DEAR DR. ROACH: I am a candidate for cataract surgery. When discussing this with my doctor, he mentioned that there are new lenses that can be used, which make it possible to correct my vision to 20/20. They are called light-adjustable lenses. There is a cost of $2,400 per eye. It seems to have great success with little risk. He did mention I would need to wear sun protective glasses all the time until the vision is set. My question is whether it is worth the money? It sounds very appealing to go through the surgery and know that my vision will be perfect afterward; whereas with the regular lens, there are no guarantees on how improved my vision will be. Your thoughts? — S.K.
ANSWER: First off, there are no 100% guarantees in surgery, ever. In any surgery, a small number of people will have adverse complications, and some will be disappointed with their results. Cataract surgery is among the most successful and least risky surgeries performed, but bad outcomes still happen rarely.
The light-adjustable lens is a new (approved in 2017) type of lens that lets the ophthalmologist adjust the strength of the lens after it has been placed into your eye. In any kind of cataract surgery, the eye is measured to get the correct strength of the lens, but post-operative changes in the eye can make the new lens focus light imprecisely. The light-adjustable implanted lens can be adjusted to make the focus precise.
Ultraviolet light is used to fine-tune the strength of the lens. Usually, two to four light treatments are used, each lasting about 90 seconds and separated by three days, to “lock in” the new strength. As you noted, you need to stay away from strong ultraviolet light, like the sun, until the new lenses are locked in.
The results after one year show that 93.4% of people with the light-adjustable lens have 20/20 or better vision, compared with 82.4% of people who received a standard lens. In both groups, 100% had 20/40 vision or better. People with persistent refractive error may need to wear glasses or contact lenses even after surgery, but this is less likely with the light-adjustable lens.
Is it worth the money? I can’t answer that, because it depends on your resources and how important it is for you to have a better chance for excellent vision. Although $4,800 is a lot of money for both eyes, if you are fortunate enough to have that at your disposal, the vision outcomes after surgery are better.
DEAR DR. ROACH: I have a question about having cough upon waking up and within 30 minutes after eating. The worst thing is I won’t stop coughing until a thick secretion from my stomach gets out. — M.A.J.A.
ANSWER: Cough first thing in the morning usually represents your body getting rid of secretions that have accumulated overnight. These may be from the nasal passages and sinuses, or from the esophagus or stomach, in people who have GERD, or from the lungs.
Thick secretions are more likely to be from the nasal passages and sinuses. Your regular doctor or an ear, nose and throat doctor might be able to help diagnose and treat the underlying condition — such as allergies or infection, or smoking — that’s causing these secretions in the first place.
Since the cough occurs after eating as well, I suspect there may be a condition called vasomotor rhinitis, which is a not-uncommon cause of cough.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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