Video Transcription (Laser Cataract Surgery Part 3)
Dr Croley: Typically speaking, a lot of those people who have driving glasses to drive at night because the nearsighted eye has all kinds of glares and halos around lights at night and so they’re not happy with their driving with monovision so they have a driving pair of glasses to drive at night. But they’re still happy. They wanted monovision, they wear contacts that way and there’s no problem doing anything that way. The advantage of the bifocal implant is that both eyes are clear at distance and both eyes are clear up close so you don’t have the depth perception problem. Yup?
Lady from the Audience: You mentioned doing three of the step procedure today, are you still doing the old-fashioned way of the phacoemulsification?
Dr Croley: Well we still phaco on both…all of them get phaco. It’s just the laser can do the incisions, the capsulorhexis can soften your lens, but we still have to go in the eye and emulsify the lens and take it out. So the laser’s advantage is, is less ultrasound time while we’re doing the procedure to get the lens out and consistency on how round the capsulorhexis is. And those are the many points of the laser. And I can’t tell you how big a winner it is because this is too early on. But I can tell you it’s very nice.
There’s one lady who had a hypermature ripe Cataract. That capsule is clear and softened. So when this happens, this white Cataract, this is almost impossible, we put a dyeing light to stain the capsule. We call that ripe or overripe, like an apple, it starts running, getting ripe it starts melting, the capsule becomes very fragile every minute. That’s why the surgery is more difficult but that laser, chook. they’re perfect.
Lady from the Audience: What is the price difference between lasers…
Dr Croley: Everybody, every doctor tells they have a price difference but the ones who are gonna be doing it, because not everybody is gonna be doing it, because there’s only two lasers in Southwest Florida. Probably the next closest to it will be Sarasota or Brayton. So the doctors who are gonna be doing it, it could be anywhere from 1200 dollars to 1800 dollars extra for the procedure. I don’t know for sure because I don’t call everyone so far for their pricing but we’re charging 1500. So somewhere I think it’s in the middle. In my opinion, and to be honest about it, most of it, though I’m not sure, I mean, this is extra another step, an extra procedure. It’s really nice for you because you could get perfect Capsulorhexis and all that but 850 only goes to the laser part.
Lady from the Audience: And then we pay for the lens…
Dr Croley: It depends on the kind of lens that you bought. So, a regular lens covered by Medicare, the fancy lenses depends on what lens you got or what the prices are. So we have a whole laundry list. I mean before, you used to come in, you have a Cataract surgery, then all day we’re gonna do and that’s it. Whereas now, Ronnie probably spends an hour with the patient, discussing everything, going over everything. I go over the lenses, she goes over the lenses. We give this all week, we have all the brochures today if you wanna get that and so it gives all what the different lenses do and all that kind of stuff. And so it’s a process anymore, I mean, this is not just, this is not Cataract surgery, it’s what kind of vision do you want when you’re done. So it’s different and is more time-consuming. Yup?
Lady from the Audience: How much time do we need before doing..
Dr Croley: About a week or two..
Lady from the Audience: What about floaters?
Dr Croley: Floaters happen because the jelly in the back of your eye that’s attached to your retina, through, sometimes just over time and age, or injuries or different things, that jelly can move or liquefy and pulls loose from your retina. So now you see that attachment flowing around in the jelly inside your eye. And 98 to 99 times out of a hundred when people get floaters, nothing happens. You have floaters, sometimes they get better, sometimes they go away but occasionally it tears your retina when it pulls loose and then you potentially have a problem for retinal detachment. So when you get floaters, you need to be seen pretty early on when it first happens so you make sure your retina is okay. As long as your retina’s okay you’re good. Yes?
Gentleman from the Audience: I think you said early on that if you don’t like your lens you can have it changed out. Is that true?
Dr Croley: No, it’s a one-time deal.
Gentleman from the Audience: Never ever?
Dr Croley: I mean, you can but the surgery that could take out your old lens, and put one of these new lenses in is more intense, more complications than the surgery the first time around. And unless there was a problem with the lenses in some way, which isn’t very common, then you would not want to change the lens unless you have to.
Lady from the Audience: Is this why you mentioned it is totally essential for placing the proper size lens?
Dr Croley: These lenses are pretty common the same sizes the strength just differ. Or in, say, Astigmatism, it’s how strong the Astigmatism we put in the eye. So all those measurements are critical in getting you the best result. And so that’s why there’s a lot of stuff to be done. Yup?
Lady from the Audience: When I was in your office the other day, you said that maybe you could tweak the Astigmatism with lens so that I could still see up close with my naked eye?
Dr Croley: Yes… No, you’re not gonna strip the Astigmatism, we can make one eye more nearsighted than the other. So you can choose, once the machine measures your eye, then I can choose the lens that makes you go the distance or I can choose the lens that gives you a little better reading but not so bad in distance.
Lady from the Audience: It still would be mono?
Dr Croley: A semi-mono, sort of a modified mono. Or I can give you really good reading but then if I give you really good reading, your distance is gonna be bad. Yup?
Lady from the Audience: It may be a common but some physicians are more adept in doing this procedure than others. I wonder, how would one know?
Dr Croley: You don’t. You don’t have a clue. I know ‘coz I see things. But you don’t, who’s tested. You have no idea and who’s on TV or not on TV makes no difference. And you don’t know. So the only way you know is the nurse here, she keeps track of who’s good or who’s not good in town. Here’s the stories and the bad stuff and the good stuff. And so if you know that, or if you know someone in the field then you can get an opinion. You can ask your personal doctor who would they go see, that helps, not a guarantee but helps at all. And so there’s no easy answer to tell you how to pick a doc.
Lady from the Audience: My daughter is a third year resident in Ophthalmology in a United States University and she said a lot of times Ophthalmologists have to correct what some Optometrists have done.
Dr Croley: Right and I have a student there but…except now in Kentucky they passed a law where they can do some surgery in Oklahoma. And Optometrists can do surgery in some of those two states just because the legislature, they bought enough people off that they got a pact. They’re gonna take the weekend course to wanna have their Cataract surgery and then they’re gonna start doing it. It’s crazy. That’s the government. Yup?
Lady from the Audience: What can go wrong during procedure?
Dr Croley: All kinds of things. So, we’ll just go with the Cataract surgery, generally speaking. You could get an infection; you could get a hemorrhage; the retina can swell after the surgery; the cornea can swell; you can have mechanical problems; the capsule can be torn; you couldn’t put the implant in; you could get severe inflammation in your eye. There could be all kinds of things.
The good thing is, Cataract surgery is probably the most successful operation, if you have to have one to choose to have. Ninety seven percent or so of people who have Cataract surgery have no problems. The two or three or four percent of people who do have problems for those kind of things: the swelling in the retina can be treated and can go away; the cornea can be fixed if it really was that bad, a lot of times it will get better as it heals; infections are very rare, maybe one in four or five thousand cases, I mean it’s pretty rare. So the complication rate is very small. As far as the laser goes, probably you do get because it attaches to your eye, you get tiny little micro hemorrhages on the white part of your eye but they go away in a few days. Not that it’s a complication. Not that it bothers you but it’s visual. We can lose suction as it sucks to the eye. So you can flinch, move or something happening and you could lose suction and it wouldn’t do any bad thing to you, it just means we’re probably not gonna continue with the laser part of it and just do it the regular way.
And theoretically in the beginning, when they were first warning with the laser, the laser, they were getting too aggressive with the back chopping and fragmenting of the lens, sometimes it’s breaking the capsule’s posterior. So they finally moved that further up and there hasn’t been a problem but those are the kind of things that can happen.
In residency, that capsulorhexis, that tearing of that little cellophane is pretty dealt. And twenty to twenty five percent of residents mess it up. It’s just because there’s a learning curve, I mean that’s just the way it is. And so a lot of them, you practice on rabbit eyes and you dumbly do what you can do all these things to get good at it. But those were the complications.
Fortunately, it’s just, most people just do really well.. as long as…the biggest problems I have is, people come to me, they say they don’t see any better after the surgery than they saw before the surgery. Now most of the time I haven’t seen this people before but they really have a pretty reasonably good result. Probably they just have a Cataract to begin with but then it’s hard to notice the difference. Like I said you have to be very careful that you really have a Cataract there and then there really is something there because the unhappy people I have, I think, they’re not that they had such horrible results, I mean, there are complications, it’s not that, it’s usually they look pretty reasonable they’re just not happy. And they’re not happy because probably didn’t see a difference because there wasn’t a Cataract to begin with.
Lady from the Audience: A couple of people, friends that I’ve had. In both eyes, always their comment was, the first surgery was wonderful. The second surgery didn’t go as well..
Dr Croley: But then that’s not uncommon. And the reason is, is the first time around you’re so scared that something’s gonna go wrong and all that that you expected this horrible procedure and then you come back a second time, well there was a little ..someone did something to my eye. It is pretty common, it is pretty funny, I mean, we hear, we’re in the operative room, they come in with the second eye and we’re due to start in this and they go, ‘I’m awake more this time than the last time’. All the time they say that and we keep saying, ‘No, you got exactly the same milligrams of Bursette as you got the first time. The thing is, it gets people amnesia. These drugs that they give you to calm you down get you amnesia so you won’t remember you told that to us, in most cases. But all they say, this is different from the first time.
Lady from the Audience: So, should you have somebody drive you?
Dr Croley: Yes, because you can’t drive. The surgery says you can’t drive for 24 hours. You can’t drive that day because they’ve given you mind altering drugs and so they don’t want you to drive. So you have to have someone come with you. Typically speaking, the time you walk in the door and walk out the door is about two hours.
Gentleman from the Audience: Where do you do yours?
Dr Croley: We have a surgery center at Fort Myers that is actually just about a year and a half old, well almost two years old. So that is state of the art, probably one of the finest surgery centers in the world, actually, top 5 maybe. I mean, well, we probably got every piece of equipment you can ever imagine.
Lady from the Audience: Where? Where in Fort Myers?
Dr Croley: It’s on US 41, just north of College Parkway, on the righthand side.
So one of the things I do for the church is whenever I do this, I don’t do it for other folks when we get seminars but for anyone who’s not a patient and they wanna know what the status of their eye is, we give you a free visit. So you can come in and I’ll tell what really is there and let you know what the status is and you can get that free consult. We also have a bunch of the brochures to give you all the different things we do about Precision Cataract surgery and all the different kind of lenses we got. So you have that information as well.
We’re gonna actually be giving another talk in March. And so in March, it’s gonna be on Dry Eyes. People can ask about Cataracts as well but it’s gonna be on Dry Eyes. Dry eyes is probably the most common problem I see in my office. And it costs the US laborers 5 million dollars loss a year in productivity in the workforce because people have problems with dry eyes. And the amount lot of people spending money on dry eye drops and treatment is billions of dollars.
We are one of the few places in the world that you can actually have your tear film analyzed. So we can actually analyze what’s wrong with your tear film. Not just say, ‘Here’s your tear drop and see you later’, but we can actually analyze what’s wrong with the layer of your tear film, how salty the layer of your tear film is, and actually, specifically treat what the underlying cause of your dry eye is, not just tears and drop. And so we’ll go over all that and give you the data behind it. I mean it’s all the best laser and this new treatment and things that we have that has happened in the last six or eight months. It’s pretty interesting on how crazy things have changed but I mean, we see… there’s a lady from Seattle to be treated for dry eyes. And another lady flew from South America…