Aug 26, 2015

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: It's The Scope Health Sciences Radio, broadcasting live at Be Well Utah in South Jordan. It's the South Jordan Family Fair and we're learning all sorts of great things about health and right now we're going to learn a little something about the eyes and cataracts. Doctor Barlow, I don't know what your first name is. William.

Dr. Barlow: William.

Interviewer: Dr. William Barlow is an Ophthalmologist at Moran Eye Center. And we're going to talk about cataracts. And if I understand correctly, many years ago, there weren't a lot of options. There was just kind of one thing you did, but that's changed now.

Dr. Barlow: That has. So, back in the day, cataracts, you'd have surgery, remove the cataract, and then a few weeks later you'd get your glasses prescription. Doctors loved it because it was simple, it was easy, and you didn't have to spend a lot of time educating patients. You just said, "You've got a cataract, you need cataract surgery," we do cataract surgery, and then they come and get their glasses. Today, we have a lot of technology, a lot of different options available to patients. So some patients may choose to have cataract surgery and have their glasses updated after surgery, but other patients that would like to be spectacle independent or to be free of or less dependent on glasses, there are lots of surgical options available to them, different lens technologies that are available.

Patients do have a lot of astigmatism and we have beautiful toric lenses that help to correct that. Patients who are interested in seeing well at distance and up close, if they have a healthy eye other than the cataract they can have what's called a multifocal lens. It's almost like a bifocal inside the eye that allows them to see distance and up close comfortably without glasses.

Interviewer: Wow, really? A bifocal inside the eye, is that annoying? Because from what I understand, one eye is corrected one way and the other eye is corrected the other way, right?

Dr. Barlow: So that's monovision, that's the concept you're talking about, which can be done with cataract surgery. People who have done that with contact lenses are usually very good candidates for that where you have one eye, your dominant eye typically, targeted for distance vision, and then the non-dominant is a mild nearsightedness to allow you to see up close. The multifocal lens allows you to do that with both eyes together, provides you with a little bit better quality vision up close, relative to monovision, but both are very good options.

The bifocal idea is slightly different than what you would think of when you think of a bifocal, a lined lens, with one part for distance and one part for near. It's a, what we call, a diffractive pattern so it has little rings that separate the light into two focus points simultaneously, and the brain chooses the image based on where you're looking. So when you're looking a distance one image is going to be in better, sharper focus. The brain will focus on that. Or if you're looking at things up close, the brain will choose the image that's in better focus for that. So you've got those two focus points. It works very well.

There have been several iterations of this technology. The most recent iterations have been demonstrated to be very effective without causing a lot of problems that were noted with the original lens technology with this multifocal concept where that had a lot of glare and halo effect with bright light sources That has been reduced significantly with adjustments to those patterns that are used in the lens.

Interviewer: It sounds like whatever you thought you knew a few years ago, probably you don't know anymore and should really talk to an expert like yourself.

Dr. Barlow: Yeah, it continues to change. The technology is ever advancing. Lots of different areas in the world, obviously in different aspects but certainly with ophthalmology, no difference.

Interviewer: And when a patient comes in, you start talking, "All right. Here are your options," I mean it's very personalizable, depending on what a person wants, right? Like what their lifestyle is, do you ask a lot of those types of questions before making a decision?

Dr. Barlow: Absolutely, you want to ask about what they like to do, are they outdoors oriented, do they do a lot of mountain biking, climbing, hiking, golfing? Do they do a lot of computer work, do they do a lot of reading, do they do a lot of sewing, whatever it is, where is their world located

Interviewer: It's a different procedure, yeah.

Dr. Barlow: Where do we want to target their vision and vision quality? And it's not just lens technology that's available. There are different technologies that help in terms of doing this surgery. So a femtosecond laser that helps to do steps with the surgery, can do it more precisely than any of us can do as a surgeon and we're pretty good surgeons, but the laser's just more accurate. It's just the reality. So these different technologies are being introduced that help us to make the surgery potentially more accurate, more safe, so it's an exciting time for us.

Interviewer: What's on the horizon? I mean, you're talking about all the things that have changed just recently. Is there anything on the horizon that you can talk about? Now that I've got an expert here, I'd love to hear about it.

Dr. Barlow: So on the horizon, lens technologies, there's discussion of a lens that can be placed in the eye and then we can use different types of light to adjust it and set it, if you will. So if we're slightly off with the prescription one way or the other we can use that light to adjust it.

Interviewer: What?

Dr. Barlow: There are certainly concepts or ideas about lenses that are flexible inside the eye. So our natural lens when we're young, the reason we're able to see a distance and then look at things up close is that we can flex and change the shape of the lens, so people are looking at that, softer materials, different things. These are still very primitive in terms of where we're at, but that's where we're going, that's where we're headed to try and recreate the natural lens. We lose the ability to see things up close and we start to develop cataracts related to these lens changes. Can we maybe be able to do surgery at a younger age at some point to correct those issues?

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