|The Whole Magilla Lens Based Surgery
| At Schuster Eye Center….
We take great pride in our teamwork and process. We have been building on this for more than 30 years. My father and grandfather were both eye surgeons in El Paso going back to 1894!
Being comfortable with your surgical choices is more than just understanding when and how it will be done.
It involves every member of our team helping you through the process pre operatively, operatively and post operatively. You will always be informed in a caring, and kind manner so that you know every step of the way what’s happening.
We know the path of recovery and the thrill of better vision and can’t wait to share it with you!
We want you to feel like family and will make every effort to carry through on this pledge.
That is because we truly believe that fear is the primary reason that patients resist newer, safer options for the health of their eyes. Hopefully, if we do our job well we can decrease the fear and increase the excitement of newer life changing vision correction choices for you.
Let us help! We will always do our best.
Dr. Stephen Schuster
Special Points of Interest:
Frequently Asked Questions and Answers
Cataract surgery today is the most common operation performed in the United States and around the world. In 2005 almost three million cataract surgeries were performed in the United States. Cataracts are a clouding of the natural lens inside the eye. Cataracts are usually not caused by lifestyle activities. Cataracts are generally an aging change. If an individual has lived long enough, cataracts will always develop eventually. So, cataract is a degenerative process. As an example, as people age their skin wrinkles. Some people have wrinkled skin earlier than others and cataract formation is similar. Some diseases cause cataracts to develop earlier. Diabetes for one, and of course, genetics plays a role too.
Unfortunately, cataracts cannot be treated by drops, pills, injections (shots) or change of glasses. The only treatment is surgery. Surgery is indicated when the patient cannot perform tasks of daily living which are important. An airline pilot will probably require cataract surgery before someone who has less demanding requirements. Requirements are different for each of us and cataract surgery is only indicated when one is unhappy with the individual visual performance of one eye or the other.
At Schuster Eye Center, ten to fifteen cataract surgery’s are performed each week. This process has been ongoing for more than thirty years.
First, I would like to explain cataract surgery in general followed by advances, which have been made, particularly in the last few years, that give patients options not available previously.
First, cataract surgery as mentioned above is a clouding of the lens inside the eye. Light entering the eye must be focused first by the cornea, which is the watch crystal part of the eye. Then it passes through the pupil, (the black spot or hole in the iris). The iris is the colored part of the eye. Behind the pupil and iris sits the lens. The lens bends the light rays entering the eye along with help from the cornea so that they are ultimately focused on the retina - the back lining of the eye. If the lens becomes cloudy (cataract) the focus becomes blurred much like fog on a cloudy day. Sometimes this presents as difficulty driving at night with glare and star burst phenomenon around lights or it may at first affect reading vision. Generally, one eye progresses ahead of the other.
When cataract surgery is performed and the cloudy lens is removed it is always replaced with an artificial lens to adequately refocus light back onto the retina.
Cataract surgery is not difficult from the patient’s standpoint although, it is a delicate operation. The procedure requires only fifteen to twenty minutes of surgical time. It is performed with a local anesthetic. However, an anesthesiologist is always present! You will not feel pain or discomfort during the operation. Keeping you under a local anesthetic is safer and from a general health standpoint recovery is quicker. Thus, the procedure can be performed as an outpatient. In other words, one presents at the hospital or surgery center approximately an hour prior to surgery and one hour after surgery the patient can be discharged to go home.
CATARACT SURGERY TODAY IS SO MUCH EASIER FOR THE PATIENT THAN YEARS AGO. The reason for this is because the surgery is performed through a small wound just 2-3 millimeters in size. In fact, it is so small stitches are no longer necessary. Because of this, pain is not a great factor in recovery. The patient may return home, the eye may or may not be patched for a day, and the vision will generally be blurry for only the first three or four days. Early blurriness is because the energy to remove the cataract always creates some swelling in the cornea and time must pass for the vision to recover fully. However, within one to two weeks the patient is usually seeing with their best potential. All is possible today because fine, small ultrasound vibrating needles or jets of water are used through the tiny wound to emulsify (liquefy) the cloudy, cataractous lens so it can be gently irrigated from the eye. No large wound or bulky sutures are necessary today.
Unfortunately, patients may have other things wrong with the eye such as glaucoma or macular degeneration or other retinal problems such as diabetic retinopathy, which limit the results of the surgery to less than 20/20. However, if the cataract is the only problem within the eye, patients can expect an excellent, rapid recovery to full vision.
The risks of cataract surgery include some but not all of the following:
Infection and hemorrhage are the most common conditions however, at Schuster Eye Center, in over thirty years of practice there has never been an infection with cataract surgery. This is because of the use of antibiotic drops (topical medication) before, during, and after surgery, so that it is very difficult for bacteria to invade the eye. Hemorrhage can occur primarily because of the anesthetic, which must numb the areas around the eye. This can sometimes cause the eye to be black and blue initially. This happens only on very rare occasions. In very nearsighted patients there is a slightly greater risk of a retinal detachment.
A more thorough informed consent will be presented which you should read and understand prior to accepting cataract surgery. This will be presented to you at least three to four days before surgery in order for you to comprehend all of the risks, expected gain, and advantages of the surgery and discuss any concerns that you have prior to the operation.
Cataract surgery always involves artificial lens implantation as mentioned and some measurements to determine the strength of the lens implant are very critical. These are performed a few days prior to your operation. The measurement of the curve of the cornea, the depth of the anterior chamber, the back of the cornea to the iris, plus the length of the eye are measured by sound waves painlessly. They are taken down to the micron level! This is to ensure the right strength of implant is used to properly focus light rays onto the retina after
It is very infrequent that the lens implant strength is not correct. However, on occasion the implant must be changed out one to two weeks after the surgery because of miscalculations or breakdowns in the mathematics of the formulas. This requires a second ten minute operation. This rarely occurs and exchanging the lens has not led to further difficulties for the patients involved.
The day after surgery, as mentioned before, the patient’s vision will be blurry but will clear quickly. This is because the swelling in the cornea and inflammation inside the eye clear quickly. Usually, the pressure is normal, the cornea is not significantly swollen, the inflammation within the eye from the surgery is minimal, and the implant is in good position. Under these circumstances the vision will improve dramatically in three to four days following the operation.
During recovery the patient will experience sensitivity to light, a scratchy feeling, as if an eyelash were rubbing on the undersurface of the lid, and the eye will water somewhat. It may also develop some matter. Flashes of light will be seen if the eye, is moved rapidly to one side or the other and multiple floaters will be seen in the vision. Sometimes, a shadow will be seen off to the side. These symptoms generally clear up within a week. Besides, not seeing well and not feeling particularly well at the end of the first day the eye does not look pleasing either. The lid will often be swollen, the white part of the eye will sometimes be red, and the pupil will not be equal on each side. However, with the use of antibiotic and cortisone eye drops after surgery, which will be explained in detail post operatively, this clears very quickly.
If the first eye is operated on and the second eye has a significant cataract, it can be removed two to three weeks after the first eye.
At this point, I would like to explain some of the newer advances in cataract surgery. Listed above has been the standard of care for approximately twenty years. Today, however, new vistas are possible for the cataract patient, which were not present previously.
Before explaining this, I think it is important for the patient to realize that LASIK surgery, and other forms of refractive surgery that alter vision by changing the shape of the cornea, have been available for the past twenty five years. First in the form of radial keratotomy, in which cuts were made in the cornea to alter its shape. This was followed by PRK (Photo Refractive Keratotomy), which brushed the skin off the surface of the cornea and then changed its shape by etching with an Excimer laser. Today, with LASIK the etching is performed under a flap of corneal tissue. Remember changing the shape of the cornea or the power of the lens inside the eye, both work similarly to better focus light on the retina.
The evolution of this technique now extends to cataract surgery. Since rays of light are focused by both the cornea and the lens of the eye changing either works to decrease the need for glasses. Changing the focus of either, allows the rays of light to focus more appropriately on the retina without glasses. Thus, cataract surgery with lens implants today has become refractive surgery. In other words, a strength of implant can be chosen, which will not only clear your vision but also, reduce your need for glasses. Over the last twenty years, this concept has been used not only to improve one’s acuity, but also to diminish the need for glasses particularly in the distance after cataract surgery. Until recently, however, one could not achieve both near and distance vision correction with a lens implant alone and reading glasses were often necessary following cataract surgery.
Today, whether a cataract is present or not the lens of the eye can be removed and an appropriate implant can be placed, which acts somewhat like bifocal glasses. In other words, the patient’s need for glasses can be eliminated most of the time as both far and near vision can be corrected by the newer implant. This is a true milestone, which has recently been approved by the F.D.A., (Food and Drug Administration).
Unfortunately, Medicare and other insurance carriers will not pay for this new implant. If a cataract is present, insurance will always pay for it’s removal and the implantation of a single vision lens implant. The newer multi-focal lens implants, which (correct both near and distance vision) are not a covered expense. Multi-focal lens implants are considered refractive surgery, or what is known as presbyopic correction, if these implants are preferred by the patients they are not covered by Medicare or other carriers as single vision implants are..
Your hospital bill and the surgery, itself, if a cataract is present, will be paid by your insurance company. But, you must pay additionally if you choose the newer multi-focal lens implant.
Multiple significant, extra measurements need to be obtained over and above what is necessary for a single vision implant in order to be certain that the multi-focal implant, which corrects vision for both far and near can be safely implanted in your eye. This requires much more diagnostic measurements, time, and interpretation than simple ultrasound measurements listed above. Because of this, the out-of-pocket cost to the patient over and above routine cataract surgery for a presbyopia correcting or multi-focal lens implant is higher. The cost breakdown will be detailed for you so you can better understand your options.
Some patients besides being nearsighted or farsighted will have some degree of astigmatism. This is not corrected by implant surgery. Following surgery, with a multi-focal (presbyopia correcting) implant included in the extra fee, which the patient must pay personally astigmatism correcting operations are also included. Corneal surgery, in the form of limbal relaxing incisions (small cuts) at the edges of the cornea can be made and/or LASIK can be performed on the cornea to eliminate the astigmatism. If the patient has astigmatism as well as nearsightedness or farsightedness, the multi-focal implant will not give perfect vision for near and far until the astigmatism is also corrected. This is also included in the out of pocket package cost to the patient. Astigmatism correction is done in a rapid office procedure following the lens implant surgery. Astigmatism is generally, corrected a few weeks to a few months after lens surgery depending on the healing process.
Many patients have worn glasses, only for reading (dime store magnifiers) in the past comfortably. If you are satisfied with this form of correction, then cataract surgery will be completely covered by Medicare and other insurance carriers since only a mono-focal implant will be used and will correct only your distance vision. However, if you would like to take the process a step further and attempt to be “glasses free” for both far and near for most activities there is an out-of-cost expense which insurance carriers do not pay. The reasoning of Medicare and the insurance companies in this endeavor is that if a cataract is blurring your vision this will be covered by your insurance. It represents a disease state but, the addition of a multi-focal lens implant with its additional cost, time, and astigmatism correction afterwards will not be covered, as it is only to reduce the need for glasses after surgery.
IF YOU DO NOT HAVE A CATARACT AND YOU WISH TO HAVE YOUR LENS REMOVED WITH A MULTI-FOCAL LENS IMPLANT TO REDUCE OR ELIMINATE THE NEED FOR GLASSES BOTH FAR AND NEAR, THIS CAN ALSO BE ACCOMPLISHED.
Since, in this case there is no disease present in the lens, e.g. no cataract, this is a totally out-of-pocket expense, which patients today may choose. Here, however, the total cost is due from the patient as this is an elective procedure and is not to eliminate disease – only the need for glasses. Surgery to decrease the need for glasses or contacts is never a covered expense by insurance in any form. This operation when performed on the clear lens or in a lens with an insignificant cataract is called a clear lensectomy, refractive lens exchange (R.L.E.), or Presbyopia Correcting Lens Implantation—all terms refer to the same process.
I realize I have presented a vast amount of information. It can be difficult for one to digest fully. All of us at Schuster Eye Center stand by to help you better understand these possibilities. We want to help you find the best fit for your lifestyle.
For example, many of us want to walk into a grocery store, recognize our friends and neighbors at the end of the aisle (distance activities) and yet be able to see prices up close without readers. We want to view our cell phones, car dashboards, computers, and read small print, etc. (all close-up activities) if possible without correction, and we also desire perfect driving vision without glasses. The newer multi-focal (presbyopia correcting) implants allow this opportunity for the first time with safe proven technology.
A way of looking at this may be as follows: An airline pilot or a long haul truck driver will probably be better off having cataract surgery or refractive lens exchange surgery with a single vision lens implant since most of their activities are in the distance. Using reading glasses would not be a handicap for this individual. However, many more of us fit the mold of the shopper listed above. Please consider these options carefully and visit with us so that the most appropriate procedure can be performed on your behalf.
Frequently Asked Questions
Clear Lens Extraction (C.L.E.),
Clear Lensectomy (C.L.),
Presbyopia Correcting Surgery and (P.C.S.),
Refractive Lens Exchange (R.L.E.)
What is a cataract?
A cataract is an opacity (cloudiness), which develops in the crystalline lens of the eye. Cataracts form for a variety of reasons, including long-term ultraviolet exposure, secondary effects of diseases such as diabetes, trauma or injury to the eye, or simply due to the natural aging process of the eye.
What causes Cataracts?
A cataract is caused by a change in the chemical composition of the lens. The most common cause for this change is the natural aging process. As we mature, the normally flexible, clear material of the lens becomes hard and cloudy. Unfortunately, there is no way to prevent the development of cataracts. Everyone who lives long enough will develop this problem. Although, most commonly seen in adults after the age of 40, cataracts can occur at any age. The condition may be present at birth or caused by an injury to the eye. Infections and other eye diseases, such as glaucoma and eye tumors, may cause the development of a cataract. Vision loss is usually gradual as a cataract develops.
What are the symptoms of cataracts?
Dimming or blurring of vision
Halos or glare around lights
Colors appear less brilliant
Feeling of “film” over the eyes
Frequent changing or cleaning of glasses
Difficulty driving or reading
How are cataracts diagnosed?
A cataract usually cannot be viewed from outside the eye and must be diagnosed during an eye examination. A variety of instruments, including an ophthalmoscope and a slit lamp are used to determine the type, size and location of the cataract. These instruments illuminate and magnify the structures of the eye.
What are the different types of cataracts?
Anterior cortical cataract
Anterior polar cataract
Anterior sub-capsular cataract
Posterior cortical cataract
Posterior polar cataract
Posterior sub-capsular cataract
Explain cataract surgery briefly…
A very small “No Stitch” incision is made in the side or top of the cornea. Such an incision promotes fast and more comfortable recovery. It is only 2.8 to 3.0 millimeters in size! The capsule of the lens is opened and then a special ultrasonic probe (Phacomulsifier) removes the cloudy lens. A small foldable artificial lens (implant) is inserted through the small incision to replace the natural cloudy, cataractus lens. There are no sutures required to secure the implant or the wound. The implant chosen may correct distance vision or both distance and near vision depending on the patient’s choice. Rapid, usually painless, recovery occurs in days.
When should cataract surgery be preformed?
Development of the cataract itself is not an indication that immediate surgery is required. A cataract should be removed when loss of vision begins to interfere with your daily activities.
Does cataract surgery hurt? How quickly will I recovery?
The surgery is done as an outpatient procedure at a hospital or a surgical center. A local anesthesia is used to numb the eye and keep it comfortable during the surgery. It doesn’t hurt! You will see blurry, the eye will feel scratchy and be slightly red and swollen for the first 3-4 days but clears quickly after that. The wound is small therefore, you can be active immediately, eat as you wish, take your usual medications, shower / bath; sleep on either side, bend down without fear, etc.
Are there ways of removing a cataract by means other than ultrasound needles?
Yes, jets of warm saline can gently remove cloudy lens tissue. Laser can be used also, but these methods sometimes are not as efficient. The key is to apply the least energy to the eye to do the job and protect the other delicate structures within.
What is an after cataract membrane? How is it treated? Is this what is called a YAG Laser Capsulotomy?
About 15% to 30% of people can develop a posterior capsule opacification, (a wrinkling of the clear capsule of the natural lens left in place after cataract surgery used to anchor the implant). This will be evaluated during your postoperative course. Think of putting saran wrap over a dish – If, as scarring can do – you pull too much in one direction you get a crease. The same can occur in the capsule. If this happens a “YAG Laser “ is used to gently open the capsule. It takes about a minute, it is painless and no patch or sedation is necessary. Vision improves immediately.
What’s the difference between LASIK eye surgery and cataract surgery?
Both the cornea (the watch crystal part of the eye) and the lens inside the eye help to focus light on the retina. If you altar the shape of the cornea with (LASIK), or remove the lens (clear or cloudy – cataract), you can accomplish the same thing – you allow the rays of light to better focus on the retina. Obviously, it is safer to etch the cornea staying on the surface of the eye, than enter the eye. To remove the lens, and place it with an implant. Each has its advantages and disadvantages. Dr. Schuster and staff can better help you decide what might be best for you.
What are the names of some multi-focal implants to replace the natural lens of the eye so I can have both near and far vision after surgery?
ReSTOR™ by Alcon Inc. / www.alcon.com
ReZOOM™ by Advanced Medical Optics / www.amo-inc.com
How does Astigmatism fit into the picture?
Astigmatism is an out of roundness of the cornea. It can be corrected with LASIK surgery (corneal surgery) along with correction of nearsightedness (myopia) or farsightedness (hyperopia) at one time. If you have cataract surgery (lens extraction with a intra-ocular lens implant) the above ReSTOR™ or the ReZOOM™ implants can correct either the nearsightedness or farsightedness, but the intra-ocular lens will not correct astigmatism. If you have astigmatism as well , you will have to have your astigmatism corrected secondarily in a rapid painless post-operative procedure in the office to gain full effect of seeing both near and far without glasses or contacts. This may be laser vision correction for astigmatism
(e.g. LASIK, PRK) or small cuts made at the edges of the cornea (limbal relaxing incisions).
What about cost?
If you have a cataract and it’s removed with a single vision implant this is a covered cost by insurance.However, if you choose to have both near and far vision corrected by implant – ReSTOR™ or ReZOOM™ intra ocular lenses, i.e. a multi-focal lens implant, please be aware that it is not covered by insurance plans. Partial payment out of pocket is required over and above your deductible. If you do not have cataracts but chose to have a clear lens extraction and a multi-focal or mono-focal lens implant, it is considered a totally elective procedure only to eliminate the need for glasses and therefore, like LASIK, it is a non-covered expense. (e.g. no help by insurance under any circumstances).
Are there forms of payment available to help cover the out of pocket expenses if there is no insurance coverage?
Yes, at Schuster Eye Center we can help. All major credit cards are accepted and we finance through, The Vision Fee Plan by Capital One. You may qualify rapidly by calling toll-free, 1-877-559-5050 or visiting our website, www.schustereyecenter.com
and linking to www.capitalonehealthcarefinance.com
. You can get approval in minutes most of the time. The rates are excellent presently. The operations are tax deductible, regardless of whether covered by insurance or not.
Is a common eye condition, caused by a mis-shaped or irregular cornea. Astigmatism is a
refractive error, (e.g., like nearsightedness and farsightedness), which results in blurred or distorted vision. In most cases, astigmatism is correctible. LASIK or similar corneal refractive procedures often are the answer. Sometimes small incisions at the edges of the cornea (limbal relaxing incisions) work better.
Pulses of warm saline (salt water) used to remove the natural lens from the eye in cataract surgery or refractive lens exchange surgery before implantation of an intra-ocular lens.
Clear Lensectomy (Refractive Lens Exchange - RLE) or Presbyopia Correction Surgery Lens
It is an elective procedure, to eliminate or reduce the need for glasses or contact lenses by operating on the clear lens of the eye. This procedure is to correct nearsightedness and farsightedness. Other refractive procedures on the cornea are also an option. Because it is an elective procedure it is not covered by insurance plans. Once removed, the lens is replaced by a multi-focal (presbyopia correction implant) on mono-vision implant (corrects for distance only). Clear lensectomy is simply cataract surgery on a lens that does not have a cataract.
The clear, front window of the eye, that transmits and focuses light into the back of the eye.
Crystalline Lens -
Is a transparent structure inside the eye that, along with the cornea, helps bend light to focus onto the retina. When the lens clouds, it is then, called a cataract. It sits behind the iris and pupil of the eye.
Hyperopia (Farsightedness) -
Vision at a distance is good, while vision at near is blurry. In a hyperopic individual, light rays that enter the eye are focused behind the retina, instead of directly on the retina, as in a normal eye, it is an inherited condition. It is present in childhood, but it does not usually becomes apparent to most people until they are in the late 30’s, when they can no longer use their own muscles inside the eye to focus well at near. It is important to remember that hyperopia is basically the opposite of myopia.
Intra-ocular Lens Implant (IOL) -
An acrylic implant used to replace the natural lens of the eye when a cataract is present or as a means to decrease the need for glasses if no cataract is present. It is placed after the lens is removed to better focus the light.
LASIK (Laser-Assited-In-Situ-Keratomileusis) -
Laser eye surgery designed to change the shape of the cornea to eliminate or reduce the need for glasses and contact lenses in cases of nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. During the LASIK procedure the surgeon creates an ultra thin corneal flap in front of the eye using the IntraLase Laser. The corneal flap is then lifted and the eye is treated with the Visx Star S4 Laser, which is pre-programmed to decrease or eliminate the need for glasses by re-etching your cornea to eliminate combinations of nearsightedness, farsightedness and astigmatism. The flap is then repositioned and healing begins.
Limbal Relaxing Incisions -
Smooth incisions made with a guarded blade at the corneal edges to decrease astigmatism after cataract or after clear lens removal.
Vision at near is good, while vision at a distance is blurry. In the normal eye, light rays pass through the cornea (clear front portion of the eye), and the lens, where they are focused on the retina (back portion of the eye). Once focused on the retina, information is then transmitted by millions of tiny nerve bundles, via the optic nerve to the brain where these images are translated into what we know as “sight”. When light rays are focused in front of, instead of on, the retina, we describe this condition, myopia or nearsightedness.
Phacoemulsification (Phaco) -
A vibrating ultrasonic probe used to remove the cloudy (cataract) or clear natural lens from the eye.
Hardening of the natural lens of the eye. Through the natural aging process, changes occur in the lens of the eye, which interfere with our ability to see clearly at near. The first change begins about the age of forty when the lens loses its elasticity and begins to harden. When this occur the lens can no longer change shape to focus properly. As a result, close objects cannot be seen and reading small print begins to be a problem. This is not a cataract; there is no cloudiness of the lens involved. However, cataracts and presbyopia can co-exist. Lens replacement surgery with a multi-focal implant essentially cures presbyopia, as afterwards the patient can see both near and far distances without difficulty if no
astigmatism is present.
PRK (Photo Refractive Keratotomy) -
Laser eye surgery to change the shape of the cornea to eliminate or reduce the need for glasses and contact lenses in cases of nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. PRK involves brushing the skin off the cornea, instead of creating a corneal flap as in LASIK before re-shaping it with the Visx Star S4 Laser. Results of PRK and LASIK are totally equal but, healing is slower and there is more discomfort initially with PRK than LASIK.
Radial Keratotomy (RK) -
Incisions made into the cornea to reduce or eliminate nearsightedness, and astigmatism. It is little used since mid 90’s.
Refractive Error –
Irregularity in the way light passes through the eye. Normally, light enters the eye and is focused at a single point onto the retina (the thin layer of cells in the back of the eye). The cornea (the clear front portion of the eye) and the lens inside the eye together, bend (refract) the light rays so that they can focus properly. The retina receives the images formed by the focused light rays and transmits them to the brain through the optic nerve. When the combination of cornea and lens power don’t focus properly onto the retina this is called a refractive error. Refractive errors include, myopia, hyperopia and astigmatism.
A thin layer of cells in the back of the eyeball that converts light energy into electricity and sends the image to the brain to process sight.
Retinal Detachment –
Disorder of the eye, in which, the retina peals away from its underlying layer of support tissue.
Without rapid treatment, this can lead to permanent vision loss.
Implantable lens for nearsightedness. This procedure is preformed on young individuals, without presbyopia. This procedure is an option when LASIK or a clear lens extraction is not. This lens is inserted through a small incision and is attached to the iris (colored part of the eye), which holds it in place. Similar to a photographer bringing a camera lens to focus, the lens helps create sharper images by combining the power of the cornea and the natural lens of the eye plus the implantable Verisyse lens to correct very extreme nearsightedness. Here the natural lens is left in place.
YAG (Yttrium Aluminum Garnet Laser) -
A laser used to perform a YAG Laser Capsulotomy (open the cloudy lens capsule after cataract surgery with an intra-ocular lens implant). This laser creates openings / holes in the back capsule of the natural lens that secures the implant. In routine lens surgery this is necessary 15% - 30% of the time. This is because the capsule clouds (wrinkles) after lens implantation surgery at times.