Thank you for watching this program tonight with the best physicians of the region.

My name is Dr. Luis Munoz.

I'm the president of El Paso County Medical Society.

It is our hope that you will find this program informative and interesting.

We at El Paso County Medical Society invest in community education with our programs.

I hope you'll find this program very informative, with great medical advice and great medical information.

Thank you again for watching this program tonight.

And have a great night.

Did you have to put on your eyeglasses before watching the show this evening?

Maybe you wear eye contacts sight problems such as nearsightedness, which is myopia or farsightedness, which is hyper appear, are very common and pretty easy to correct.

There are, however, more serious eye conditions that we're going to be talking about this evening.

There are cataracts, glaucoma, macular degeneration and other eye diseases and infections.

During this next hour, we're going to have experts talking to you about what's new in premium cataract surgery.

It's not your mom's cataract surgery.

It's some new stuff.

And I think you're going to really enjoy it.

This evening's program is underwritten by Southwest Eye Institute.

And we also want to thank the El Paso County Medical Society for bringing this program to you.

I'm Kathrin Berg, and this is the El Paso physician.

Thanks again for joining us.

This is the El Paso Physician.

I'm Kathrin Berg, and we are here this evening talking about premium cataract surgery.

And cataract surgery is not just cataract surgery.

There are people that I know, many people that I know that go in to have their cataracts fixed, and then all of a sudden their eyesight that they had to wear eyeglasses or contacts since they were 12.

That's fixed too.

So there's always some nice positive things that go along with this.

We have a veteran here at the table, Dr. Javier De La Torre, who is an ophthalmologist with Southwest Eye Institute.

And then we have Dr. Brian, and we just practices in this.

All right.

Lallathin who is an optometrist with Southwest Institute and then Dr. Calvin McNelly, , ophthalmologist with Southwest Eye Institute and Dr. Brian.

Excuse me.

See, this is my order again.

And Dr. James Cole with Southwest Eye Institute, also an ophthalmologist saying all that ophthalmologist is a hard word to say, harder to spell You know, I am doing the dictation these days, so things automatically are spelled correctly on Dr. De La Torre Since you're the veteran on the board and you kind of know how this works, we have three ophthalmologist, one optometrist, and we have.

And thank you, by the way, the way you guys developed, the way the dance of the shows going to go is beautiful.

So you have questions that are coming in to other questions.

You made my job very easy tonight.

That being said, what is it that you do all day, every day?

And we're going to ask the same question of all four of you.

So we are a comprehensive ophthalmologist with the Southwest Eye Institute.

We focus on routine eye exams.

We do a also LASIK evaluations.

That is my specialty and my niche within the practice.

And we see also emergencies that come in.

So we focus on all comprehensive eye care.

And I had my son come to you a couple of years ago.

We talked about we were on this program and you talked about that little stye that doesn't go away.

I'm bringing you in.

It was common courtesy.

It was something that just.

So thank you for being that guy, Dr. Lallathin So an optometrist versus an ophthalmologist.

Maybe you can kind of explain the difference between the two.

I think a lot of people do inner change.

Sure.

Absolutely.

The difference between it is basically ophthalmology does surgery, optometry doesn't, and we have optometry practices.

I practice medical optometry where I treat glaucoma, diagnosed, diabetic bleeding inside the eyes, cataracts, other eye disease, treat eye disease, treat glaucoma as well, and also perform some light device delivery systems there for us to modify lenses after cataract surgeries as well.

So that's the main difference from that.

Okay.

Thanks for explaining that.

And now you two have to follow with Dr. De La Torre You have to think of something a little bit new and different.

Dr. McNelly, Yeah, I can go next.

So I'm.

I'm the newest doctor of the group.

I just joined the practice this summer, and I'm a comprehensive ophthalmologist as well, just like Dr. De La Torre is.

And I do a little bit of everything.

So I do I spend most of my time seeing patients in the clinic, and then usually one or two days a week, I'm doing cataract surgery in the operating room.

I'm doing a little bit of LASIK and PRK, some refractive surgery.

And then I also do like some minor eyelid procedures sties, like you were mentioning, eyelid lesions, things of that nature.

Okay, Very nice.

Thank you.

Dr. Cole.

And you have been on this program before.

You know what kills me, though, is this "I don't remember?"

Dr. De La Torre and I remember.

Yeah, No.

So welcome back, sir.

Thank you.

But my difference, I'm a retired farmer.

I stopped growing corn and soybeans at age 27 and went off to medical school.

And now I do nothing but cataract surgery three days a week solid all day long or four days a week solid all day long.

So that's what I do in my career right now.

Cataract surgery I love.

Are you growing any tomatoes on the side somehow?

Yeah.

I tried growing some tomatoes out front and the other things kind of crowded them out.

So no tomatoes this year, but I'll move to a different spot next year.

I have a few.

I'd actually some my my vines right now.

Well, actually after this weekend.

Probably not.

Doctor De La Torre, let's start with you.

So Southwest Eye Institute.

There is a lot going on there.

If you can kind of give the audience a breadth of what the Southwest Southwest Institute does, how you guys were established, etc.. Yeah.

So the office was founded by a Dr. Mark Ellman in 2004 and his family helped him grow the practice and I joined him in 2012 after serving with the Army.

I was stationed here at Fort Bliss.

I joined him full time in 2012 and we started a growing adding colleagues like Dr. Cole, Dr. Lallathin that joined us in the late mid mid teens.

And late teens right 2020.

And then when the pandemic hit and with all the difficulties that the pandemic brought, we made a strategic merger with American Vision Partners, which is a private equity backed group out of Arizona.

And so they've helped us grow.

And so that's how we've been able to acquire talented young talent like Dr. McNelly, and the equipment that we're going to be discussing today as a for premium cataract surgery Okay.

And I love hearing that, too.

There's a neat fancy equipment every four or five years.

I feel like you need something new, and it's nice to be able to have the capital to do that.

Exactly.

And so we've added doctors, we've added a offices, surgery centers.

So in El Paso, we have four locations where patients can be seen.

In Las Cruces, we have two offices and we have a surgery center in El Paso and in Las Cruces.

And again, we offer all services eye related.

Very nice.

Thank you.

My eye person retired and so I am now with you all.

So thank you very much.

I enjoy coming to your offices.

Thank you for the trust Oh, sure.

Dr. Lallathin, then.

So a cataract.

And so we joked a little bit in the hallway to because, oh, dogs have cataracts.

People have cataracts.

You have cataract surgery.

Is there a lens involved?

Is there not a lens involved?

Explain to the audience what a cataract is and then also the symptoms that people start developing when their eyes just start changing with age?

And if you can explain both of those, that'd be great.

Sure.

I think the first important thing to think about for a cataract is a cataract is where the lens of the eye becomes cloudy.

The lens is located inside the eye.

And oftentimes we have patients that think they have something on the outer surface of the eye, and that's a cataract.

And it's not true in the lenses behind the colored part of the eye there for us and think of the eye is like a camera.

So we have that lens that's in the camera that allow us to be able to get good vision for us or good pictures there for us.

And same thing with the eye.

So what a cataract is, is the lens of the eye becomes cloudy, kind of like looking out of the window can decrease vision and give us a generalized hazy appearance.

Two things make us more sensitive to light a lot of folks.

So notice the halos around headlights at nighttime or a starburst effect for it.

Also, color perception is usually reduced as well.

A cataract is not only cloudy, but it also it makes the lens kind of yellowish, a yellowish brown color for us.

So that distorts colors there for us.

And so those are the main symptoms with it.

And again, it's inside the eye, something that you just can't physically see or somebody can take a look at.

And it's literally inside the eye for us.

Okay.

And when you're talking about surgery, this is a perfect transition to Doctor McNeely.

When you are when you are treating cataracts, we have cataract surgery.

What is happening?

They're like, physiologically, what are you doing?

So that's a great criteria.

That's a great question.

I'd like doctor all to mention the other main thing with cataracts is it's just the vision kind of getting cloudy with time, and once a cataract kind of becomes visually significant, there's really, you know, glasses don't really help you see well anymore.

There is no medication, there's no eye drops or anything that are really going to help it.

There's really nothing short of surgery and glasses can only get you so far.

And once the cataract gets, you know, dense enough or or dark enough, kind of the vision just kind of starts to slowly decline.

Dr. Cole is going to talk a little later about the history of cataract surgery.

What cataract surgeries come a long way since the ancient Egyptian times, but in the most simple sense, what cataract surgery involves is taking out the cloudy lens and replacing it with a new artificial lens on the inside of the eye.

So like Dr. Lallathin mentioned, our our natural lens inside the eye is really important for focusing light.

So whenever we take the cataract, well, we can we most of the time we don't just leave it empty.

We have to put something in its place that's going to help us to focus light and give us crystal clear vision.

So it's almost like a prosthetic lens that you permanently are putting on the eye socket.

And I do want to talk about to just other corrective surgeries that come with that, not not other surgeries, the things that you can do while you're in there with that surgery.

So, Dr. Cole, perfect for you.

So how has cataract surgery evolved from the Egyptian days, so to speak?

But it's a lot different now than it used to be.

Yeah, I wasn't an ophthalmologist in Egyptian days, but I've been an ophthalmologist for well over 20 years doing eye surgery.

And I went to a good training program in Boston, but it was populated by a bunch of old guys who'd been there a long time.

And they did things the old fashioned way.

And without going into details, that would make our audience sick.

I think we can describe the surgery is pretty crude and pretty rough.

Unpleasant for the patients.

Took a long time, took a whole hour at least to do a cataract surgery.

They remove the cataract all in one piece.

The eye was sewn back together like a garment with sutures.

Things have come a long ways, Doctor McNelly, and I have training with special machines now that do such a gentle job with the cataract surgery.

These eyes, a lot of them, you can hardly tell they've been operated on the next day.

Other than the cataract is gone, it's so much more pleasant for the patient.

The recovery time is so much faster.

And instead of taking an hour to do the surgery instead of doing four surgeries all day, we can do six surgeries an hour.

Wow.

So it's that much better for the patient.

And if it's better for the patient, then that's better for us as well.

And they're just a follow up with that.

When do you finally see patients?

Like when is it that they finally come in and say, okay, this is bad enough for me to do something about it and doctor De La Torre.

And that's what we're trying to get across.

The message is that no longer there's a reason to wait until the cataracs are right to do cataract surgery.

That's the mentality of that surgery that the Doctor Cole described that was rude and antique and was a rough surgery for the surgeon and for the patient as well.

With modern technology and with a first world medicine that we have, there's no reason for somebody in the U.S. to wait until be legally blind to seek for help.

So we don't do beginning cataract, but we also don't let cataracts mature to patient be like.

So somewhere in the middle is where that decision is made and is not a decision that is unilateral.

It's not us telling you unique surgery or the patient telling us, Oh, I have a correct do cardiac surgery.

It's a back and forth communication tone where the symptoms are enough, where we've tried to improve the vision with glasses and we failed.

And it's gotten to the point where patients are going to have trouble passing their driver's license.

They're having issues performing their hobbies or what they like to do.

Then we proceed with surgery.

Okay.

And this is something that and that's something to we can kind of plug in how people come and see the eye doctor more often.

Right?

Normally would.

And Dr. Lallathin, and that's a great transition to you, like who can perform these cataract surgeries?

And as an optometrist, are you sometimes the first line that people come to and it's like, Oh, wait a minute, now it's time you refer somewhere else.

How does that usually work?

Sure.

So first of all, cataract surgery.

It will be done by an ophthalmologist.

However, the cataract surgery evaluation can be done by optometrists.

It can be done by an ophthalmologist.

We have numerous optometrists and ophthalmologists that are different clinics throughout the town for us, but either optometrist or ophthalmologist can perform a cataract surgery evaluation.

And a lot of folks are confused sometimes what a cataract surgery evaluation is.

They come in, they're scared or have some decrease in vision.

So it's basically a comprehensive eye exam.

So we start off by checking their vision and we do some glare testing because as earlier I have said, symptoms are sometimes glare issues.

At nighttime, it's an ear fearing with their life daily lifestyle for us.

And so we check in a glare to see where their vision is was bright lights for us as well.

We dilate the eyes and what we mean by that we use eye drops to allow the pupil or the black part of the eye to open up very large.

Why is that important?

Well, it's like opening up a door to a room.

If we don't dilate the eyes, like looking through a little peep hole And then when we dilate the eye and opens it up, we're able to check and make sure that we don't have any other eye disease causing any problems there for him.

And again, we look at the lens, physically look at the lens and see, you know, how much cloudiness they have.

Color changes with the lens as well.

For us.

So we do we do that dilation and we do that examination.

If we determine that they need and do need cataract surgery, then the next step is we start to send them to our surgical counselors and for a pre-op appointment where we actually take some measurements to calculate lens power, that's going to be inserted into the eye there for us, the artificial lens that we're putting in there, as you were saying, that like a prosthetic hand there for us, calculate lens power for that.

The other nice thing with our surgical counselor is I always tell my patients, you know, we're talking about a lot of things here for it.

So if you have questions, let us know or write them down.

Because myself, if I walk out, I'm like, Oh, I get it handed.

You know, two days later I should ask that question.

I always tell them, Write it down.

And then so you can either call us or even talk to the surgical counselor and they'll be able to answer those questions for us.

So here's a question.

When people we were joking also in the hallway about Dr. Google.

Right.

So I think people that that are trying to figure out why is it that I can't see.

Right.

Or people say, well, I just don't drive at night in morgues.

It's hard for me to see.

Do you find and this is for anyone to to answer this, do you find that patients will come to you and say, okay, well, I saw this on the Internet or I saw an advertisement for this, this, that and the other?

How do you usually handle the patients that are coming to you?

They don't really have the proper information, but the assumption is, well, my grandma did this and so-and-so had that.

So how do you usually handle patients that come to you with this information?

Yeah, I think I think it's a great question and something we definitely see all the time.

And I think sometimes sometimes we joke about and I see it in my own relatives to my family often calls me for medical advice and they I've always looked it up on the Internet beforehand and usually they have some misinformation in their mind that makes it hard.

But, you know, when you're Googling things on the Internet, you're kind of just going based off of your symptoms.

And one thing that I really love about ophthalmology and I think is really cool about our specialty is that the examination is really so important.

When we look at the eye, the eye does align.

The eye will tell us exactly what's going on.

The history and the symptoms and everything, of course, play a part and they tell part of the story.

But when we look at the eye, we can usually tell what's going on.

And so I think especially when it comes to eye problems, looking things up, you know, it may not be the end of the world, especially if you're trying to decide if this could be an emergency or something serious.

But it's really better to have a kind of a full eye exam and see a professional so that you get all the information because the symptoms and what you're feeling are really only part of the story.

Right.

And so and I know I'm going a little bit off script here, but I just feel like it works with what we're talking about.

When you have people starting to feel a bit cloudy and Dr. De La Torre you said that, too.

We don't want to do that right at the beginning.

But there is that that sweet spot.

How is the following?

Like, do you ask them to come in every year more than that?

Or when you're noticing different changes, how does that usually end and every patient's different?

I completely respect that.

So it typically is a yearly exam, always with a timing that the patient has a cataract and we do a refraction and then we follow their vision and their refraction on a yearly basis.

And then we see if there's changes year over year.

If we start to see a trend towards worse vision, cataract looks worse.

Prescription is not really changing much.

The vision.

So you check glasses and glasses don't improve the vision.

Those are the signs that we're looking for that this is the indication that cataract is the answer.

Okay, nicely explained.

So, Dr. Cole, now we're going to go to you.

So where is the cataract surgery performed?

How long does it take on a You talked a little bit about that.

Now even do six in an hour, maybe Describe the room and what you're using.

Well, the surgery takes place a Vista surgery center on the east side of town on Carman Drive.

And the it's a real gem for patients because the only thing that we do there five days a week is one eye procedure or another.

It's not a mix of other things.

It's only eyes all the time.

And that's great for patients because that means the staff knows how to make everything is smooth and relaxing, and comfortable for the patient as possible.

And they side effect from that is also great for the surgeon because the staff knows how to work with the surgeon.

They get used to working with them.

It gives the patient the best chance of the best result as well.

As I said, most cataract surgeries take 5 to 10 minutes.

Some things take a little longer for doing some specialized service or premium cataract surgery, which we'll talk about a little later.

And you were talking about comfort level and Doctor McNelly this is where you come in anesthesia.

How you talk about, again, the comfort level when you're going to have this done.

There is the idea, too.

And we were talking about getting the heebie-jeebies.

when something is cutting into your eye, but there is a very good comfort level.

Yeah.

Since the Egyptian time that the entire show now feels a little different than than it was thousands of years ago.

It's really a great question.

And the, you know, the crystal clear answer about what anesthesia we use is it depends.

You know, the main thing is most people are awake during surgery but are nice and relaxed people.

People tolerate the surgery very well.

It's very comfortable.

We always numb the eye very well with eye drops.

And we we you know, at surgery center.

And we have an anesthesiologist in the house at all times.

They can kind of titrate or in other words, kind of scale up or down the amount of medicine and anesthesia that's needed depending on the patient's anxiety level, how nervous they are, how uncomfortable they are, or any uncomfortable sensation they might be feeling.

Okay.

And then a follow up to that.

Can you do both eyes in one day?

We usually don't.

We usually do one at a time.

Okay.

And explain why.

Because I think some people like I just want to get it done.

But explain why.

The main reason is just from a patient safety standpoint, you know, there's you know, cataract surgery is one of the most commonly done surgery in the country.

It's a very safe procedure, but there's no surgery that's without risk.

And so one of the main reasons that we don't do both eyes on the same day is, you know, just in case something were to go wrong or in case one eye needs a little bit more healing, it's better to to just have one eye operated on at a time before we go ahead and proceed with the other one, which makes perfect sense.

So and now, Dr. Lallathin, then let's talk about eye drops So cataract surgery, there's eye drops.

There's the the after follow up from there.

How does that used to work?

Sure.

And again, I've been practicing for 30 years.

And so when I first started, there was always eye drops for cataract surgery.

Antibiotic eye drops use a steroid.

I drop their force and it's been amazing to see the progression of advanced technology and surgical techniques that allow us to not have to use eye drops after cataract surgery.

It's very small amount of patients or minority of patients that have to use eye drops.

So during the surgery itself, the surgeon is able to put an antibiotic inside the eye to prevent infection.

They're forced to also, we use a medication that is actually inserted into the eyelid.

It's a small it's smaller than a grain of rice.

Their fourth and what it is, is a steroid which reduces inflammation force.

So it actually promotes healing and helps decrease swelling as well in the cornea.

For us, it stays in the eyelid.

Yeah, it stays in the eyelid.

We have an area in the corner of our eye and that is the drainage system where our tears drain out too.

And that's where they insert that in.

And again, it penetrates to the eye itself and reduces inflammation and swelling there for us.

So the majority of our patients won't need any eye drops there for us.

Now, there are some that may have some increase inflammation, their force or swelling that we have to prescribe a medication that's typically just only a steroid eye drop to reduce the inflammation force.

And they'll use those usually for about a month long.

They're for us and they'll taper down, which means reducing the amount of drops they use per week there for us to help control that inflammation if needed.

But it's again, it's a very small amount of our patients that actually require eye drops afterwards.

And that's what's nice about our technology and our practice is I will say when I started 30 years ago and we still have patients coming in, well, my grandmother had to use all these drops.

Am I going to get drops?

Do I need drops and it's like, No, you don't need any drops.

We've taken care of that during surgery itself.

And it's nice.

They're like, Oh, I don't have to worry about the drop regimen.

So it's really fantastic.

And they're getting older is a great and the costs related to the eye drops, which is the added benefit, those eye drops are costly at times.

And so taking away that burden from from the patients is one of the advantages of this modern technique.

Absolutely.

And this is my see, you were talking about after cataract surgery.

And so Doctor Cole like to talk to you about recovery time.

Dr. McNelly said it's probably it's better not to do both eyes at one time, but say, did you need both eyes done recovering on one eye and taking the other one done, etc.?

Yeah.

We typically wait a week between the two eyes is our standard thing.

Recovery is surprisingly rapid.

Most of our patients see much better.

Even the very next day.

Some patients need a little bit longer to recover, especially if they've been a little shy about showing up for cataract surgery in the cataracts.

Very large or may need some extra time to recover terms of activities.

We have them wear a clear shield on the day of surgery.

They can still look through it and then they take that off the next day.

They wear it a night for a week.

I keep patients from swimming or jumping into a body of water for about three weeks because you don't want water to get through the incision into the eye.

That's usually not a problem for most people.

And I learned my patients about £20 of lifting just for a few days.

And as soon as they feel like they can lift more, they can.

Theoretically, patients can play golf on the afternoon of their surgery.

I've never had one do it in 20 years, but you could do it if you were really motivated with the sunglasses.

So it's better not to, which I think is great.

Dr. De La Torre So people who have had I know you said you specialize a lot in lasik too, but people who have had ARC or PRK or LASIK in general, how does that affect cataract surgery going forward for them?

So any of their refractive surgeries, the first generation rk radial is the formal name PRK for Photorefractive Keratextomy and LASIK which is the most common and done in the US.

They are all done at the level of the cornea, which is the first lens of the eye.

So think.

And the example that developing is about the camera with different lenses, the cornea and then the inside lens is the lens that turns into a carrier.

So we have a two lens system, okay?

The first lens, we change the shape of it, and that's how we can get rid of glasses with Lasik PRK or it used to be RK because we altered the shape of the cornea.

The machines that measure the cataract at the time of cardiac surgery to calculate the power of that lens that will go inside the eye.

They get fooled by the cornea eyes that are shapen and or misshapen by this refractive procedures.

So that's why it's important that if you had any refractive procedure that you tell your doctor when you're undergoing surgery evaluation, because that needs to be taken into account when you're calculating for that lens.

I will go inside the eye and there's now technology that help us not get fooled with those eyes that arc PRK and Lasik.

And that's why it's it's important to take advantage of those modern techniques and modern technology nowadays that we have, especially in our office.

So I like how you say to the power of the lens, and that's something we can talk about later.

But again, that's it's very specialized, each individual person.

So what I like to do now this show is specifically on premium cataract surgery.

I like to kind of differentiate between the two and Doctor McNealy, if you don't mind, I'd love for you to talk about traditional cataract surgery.

And Dr. Cole, if you can talk about what the new premium cataract surgery is and what the differences are.

Sure.

McNelly, If you can start that off, and it's really a great question, especially because we have patients all the time whose aunts, uncles, neighbors, you know, friends at church and whoever have had cataract surgery and everybody has had a different experience.

And there's a lot of variation in terms of how we do cataract surgery and how people around the around the world do cataract surgery.

And there are a lot of different techniques.

So when we talk about the the technique or how we do cataract surgery, we're really talking about there are two different ways that it varies.

One is in terms of the technique of actually removing the cataract and putting the new ones in.

If there is any advanced technology or anything like that involved that Dr. Cole is going to talk about.

But the main thing that we're talking about is in terms of the lens that we put in.

And so we'll talk about it later in the show, but we have different lens options that we can replace the the cloudy cataract lens with with traditional cataract surgery.

Usually it's we usually use what's called a mono focal lens.

So mono focal meaning one focal point.

And that for most patients is a distance.

So we try to give people really good distance vision.

The limitations of that lens are that it doesn't really connect any of the presbyopia or ability to see kind of a whole range of vision.

So most people, people after traditional cataract surgery still need reading glasses to read up close, really anything closer than about arm's length.

And then also if patients have a lot of astigmatism, then that doesn't really get corrected with them on a focal lens either.

Okay.

And now going to the non mono focal lens will premium cataract surgery is a very large category.

There is going to be a lot of different things to talk about it.

So all my colleagues here are going to discuss.

One aspect of that premium cataract surgery itself really is simply defined as we're going to do something extra and special above and beyond the traditional cataract surgery where we simply put in a standard lens that might mean that we take special measurements during the case, using a special machine to confirm that the standard lens we're putting in is just right.

It might mean that we're going to use special equipment such as a laser, to do the machine or to do the surgery, assist with it.

And it also might mean that we're going to use special implants to try to get patients out of glasses more and more, depending upon what type of premium service.

Hmm.

So getting patients out of glasses and that's what we were talking about earlier.

And Doctor Lallathin I'm going to ask you about the different types of lenses, but when you're talking about the power of lenses and just just as an added bonus, you get to see better not just because of the cataracts, but because of myopia, myopia or hyper appear in it, right?

So, Doctor, Dr. Lallathin, let's talk about the different types of lenses that can be sure.

And as Dr. McNelly, said in the one of them is a mon focal lens there for us.

And again it's design.

Usually we try to do it for distance only, therefore it and still will need some help for sitting up close.

If folks have heard from, you know, when they go to the eye doctor, Oh, I have astigmatism.

Most folks don't understand that.

I was one of those back when I had my astigmatism as well until I went to school for have for this.

And basically it think of the eye as having the need of two lens powers for us.

And so there's a type of lens called a toric lens, and that's one that helps compensate for correction for astigmatism.

Therefore is there's another another type of lens as well As we're saying mono focal is just good for usually for distance there for us is usually how we do that.

There's another one that is multifocal which tries to give us the ability to see both out in the distance and up close there for us.

Last but not least, there's also an extended depth of focus or a light adjustable lens there for us that allows to blend in distance vision as well as up close the vision for us.

So a question here.

I have one eye that can see very well up close and the other one that so I'm nearsighted on one and far side in the other.

Is this something to that you all do with and with the different types of lenses?

That's and I would just love to expand a little bit on that because I think most of us have different powers of that that is that is called mono vision and that is something that we can, by design do at the time of cataract surgery and we can purposely aim to retain that mono vision.

So yes, that that is possible to be done during that.

But you're used to that surgical.

Yes.

And most patients are not used to that.

So that's a great choice for you, perhaps when you have cataract surgery, but it might be a not a good choice for someone who's your grandmother, who's 86 years old and never actually been mono vision.

She may need one of these other special lenses.

And what a great option that you have all these out there that you can choose from.

And again, that kind of goes with the is you were talking about earlier the the the counseling.

Okay so this is something new to me, intraocular lens, not new to me.

But when I was looking at the the acronym early, it's like what is an IUL?

So what is a toric intraocular lens and who is a good candidate for that.

And Dr. McNeely, you get that?

Sure.

So it's a great question.

So like Dr. Lofton mentioned, so and like we've been talking about all along, when you take the cataract out, you've got to put a new lens and focus to like what a toric lens does is it helps to correct some of your astigmatism.

So patients have varying degrees of astigmatism, some people have no astigmatism, some people have a little bit and some people have a lot.

The lenses like we've also mentioned come in different powers, which is also just in terms of how how kind of like what strength glasses you need is very variable between people.

The lens power that we put inside the eye varies, but also not only the lens power, but the power of your astigmatism.

And exactly where that astigmatism falls.

So astigmatism, as we like to explain, it's kind of like instead of the eyes being shaped, being shaped round like a basketball, it's kind of oblong, like a football, and that it's steeper on one side than it is on another.

And so when we put the toric lens inside the eye, if there's any astigmatism in the cornea than that, than the toric lens can correct that.

Not everybody with astigmatism is a great toric lens candidate.

The astigmatism has to be relatively what we call regular and the regularity of the astigmatism is kind of determined by our preoperative measurements.

I'm taking pictures of the eyes with very fancy cameras, and that's kind of how we decide who's a good toric candidate and who is a who.

And almost the same question for Dr. Cole, but a little bit different again, who's a good candidate but for multifocal?

Well, so the beauty of a multifocal I. Oh well is that it's a lens.

It gives each eye distance vision and near vision.

It's hard to believe these lenses have been around for almost 20 years.

But I looked it up tonight.

The first ones were approved in 2005, and I've been using them since.

They've almost been approved.

So how years now?

So is it like a progressive lens or a bifocals or high low or how, how, how?

There are there are many different types of multifocal lenses.

And the salesman will all tell you that the greatest thing since sliced bread are.

But you start putting them into patients and listen to what your patients have to say.

And you realize that some work better than others.

That's an advantage I have of working with them for almost 20 years now.

So what I do is I deliberately place a different model of multifocal lens in the two eyes so that patients get good distance vision in both eyes, but one eye will get a little bit better.

Intermediate vision for the dashboard of the car.

The computer across, the desk and the second I will get even better near vision for their smartphone on their iPads so the patient ends up with distance, intermediate and near.

It's wonderful to have them.

I'm losing.

Like how?

How so?

So that the lens splits like it does split.

It was successful.

It's like, there we go.

It's a light.

It's a light splitting.

It doesn't have any moving parts, but it splits the light so that some of the images are for distance and some are for near a close.

Okay, So when you look at the lens, it has multiple rings and that's by design engineered that way and each ring has a different power.

So when the light goes through the lens, it splits and creates like a spectrum of light inside the eye.

Okay, the focus is the light, but gifts, the pacing, our range of vision.

Okay.

But I like to explain it to the patients that we're a the trade of it.

When you're using these lenses, you're trading off quantity for quality.

You have to in order to get that range of vision, you lose sharpness at all distances to be able to see everything good or not.

I'm noticing that with my progressive lenses and it's driving me credit.

Maybe it's just my prescriptions a little bit different, but I noticed that too, that anyway, that that mean I'm learning like I'm 57 years old.

I'm just now starting to get a pair of glasses that have both but extended depth focus.

What exactly is that?

This is the newest generation of lenses that are in the category of multifocal, meaning that there's multiple points of focus.

But the advantage of this newer generation of extend, the depth of focus is that you don't have to compromise the quantity for the quality that that patients can still have some quality of vision at all ranges without reading, compromising too much.

And that's where this newest lens that we're very excited about that we're going to be talking a is, which is the light adjustable lens.

It gives us that a range of focus without compromising the quality.

See, look at him throwing that football team right there are about will lower honor roll whatever your sport a designer well nice marathon yes it's Patrick Mahomes.

All right good doctor a lot of them used to talk about that when the light adjustable lens.

Yeah, I'm very excited about this.

Again, doing this for 30 years and having limitations for being able to allow patients to enjoy their vision with without having to do glasses.

So when we do contact her and has contact lenses, when we do cataract surgery, we try to get the best we can.

Okay?

So oftentimes we try to get folks less dependent on glasses.

Still may need some glasses.

They're after cataract surgery and that's a possibility for it.

So when we do the glasses, I think of when we all go for an eye exam, which is better, one or two, we have the little machine there and we're doing that Well, that's basically coming up with the prescription for glasses.

The light adjustable lenses are the only lens available now where we can actually fine tune the lens itself, basically taking the prescription in that machine that we do, which is better one or two, putting it on the lens itself for us, and we're able to fine tune it four, three times if needed to after cataract surgery and how going back into the eye surgically and then know.

And that's the beauty of that.

So there's no new surgery.

Good that goes on.

What is is a light adjustable lens is we use a specific lens or a lens that we place on the eye when we're doing this procedure.

And it's a light, UV light that stimulates they're called macrumors, but it's photosensitive material in the lens itself.

We use a UV light there.

For us that's not harmful to the eye or anything like that.

For us in.

By using that, it's able to calculate the power that's needed, our machine that we use for that to actually put that lens power in from the for optic or the thing that we do, which is better one or two directly onto the lens.

So it's a light, it's using UV light to actually shape change the shape of the lens, which is basically, again like doing another pair of glasses on somebody but in their eye itself.

So no surgery needed at all.

It's it's phenomenal technology and I'm so happy we're able to have it and deliver it.

I've had several patients now that have gone undergone that and doing fantastic.

It's really, really exciting.

Okay.

So my next question, Dr. De La Torre, like who who can have this is are there are there candidates is there some people that can or can't have it?

How does that work?

Yeah, so this is where the exciting of it is that the the lens that we can now safely say this is for everybody.

So we can not say about the toric lens, we cannot say about that a multifocal lens, but this is the first lens that we can safely say, if you want this, you can, you can have this.

And this is safe for everybody, including patients that had AAC, PRK, LASIK, which are those eyes that are very difficult to calculate a phase in cataract surgery.

That's the advantage of our cataract.

Surgeons are able to deliver the lens safely inside the eye during cataract surgery.

We wait at least three weeks lens, let the lens settle and scar in the place inside the eye.

And then we can use the light device to change the prescription of the lens.

Once it's inside the eye.

And we can then customize each patient's vision.

After surgery, there almost seems like it's impossible just listening to it.

How long has this been around?

So it was approving 2018.

Okay, in the US, very slowly adopting because skepticism like yours.

Yeah.

I don't mean to be skeptical.

It's fascinating because like I said, it was it was it was hard to believe.

Right.

And and it was only one company that that owned the technology.

So very expensive to jump into this as well.

So this is part of why this AVP merger, American Vision Partners, has helped us bring this technology to El Paso so patients don't have to go to Dallas, to L.A., to New York to get surgery.

They can get it here in El Paso with this new technology.

So now let's say and Dr. Cole and throw this your way.

We've got this.

Somebody is now having cataract issues after having this treatment.

Is there an affecting situation there?

So is cataract surgery different one somebody has had the light adjustable lens like is it is it is the surgical procedure where we put the light adjustable lens in different than regular cataract surgery, I think is what you're trying to ask.

Yes, the answer is disappointingly short.

The answer is the surgery is shorter than normal because we don't have to take all the normal intraoperative measurements that we would use there.

So the time for the surgery, just like a regular cataract surgery, not extra long.

Well, I'll tell you what, that's a good answer.

Who doesn't want to have that?

It's like, you know, it's kind of non dramatic.

I like everything about that.

So, Dr. McNeely, is the recovery of cataract surgery difference when you use a little bit of a lot of well, what just for lens as far as the recovery from like a medical standpoint, recovering from the surgery, it's essentially the same.

So all those things that Dr. Cole mentioned a few minutes ago about not lifting heavy things for a few days, wearing the protective shield at night and not going swimming for a few weeks, all that's pretty much the same.

The real difference when it comes to the light adjustable lens is like Dr. Lallathin was mentioning, the whole beauty of the lens is that we can adjust the power and prescription of the lens afterwards.

First lens we've ever been able to do that with.

And we do that by using UV light.

And so the biggest difference in terms of recovery from the LAL is that you have to wear U.V.

blocking sunglasses because otherwise sometimes it's thought that the UV light, you know, that's just in our environment that comes from the sun, could somehow you change the prescription of that or lock in the prescription before it's too early?

And we'll talk about that a little bit more later.

So you have to wear some U.V.

blocking glasses any time you're outside or kind of basically a wake until the lenses kind of fully, fully set in its final position.

And so that's a great transition to doctor lath.

And so how long does it usually take for that to start working, per se?

Oh, so for the treatment itself, the start working is usually 48 hours.

Therefore it most folks are seeing improvement after 48 hours there for us.

With that being said, one thing I want to make clear is because a lot of folks that we've done these on or with the glasses that they have to use their U.V.

blocking and we tell our patients, if you forget and you're going out to the mail and you forget to put them on, okay, it's you didn't ruin your eyes.

And the lens itself has something called Active Shield.

And what it is, is it turns on, it protects the lens from UV and from and which is great, But we don't want to get in the habit of I tell my patients, the FDA says you need to wear this again.

We don't want to You've invested time, effort and money in these things.

We want to make sure that you protect it and protect your investment and protect your gift of vision.

So with that being said, we want to make sure we do it.

But I don't.

I tell my patients, don't panic.

If you, you know, go out and say, oh my gosh, I think I ruined my eyes.

No, that's not going to happen.

Therefore It so it's very important that, you know, I think for folks to understand, we're like, oh, it's I got to wear these glasses.

Well, yes, you do.

But if you happen to make an error and not wear them, it's not going to be detrimental to the eye there for us.

And again, we just don't want to get in the habit of of doing it like that for every patient that gets their light adjustable lens, they get three lenses to use after surgery.

There's a sunglasses outside and there's two for inside the very clear one that is just clear and one that has a bifocal.

So they can read with those as well.

Okay.

And we encourage them, like Dr. Lallathin said, to use them all the time until they can get light adjustments.

Okay.

Once they log in, treatment is done, then they can let go of those sunglasses.

But it's again, you're looking at 48 hours ish.

Well, this the the the entire process.

It's it's weeks of where the patients have to make that sacrifice.

But a recently one patient that told me people ask me about the sunglasses where I got them that that eye that they think that I'm an athlete so they get compliments with that, with the fancy glasses.

I love that.

So it's it's a very little sacrifice for their big gain of independence, of glasses for the rest of us.

Oh, my gosh.

I can't even imagine that right.

And just the whole idea that it's light adjustable that that that is amazing to me.

One thing I would like to share with that just with the glasses, because I've had the same thing or that patients are like, did I get compliments on these things?

But the the producer of the film, Oppenheimer, there's a picture of him receiving his Oscar, and he's actually wearing a pair of those clear glasses there for us.

There's been another one with Michelle Pfeiffer wearing the sunglasses.

So they're out there.

You know, everybody stars in that or using them in it.

You know, you're going to the Academy Awards with them.

And I know that was not right or was.

Yeah, exactly.

It's is really amazing.

But they're they're pretty cool, actually.

Can you still continue using them for you can't be theoretical.

I've even joked with the patients you can get them bedazzled if you want.

You know, something like that.

They have some fun.

I know a friend of mine that would totally do that.

I think we touched base on this a little bit.

The Doctor Cole, if we want to say anything more about the amount of adjustments that you can have with this, you know, I just have to go off script a little bit here because I cannot contain my enthusiasm for this new technology, this light adjustable lens.

How great is this, guys?

Because I've been an eye surgeon for over 20 years and I've always prided myself on being able to offer the greatest technology and the latest technology to all my patients to give them the best visual results.

This is just a totally different paradigm.

It's a totally different way of doing things than before.

Before you put something in the eye and what's in the eye, you're stuck with that, and then you have to do some other things to work around it.

With this, you put the lens in the eye and painlessly there are treatments for the patient as very pleasant in the office afterwards to fine tune that prescription if they need it.

A lot of patients seem to get pretty close right off the bat, but if they need a tune up, they can get it up to three times.

That's the answer to the question well before that final prescription is locked in.

So I'm really excited about this light adjustable lens.

You hate to use words like revolutionary or breakthrough, because those are usually code words for things that aren't quite kosher.

Boy, this is the real thing here.

So do people start doing this when I know I'm thinking about age, right?

Because I feel like and correct me if I'm wrong, I think we had a conversation about this years ago, that there is a lot of movement in corrective lenses for until you're like 20 or 25 years old and your eyes kind of stay stagnant for a couple of decades and then they start changing in at 50 ish.

I am I dreaming?

That is correct.

So then all the normal age related changes of the eye and your eye grows in about.

When you stop growing this way, the eye stops growing this way.

I tell patients so males 21 Female 19-20.

The prescription stays about the from that age to about 45, and then between 45 and 55, our lens starts to get lazy and not as flexible anymore and we start needing reading glasses and then 55 to 65, then the lens starts to get cloudy and that's when the correct starts doing to show.

And pretty much everybody like 65, they have at some degree of cataract.

And so the advantage of having a this technology is that you don't have to wait until that big cataract develops to take advantage of of the light adjustable.

It's fascinating.

I love everything about this.

We were talking about adjustments.

Dr. Cole So, Dr. Wallace, then I'd love to ask you when the adjustment is done, how was that done?

Like physiologically, what is occurring while those adjustments are being done?

Yeah, So the adjustment itself, the patient comes in and we have a machine that they're going to sit at.

And so I tell the patients, you really have to just concentrate on just a few things and we do the rest.

Those and those things involve.

We have each interest in the forehead rest, keep your chin on the chin and generous forehead against the strap there for us.

We have somebody to gently hold their head there so they don't back away from it or moving during the procedure.

They're for it.

And we have them look at a green light in the instrument itself.

For us, the what we do is we place a drop on the eyes to numb the eyes.

Therefore, I have a small lens that we put a a lubricating gel on and we place it directly on the eye itself for us doesn't hurt.

And it's just like looking through some goggles basically for the patient.

So we have that on the eye.

They look into the instrument there, they will see a green light.

We have them just be still.

Don't move your eye around.

Try not to blink, which they're not going to blink.

The eyes numb.

And when they're with that lens that we place on the eye prevents it from blink blinking as well for us.

And basically the patient just has to look at the green light gene on general for head against a strap.

So then what we do is we get it aligned in the instrument there for us and we, I have a foot pedal that I use and press that and it delivers UV light to the lens.

So what it's going to do again is going to change the shape of the lens by activating the photosensitive chemicals in the lens to be able to change it.

And that's based on UV light there.

For us, that itself usually is only about 90 seconds less per eye for us.

And it's very simple, very, very easy there for us which, which is outside.

And the exciting thing is that though those jasmine, both eyes can be done the same.

They seem not like cataract surgery.

It's one at a time.

So cataract surgery, they'd get one at a time.

But the adjustments can be conveniently done both eyes the same day.

And so usually in our experience so far is that patients just need one adjustment.

Which one adjustment?

We hit the target.

They're happy with their vision and then we proceed with what is called a blocking treatment.

And those are treatments that will seal the prescription permanently in the lens.

And the reason it's they do the lock in is because, again, U.V.

light can possibly change it.

So once we have the final lock in, then they're happy with it.

We're there.

We've done our final adjustments, we do the locking.

And what it does is it activates all those chemicals.

So the lens is not going to be affected by when they go out and go golfing or running or whatever like that.

Maybe I miss it.

How does the lock in than occur?

Yeah, so the lock in actually happens after the adjustments.

We can have up to three adjustments there for it.

There's usually to lock in procedures after after the adjustments are made.

For us, same thing, it's light delivery.

It the lock in procedure actually usually only takes again about 90 seconds therefore per eye and in the patients are happy afterwards with that there's no downtime from work.

Some things that some patients can experience is a little bit of a rose color vision to it.

I haven't had any of that of experienced that that's in literature there for it, but all my patients have not noticed any of that for.

So that's that's comes after the adjustments in the adjustments it's nice as well because we make the adjustment and I tell my patients it's like test drive, we get to test drive it for a week.

I want you reading, I want you watching TV, I want you doing all your normal things there for us so that way we can blend that vision.

It's the lens blends vision for both out in the distance and up close, where we had talked about the Multifocal.

You know, there's, you know, positives and negatives with it, but you're also decreasing some of the quality or crispness of the vision with this by blending it.

We're not having that or we're not doing a mono vision where one eyes for distance and one eyes for up close.

It's treating for both the allow that both eyes to work together, the visual system to allow us to see both out the distance.

And of course it's fantastic.

It is amazing, absolutely amazing.

And I again, the exciting part of it, we're going to talk about fashion again.

Doctor McNelly this is you.

So these you be glasses that we were talking about.

How long again you, can use them forever too.

But in general, how long is the recommendation after this?

And, you know, maybe the pair of glasses you wear forever?

Yeah, it could be.

I mean, there's there wouldn't be any reason to wear them unless you just like the fashion of them.

But after the final lock in treatment, you don't have to wear the glasses anymore.

There's no way you can.

You're done.

Lock in, you're done.

And I would jump in there for that.

With the lock in procedure itself, you have to wait 24 hours and then you can stop wearing, you know, therefore that.

So yeah, it's, it's, it's nice.

Yeah, it's really good.

So idea the ideal time frame for a patient that is out there that it's interesting in design thinking well how how does that work with my schedule my work schedule.

So evaluation for cataract is done in any of our locations patients them that it's a candidate.

There's going to be a prep visit where they're going to take measurements of the eye for this lens.

We really don't need to spend a lot of time as special measurements because this lens allows for those adjustments so we don't have to go about like when we used to with our K, PRK and LASIK, we had to do extra measurements.

That's not the case with this lens.

We scheduled the cataract surgery one eye at a time, one week apart.

Typically, bases wait three weeks at the three weeks we do the first refraction.

We see if there's any residual prescription and we can schedule the first long a adjustment that day.

We wait a week, like you said, the patients that drive the vision for a week, if they like it, we can start the locking in treatment the following week.

So we're talking about four weeks after surgery already.

They can start the in treatment if don't like the vision or the one a second adjustment, we have two more chances to do it.

So we're talking about anywhere in the earliest about four weeks at the latest eight weeks that they're using those sunglasses for permanent.

Correct.

For permanent progression of that.

We have a couple more minutes before we need to wrap up.

So people who are listening to this are pretty dang excited.

So where do they call?

Where do they do?

What do they do?

So maybe let's talk about the first evaluation to get a hold of you guys.

You've got several locations and I have a phone number, so I throw that out.

So the phone number is 915 if you're not in the El Paso area, but 915267 and then 2020 to remember.

So two six, seven, which is great because I was born in February 1967, if you remember my birth date, that's the number.

So 915267 2020.

I always remember it from there.

And then also southwesteye.com is the place to go so so they can call make an appointment.

We have again four locations in El Paso, two in Las Cruces.

We also have a surgery center in Las Cruces that Dr. Cole operates on and and we can do this surgery as well in Las Cruces.

So we have social media as well.

The patients can follow us and there's appointments online that they can do on their own.

A So multiple ways that they can get to our office.

Okay.

And if for some reason you didn't catch all of this program, there are several places that you can watch this again and get all this information.

The first one is kcostv.org So that's PBSElPaso.org.

You can also type in at kcostv.org and you'll see the logo of the El Paso physician on there.

Also the El Paso County Medical Society site that's EP CMC.

Just think of that acronym EPCMS.com.

There are years worth of programs and then when you have patients and they're curious just directed to this program and I think that you all answered any question that I can even think of answering, but you to just look up the word the El Paso Physician.

And again, you guys are the Southwest Institute.

We have 2 minutes.

Actually, we don't we've got 30 seconds.

But I want to say thank you because I was going to say about Lasik, too.

So Lasik is still something big.

You all do.

And I don't want to dismiss that.

I know this is all about premium cataract surgery, but you all like you said, it's a one stop shop for all kinds of specialties.

So thank you for doing that.

Thank you for hosting.

Goodness, I love it.

Dr. De La Torre, We have Dr. Lallathin, we have Dr. McNelly and Dr. Cole.

Thank you for being here.

I'm Kathrin Berg, and you've been watching the El Paso physician.

I am Dr. Allison days, a past president of the El Paso County Medical Society, the El Paso County Medical Society has put on the El Paso physician TV program for the last 26 years in conjunction with some of our local health care partners.

Topics over the years have included colon and breast cancers, healthy lifestyle issues, public health.

These programs are archived on kcostv.org epcms.com and on YouTube you may access the programs at any time on these websites.

If you have questions on tonight's topic, please reach out to epmedsoc@aol.com and we will try to get your questions answered in a timely manner by an expert in the field.

Thank you again for tuning in to the El Paso physician tonight.