Advanced Lenses

By Dr. Pooja Khator
Pooja Khator, MD, a glaucoma specialist and cataract surgeon, is certified by the American Board of Ophthalmology. She joined Coastal Eye Institute in 2006. 

Cataracts, or clouding of the lens of the eyes, are common as we age. Fortunately, cataract surgery is quite effective and, in fact, one of the most common surgeries performed in the United States. lenses

When ophthalmologists perform cataract surgery, they remove the eye’s old lens and replace it with an intraocular lens (IOL). Originally, a standard intraocular lens, which can certainly help patients see better but cannot correct astigmatism or presbyopia (the ability to see close up), was the only option for such a replacement. Advances in lens technology, however, have expanded our arsenal, and we now have lens options to help improve astigmatism and reading vision after surgery.

Advanced options in lenses

Astigmatism is a common vision condition that happens when a person’s cornea is not symmetrical. A normal cornea is round like a baseball. With astigmatism, the cornea curves more like a football.  With the toric intraocular lens, regular astigmatism can be corrected, allowing for crisp distance vision without glasses.

Another premium lens option is the multifocal intraocular lens. By separating the light entering the eye into zones for distance and for near vision, it can allow correction for driving and for reading at the same time. Many multifocal lenses come in several reading powers, allowing surgeons the ability to tailor the lens to fit specific visual needs. Not all patients are good candidates for this type of lens, however, and a full eye examination to exclude the presence of glaucoma or macular degeneration is necessary.

The latest arrival to eye surgery is the Technis Symfony lens. The Symfony allows correction for distance and intermediate vision. These days, much of our world is in the intermediate range of vision. If you are over the age of 40, chances are you have experienced loss of intermediate vision, making you wish you had longer arms to read your phone screen, the labels of cans on a shelf, or a recipe in a cookbook. The Symfony lens is potentially an excellent choice for those who do a lot of computer work or spend a lot of time reading on smaller devices, such as an iPad. Furthermore, the Symfony lens comes in options that correct astigmatism at the same time, as well as being a good choice for patients with mild glaucoma and macular degeneration who may not be good candidates for a multifocal lens.

How do I choose?

Your ophthalmologist can conduct certain tests to make sure you are a good candidate for a premium intraocular lens and help educate you about the benefits of these lenses following cataract surgery. These lenses take some time to get used to, so it is important to understand exactly how they work and their limitations. Although a premium intraocular lens can reduce your dependence on eyeglasses, it does not completely eliminate the need for glasses in all situations.

Coastal Eye Institute has served this community since 1964, focusing solely on comprehensive eye care and providing everything from routine check-ups to diagnosis, correction and management of complex medical eye conditions. Coastal Eye Institute has four offices to serve you. For an appointment visit or call 941.748.1818.

50, 60, 70 is the New….

by Dr. Alissa M. Shulman

Dr. Alissa M. Shulman is a board-certified plastic surgeon who founded her solo practice, Sovereign Plastic Surgery, in Sarasota, in 2009. Long before she became a cosmetic plastic surgeon, Dr. Shulman wholeheartedly pursued her passion for art. The unique combination of outstanding medical credentials and an in-depth artistic background truly sets Dr. Shulman apart from most other plastic surgeons.

Let’s face it, we are living longer, are more active, and continue to redefine what “old” is. As a plastic surgeon, I’m frequently asked “Doctor, am I too old for this procedure?” Rather than looking at the patient’s birth date, I look at their list of medications and medical conditions. This is the “age” that truly counts for elective surgery of any kind.

Now, I will also consider different factors for the “over 60” prospective surgery patient. Is the person on blood thinners? Is the surgery worth the risk of being off their medications for the necessary time before surgery? If this situation is part of the equation, I recommend the patient discuss this with their cardiologist before we proceed.

How long will the actual surgery take? After two or three hours of general anesthesia, the after-effects start building up. I think older patients do better with multiple shorter procedures — well-spaced. Virtually all surgeries for patients over 50 require a request be sent to their primary doctor for “surgical clearance.” As a surgeon, I also want to make sure that the doctor handling their overall health is kept in the loop.

Another (often ignored) factor to consider is help at home. Many older patients are living alone and do not want to bother their friends, thinking that they will be fine the next day. I try to make sure we have addressed this assumption thoroughly before surgery; I prefer someone stay with them at least a day after surgery. If there is truly no one available, my office can help connect the patient with one of the many wonderful nursing services in our area.

While I consider these factors with all my patients, it is doubly important for the more mature ones. Every potential surgery patient needs to ask themselves:  Is the risk of surgery worth the potential reward? Are the expected scars worth the risk? Are my expectations realistic?

I often meet two or more times with the patient to talk about the surgery plan. I have been known to change the plan after further consideration, and always want the patient to understand that there are many ways to address the same issue. This is not a simple mathematical formula with one solution; the initial consult is only the beginning.

Some of the most common procedures for my mature patients are breast lifts (mastopexy), old implant removal (+/- lift), abdominoplasty, and liposuction. Liposuction is the one I tend to be most cautious of, as the skin does not spring back very well after the age of 50. These patients need to expect excess skin (which could be removed with a separate surgery). Each of these surgeries is less than three hours.

Suffice it to say, age is more than just a number!

Sovereign Plastic Surgery is located at 1950 Arlington Street, Suite 112 in Sarasota. For an appointment, visit or call 941.366.LIPO (5476).