps me decide if if the football shaped IOL is lined up correctly or needs to be rotated. I keep rotating until ORA feels that the astigmatism is reduced as much as possible. Even a single degree of shift, decreases the astigmatism correction by 3%! I wish that treating astigmatism with toric IOL's was as accurate as it is with LASIK. Fortunately, ORA is improving our ability and getting us closer to that goal.

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