Glaucoma, Eye floaters and Symfony (2)

Author: Вадим Аврукин (Vadim Avrukin)
Published: 2022-11-20

Part 2. IStent is an FDA-approved implantable device that reduces the intraocular pressure, slowing down the loss of vision from glaucoma. IStent can be performed in conjunction with the cataract surgery and it is very safe and effective.

Glaucoma, Eye floaters and Symfony (2)


Are there many people that need this shunt?

At Benjamin Eye Institute, practically every other patient has glaucoma, and the patient’s intraocular pressure will be normal for about 7 years.

Many people ask: “Why is it called Benjamin Eye Institute when there’s only oneDoctor Benjamin?”

He is not alone! We have many specialists.  Ophthalmology has seven disciplines with corresponding specialists for the cornea, glaucoma, plastic surgery, neuro-ophthalmology, and so on.  I do refractive surgery and general ophthalmology, and there are clearly things that aren’t my area of expertise.  I can look at the retina and determine if someone has macular degeneration (or a number of other things), but its treatment should be left to dedicated specialists.  One of the most in-demand is the retina specialist.  Previously, we had to refer patients to other offices, which is problematic.  We don’t know what kind of insurance others take, and it isn’t always clear who will take the patient, so we hired a retina specialist of our own, Pamela Golchet.  She has been with us for about a year-and-a-half.

Some people are afraid of the word “retina”, and think someone will go in there and make things worse. 

You should be scared of random doctors, but not proven specialists.  Pamela Golchet can give an objective opinion on whether the patient needs an operation.  For example, are there holes in the retina, or just floaters and flashes?

I’m familiar with floaters.  I see them all day.  I have this idea that all these spots and  blurs are the consequence of old cataract surgery, and not because I didn’t receive the operation from you (I didn’t know about Benjamin Eye at the time), but because of the procedure itself.  Is that possible?

That’s a great question.  4/5 of the eye’s volume is filled with a gelatinous substance called the vitreous body.  It fills a shell that holds the shape of the eye and is rigid, or minimally elastic.  The other 1/5 is various muscles on the outside, with the lens, iris, retina inside.  That vitreous body allows light through to the retina and is composed of 20% hyaluronic acid which keeps a water between its long chemical chains.  With age, these chains decompose, so the gelatinous center thins, shrinks, and peels off the back wall of the eye.  This is what causes persistent floaters.

Is there a method for getting rid of them?

There’s vitrectomy, which can remove all kinds of floaters and spots.  But this operation is complicated, expensive, and also risky.  Methods for splitting large floaters into hundreds of smaller ones are available, but the YAG laser used in these procedures causes trauma that can translate into retinal detachment or glaucoma.  Among serious ophthalmologists, doctors who use these procedures do not have the best reputation.

What specifically causes their development?

It is often spontaneous.  You’re not doing anything special, maybe reading a book or watching tv, and it happens suddenly.  Also after head injuries from a fall or sports like boxing.  The eyes have the fastest muscles in the body.  After the peeling has occurred, fragments of the vitreous body move about and can’t keep up with the movement of the eye, while progressively more peels off and conglomerates…  These cast shadows and are seen as floaters.

As far as I can tell, the new generation of Symfony lenses has caused quite a stir.  You were the first surgeon in Los Angeles to use Restore, which at that time were cutting-edge, and now you’ve done it again!  Remind me what makes Symfony so revolutionary. 

Regular multifocal lenses allow you to see things in the distance and up close, but aren’t as good in mid-distances – interpersonal communication, the computer, shopping, speedometer, GPS…  In addition, there are problems with halos, reflections, rays, loss of contrast perception and partial loss of light.  Conventional lenses lose about 20% of light, and in the case of astigmatism, the result heavily depends on corneal procedures.  People often complain that they can see everything, but there isn’t enough light.  Now, finally, there’s a lens that solves all these problems.

Yes, it is a powerful step forward.  A new quality of life. 

This is a phenomenal invention – a complex diffractive lens with an excellent resolution!  Manufacturing such a lens is extremely difficult.  If you’re creating it for a huge telescope, it costs hundreds of thousands of dollars, but so does this tiny lens on an industrial scale.

I hope we can continue to talk about them next time.  In the meantime, I have questions from our readers:

Are Symfony lenses perfect, or where can they improve?

  1. Are other lenses doomed?
  2. Can a method for cataract treatment be invented that doesn’t involve a replacement lens?
  3. If these lenses do not suit the patient, what can be done?
  4. Is there a waiting list?  If so, how long is the wait?
  5. Have they been tested on others?
  6. Is there a way to prevent cataracts?

Thank you.