Dr. Lehman talks about Eye drop Regimens for eye surgery patients.
Speaker 1: Welcome to Focal Point Vision, Texas’ preferred cataract provider for over two decades. Our doctors are among the most experienced cataract surgeons in the country. And as you’re about to hear, they’re also setting standards in laser cataract surgery, premium cataract implants and customizing your cataract procedure to fit your unique lifestyle. Thank you for your faith and confidence in Focal Point Vision, where we’re advancing the art of cataract surgery.
Kenneth Maverick: So my family tradition in Texas goes back to the 1800. My family has been here, I guess, five or six generations, and we’re very deeply rooted. I had never had an intentional plan to come back necessarily, but having come back and it’s meant a lot to me and being part of the community and watching community grow and being able to take care of friends and family and coaches and teachers that I grew up with and who taught me is one of the more rewarding things that I’ve gone through in medicine.
James Lehmann: My parents live here. My sister lives here. My parents grew up in Eagle Pass. I grew up in Seguin. I see patients that were friends of my parents. I see patients that I went to school with. And so, you can automatically kind of relate to people, you know where they’re coming from. It’s a level of comfort that makes things very easy. And when it comes down to it, patients are coming to you to do their eye surgery. You have to be able to establish that trust. And it’s much easier that they know my story, they know where I’m from and those things.
Kenneth Maverick: So I don’t think it’s ever been a better time to be a cataract surgeon. We have so much technology at our fingertips. In many ways, the hard part is explaining so many of these options. Because many times people will have multiple options, but it’s our job as surgeons to hone down on your several best options and explain the pros and the cons, and try to help you make a decision as to what type of technology and how you want to see.
James Lehmann: Almost everybody gets a cataract if they live long enough. Maybe a small fraction of patients will get older and not have a visually significant cataract. And so, is it something to fear or is it an opportunity? Cataract surgery is one of the surgeries where we don’t just get you back to where we were, we can actually make you better. So I think it’s more something to look forward to than to fear.
Kenneth Maverick: When a patient comes in, each person is different. Each eye is different. And so we’ve been able to customize the procedure and even per eye. And so, the nice thing about today’s technologies is there’s not one size fits all, but we have all the tools in the toolbox in order to give people largely what they want.
James Lehmann: Refractive surgery is using all the technology and tools to give patients the vision that they want. And that’s not the same for everybody. So if a patient says, “They want excellent distance vision, and they don’t mind using reading glasses.” It helps us achieve that. If they say, “They want to be less glasses-dependent” so they can see their phone, they can look at a menu, a laptop. Then it helps us to do that as well. So it’s tailoring the surgery to the patients’ needs.
Kenneth Maverick: So when I started cataract surgery in early 2000, there was one lens and it was a monofocal lens and they worked just fine. But patients had to expect to wear glasses and it improved vision. Very shortly and even in my training, some of these new technologies really started coming out and that’s partly why I got so interested in ophthalmology. I still remember the day that the insurance payers were allowed to offer cataract surgery, but a patient could upgrade. And previous to that, they couldn’t. And what that did to the industry is it infused a tremendous amount of research and development into these technologies. And that’s what’s largely allowed all these technologies to bloom. And it’s really been to the benefit of patients because now we can do a cataract surgery, but we can also help so you don’t need glasses.
James Lehmann: Back then, we would just offer the patients one choice for cataract surgery, the surgery or nothing and then they would be in glasses afterwards. And there was not much we could really do about that. But again, all these different technologies, the presbyopia, that’s giving you near vision. toric lenses, that’s fixing your astigmatism. Light Adjustable Lens. All that’s come about in the last decade and it’s continuing to improve still.
Leslie Smith: So for almost 40 years, I had no near vision unless I had my glasses on and it was getting worse and worse. And I thought, “Well, the prints just getting smaller and smaller and I’ll never.” But it was really a struggle just day-to-day things and I’m now retired. I’m a registered nurse. So it’s not as important as it used to be looking at little medicine bottles and things, but I can read little medicine bottles and things now. I do not need glasses for near vision at all. I can read the fine print.
Leslie Smith: The doctors at Focal Point Vision walk on water. They’re fabulous. And the whole staff here, I’ve never had such a wonderful experience in my life and that I got my near vision back. I can wake up in the middle of the night and look at my phone if I want to and I don’t need any glasses. I don’t need glasses for anything in my routine life at home. No glasses.
James Lehmann: So what the laser does is it’s another tool in our arsenal. It’s able to do in a few seconds, what it takes us five minutes to do. And so what it does is it creates the incisions and it breaks up the cataract for us. It also makes the little opening that allows us to take the cataract out of its capsule. So it does it in a precise, repeatable way that helps us to be more comfortable with the surgery and to deliver better results.
Kenneth Maverick: So laser cataract surgery is one of the most interesting and I think biggest evolutionary steps in cataract surgery in my practice lifetime over the last 15 or 20 years. I was the first surgeon actually in South Texas to do laser cataract surgery. And the very first patient, “I still remember you’re a little worried. Okay, is this going to go well or what is this going to be about?” And as with anything that’s new, you don’t know all the ins and the outs of it and having done hundreds and thousands since that time, I can say definitively that it’s a better way to do it.
James Lehmann: Here’s a good analogy. Let’s say that somebody asks you to draw a circle 20 times on a piece of paper, you get pretty good every time, but it may not be perfect. The laser can make a perfect circle 20 out of 20 times. And so, he does some steps better than us. Now, it doesn’t obviate the need for the surgeon. We still have to be in there. We have to take out the cataract, put in the lens, deal with any kind of pressure issues and things like that. But overall, it’s a tool that makes us more efficient and more precise.
Kenneth Maverick: I think the best part of the laser surgery is it makes it easier on the patient and makes the patient more comfortable. It’s faster. The laser can do in about 30 seconds what takes me about five minutes. And it is more precise. The Capsulorhexis, which is the opening of the lens to access the cataract is always perfectly round, and we can tune it into a 10th of a millimeter. And as good as the best surgeons are in the world, can they do that a hundred times in a row? They can’t.
James Reavis: I was told my vision to be as good as it was in my 20s or 30s, because back then I crop dusted and I had good vision. I could see wires. I couldn’t anymore. I couldn’t see wires and I don’t do that anymore, but I still wanted that kind of vision. I see you great. I see everything great. I can read small print on the television when I couldn’t. So yeah, I could do that immediately after surgery.
James Reavis: I’m halfway there on this journey to get my eyesight the way I want it and if they could, I would leave this interview and go do the other one right now. My only pain was to drive down here. I’ve had absolutely zero pain. No pain at all. And I’ve had metal in my eyes before and it was very painful and I thought it would at least feel like that. Like I’d scratched my eye or something. But no, I never felt anything. I’m going to tell everybody about how my procedure went. I don’t see how it could be any better.
Kenneth Maverick: So the Light Adjustable Lens is a new thought process in technology where we implant a lens inside the eye, we’ll let you heal from the cataract surgery for a couple of weeks. And then we have the ability to tune in or adjust the lens to any given distance that you want. The advantage of the Light Adjustable Lens is no matter where you end up or if you heal a little differently, we have the ability to enhance it after the fact without going back to the operating room or another surgery.
Kenneth Maverick: It’s an office procedure where you sit at a slit lamp and it usually takes 60 to 120 seconds. And we can tune it in a number of times and make it a little better and a little better and a little better until we get it where you want and then we lock it in.
James Lehmann: So the Light Adjustable Lens is one of those IRLs, but what’s unique about it is you place it in the patient’s eye and then you can go back two weeks later without additional surgery and shine a light on it and change the shape, giving somebody that refractive result that we want. It’s FDA approved. We’ve been able to use it since last summer. We’ve treated over 50 patients with it already and the results have been great. We’ve really been able to deliver on patients, especially those with a history of previous surgery like LASIK, PRK, radial keratotomy. All of those things make obtaining a good result after cataract surgery difficult and the Light Adjustable Lens really helps us with those patients.
James Lehmann: Astigmatism means your cornea, the outside part of the eye is shaped more like a football rather than a baseball. Okay. And so, that affects your glasses prescription. Have you ever seen your glasses prescription? It has two numbers in it. That second number is how much astigmatism you have and everybody has a little bit. Well, if you don’t pay attention to that at the time of cataract surgery and you don’t try to fix it, then patients are going to need glasses after surgery. But we have different tools. We can use the laser to make incisions. We can use special lenses to reduce it. And we’re trying to get that number as close to zero as we can.
Kenneth Maverick: To correct astigmatism, we can combine a higher amounts of astigmatism with a toric lens, which will correct the bulk of the astigmatism. And we use the laser to even fine tune that over and above the toric lens. And so, that’s what gives the patient an outstanding outcome. And it also helps center the lens and helps align the toric lens. One of the benefits of our system is it’s very much automated where we use measurements from one machine and it automatically downloads into the laser that allows us great precision and what that access is.
James Lehmann: So this is where the cataract surgery happens. It’s my OR behind me. We have one right over there. And from a patient’s perspective, what they always ask me is, “Am I going to see what you’re doing? Am I going to see your hands?” And the answer is no. So what happens is a patient will get an IV and then right before we bring them to the operative suite behind me, we give them medicine in the IV that makes them relaxed.
James Lehmann: They kind of go into a twilight state, kind of like if they had wisdom teeth removal or a colonoscopy and they don’t really know what we’re doing. They’re breathing on their own and kind of in and out of conscious, but they don’t know what’s happening. The surgery takes about 20 minutes and people generally have no pain associated with the procedure. And then afterwards, we wheel them out into post-op and they sit up and then a nurse stays with them until they’re kind of alert enough to kind of get out of their own volition.
Kenneth Maverick: Behind me, we built the most technologically advanced cataract operating room in the area. And because we invest so high in technology, we have state-of-the-art microscopes, state-of-the-art monitoring systems. Everything possible to make the patient comfortable. The latest equipment for removing the cataract and the latest safety equipment. And we have very specifically tried to make a unique and good experience for cataract surgery for the patient.
Kenneth Maverick: So the benefit of having a dedicated eye surgical center is that our nurses, our staff, our sterilization staff, that’s all they do. And som they’re very used to coaching patients through it. They know exactly what to do. They’re very reassuring. They’re very efficient. They’re very professional. And so, we don’t have to worry about knowing multiple other specialties or other instruments or how they clean other instruments. All we do is eyes and all we want to do is eyes very well.