Dr. Douglas Liva is a superb cataract surgeon who utilizes the latest techniques and technology available. Dr. Liva performs most of his cataract surgery at Ramapo Valley Surgical Center. It is conveniently located in Ramsey at 500 N Franklin Tpke in the Office Centre office building. .
Cataracts, the leading cause of treatable blindness, create vision cloudiness and develop for a variety of reasons, but most commonly result as part of the aging process. However, they can also be caused by long-term ultraviolet (UV) light exposure, trauma to the eye and as secondary effects of diseases such as diabetes. Cataracts typically require surgical removal and replacement of the eye’s lens.
Cataract surgery is a highly effective way to restore vision impaired by cataracts. Both the removal of the clouded natural lens and the implantation of the replacement IOL are accomplished through microscopic incisions from 2.4 millimeters in length. Incisions this small usually avoid the need for stitches and induce minimal amounts of astigmatism. Foldable lens technology has led to the development of microincisional surgery.
Optical Biometry
To calculate the lens power for for intraocular lens insertion Optical biometers, such as the Carl Zeiss Meditec IOLMaster 700, perform a new method of preoperative A-scan biometry where infrared light is used to calculate axial length, keratometry and anterior chamber depth. This precise, rapid method reduces technical variance and eliminates physical contact with the cornea. However, optical biometry may not perform consistently with patients who have dense cataracts. So in those cases where the cataract is so dense that even a laser can’t penetrate. Dr. Liva uses an excellent alternative, immersion ultrasound. This procedure involves doing ulrasonic measurements through a shell filled with water to avoid having error produced by compression artifact of the ultrsound probe indenting the cornea. Analysis of Dr. Liva’s postoperative for results for 2023 showed that an approximately 2/3 of postoperative cataract patients had a refraction within 0.25 diopters, 98% within 0.5 diopters and 100% within 0.75 diopters of expected. The latest technology, evolved lens calculation formulas, surgical precision, and attention to detail have enabled such accurate results.
Alcon Clareon Monofocal IOL
The Alcon Clarion Monofocal IOL in the standard monodical implant that Dr. Liva usually implants in patients who don’t upgrade to one of the advanced technology lenses. It is an excellent lens that reduces spherical aberration, has an acrylic lens material that has shown to be well tolerated and that will last a lifetime. It also has ultraviolet and blue blocking filters which are thought to reduce retinal damage from the harmful effects of high energy light. Monofocal means that most light is focused in one location leading to high contrast but less depth of focus. If calculations are set for distance then the patient will need glasses for intermediate and near vision. If calculations are set for near then the patient will need glasses for distance and intermediate. When considering lens options it is best to consider vision separated into 3 ranges. Distance is required for driving, hiking, watching TV, hunting, attending sporting events and plays. Intermediate viewing is required for computers, phones, the car dashboard and store shelves. Near vision is necessary for reading, sewing and any close detailed work. So when deciding which lens is best for you it helps to consider what activities occupy your time.
For patients who have small amounts of astigmatism and don’t find reading glasses , computer glasses or progressive lenses inconvenient or can’t afford to upgrade to a premium lens, this lens is an ideal choice.
Premium Advanced Technology Lenses
For correction of astigmatism or presbyopia
In May of 2005, the Centers for Medicare and Medicaid Services (CMS) clarified its payment rules to present Medicare beneficiaries with the choice to receive advanced technology lenses. These lenses can correct astigmatism and improve near and intermediate vision. These enhancements create less dependency on eyeglasses or contact lenses following cataract surgery.
Prior to the CMS ruling, limitations on Medicare payment prevented beneficiaries from choosing to purchase these lenses. Under the revised policy, Medicare will continue existing reimbursement amounts for cataract surgery, and patients may elect to pay additional charges for advanced technology lenses such as the Toric IOL, multifocal IOLs and enhanced depth of focus IOLs. Multfocal and enhanced depth of focus implants also come with astigmatic correction if indicated.
Private insurances and Medicare consider these premium advanced technology lenses a “luxury” and not medically necessary and require that patients to pay for the additional expenses involved with their implantation.
Panoptix Trifocal Intraocular Lens
A trifocal lens is designed to provide vision at distance , intermediate and near. The lens focuses the light into three regions with approximately 50% of the light focused for distance, 25% focused for intermediate and 25% focused for near. Distance vision is used for tasks such as driving and watching TV. Intermediate vision applies to objects at a viewing distance of around 24 inches which would include car dashboards and most computer screens. Near viewing is set for around 16″ which works for reading and using cell phones. The lens had a European launch in September 2015. Since that time studies have been performed showing that over 90% of patients without other ocular pathology achieved an uncorrected vision of 20/25 or better for distance. Over 80% had intermediate vision better than 20/40 and 85% had reading vision 20/25 or better. The only downside to the lens besides not being covered by insurance is that some people experience glare and haloes. No lens is perfect and all lenses can produce glare and haloes. Standard monofocal intraocular lenses cause less glare and haloes than multifocal, trifocal and extended depth of focus lenses. However, the vast majority of patients implanted with the latest generation of premium lenses feel that the visual benefits outweigh the side affects and loss of contrast sensitivity. In a recent study done at 12 US centers over 99% of patients were so satisfied with their vision that over 99% said they would choose the lens again. On rare occasion I have had to exchange out the Panoptix IOL for another implant due to intolerable glare and haloes. Unfortunately there is no test preoperatively to select out which patients will have intolerable side effects. Most patients love this lens but it doesn’t come without risk. The patients that I had to exchange were given the Vivity lens and were happy with the end result.
Clareon Toric IOL
In cataract patients with significant corneal astigmatism, Dr. Liva may highly recommends the toric implant . Corneal astigmatism is a condition where the cornea is shaped like a football rather than a basketball. The two different curvatures results in having two focal points causing blurred vision . The toric intraocular lens neutralizes corneal astigmatism. The lens is aligned with the steep axis of the cornea at the time of implantation during cataract surgery. Correction of preexisting corneal astigmatism enables these patients the best opportunity for quality distance vision without glasses. I employ several methods of measuring preoperative astigmatism due to the fact that no method is 100% accurate. In the past only the anterior corneal astigmatism was measured, however, it was discovered that posterior astigmatism also played a role in determining a patient’s astigmatism. This revelation resulted in me replacing my previous IOLMaster for obtaining preoperative measurements with the new model 700 which is able to measure posterior astigmatism and incorporate those measurements into the modern calculations.