Eyedrops For Cataract Surgery

Dr. White is our cataract surgeon at Skyvision Centers. He is one of the most experienced cataract surgeons in Cleveland, and indeed in the entire country! He, along with Drs. Schlegel and Kaye, form our cataract team of doctors. They choose which eyedrops are the best available for use before and after cataract surgery. In addition the doctors have chosen a group of medicines that are easier to take (most times you only need to use the drops twice per day), and eyedrops that are comfortable so you don't avoid using them!


There are typically three types of eyedrops used around the time of your cataract surgery. An antibiotic is prescribed which is to be used starting 5 days BEFORE cataract surgery. The antibiotic typically is continued for a week after the surgery. The doctors have chosen an antibiotic drop from the strongest class of antibiotics now in existence in order to prevent infections. There are three choices in this class of medicines, two of which can be used twice per day.

A non-steroidal anti-inflammatory drop (NSAID), kind of like Motrin in a drop form, is also prescribed to start 5 days prior to the surgery. This medicine is then continued for 4 weeks after the surgery. It is used to prevent a type of swelling in the back of the eye. The doctors have chosen a medicine that is easy to take (twice per day), doesn't hurt when you put it in, and doesn't have any dangerous side effects. There are NO TRUE GENERIC EQUIVALENTS for this medicine. The generic medicines on the market must be used 4 times per day. They can be very uncomfortable; most people complain bitterly that they sting. Most importantly, the generic option has a 30% complication rate. That's right, 3 out of 10 people have swelling and inflammation in their cornea caused by this drop and this causes pain and a big drop in vision.

Finally, a steroid eyedrop is prescribed to be used after the surgery, beginning on the 1st day after the surgery. This drop treats the normal post-op inflammation in the eye. Like the other eyedrops it is used twice per day, and you continue to use it for 4 weeks after the surgery. There are NO TRUE GENERIC EQUIVALENTS for this medicine. The generic medicines must all be used at least 4 times per day and they are not as strong or as effective.

We understand that medicines can be expensive, especially when an important medicine is not fully covered by your health insurance. But we are talking about YOUR EYES and eye surgery. Your Skyvision doctors have chosen what they feel are the best medicines possible to do every thing possible for you to have a great surgical result.

What could be more important?!

Trends In Treating Astigmatism

The surgical revolution in treating astigmatism began with the onset of Radial Keratotomy (RK) in the late 1970's and continued into the era of Laser Vision Correction. When a cataract was to be replaced, if you had astigmatism you either had to undergo a procedure like RK called a Limbal Relaxing Incision (LRI) during or after the surgery, or a laser procedure like LASIK or PRK. These all work well.

About 5 years ago there was a new development in Intra-Ocular Lenses (IOL) that not only improved vision after cataract surgery, but also treated astigmatism: Toric IOL's. A study of refractive cataract surgeons like our Dr. White recently reported that 75% now prefer to use these new IOL's rather than LRI's in patients with astigmatism.

"We really like the Alcon Toric IOL when we are aiming to make our  Cleveland patients independent from glasses for their distanc vision needs like driving or watching TV," said Dr. White.  "Our golfers are particularly happy!"

Extra pre-operative measurements like corneal topography are necessary to choose both the power and the orientation of the IOL. Once it's in the eye it is amazingly stable!

The technology of cataract surgery now includes multiple ways to address astigmatism. Dr. White and a majority of the top surgeons in the United States are now opting for a Toric IOL in cases where astigmatism is treated during the surgery.

Eye Health and Vision Questions Answered by SkyVision Centers

Wow! Look at all of the posts here on our Skyvision blog! We started out hoping to be helpful to our Skyvision patients as well as our Cleveland neighbors, mostly by talking about the stuff our doctors and staff spend their days discussing in our Westlake office. How are we doing? Are we talking about stuff you are interested in?

How about this? Tell us what kinds of things YOU are interested in. Maybe it's a question about yourself, or maybe someone in your family has an eye disease and you'd like more information. Thinking about LASIK? Perhaps there's an area of research that peaked your interest. Fashion questions for our optical staff?

Really, pretty much anything that's eye or vision related is fair game. You can leave a comment for us here on the blog, or leave a comment on our Skyvision Centers Facebook page (just search for 'Skyvision Centers'). We are on Twitter @drdarrellwhite and @skyvisioncenter, too, if you are a Twitterbug!

Let us know what YOU are interested in, Cleveland!

What Is Astigmatism?

What is Astigmatism? It's a funny word, isn't it? Lots of people think the word is "stigmatism" and that you have "a stigmatism". That of course means that you could have one or more "stigmatisms", but that's not really how it works!

Astigmatism is an optical term that relates to how an optical system focuses, or doesn't focus, light. In our situation the optical system is the eye! There are three different parts of the eye that make up the focusing elements of our vision system: the TEAR FILM that sits on the very surface of the eye (that's why Dry Eye causes vision problems!), the CORNEA or window to the eye, and the LENS that sits in back of the pupil. Astigmatism is present when the combination of these pieces parts creates two or more focused images from a beam of light.

Most of the time astigmatism is caused by the shape of the CORNEA. In a normal eye, one without astigmatism, the cornea is like the front of a sphere; it's round like a basketball or a soccer ball. A cornea that has astigmatism is longer in one direction than the other. It's STEEPER in one direction and FLATTER in the other. In other words the astigmatic cornea is shaped like a football instead of a basketball.

Whether you are nearsighted or farsighted, if you have astigmatism you will have at least two images focused in the eye. There are lots of ways to correct this, and we'll talk about all of them as time goes on. Be sure to check here, and watch for the Dr. Whiteboard videos on the SkyVision Centers Youtube channel SkyVisionCenters105 for more info on ASTIGMATISM

Hey! My Arms Shrunk!

We know what you're thinking...who shrunk my arms? It's happening a lot around the office at Skyvision Centers, too. We're all getting a little older  around here and it seems like there are a bunch of reading glasses lying around everywhere now. As a matter of fact, the only person in the office who can't seem to find Dr. White's readers is DR. WHITE!

Why do we start to have trouble reading when we get older? To answer that we have to go all the way back to age 2 or so. Almost all of us is born a little farsighted or hyperopic. We focus our eyes to overcome this little bit of farsightedness using the same muscles that we use to focus on objects up close. This muscular process is called ACCOMMODATION. When we look at things up close three things happen: our eyes come closer together, our pupils get smaller, and the lens inside our eyes gets fatter. We have massive powers of accommodation at age two and then we gradually lose those powers as wel get older.

The medical term for "Over 40 Eyes" is PRESBYOPIA. When we lose enough of our power of accommodation that we can no longer see things up close we become presbyopic. Of course your kids will just say you got old! Here's a LINK to the Eyemaginations video on presbyopia.

So what can we do? Well, there are a bunch of options, actually. If your eyes are health you can just buy reading glasses at the pharmacy. You might have a different prescription in each of your eyes, and if so your Skyvision Centers eye doctor can prescribe a pair of reading glasses that are specific to you. Many of us need to wear glasses to see things far away--a pair of bifocals takes care of the up-close problem. Bifocal contact lenses are available, and you can even correct your vision with something called MONOVISION, with one eye corrected for near and one eye corrected for far vision.

Whew! That's a lot of options! Don't worry...we'll have lots of answers for you in future posts, and of course,  you can go to the SkyVisionCenters101 YouTube channel see several "Dr. Whiteboard" videos about bifocals!

Fun In the Operating Room

What a good time we all had in the operating room this morning! My OR's tend to be pretty light in atmosphere and generally low-stress environments. It seems that this extends to our patients as well. At the beginning of one of the cataract surgeries our patient, a 75ish year old woman, wanted to share a joke with everyone in the room. I suggested that she wait for the end of the case--I'd already started--and she did!

Here's her joke:

Three older ladies were having tea, and two of them were commenting on how happy their friend was with her new beau.

"What is it about him? Is he rich?"
"Is he a good dancer?"
"What is it?!"

With a little smile their friend leaned in and said in a low private voice, "No...it's none of those things. I'm happy because he can drive at night!"

Busted all of us up! You have to love a patient who can poke fun at herself and her generation!

Dr. White

Exercise Powers Your Brain!

As you know by now, Dr. White is a HUGE exercise buff (that's him in the grey shirt on the rope!). In fact he just completed all of the course work and passed his test and is now a full-fledged Crossfit Trainer! Here's an article he'd like to share about the brain health benefits from exercise. By the way, this is a big part of the science background underlying the teaching methods in Crossfit Kids.

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Exercise - long known to promote heart and bone health, among other benefits - increases the growth of brain cells and improves brain function, according to research reviewed today at the American College of Sports Medicine's 15th-annual Health & Fitness Summit & Exposition.

Terry Eckmann, Ph.D., briefed attendees on recent findings, saying the protein known as brain-derived neurotrophic factor (BDNF) is "like Miracle-Gro for the brain." BDNF, Eckmann explained, helps to grow new neurons in the hippocampus and helps the transmission of information across the synapses (or connections) between neurons.

Fueling these enhanced brain processes, quite literally, are elevated levels of oxygen and glucose which the cardiovascular system - strengthened by exercise - can deliver to the brain. The brain uses about 20 percent of the body's oxygen and glucose.

Scientists have also found that repetitive gross motor movement strengthens the branching of dendrites, which conduct electrochemical stimulation among neurons. "Dendrites receive messages from surrounding brain neurons, and the more dendrites, the more information can be transmitted and stored," said Eckmann.

Recent studies show that students with higher fitness levels score higher on academic tests and show an improved ability to focus. Scientists have also documented the ability of exercise to help prevent dementia and Alzheimer's disease.

"Exercise is medicine and can make a difference in disease prevention and management."

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So make sure you get up off your couch and MOVE! You don't have to do Crossfit, but you may want to give that some thought. Heck, even Charles Barkley is now on the Crossfit bandwagon!

Electric Bifocals! The EMPOWER Lens

Here's the latest news in eyewear, the PixelOptics EMPOWER lens. Believe it or not, this lens can actually change its focus, either automatically by changing the position of your head, or at any power you choose.

Skyvision Centers is one of only a handful of practices in the whole United States to introduce this revolutionary lens. Our main office in Westlake, just outside of Cleveland, Ohio will be the place to find all 28 frame styles. Our Optical staff is ready to answer your questions and assist  in fitting you properly, and Dr. White will be the first person in Cleveland to try out the Empower lens!

Tiny batteries are charged each night to power the piso-electric current passing through the lenses. Stay tuned for more updates. We'll make sure to get the scoop from Dr. White!

Skyvision Docs Have Another Skyvision EDU Meeting

Skyvision Centers Docs had another Continuing Education meeting for area optometrists.  This is the second meeting in the Continuing Education series called Skyvision EDU.  The local optometrists met at The Surgery Center on Bagley Road in Middleburg Heights.  The Surgery Center, owned and operated by Barb Draves, is one the excellent surgery centers used by Dr. White for his cataract patients. 

Leading off the was our very own Dr. Scott Schlegel with a presentation about the very popular Toric Intraocular Lens implant.  He discussed the protocols used in the post operative period of toric IOL cataract surgery. 

Finishing up the meeting was Dr. Darrell White presenting information on the establishment of a Dry Eye Center of Excellence.  The doctors were thoroughly entertained by Dr. White's weaving of stories and technical information.  

Skyvision EDU #3 is scheduled to be held late this summer with topics TBD as the area docs were asked to submit their topics of interest.   The Skyvision doctors have enjoyed connecting with the other area docs and look forward to the continued interaction via the Skyvision EDU meetings.  

A cell Phone App For Skyvision!

Did you know that you can contact individual divisions at Skyvision Centers in Westlake? If you have a smartphone from Apple, or any phone using the Android operating system you can directly be in touch with scheduling, billing, and the optical. You can even ask questions!

Simply go to the iTunes app store on your iPhone, or to the Market on your Android phone and search for "Skyvision". The app is FREE.

And when you get to our office in the suburbs of Cleveland don't forget to "Check in" using your Facebook account, and then go right to Facebook and 'like' Skyvision Centers!

The Skyvision Centers Smartphone App! One more way we are bringing you a chance to "See What's Next (R)"!!

Side Effects From Your Medicines II: Topamax and Acute Glaucoma

Here is another medicine that is used for regular medical reasons that can have side effects on your eye: Topamax (topiramate). Topamax is a medicine that is used for epilepsy and some types of migraine headaches. It is sometimes used "off-label" as a treatment for depression and bipolar disease, and occasionally as a weight loss drug.

Topamax can cause shallowing of the front of the eye which can lead to a glaucoma attack. Pain, redness, blurry vision, and COLORED HALOES around lights are the symptoms They can occur in patients of any age, and they arise in the first 14 days after the first dose of the medicine. The most important thing to do is to see an eye doctor as soon as possible and to stop the medication.

If you are taking Topamax and have any of the above symptoms be sure to call your family doctor, and to call Skyvision Centers for an emergency visit.