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So you note symptoms of decreased vision and glare. Your ophthalmologist determines cataract surgery is required to improve your visual function. What additional information do you require to make an informed decision about your cataract surgery?

As our Hamilton eye doctors can attest, cataract surgery has improved drastically over the past 3 decades. Two advancements have been the vanguard of this revolution:  small incision surgery and the refinement of the intraocular lens (IOL).

Cataracts can now be removed using incisions less than one-tenth of an inch across. Surgical microscopes, a vibrating needle to break up the lens (phacoemulsification), and foldable intraocular lenses make this miracle a daily reality. These instruments in an experienced surgeon’s hands provide rapid, painless vision recovery.

The type of intraocular lens implanted at the time of your cataract surgery will determine how often you will require glasses to perform your daily tasks. The greater your understanding of these choices, the more productive your preoperative discussion with our Princeton-area ophthalmologists will be. The choice of lens implant will determine how frequently and under what circumstances you will require glasses following your surgery.

The lens in the eye sits behind the iris (i.e., the colored part) and along with the cornea, it is responsible for focusing the light on the retina.

Current IOLs are miracles of modern science; however, even the most advanced lens does not match the phenomenal capabilities of the natural crystalline lens that you were born with. Your native lens, in its youth, could effortlessly change power to bring whatever you chose to view into focus instantly.

As the lens becomes more rigid and inflexible with time, it can no longer change its focus easily, leading to the need for reading glasses or bifocals some time in the mid-forties. As the lens ages, it becomes cloudy — and when it begins to obscure the vision, then it is considered a cataract.

When this lens is removed during cataract surgery, a new lens must be implanted — much like if you removed a lens on a camera, you would have to put a new one on before you could expect to take a photo.

When deciding which lens is ideal for you, consider the following:

  1. How important is it for you to minimize your need to wear glasses?
  2. Is it more important to you to perform near tasks, like reading or distance tasks, such as driving and watching TV.

Current lens choices:

  1. Monofocal Lens: This is the most versatile and most widely implanted lens by far. It has a single refractive power. Measurements of your eye are taken to determine the power of the implant needed to give you the desired refractive result. A popular choice with the monofocal lens is monovision. With monovision, a monofocal lens is used to allow one eye to see distance and one eye to see near. This allows for most tasks to be done without spectacles. If better vision is required (for driving at night, for example) glasses can be used for those more demanding situations.
  2. Toric Lens: The toric lens addresses astigmatism. The astigmatic error due to the cornea is not alleviated with cataract surgery. A toric lens has different refractive power, along different portions of the lens. This lens has to be lined up with the axis of the patient’s corneal astigmatism. Correcting the astigmatism with the toric lens allows patients with corneal astigmatism to be more spectacle independent. This lens can also be used for monovision.
  3. Multifocal Lens: These implants use the optical principle of diffraction to divide the incoming light, providing both a distance and near focal point. Using this lens, both eyes can be set up in a similar fashion, and both eyes can function at both distance and near. Since the light is divided into two focal points, there is some degradation of the quality of the image, and this can decreased contrast sensitivity, a more sensitive measure of vision. These lenses also produce significantly more glare at night — so if night driving is an important task, these lenses are not ideal. The optical aberrations produced by these lenses cannot be corrected by simply wearing glasses. Recently, extended range of focus lenses have been introduced as variants of multifocal lenses that attempt to minimize the downsides of a multifocal lens.

Only you can determine when or if you would like to be spectacle independent after cataract surgery. The evaluation and discussion with your ophthalmologist will determine what is ideal for you.

Cataract surgery is indeed a modern miracle.  Choosing the correct implant for you will ensure you get the most out of your surgery.


At some point in our lives, almost all of us experience at least some degree of floaters or flashing lights in our vision. As eye doctors, we tend to get questions about them often from our Hamilton and Princeton, NJ patients. There are various causes for these phenomena, and I will try to shed some light on this topic.

First I will start with flashes and floaters caused by problems within the eye and retina.

The inside of our eye contains a jelly called the vitreous. For most of us, there is debris within this jelly.  When light enters the eye, it hits this debris and casts a shadow on the retina, which in turn causes us to see floaters. This is a very benign condition, and although it can be annoying at times, it will not damage or harm our eyes or vision. There is also much variability from patient to patient with how noticeable these floaters are. Some patients will never notice them, while others see them constantly.

As we get a little older, the vitreous starts to contract and tugs on the retina. As it begins to tug, patients will often notice a flash of light. This flash usually lasts 1 or 2 seconds and is white in color. Eventually the vitreous will tug hard enough and separate from the retina, which is called a vitreous detachment. This leads to a different kind of floater and one that is usually larger and often looks like a circle or cobweb. This too can be very annoying but is harmless to our eyes. Over time, this floater will usually settle below our line of sight so we don’t see it as much. In certain cases, as the jelly separates from the retina, it will cause a rip or tear in the retina, which can lead to a retinal detachment. This is a more serious condition that requires prompt attention to prevent damage to the retina and vision loss. When this occurs, patients will typically notice more flashing lights, a greater number of floaters, and sometimes a veil or curtain over their vision.

In addition to flashes and floaters caused by problems to the retina, patients can experience these phenomena from other non-eye related conditions. Our eyes are an extension of the brain, so if something is disrupting the parts of the brain responsible for our vision, we can experience a number of different visual symptoms.

Transient ischemic attacks (TIAs), more commonly referred to as mini strokes, are an event in which the brain lacks proper oxygen for a timeframe of less than 24 hours. The most common cause for this is when an embolus, or blood clot, restricts the flow of blood to the brain. Depending of which part of the brain is affected, symptoms can include: weakness on one side of the body, difficulty speaking, confusion, and even visual symptoms such as loss of vision or flashing lights. There are even times when a patient can experience a mini stroke and have only these visual symptoms. Depending on where the blood clot is, these visual symptoms could affect one or both eyes. They can be described as a loss of vision, dimming of vision, or flashing lights. When patients see flashing light from a TIA or even a complete stroke, the flashes tend to last for minutes to hours, versus the retinal flashes that last for a few seconds as described earlier. This difference in duration of the flashes is important and helps to distinguish if the flashes are caused by something in the retina or brain.

In addition to mini strokes and strokes, flashes can also be a result of migraines. This type of flash is referred to as a migraine with “aura.” These flashes will often sparkle and grow in size then shrink. They will generally occur for minutes to an hour. Oftentimes, a headache will follow after the visual symptoms subside, but there are times where no headache will follow and the only symptoms are visual.

Typically, when patients come to see me complaining of flashing lights, the first concern they immediately think of is a retinal detachment. However, there are a number of different causes for flashing lights. My general advice to patients is to alert their eye care professional if they notice new flashes, floaters, or any changes to their usual floaters.

Do you have questions about floaters or flashes? Leave them for us in a comment.

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Outlook Eyecare
5 Centre Drive #1B
Monroe Township, NJ 08831
Phone: (609) 409-2777

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100 Canal Pointe Boulevard #100
Princeton, NJ 08540
Phone: (609) 419-1920

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