September 26, 2025 • 37 mins
In this episode of The Eye-Q Podcast, I sit down with Dr. Kenneth Rosenthal, a world-renowned cataract surgeon, to demystify everything about cataracts. We explore who gets them, why they happen, and how to slow their progression. Dr. Rosenthal also reveals how cataract surgery has transformed into one of the safest, most effective procedures in medicine, with innovations like advanced intraocular lenses, lasers, and customized options for patients.
Kenneth J. Rosenthal, M.D., F.A.C.S., Surgeon Director, has been in private practice in New York City and Great Neck, Long Island, NY since 1980 and is the Surgeon Director of Rosenthal Eye Surgery and Fifth Avenue EyeCare and Facial Plastic Surgery. He is also the Medical Director of Eye Diagnosis of Greater New York, the largest and most comprehensive free-standing diagnostic center in the tri-state area.
Kenneth Rosenthal, MD
Website: https://eyesurgery.org/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The truth is that the cataracts will progress despite our best
efforts in the majority of people.
There are things that we can do to to to delay the need for
surgery, though, in the case that the cataract doesn't
develop too quickly. The chief amongst those is what
I mentioned earlier is better control of diabetes.
If patients have diabetes and they're out of control and they
(00:21):
control, it's going to slow downthe progression of their
cataract. Exposure to sunlight may have a
role, so pieces to spend a lot of time outdoors should be
wearing good protective eyewear.And by the way, it's not so
important that they are dark, but that they have good
ultraviolet protection. Welcome to the IQ podcast.
I'm Doctor Ronnie Bannock. Here to help you boost.
(00:42):
Your IQ with powerful insights that connect your eyes, your
brain and your whole body Wellness.
Welcome. Back, I'm your host, Doctor
Ronnie Bannock, and today I'm sohonored to have with me as my
expert guest, Doctor Kenneth Rosenthal.
He is the surgeon director of Rosenthal Eye Surgery.
Thank you so much for joining us, Doctor Rosenthal.
(01:04):
Thank you so much for having me.I'm looking forward to speaking
with you this morning. Absolutely no.
We. So for our audience, Dr.
Rosenthal is a world renowned cataract surgeon.
He is based out of New York City.
He gives many talks nationally, internationally.
And again, we are so honored to have you with us today to share
your expertise in this topic of cataracts.
(01:25):
But before we talk about cataracts, could you first share
with our audience what got you so interested in this particular
subspecialty of cataract surgery?
Just please share your journey with this.
Sure, thank you. It started probably the Seminole
moment was, believe it or not, when I was in high school and my
Grandma Rose had cataract surgery.
(01:46):
Now we have to remember this wasin the 1960s or early 70s, and
in those days cataract surgery was very different.
So she was completely blind fromher disease, from her cataracts
because in those days we waited until cataracts were ripe, until
they were so bad that the patient was banging into walls
and she had cataract surgery done and she had successful
(02:08):
surgery. She wore those thick Coke bottle
glasses that you may have seen historically that people wore
back then. And that was before intraocular
lens were introduced in the United States.
And so that prompted my interestinitially.
But if you Fast forward then fora period of time when I was in
medical school, I simply did a rotation in deciding what to do.
(02:29):
I did a rotation in ophthalmology, which by the way,
was required in my medical school.
And the first day it became clear what I wanted to do.
And if I thought about it, this made sense because I'm a
musician, I'm a pianist. So my I, I enjoy things, doing
things with my hands and have dexterity.
My father was an engineer, so I drew on some mechanical and
(02:51):
analytical things. And of course, with the
scientific background, ophthalmology is the perfect
meld of that. And cataract surgery in my world
as the epicenter of that just made a lot of sense.
And so I was drawn to it very early.
Thank you for sharing your journey and I have to say your
hands are so skilled. I've seen some of your work.
It is beautiful. And so your patients are very
(03:13):
fortunate to have you as their doctor and their surgeon.
Thank you. You're too kind.
Appreciate. That now it's comes from the
heart and I really mean every word.
Doctor Rosenthal for our audience, give us just a general
overview of we've heard this term cataract.
A lot of people don't really know exactly what it means.
So what is a cataract? Why does it develop?
How does it impact vision? Just give us a 30,000 foot view
(03:36):
of the topic. Sure.
OK, So cataract is nothing more or less than a clouding of the
natural lens of the eye. The eye is built like a camera,
if you will, and the eye has a lens inside of it.
And when that lens opacifies, itbecomes cloudy, it impedes the
vision, it prevents light from getting from the front of the
eye to the back of the eye. And the patients will usually
(03:59):
have symptoms when the cataract develops sufficiently things
like just decreased vision in general and it may take the form
of glare, particularly glare from headlights at night is a
common is a common complaint that patients have trouble
seeing small print. And then just generally people
may just have difficulty conducting what we call
(04:20):
activities of daily living, the day-to-day tasks that require us
to have good and reliable vision.
And so at the point that the cataract is becoming significant
in that way, that's when we entertain cataract surgery.
Thank you for that eloquent explanation.
Now I wanted to ask in terms of cataracts, this oftentimes comes
(04:43):
up. Does everybody get them or are
more people, are some people more at risk?
Could you explain that a little bit?
Sure, the answer is yes if and Ioften tell my patients if who
have early cataracts. If you live long enough, you
will have cataract surgery. Having said that, I had the
pleasure of seeing about 3 weeksago a very nice lady who's 107
(05:05):
years old and who's just now coming to cataract surgery.
She lives alone independently, has all of her faculties, and
now is first time. But more typically, cataracts
will develop earlier on. Usually the average age for
cataract surge in the United States, last I looked, was in
the mid 70s. But it runs the gamut.
You can have childhood cataracts.
(05:26):
In fact, you can have cataracts that you're born with.
They're called congenital cataracts.
They're a little different than adult cataracts, but they are
nonetheless share the feature ofcloudy lens.
So you can develop it at any age.
But there is an increase incidence of cataracts as we get
older, and it's inevitable. Pretty much, yeah.
Yeah. To echo what you said earlier,
if you're fortunate to live longenough, you will develop a
(05:49):
cataract. And what I always tell my
patients is that even though youmay have a cataract, it doesn't
necessarily mean that you need to get surgery right away.
As you mentioned in your centenarian patient, she was not
affected by her cataract. She probably had them for for
decades before she finally came to you for surgery.
Just having a cataract does not mean that you have to be rushed
(06:10):
into any type of intervention for them unless they're
affecting a person's daily activities.
Is that fair to say, Doctor Rosenberg?
Precisely it it has to do with what the patient's particular
needs are. Now, as one might imagine,
everyone's needs are different. So someone who is who is you or
me who's doing surgery, who needs keen vision would probably
come to surgery much earlier because we were vision on the
(06:34):
other. And so that's at one extreme.
But the other extreme would be, let's say a more sedentary
individual who spends most of the time, say, watching TV and
doing a general test, doesn't read and doesn't have a lot of
visual needs. Indeed, the cataract may be a
lot worse before it starts to impact the activities of daily
living, as we say. And then there's everything in
(06:54):
between. And most people fit in between
those two things. And again, it's our task as
surgeons, as the doctor responsible for making that
decision to, to give patients good advice as to when the time
is to have surgery. But more and more we're going
earlier and we'll, I guess we'llget to that eventually is
because we keep getting better and better doing the surgery.
(07:16):
So the risk profile, since it becomes less, will accordingly
allow us to do surgery in an earlier stage.
Contrast it, if I will, with what I described to you as my
grandmother's journey where she was basically banging into walls
before in an earlier age where cataract surgery was far
riskier, that cataract surgery now has a much lower risk
(07:36):
profile. In fact, it's probably 1, if not
the most safe, one of the safestsurgical procedures in old
medicine. Doctor Rosenthal, it seems like
age is perhaps the biggest risk factor for cataract development.
As you mentioned earlier, there can be other things like
pediatric cataracts, congenital cataracts.
What are some additional risk factors patients may have for
(07:59):
cataract development or cataractprogression?
So less common but also prevalent enough are systemic
diseases that affect the eyes. The most common one in my
practice is diabetes. So patients who have
particularly poorly controlled diabetic condition are more
prone to develop cataracts lateron, earlier on than they would
(08:21):
otherwise considering other factors.
Other risk factors are things like patients who take steroids
or cortisone for a variety of medical conditions.
And by the way, less well known is there are a number of nasal
sprays used to things like sinusitis and allergies that
have corticosteroids in them. And indeed those have been
linked to development of cataracts too, something which
(08:44):
by the way, is often not heated by the patient.
They're not aware of it. Of course, taking steroids is
sometimes inevitable. The cataracts that develop are
no more difficult or easy to remove, but that is an
additional risk factor. Poor nutrition would be 1.
But in the United States is extremely rare to to see people
who are severely malnourished. But that is also a less common
(09:06):
factor worldwide. Yeah, just to expand on what you
said earlier about steroid use, I've even had patients who take
not just steroid sprays or inhalers for asthma, but people
who use a lot of topical steroids for certain skin
conditions, especially when it'saround their face.
I've even seen earlier cataractsdevelop in patients who do take
(09:27):
even topical steroids and drop form as well.
So it's basically if is this correct like any type of steroid
can maybe? Unless I left that perhaps the
most common in our practice, which is topical steroids in the
eye. So there are a lot of eye
conditions that are treated withsteroids and sometimes people
are treated with steroids in a less than careful way and in
(09:48):
advised and advisedly careless way.
And they use more steroids than they need to develop early
cataracts. By the way, topical steroids are
also associated with the development of glaucoma, which
is also a serious condition and so one has to be always
cognizant of it. Absolutely and definitely let
your eye doctor know if you're taking steroids of any kind when
(10:09):
you go for your annual visit, make sure that you let your
doctor know that you're on steroids.
One other quick thing I wanted to ask you about, what about
trauma? Could that be a risk factor for
cataract progression and? Yeah, sure.
Yeah. And injury and interestingly
enough, injury that's remote. And we see patients who had hit
an eye with baseball as a teenager and now they're 70 and
(10:29):
they've developed traumatic cataracts.
And we know that too because traumatic cataracts often look
different than regular cataracts.
And they constitute a subset of the high risk group for cataract
surgery because the natural support system of the cataract
of the lens of the eye, if they're called zonules, they're
like trampoline wires, they become extended and or broken
(10:52):
and it can lead to instability of that lens.
And that requires the special kinds of surgical interventions.
But indeed, trauma is an important consideration.
Now I wanted to move on to ask you about prevention, things
people can do. We mentioned, OK, it's going to
cataracts happen to everyone. No matter how clean a life you
have, you will still develop a cataract if you live long
(11:14):
enough. But what are once a cataract
develops? Are there things people can do
to prevent it from progressing? What are your thoughts on that?
So first of all, I'm going to preface it by saying yes, but
because the truth is that the cataracts will progress despite
our best efforts in the majorityof people.
There are things that we can do to to to delay the need for
(11:36):
surgery, though in the case thatthe cataract doesn't develop too
quickly. The chief amongst those is what
I mentioned earlier is better control of diabetes.
If patients have diabetes and they're out of control and they
control, it's going to slow downthe progression of their
cataract. Exposure to sunlight may have a
role. So pieces to spend a lot of time
out outdoors should be wearing good protective eyewear.
(11:58):
And by the way, it's not so important that they are dark,
but that they have good ultraviolet protection.
And then generally there are nutritional.
The nutritional aspects are a little bit more controversial,
but there is some evidence that antioxidant vitamins, ACE as
well, may have some role in somewhat retarding development
of cataracts. Absolutely.
(12:20):
I'm thinking back to the studiesthat were published.
I know that some were controversial, some said that
they helped and many others saidthat they didn't, whether it's
dietary or supplement wise. But I always tell my patients
it's always important to have a diverse diet rich in fruits and
vegetables because even though it may not prevent cataract
progression, it will help you inmany other aspects of your eye
(12:41):
health. So that's always key as a
foundation to eye health. I wanted to ask you also, Doctor
Rosenthal, there are some products on the market.
Some of my patients have come tome.
Taking eye drops that. Have been branded or they're
promoted to help prevent cataract progression?
What are your thoughts on those types of products that are
available over the counter for cataracts?
(13:05):
Right. In a word, in my opinion, they
don't work. Every few years something new
comes out and I have yet to see something that I have feel is
convincing in terms of either preventing progression of and or
reversing cataracts. But you still see them on the
market and egregiously I think some of them are actually
(13:26):
labeled that way. Reverse your cataracts and so on
with one of them. Not to be political here, but
one of the new administration's projects as well is to try to
produce some truth in advertising even for over the
counter items. And I think that's a key target.
I think that people spend money on things that have no proven
benefit. And the truth is, and I don't
(13:48):
mean to be glib about cataract surgery, it is real surgery.
And of course it has risk. But since it is one of the
highest, most successful procedures, with the highest
yield and the greatest patient happiness, there's very little
reason to to agonize over and when the time comes.
Yeah, thank you for your opinion.
I'm very much so in agreement. I typically do not recommend to
(14:10):
my patients that they use these over the counter products.
However, if someone is really adamant they want to take their
homeopathic medications for their eye health and for
prevention, I don't tell them tostop.
I'm very much aware that some people truly want to do things,
whatever they feel they're in line with to promote their eye
health. And as long as it's not going to
(14:31):
hurt, I don't tell them that they absolutely need to stop
those. Impede.
They're coming to surgery when they really need it because
there are cases where people wait longer than is ideal.
We can remove the worst of cataracts and we can have create
good results. But the truth is that a very
advanced cataract does bear somewhat of a higher risk
profile than a more moderate cataracts.
(14:52):
If it becomes ill advised to wait an excessive period of
time. Not the least of which too is
that when patients cataracts become severe enough and it
impedes their vision enough, there are risks to them.
For example, trips and falls because they can't see.
And that is that's one of the indications where we will step
in even when the patient is not have a lot of complaints and
(15:13):
say, look, you really need to dosomething.
We've seen from time to time people who have repeated
automobile accidents and it's clear that it's because they
can't see. And that's where you have to
step in and be the doctor and say this is what you really
need. Yeah, yeah.
And I've actually had that conversation with a few patients
where I basically tell them yourvision is no longer, it doesn't
(15:35):
meet the state's requirements todrive.
So unless you have your cataractsurgery, you really should not
be driving at this stage. It's a risk to you as well as to
others. Yeah, absolutely.
Doctor Rosenthal, thus far, thishas been such an enlightening
conversation. You have been so informative,
giving some really unique insights into cataracts.
And I'm looking forward to hearing more about cataract
(15:57):
surgery as well. But first, we're going to hear
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Today we're chatting with DoctorKenneth Rosenthal, a leading
cataract surgeon. So Doctor Rosenthal, let's now
dive into your specific area of expertise, which is surgery.
(18:50):
Tell us about cataract surgery. How is it done, and also maybe
how is it different now than what your Grandma Rose
experienced? What are some of the
technological innovations that have happened over the past few
decades that make cataract surgery such as safe and
effective procedure? Sure, good.
Thank you. So this is one of my favorite
(19:11):
topics to talk about and I've been around just long enough to
have seen an incredible evolution over what I would can
see is historically a very shortperiod of time in the evolution
of cataract surgery from a moderately to high risky
procedure to an elegant, highly successful, very safe rocedure
with incredible visual results. What I'm going to say, I'm going
(19:34):
to go to the punch line 1st and then come back and retrace it.
And the punchline is that when we do cataract surgery on the on
patients, most of the time now we exclude patients of course
who have other, we call comorbidities.
So we have other medical problems or other problems with
their eyes that preclude having perfect vision.
(19:54):
But if you have an otherwise perfect eye with a cataract, the
likelihood of you restoring perfect vision is extremely
high. And in fact, I would have to say
that in a majority of patients, they see better after cataract
surgery than they've ever. Seen in their life and as a
youth and that's a remarkable and let me lead you through how
we got there. So if we go back to the 1950s
(20:17):
and 60's, the conventional surgery was done.
We'd remove the natural lens of the eye, but you didn't replace
it with anything. You'd give patients these very
thick sort of Coke bottle glasses and indeed they work.
But of course you were also working there with a large
incision. So if we look at large incision
and no lens to put in the eye, we had a very different
operation. Probably the greatest innovation
(20:41):
in eye surgery in its history was the development of the
intraocular lens. Intraocular lens was invented by
a gentleman by the name of Harold Ridley, who ultimately,
by the way, was knighted by Queen Elizabeth for his
achievements. And actually I had the honor of
being invited to a 75th celebration, 75th anniversary
(21:03):
celebration of the invention of a Dracula lens in London.
It was actually held in the Tower of London.
And it was absolutely an awesomeexperience.
And realized that now 75 years later, not only we have
intraocular lens, but highly evolved ones.
And I'll get there in a moment, but that's where we've come to
the intraocular lens. And by the way, Harold Ridley
(21:24):
met with tremendous opposition. He was called a charlatan.
He they people tried to take hislicense away.
It was a horrendous for him and the, the, but he prevailed.
And by the way, never patented the intraocular lens and never
derived a dime of royalties fromthis incredible invention.
So his great gift to the world now the intraocular lens.
(21:47):
So let me follow the intraocularlens path forward has continued
to evolve. We developed lenses that
function better, lenses that have been engineered so that the
visual outcome from them is better than the natural lens of
the lens that we're we're born with the sake of being
sacrilegious that God gave us isan imperfect lens in some ways.
(22:09):
Well, the engineers have figuredout ways to make the vision even
better. So the intraocular lenses that
are available now are highly evolved lenses that provide an
incredible quality vision. That's why I said that a large
percentage of patients see better than they've ever seen.
Now if you add to that some lensfeatures, I'm going to talk
about two in particular that I've been involved with in that
(22:30):
I think are very exciting. I was very fortunate to be the
first person in New York to use a particular lens now which is
called an EDF or extended depth of and this particular lens
gives a full range of vision andthis lens allows patients to see
without glasses. Now I want to give you
perspective here. Picture an 85 year old patient
(22:52):
who now does not wear glasses atall, not for reading, not for
distance, not for driving. That's remarkable.
Not only that patients who have been extremely nearsighted,
meaning they couldn't see past the end of their nose without
glasses, now suddenly are able to see without glasses at all.
So we can do that by implanting an intraocular lens,
appropriate. The other exciting lens which
(23:14):
goes along the parallel with that is a lens called a light
adjustable lens. And without going into too much
detail about that, the light adjustable lens is a lens that
you put in the eye and look you put.
Sometimes we put on a new suit and we think it fits pretty well
until we get it home. But we can bring it back to the
tailor a few days later and havethem make it fit perfectly spoke
(23:35):
version of the intraocular lens because the intra, this lens can
be implanted in the and then youcan make adjustments if the
person wants to see a little better close up or far, you can
adjust that lenses power or prescription after the surgery.
So that's another great innovation that we've been
working with a lot now and whichreally does enhance it decreases
(23:55):
patients need for wearing glasses and improves the quality
of vision overall. OK, now that's the intraocular
lens track. Let's go back to the other parts
of the procedure. I mentioned to you that in the
1950s and 60s a large incision had to be made and the cataract
that was removed in an entire piece.
Charlie Kelman, who's from new was from New York, invented a
(24:18):
device that could go into the eye and break up the cataract
and make the incision. Now modern day cataract surgery
less than 2mm in size. That means that the that's about
the size of the tip of a pencil.What does that mean?
It means is less invasive surgery.
So we, we meaning US ophthalmologist really started
the exploration of what's now been considered minimally
(24:41):
invasive surgery for all specialreally the first ones to do
that. And so now we have a minimally
invasive procedure. And of course those instruments
have undergone incredible refinements too, so that the
healing process is faster, the surgery is safer, and very
importantly, we've developed techniques which allow us to do
more difficult cataract surgery without having morbidities.
(25:04):
Then the last leg of the three legged stool is the femtosecond
laser. Now this is a laser which was
developed more recently in the last 15 to 20 years and much
more commonly used in the last decade.
And this is a laser specificallydesigned for cataract surgery.
And this laser opens up the cataract very precisely, and
(25:25):
then it fragments the cataract into pieces.
Now, you do this before you go into the operating room.
So what happens when you go intothe operating room?
The lens has already been fragmented, and the surgery
removal of that lens is much more gentle.
That means there's less energy fed into the eye.
That means there's less surgicaltrauma, there's less
inflammation, and the faster healing of that patient.
(25:45):
It also enables to safely do surgery on patients who have
other problems. We published a paper a few years
ago showing that, for example, patients with cornea problems
who would be affected adversely by a lot of surgery did better
with the femtosecond laser than by doing conventional surgery.
So those, I, to my mind, those are the three major innovations.
(26:06):
And if you look at the visual outcomes and you look at the
patient happiness factor in all of this, it's remarkable.
Yeah, wow, that is amazing, thisevolution that you walked us
through that Doctor Rosenthal. So just to recap for our
listeners, 3 major types of innovations with cataract
surgery #1 the procedure itself,the size of the incision, and
(26:27):
how the lens is removed. And correct me if I'm wrong, but
we're still mainly using ultrasound energy for removal of
the lens. Is that ultrasound and vacuum?
But less but love it because of right?
Yeah. And then we have the femtosecond
laser that can be used before the actual procedure.
So it's almost like a 2 step procedure.
(26:49):
So the laser can help to open upthe cataract kind of bag that
holds the cataract and then to fragment the cataract.
And then you would have these amazing range of options for
lens implants, which didn't exist until relatively recently
when even when Doctor Ridley created the first lens implant,
it took a very long time of manydifferent iterations to get the
(27:11):
optical quality and the range offocus as you mentioned, the
enhanced depth of focus and thenthe light adjustable lens to
have all of those developments come become available for our
patients. Now I know that there is some
choice when it comes to cataractsurgery, the laser, the lens
options in our last few minutes together.
(27:33):
Doctor Rosenthal, can you walk us through maybe in just a
minute or two, how a patient canhelp and you can be how you can
help a patient make that choice in terms of the procedure and
the lens options that are best suited for that patient?
Sure. So first of all, good Sir, good
medical care begins and ends with a conversation with the
(27:53):
patient. And in in our practice, we spend
a lot of time getting to know the patient, getting to
understand what their visual needs are, what their
limitations are and and frankly what they don't want.
So for example, the, and I should disclose here, for
example, that some of the because of the way the insurance
(28:18):
system is established, some of these do come at additional out
of pocket costs. And so one has to be sensitive
to the vision to the financial, financial limitations of
patients in some cases as well. But if we look back at the pure
medicine of it, well, for example, if I have a patient
who, who has a very active lifestyle, they drive, they
(28:38):
watch, they drive, they use a computer, they read, they carry
their iPhone around. Those are patients who are very
good candidates for being spectacle free.
Also patients who are extremely near or very farsighted, who
have gone their whole lives basically shackled to glasses or
contact lenses, now have the option of having those kind of
(28:59):
that kind of a procedure. The light adjustable lens, I
consider it the perfectionist lens, the light adjustable lens,
probably the lens I'll have whenI need cataract surgery because
it does allow such exact focus. My number one candidate is my
golfer who wants to see their golf ball at 300 yards.
OK, so you can perfect the result there.
(29:21):
So everything is a discussion with the patient and then we
discussed the potential risks and benefits there as well.
The downside for the light adjustable lens, for example, is
that it does require some work after the surgery.
They have to meet with the with my associate who does the
adjustments and there's a numberof visits there as well.
So they have to be willing to dothat.
(29:42):
But that's that's the conversation that we have with
them, yeah. Got it.
So what I'm hearing from you, Doctor Rosenthal, is that there
is no ideal procedure implant for everyone and it really is a
personalized choice based on thepatient's individual needs and
their activities of daily living.
What do they need to do in theirdaily life?
So patients just sit down with their surgeon and have that
(30:04):
conversation well in advance of the day of surgery.
It should not be done on the operating table, correct?
And a matter of fact, what I left that which is extremely
important is we have to look very careful at each patient to
see whether or not there are anyother problems with their eyes.
For example, a patient with macular degeneration is not
(30:24):
generally a good candidate for some of these technologies.
So we have to examine them, evaluate that.
We do 18 separate exams and tests on every patient that
comes in for cataract surgery. And we do this a for the
accuracy of measurement because you realizes that to perfect
that visual result, we have to do a lot of measurements.
We do a a lot of calculations, we do a lot of evaluation, but
(30:46):
we also do tests to determine the safety.
In other words, is there a problem with the cornea?
Is there a retina problem? Is a neurological problem?
Do they have glaucoma, Any of those things.
And those always weigh into our decision about what to recommend
to the patient as well. Wow, thank you for sharing all
of your incredible insights about cataract surgery.
(31:07):
I can tell like you're one of the leading experts in this
field and your patients are proof of the miraculous
recoveries that people can have so quickly.
And some patients can go back towork, sometimes even the next
day or a few days later. Isn't that right, Doctor
Rosenthal? That's right.
Yeah. And in an average case, the
patients have excellent vision even day one.
And it's not uncommon to see 2020 vision on day one, doesn't
(31:29):
always happen, not uncommon at all.
And quick recovery to vision, weusually we operate on one eye at
a time, but we usually try to dothem fairly close together so
the patients get a quick rehab. The results are really
astounding. I'm I want to leave you with a
thought, 'cause I have to put this in as one of the loveliest
things that a patient ever told me.
(31:50):
First of all, I tell patients before surgery expect to be
amazed because with patients lose vision gradually over time.
They forget how their good vision really is and they come
in the next day. The wow factor is there and I
can tell you that after doing this for over 40 years, the
thrill is still there for me to be able to do that for patients
to see that result. But the nicest thing a patient
(32:11):
ever told me, this was an elderly Greek lady who had this
very poetic Greek way about her.And she came the next day and
she said, Doctor Rosenthal, you washed the flowers for me.
A lovely way of expressing what cataract surgery really does.
It really clears their vision and gives them vibrant colors
and clear vision. Yeah, I've had patients tell me
(32:34):
I never, I didn't realize that my vision was hazy for so long
or what colors are so washed out.
Then after cataract surgery I feel like I see in Technicolor,
like it's really incredible. Like the difference pre and post
op. Again, thank you Doctor
Rosenthal for explaining all of this in such an easy to
understand manner and for all the work that you do.
(32:58):
One last question before before I let you go today.
Is there any common myth or misconception about cataracts or
cataract surgery that you would just love to dispel for our
audience today? Sure.
This is a long laundry list of misconceptions that people have.
The thing we used to hear a longtime ago, we don't hear it as
much now, but we do hear is the concept that the cataract has to
(33:20):
be ripe as if it was some sort of optical fruit.
But in fact, ripe came from the concept that cataracts in old in
the old days, what we say had tobe so bad that it had that
patients had to be completely disabled.
So patients who come in saying, but is my cataract right by say
we don't use that expression anymore.
(33:41):
The other silly things people say, do you have to take my eye
out in order to out of its socket in order to do the
surgery? Is the surgery painful?
You know what does? Sometimes we'll see patients
with milder cataracts in their intent that they need to have
surgery. And we explain that we generally
not only have to do the surgery when they're having trouble.
And sometimes we kind of straighten to say, I have a
(34:02):
cataract. Don't you want to take it out
and say, no, we don't need to dothat?
I would say those are probably the most common things.
Oh, and then, of course, what wealluded to before is patients
asking me about eye drops or other medications that they can
take that are going to make the cataracts dissolve.
And that's a misconception. Yeah.
Yeah, yeah, I've definitely heard those and many more.
(34:25):
Another common one is do you have to do the surgery again or
is my cataract going to grow back in a few years and will I
have to have it done again? So.
So that's actually a. Good question because the answer
to that is the cataract doesn't grow back, but a film may grow
behind the lens implant and it then in fact sometimes it's been
called a secondary cataract. It's a misnomer, but it also may
(34:46):
block the vision again down the line.
And that's a that's called capsular opacification and it's
easily treated with a an in office laser procedure that
takes about 3 to 5 minutes. But that would be the only.
But it's a simple. Fix if that happens and it's not
the. Cataract.
Showing that. And in fact, it happens, I would
have to say, in the majority of people at some place along the
(35:08):
way. Yeah, yeah, I've definitely seen
that as well. Again, Doctor Rosenthal, you are
a wealth of information. Thank you so much for doing
everything you do for your patients and for us as
ophthalmologists and advancing the field.
And you've participated in many research endeavors to help
improve cataract surgery and getsome of the new products onto
(35:28):
the market. So thank you for your work with
that. If anyone wanted to learn more
from you, perhaps even seek out a consultation for cataract
surgery, how could they find you?
Sure. And let me say before I answer
that it's been a joy to spend some time with you and discuss
basically my favorite topic and I'm glad to have the opportunity
to share it with others if anyone to be in touch with us.
(35:51):
We have two offices, 1 is on theUpper East Side across the
street from the Metropolitan Museum, the other ones on Long
Island and Great Neck. We also do teleconference with
patients from literally around the world who want a general
idea, want us to review records or and particularly patients who
have a complex problem has been unsolved so that those are the
ways to reach us. Our website is
(36:13):
www.somebodysimple www.eyesurgery.org.
Our contact information and information about what we do is
there as well. Wonderful.
And we will include all of thoselinks right below the
interviews. So if anyone wanted to reach
out, perhaps seek a consultationfor surgery or second opinion, I
highly encourage you to do. Again, thank you, Doctor
(36:35):
Rosenthal for spending some timewith us.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new.
To help. You boost your IQ.
Leave us a review and share the podcast with your family and
friends. Stay connected with me for more
eye opening insights on ihealth,nutrition and lifestyle.
(36:56):
Until next time, keep your vision clear and your IQ.
The truth is that the cataracts will progress despite our best
efforts in the majority of people.
There are things that we can do to to to delay the need for
surgery, though, in the case that the cataract doesn't
develop too quickly. The chief amongst those is what
I mentioned earlier is better control of diabetes.
If patients have diabetes and they're out of control and they
(00:21):
control, it's going to slow downthe progression of their
cataract. Exposure to sunlight may have a
role, so pieces to spend a lot of time outdoors should be
wearing good protective eyewear.And by the way, it's not so
important that they are dark, but that they have good
ultraviolet protection. Welcome to the IQ podcast.
I'm Doctor Ronnie Bannock. Here to help you boost.
(00:42):
Your IQ with powerful insights that connect your eyes, your
brain and your whole body Wellness.
Welcome. Back, I'm your host, Doctor
Ronnie Bannock, and today I'm sohonored to have with me as my
expert guest, Doctor Kenneth Rosenthal.
He is the surgeon director of Rosenthal Eye Surgery.
Thank you so much for joining us, Doctor Rosenthal.
(01:04):
Thank you so much for having me.I'm looking forward to speaking
with you this morning. Absolutely no.
We. So for our audience, Dr.
Rosenthal is a world renowned cataract surgeon.
He is based out of New York City.
He gives many talks nationally, internationally.
And again, we are so honored to have you with us today to share
your expertise in this topic of cataracts.
(01:25):
But before we talk about cataracts, could you first share
with our audience what got you so interested in this particular
subspecialty of cataract surgery?
Just please share your journey with this.
Sure, thank you. It started probably the Seminole
moment was, believe it or not, when I was in high school and my
Grandma Rose had cataract surgery.
(01:46):
Now we have to remember this wasin the 1960s or early 70s, and
in those days cataract surgery was very different.
So she was completely blind fromher disease, from her cataracts
because in those days we waited until cataracts were ripe, until
they were so bad that the patient was banging into walls
and she had cataract surgery done and she had successful
(02:08):
surgery. She wore those thick Coke bottle
glasses that you may have seen historically that people wore
back then. And that was before intraocular
lens were introduced in the United States.
And so that prompted my interestinitially.
But if you Fast forward then fora period of time when I was in
medical school, I simply did a rotation in deciding what to do.
(02:29):
I did a rotation in ophthalmology, which by the way,
was required in my medical school.
And the first day it became clear what I wanted to do.
And if I thought about it, this made sense because I'm a
musician, I'm a pianist. So my I, I enjoy things, doing
things with my hands and have dexterity.
My father was an engineer, so I drew on some mechanical and
(02:51):
analytical things. And of course, with the
scientific background, ophthalmology is the perfect
meld of that. And cataract surgery in my world
as the epicenter of that just made a lot of sense.
And so I was drawn to it very early.
Thank you for sharing your journey and I have to say your
hands are so skilled. I've seen some of your work.
It is beautiful. And so your patients are very
(03:13):
fortunate to have you as their doctor and their surgeon.
Thank you. You're too kind.
Appreciate. That now it's comes from the
heart and I really mean every word.
Doctor Rosenthal for our audience, give us just a general
overview of we've heard this term cataract.
A lot of people don't really know exactly what it means.
So what is a cataract? Why does it develop?
How does it impact vision? Just give us a 30,000 foot view
(03:36):
of the topic. Sure.
OK, So cataract is nothing more or less than a clouding of the
natural lens of the eye. The eye is built like a camera,
if you will, and the eye has a lens inside of it.
And when that lens opacifies, itbecomes cloudy, it impedes the
vision, it prevents light from getting from the front of the
eye to the back of the eye. And the patients will usually
(03:59):
have symptoms when the cataract develops sufficiently things
like just decreased vision in general and it may take the form
of glare, particularly glare from headlights at night is a
common is a common complaint that patients have trouble
seeing small print. And then just generally people
may just have difficulty conducting what we call
(04:20):
activities of daily living, the day-to-day tasks that require us
to have good and reliable vision.
And so at the point that the cataract is becoming significant
in that way, that's when we entertain cataract surgery.
Thank you for that eloquent explanation.
Now I wanted to ask in terms of cataracts, this oftentimes comes
(04:43):
up. Does everybody get them or are
more people, are some people more at risk?
Could you explain that a little bit?
Sure, the answer is yes if and Ioften tell my patients if who
have early cataracts. If you live long enough, you
will have cataract surgery. Having said that, I had the
pleasure of seeing about 3 weeksago a very nice lady who's 107
(05:05):
years old and who's just now coming to cataract surgery.
She lives alone independently, has all of her faculties, and
now is first time. But more typically, cataracts
will develop earlier on. Usually the average age for
cataract surge in the United States, last I looked, was in
the mid 70s. But it runs the gamut.
You can have childhood cataracts.
(05:26):
In fact, you can have cataracts that you're born with.
They're called congenital cataracts.
They're a little different than adult cataracts, but they are
nonetheless share the feature ofcloudy lens.
So you can develop it at any age.
But there is an increase incidence of cataracts as we get
older, and it's inevitable. Pretty much, yeah.
Yeah. To echo what you said earlier,
if you're fortunate to live longenough, you will develop a
(05:49):
cataract. And what I always tell my
patients is that even though youmay have a cataract, it doesn't
necessarily mean that you need to get surgery right away.
As you mentioned in your centenarian patient, she was not
affected by her cataract. She probably had them for for
decades before she finally came to you for surgery.
Just having a cataract does not mean that you have to be rushed
(06:10):
into any type of intervention for them unless they're
affecting a person's daily activities.
Is that fair to say, Doctor Rosenberg?
Precisely it it has to do with what the patient's particular
needs are. Now, as one might imagine,
everyone's needs are different. So someone who is who is you or
me who's doing surgery, who needs keen vision would probably
come to surgery much earlier because we were vision on the
(06:34):
other. And so that's at one extreme.
But the other extreme would be, let's say a more sedentary
individual who spends most of the time, say, watching TV and
doing a general test, doesn't read and doesn't have a lot of
visual needs. Indeed, the cataract may be a
lot worse before it starts to impact the activities of daily
living, as we say. And then there's everything in
(06:54):
between. And most people fit in between
those two things. And again, it's our task as
surgeons, as the doctor responsible for making that
decision to, to give patients good advice as to when the time
is to have surgery. But more and more we're going
earlier and we'll, I guess we'llget to that eventually is
because we keep getting better and better doing the surgery.
(07:16):
So the risk profile, since it becomes less, will accordingly
allow us to do surgery in an earlier stage.
Contrast it, if I will, with what I described to you as my
grandmother's journey where she was basically banging into walls
before in an earlier age where cataract surgery was far
riskier, that cataract surgery now has a much lower risk
(07:36):
profile. In fact, it's probably 1, if not
the most safe, one of the safestsurgical procedures in old
medicine. Doctor Rosenthal, it seems like
age is perhaps the biggest risk factor for cataract development.
As you mentioned earlier, there can be other things like
pediatric cataracts, congenital cataracts.
What are some additional risk factors patients may have for
(07:59):
cataract development or cataractprogression?
So less common but also prevalent enough are systemic
diseases that affect the eyes. The most common one in my
practice is diabetes. So patients who have
particularly poorly controlled diabetic condition are more
prone to develop cataracts lateron, earlier on than they would
(08:21):
otherwise considering other factors.
Other risk factors are things like patients who take steroids
or cortisone for a variety of medical conditions.
And by the way, less well known is there are a number of nasal
sprays used to things like sinusitis and allergies that
have corticosteroids in them. And indeed those have been
linked to development of cataracts too, something which
(08:44):
by the way, is often not heated by the patient.
They're not aware of it. Of course, taking steroids is
sometimes inevitable. The cataracts that develop are
no more difficult or easy to remove, but that is an
additional risk factor. Poor nutrition would be 1.
But in the United States is extremely rare to to see people
who are severely malnourished. But that is also a less common
(09:06):
factor worldwide. Yeah, just to expand on what you
said earlier about steroid use, I've even had patients who take
not just steroid sprays or inhalers for asthma, but people
who use a lot of topical steroids for certain skin
conditions, especially when it'saround their face.
I've even seen earlier cataractsdevelop in patients who do take
(09:27):
even topical steroids and drop form as well.
So it's basically if is this correct like any type of steroid
can maybe? Unless I left that perhaps the
most common in our practice, which is topical steroids in the
eye. So there are a lot of eye
conditions that are treated withsteroids and sometimes people
are treated with steroids in a less than careful way and in
(09:48):
advised and advisedly careless way.
And they use more steroids than they need to develop early
cataracts. By the way, topical steroids are
also associated with the development of glaucoma, which
is also a serious condition and so one has to be always
cognizant of it. Absolutely and definitely let
your eye doctor know if you're taking steroids of any kind when
(10:09):
you go for your annual visit, make sure that you let your
doctor know that you're on steroids.
One other quick thing I wanted to ask you about, what about
trauma? Could that be a risk factor for
cataract progression and? Yeah, sure.
Yeah. And injury and interestingly
enough, injury that's remote. And we see patients who had hit
an eye with baseball as a teenager and now they're 70 and
(10:29):
they've developed traumatic cataracts.
And we know that too because traumatic cataracts often look
different than regular cataracts.
And they constitute a subset of the high risk group for cataract
surgery because the natural support system of the cataract
of the lens of the eye, if they're called zonules, they're
like trampoline wires, they become extended and or broken
(10:52):
and it can lead to instability of that lens.
And that requires the special kinds of surgical interventions.
But indeed, trauma is an important consideration.
Now I wanted to move on to ask you about prevention, things
people can do. We mentioned, OK, it's going to
cataracts happen to everyone. No matter how clean a life you
have, you will still develop a cataract if you live long
(11:14):
enough. But what are once a cataract
develops? Are there things people can do
to prevent it from progressing? What are your thoughts on that?
So first of all, I'm going to preface it by saying yes, but
because the truth is that the cataracts will progress despite
our best efforts in the majorityof people.
There are things that we can do to to to delay the need for
(11:36):
surgery, though in the case thatthe cataract doesn't develop too
quickly. The chief amongst those is what
I mentioned earlier is better control of diabetes.
If patients have diabetes and they're out of control and they
control, it's going to slow downthe progression of their
cataract. Exposure to sunlight may have a
role. So pieces to spend a lot of time
out outdoors should be wearing good protective eyewear.
(11:58):
And by the way, it's not so important that they are dark,
but that they have good ultraviolet protection.
And then generally there are nutritional.
The nutritional aspects are a little bit more controversial,
but there is some evidence that antioxidant vitamins, ACE as
well, may have some role in somewhat retarding development
of cataracts. Absolutely.
(12:20):
I'm thinking back to the studiesthat were published.
I know that some were controversial, some said that
they helped and many others saidthat they didn't, whether it's
dietary or supplement wise. But I always tell my patients
it's always important to have a diverse diet rich in fruits and
vegetables because even though it may not prevent cataract
progression, it will help you inmany other aspects of your eye
(12:41):
health. So that's always key as a
foundation to eye health. I wanted to ask you also, Doctor
Rosenthal, there are some products on the market.
Some of my patients have come tome.
Taking eye drops that. Have been branded or they're
promoted to help prevent cataract progression?
What are your thoughts on those types of products that are
available over the counter for cataracts?
(13:05):
Right. In a word, in my opinion, they
don't work. Every few years something new
comes out and I have yet to see something that I have feel is
convincing in terms of either preventing progression of and or
reversing cataracts. But you still see them on the
market and egregiously I think some of them are actually
(13:26):
labeled that way. Reverse your cataracts and so on
with one of them. Not to be political here, but
one of the new administration's projects as well is to try to
produce some truth in advertising even for over the
counter items. And I think that's a key target.
I think that people spend money on things that have no proven
benefit. And the truth is, and I don't
(13:48):
mean to be glib about cataract surgery, it is real surgery.
And of course it has risk. But since it is one of the
highest, most successful procedures, with the highest
yield and the greatest patient happiness, there's very little
reason to to agonize over and when the time comes.
Yeah, thank you for your opinion.
I'm very much so in agreement. I typically do not recommend to
(14:10):
my patients that they use these over the counter products.
However, if someone is really adamant they want to take their
homeopathic medications for their eye health and for
prevention, I don't tell them tostop.
I'm very much aware that some people truly want to do things,
whatever they feel they're in line with to promote their eye
health. And as long as it's not going to
(14:31):
hurt, I don't tell them that they absolutely need to stop
those. Impede.
They're coming to surgery when they really need it because
there are cases where people wait longer than is ideal.
We can remove the worst of cataracts and we can have create
good results. But the truth is that a very
advanced cataract does bear somewhat of a higher risk
profile than a more moderate cataracts.
(14:52):
If it becomes ill advised to wait an excessive period of
time. Not the least of which too is
that when patients cataracts become severe enough and it
impedes their vision enough, there are risks to them.
For example, trips and falls because they can't see.
And that is that's one of the indications where we will step
in even when the patient is not have a lot of complaints and
(15:13):
say, look, you really need to dosomething.
We've seen from time to time people who have repeated
automobile accidents and it's clear that it's because they
can't see. And that's where you have to
step in and be the doctor and say this is what you really
need. Yeah, yeah.
And I've actually had that conversation with a few patients
where I basically tell them yourvision is no longer, it doesn't
(15:35):
meet the state's requirements todrive.
So unless you have your cataractsurgery, you really should not
be driving at this stage. It's a risk to you as well as to
others. Yeah, absolutely.
Doctor Rosenthal, thus far, thishas been such an enlightening
conversation. You have been so informative,
giving some really unique insights into cataracts.
And I'm looking forward to hearing more about cataract
(15:57):
surgery as well. But first, we're going to hear
from one of our sponsors. We're going to take a very short
break. Please stay tuned.
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Today we're chatting with DoctorKenneth Rosenthal, a leading
cataract surgeon. So Doctor Rosenthal, let's now
dive into your specific area of expertise, which is surgery.
(18:50):
Tell us about cataract surgery. How is it done, and also maybe
how is it different now than what your Grandma Rose
experienced? What are some of the
technological innovations that have happened over the past few
decades that make cataract surgery such as safe and
effective procedure? Sure, good.
Thank you. So this is one of my favorite
(19:11):
topics to talk about and I've been around just long enough to
have seen an incredible evolution over what I would can
see is historically a very shortperiod of time in the evolution
of cataract surgery from a moderately to high risky
procedure to an elegant, highly successful, very safe rocedure
with incredible visual results. What I'm going to say, I'm going
(19:34):
to go to the punch line 1st and then come back and retrace it.
And the punchline is that when we do cataract surgery on the on
patients, most of the time now we exclude patients of course
who have other, we call comorbidities.
So we have other medical problems or other problems with
their eyes that preclude having perfect vision.
(19:54):
But if you have an otherwise perfect eye with a cataract, the
likelihood of you restoring perfect vision is extremely
high. And in fact, I would have to say
that in a majority of patients, they see better after cataract
surgery than they've ever. Seen in their life and as a
youth and that's a remarkable and let me lead you through how
we got there. So if we go back to the 1950s
(20:17):
and 60's, the conventional surgery was done.
We'd remove the natural lens of the eye, but you didn't replace
it with anything. You'd give patients these very
thick sort of Coke bottle glasses and indeed they work.
But of course you were also working there with a large
incision. So if we look at large incision
and no lens to put in the eye, we had a very different
operation. Probably the greatest innovation
(20:41):
in eye surgery in its history was the development of the
intraocular lens. Intraocular lens was invented by
a gentleman by the name of Harold Ridley, who ultimately,
by the way, was knighted by Queen Elizabeth for his
achievements. And actually I had the honor of
being invited to a 75th celebration, 75th anniversary
(21:03):
celebration of the invention of a Dracula lens in London.
It was actually held in the Tower of London.
And it was absolutely an awesomeexperience.
And realized that now 75 years later, not only we have
intraocular lens, but highly evolved ones.
And I'll get there in a moment, but that's where we've come to
the intraocular lens. And by the way, Harold Ridley
(21:24):
met with tremendous opposition. He was called a charlatan.
He they people tried to take hislicense away.
It was a horrendous for him and the, the, but he prevailed.
And by the way, never patented the intraocular lens and never
derived a dime of royalties fromthis incredible invention.
So his great gift to the world now the intraocular lens.
(21:47):
So let me follow the intraocularlens path forward has continued
to evolve. We developed lenses that
function better, lenses that have been engineered so that the
visual outcome from them is better than the natural lens of
the lens that we're we're born with the sake of being
sacrilegious that God gave us isan imperfect lens in some ways.
(22:09):
Well, the engineers have figuredout ways to make the vision even
better. So the intraocular lenses that
are available now are highly evolved lenses that provide an
incredible quality vision. That's why I said that a large
percentage of patients see better than they've ever seen.
Now if you add to that some lensfeatures, I'm going to talk
about two in particular that I've been involved with in that
(22:30):
I think are very exciting. I was very fortunate to be the
first person in New York to use a particular lens now which is
called an EDF or extended depth of and this particular lens
gives a full range of vision andthis lens allows patients to see
without glasses. Now I want to give you
perspective here. Picture an 85 year old patient
(22:52):
who now does not wear glasses atall, not for reading, not for
distance, not for driving. That's remarkable.
Not only that patients who have been extremely nearsighted,
meaning they couldn't see past the end of their nose without
glasses, now suddenly are able to see without glasses at all.
So we can do that by implanting an intraocular lens,
appropriate. The other exciting lens which
(23:14):
goes along the parallel with that is a lens called a light
adjustable lens. And without going into too much
detail about that, the light adjustable lens is a lens that
you put in the eye and look you put.
Sometimes we put on a new suit and we think it fits pretty well
until we get it home. But we can bring it back to the
tailor a few days later and havethem make it fit perfectly spoke
(23:35):
version of the intraocular lens because the intra, this lens can
be implanted in the and then youcan make adjustments if the
person wants to see a little better close up or far, you can
adjust that lenses power or prescription after the surgery.
So that's another great innovation that we've been
working with a lot now and whichreally does enhance it decreases
(23:55):
patients need for wearing glasses and improves the quality
of vision overall. OK, now that's the intraocular
lens track. Let's go back to the other parts
of the procedure. I mentioned to you that in the
1950s and 60s a large incision had to be made and the cataract
that was removed in an entire piece.
Charlie Kelman, who's from new was from New York, invented a
(24:18):
device that could go into the eye and break up the cataract
and make the incision. Now modern day cataract surgery
less than 2mm in size. That means that the that's about
the size of the tip of a pencil.What does that mean?
It means is less invasive surgery.
So we, we meaning US ophthalmologist really started
the exploration of what's now been considered minimally
(24:41):
invasive surgery for all specialreally the first ones to do
that. And so now we have a minimally
invasive procedure. And of course those instruments
have undergone incredible refinements too, so that the
healing process is faster, the surgery is safer, and very
importantly, we've developed techniques which allow us to do
more difficult cataract surgery without having morbidities.
(25:04):
Then the last leg of the three legged stool is the femtosecond
laser. Now this is a laser which was
developed more recently in the last 15 to 20 years and much
more commonly used in the last decade.
And this is a laser specificallydesigned for cataract surgery.
And this laser opens up the cataract very precisely, and
(25:25):
then it fragments the cataract into pieces.
Now, you do this before you go into the operating room.
So what happens when you go intothe operating room?
The lens has already been fragmented, and the surgery
removal of that lens is much more gentle.
That means there's less energy fed into the eye.
That means there's less surgicaltrauma, there's less
inflammation, and the faster healing of that patient.
(25:45):
It also enables to safely do surgery on patients who have
other problems. We published a paper a few years
ago showing that, for example, patients with cornea problems
who would be affected adversely by a lot of surgery did better
with the femtosecond laser than by doing conventional surgery.
So those, I, to my mind, those are the three major innovations.
(26:06):
And if you look at the visual outcomes and you look at the
patient happiness factor in all of this, it's remarkable.
Yeah, wow, that is amazing, thisevolution that you walked us
through that Doctor Rosenthal. So just to recap for our
listeners, 3 major types of innovations with cataract
surgery #1 the procedure itself,the size of the incision, and
(26:27):
how the lens is removed. And correct me if I'm wrong, but
we're still mainly using ultrasound energy for removal of
the lens. Is that ultrasound and vacuum?
But less but love it because of right?
Yeah. And then we have the femtosecond
laser that can be used before the actual procedure.
So it's almost like a 2 step procedure.
(26:49):
So the laser can help to open upthe cataract kind of bag that
holds the cataract and then to fragment the cataract.
And then you would have these amazing range of options for
lens implants, which didn't exist until relatively recently
when even when Doctor Ridley created the first lens implant,
it took a very long time of manydifferent iterations to get the
(27:11):
optical quality and the range offocus as you mentioned, the
enhanced depth of focus and thenthe light adjustable lens to
have all of those developments come become available for our
patients. Now I know that there is some
choice when it comes to cataractsurgery, the laser, the lens
options in our last few minutes together.
(27:33):
Doctor Rosenthal, can you walk us through maybe in just a
minute or two, how a patient canhelp and you can be how you can
help a patient make that choice in terms of the procedure and
the lens options that are best suited for that patient?
Sure. So first of all, good Sir, good
medical care begins and ends with a conversation with the
(27:53):
patient. And in in our practice, we spend
a lot of time getting to know the patient, getting to
understand what their visual needs are, what their
limitations are and and frankly what they don't want.
So for example, the, and I should disclose here, for
example, that some of the because of the way the insurance
(28:18):
system is established, some of these do come at additional out
of pocket costs. And so one has to be sensitive
to the vision to the financial, financial limitations of
patients in some cases as well. But if we look back at the pure
medicine of it, well, for example, if I have a patient
who, who has a very active lifestyle, they drive, they
(28:38):
watch, they drive, they use a computer, they read, they carry
their iPhone around. Those are patients who are very
good candidates for being spectacle free.
Also patients who are extremely near or very farsighted, who
have gone their whole lives basically shackled to glasses or
contact lenses, now have the option of having those kind of
(28:59):
that kind of a procedure. The light adjustable lens, I
consider it the perfectionist lens, the light adjustable lens,
probably the lens I'll have whenI need cataract surgery because
it does allow such exact focus. My number one candidate is my
golfer who wants to see their golf ball at 300 yards.
OK, so you can perfect the result there.
(29:21):
So everything is a discussion with the patient and then we
discussed the potential risks and benefits there as well.
The downside for the light adjustable lens, for example, is
that it does require some work after the surgery.
They have to meet with the with my associate who does the
adjustments and there's a numberof visits there as well.
So they have to be willing to dothat.
(29:42):
But that's that's the conversation that we have with
them, yeah. Got it.
So what I'm hearing from you, Doctor Rosenthal, is that there
is no ideal procedure implant for everyone and it really is a
personalized choice based on thepatient's individual needs and
their activities of daily living.
What do they need to do in theirdaily life?
So patients just sit down with their surgeon and have that
(30:04):
conversation well in advance of the day of surgery.
It should not be done on the operating table, correct?
And a matter of fact, what I left that which is extremely
important is we have to look very careful at each patient to
see whether or not there are anyother problems with their eyes.
For example, a patient with macular degeneration is not
(30:24):
generally a good candidate for some of these technologies.
So we have to examine them, evaluate that.
We do 18 separate exams and tests on every patient that
comes in for cataract surgery. And we do this a for the
accuracy of measurement because you realizes that to perfect
that visual result, we have to do a lot of measurements.
We do a a lot of calculations, we do a lot of evaluation, but
(30:46):
we also do tests to determine the safety.
In other words, is there a problem with the cornea?
Is there a retina problem? Is a neurological problem?
Do they have glaucoma, Any of those things.
And those always weigh into our decision about what to recommend
to the patient as well. Wow, thank you for sharing all
of your incredible insights about cataract surgery.
(31:07):
I can tell like you're one of the leading experts in this
field and your patients are proof of the miraculous
recoveries that people can have so quickly.
And some patients can go back towork, sometimes even the next
day or a few days later. Isn't that right, Doctor
Rosenthal? That's right.
Yeah. And in an average case, the
patients have excellent vision even day one.
And it's not uncommon to see 2020 vision on day one, doesn't
(31:29):
always happen, not uncommon at all.
And quick recovery to vision, weusually we operate on one eye at
a time, but we usually try to dothem fairly close together so
the patients get a quick rehab. The results are really
astounding. I'm I want to leave you with a
thought, 'cause I have to put this in as one of the loveliest
things that a patient ever told me.
(31:50):
First of all, I tell patients before surgery expect to be
amazed because with patients lose vision gradually over time.
They forget how their good vision really is and they come
in the next day. The wow factor is there and I
can tell you that after doing this for over 40 years, the
thrill is still there for me to be able to do that for patients
to see that result. But the nicest thing a patient
(32:11):
ever told me, this was an elderly Greek lady who had this
very poetic Greek way about her.And she came the next day and
she said, Doctor Rosenthal, you washed the flowers for me.
A lovely way of expressing what cataract surgery really does.
It really clears their vision and gives them vibrant colors
and clear vision. Yeah, I've had patients tell me
(32:34):
I never, I didn't realize that my vision was hazy for so long
or what colors are so washed out.
Then after cataract surgery I feel like I see in Technicolor,
like it's really incredible. Like the difference pre and post
op. Again, thank you Doctor
Rosenthal for explaining all of this in such an easy to
understand manner and for all the work that you do.
(32:58):
One last question before before I let you go today.
Is there any common myth or misconception about cataracts or
cataract surgery that you would just love to dispel for our
audience today? Sure.
This is a long laundry list of misconceptions that people have.
The thing we used to hear a longtime ago, we don't hear it as
much now, but we do hear is the concept that the cataract has to
(33:20):
be ripe as if it was some sort of optical fruit.
But in fact, ripe came from the concept that cataracts in old in
the old days, what we say had tobe so bad that it had that
patients had to be completely disabled.
So patients who come in saying, but is my cataract right by say
we don't use that expression anymore.
(33:41):
The other silly things people say, do you have to take my eye
out in order to out of its socket in order to do the
surgery? Is the surgery painful?
You know what does? Sometimes we'll see patients
with milder cataracts in their intent that they need to have
surgery. And we explain that we generally
not only have to do the surgery when they're having trouble.
And sometimes we kind of straighten to say, I have a
(34:02):
cataract. Don't you want to take it out
and say, no, we don't need to dothat?
I would say those are probably the most common things.
Oh, and then, of course, what wealluded to before is patients
asking me about eye drops or other medications that they can
take that are going to make the cataracts dissolve.
And that's a misconception. Yeah.
Yeah, yeah, I've definitely heard those and many more.
(34:25):
Another common one is do you have to do the surgery again or
is my cataract going to grow back in a few years and will I
have to have it done again? So.
So that's actually a. Good question because the answer
to that is the cataract doesn't grow back, but a film may grow
behind the lens implant and it then in fact sometimes it's been
called a secondary cataract. It's a misnomer, but it also may
(34:46):
block the vision again down the line.
And that's a that's called capsular opacification and it's
easily treated with a an in office laser procedure that
takes about 3 to 5 minutes. But that would be the only.
But it's a simple. Fix if that happens and it's not
the. Cataract.
Showing that. And in fact, it happens, I would
have to say, in the majority of people at some place along the
(35:08):
way. Yeah, yeah, I've definitely seen
that as well. Again, Doctor Rosenthal, you are
a wealth of information. Thank you so much for doing
everything you do for your patients and for us as
ophthalmologists and advancing the field.
And you've participated in many research endeavors to help
improve cataract surgery and getsome of the new products onto
(35:28):
the market. So thank you for your work with
that. If anyone wanted to learn more
from you, perhaps even seek out a consultation for cataract
surgery, how could they find you?
Sure. And let me say before I answer
that it's been a joy to spend some time with you and discuss
basically my favorite topic and I'm glad to have the opportunity
to share it with others if anyone to be in touch with us.
(35:51):
We have two offices, 1 is on theUpper East Side across the
street from the Metropolitan Museum, the other ones on Long
Island and Great Neck. We also do teleconference with
patients from literally around the world who want a general
idea, want us to review records or and particularly patients who
have a complex problem has been unsolved so that those are the
ways to reach us. Our website is
(36:13):
www.somebodysimple www.eyesurgery.org.
Our contact information and information about what we do is
there as well. Wonderful.
And we will include all of thoselinks right below the
interviews. So if anyone wanted to reach
out, perhaps seek a consultationfor surgery or second opinion, I
highly encourage you to do. Again, thank you, Doctor
(36:35):
Rosenthal for spending some timewith us.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new.
To help. You boost your IQ.
Leave us a review and share the podcast with your family and
friends. Stay connected with me for more
eye opening insights on ihealth,nutrition and lifestyle.
(36:56):
Until next time, keep your vision clear and your IQ.
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