Dr. Joseph J. K. Ma

Blade-Free Laser Cataract: ISA®

ISA® Bespoke Blended: Reading Glasses

Laser / Vision Correction Post-Cataract

Blade-Free Laser Cataract / Lens Refractive Surgery: ISA® Bespoke Blended

ISA® Bespoke Blended Refractive Cataract/ Lens Surgery:

ISA® Bespoke Blended Refractive Cataract/ Lens Surgery is a custom optimized treatment option for those over the age of 40 who would benefit from either cataract or lens surgery, designed to minimize your need for reading glasses, as well as distance glasses. While every individual ages at a different rate, for any given person, beyond a certain age, there is no perfect solution to completely eliminate the need for reading glasses under all situations. However, with thoughtful forward planning, a careful evaluation of your individual visual architecture, and special consideration for your specific visual needs with our ISA® Customized Surgical Consultation, we can work together to decrease the frequency of when reading glasses would be required post-operatively.

Once you arrive for your consultation, you will first have the initial evaluation components of the ISA® Customized 13-D Diagnostic Set performed. This is a proprietary combination of evaluation indices and protocols for capturing the most important aspects of your specific visual architecture. You will then proceed with our ISA® Customized Surgical Evaluation to identify which specific option is most suitable for your visual needs and lifestyle, and whether you would be a suitable candidate for that procedure. This is done in combination with a selection of a suitable Bespoke Blended technique that would result in the safest and best possible reading vision for you.

ISA® Bespoke Blended Methods:

There are several ISA® Bespoke Blended methods for decreasing the need for reading glasses. These include:

1) Optimized blended refractive anisometropia

2) Optimized blended asphericity

3) Combination blended optics – also known as Bioptics: small aperture, multifocal, diffractive, and chromatic aberration optimized solutions often combined with a laser procedure.

These technologies are leveraged using ISA® protocols and algorithms, to help you optimize each eye to your own personal preferred tasks, and decrease (but not entirely eliminate) your need for reading glasses. Without treatment, individuals will need reading glasses to read computers, phones, and even larger print reading materials, even if held further out. Although there is no perfect solution for presbyopia, ISA® Bespoke Blended solutions, can decrease the situations and the distances at which glasses would be necessary.

ISA® Bespoke Blended Vision vs Traditional Monovision

Blended vision means having one eye corrected preferentially to focus well in the distance, while the other eye is corrected preferentially to focus well at an intermediate or near distance. This is different from traditional monovision. Traditional monovision generally refers only to an intended discrepancy in the prescription between the two eyes of approximately +2.50 to +3.00 D, such that one eye is targeted for distance and the other eye targeted for very near close tasks. For the average person, this is usually too large of a difference in refraction to accept and tolerate without correction. However, there are some patients who either naturally have a large discrepancy in their prescriptions, or have no problems adjusting to this difference. These individuals may do well with this option. Our ISA® Customized Surgical Evaluation allows us to take the concept of a blended vision even further by optimizing and combining the necessary technologies based on your needs, your visual habits, and the specific visual architecture of your eye to arrive at the safest, most appropriate and most accurate procedure for you.

Not everyone is suitable for ISA® Bespoke Blended Refractive Cataract/ Lens Surgery however. Your ISA® Customized Surgical Consultation based on your 13-D Diagnostic Set allows us to fine tune the ISA® Bespoke Blended procedure to best suit for your needs and the very special and unique visual architecture of your eyes.

What is Blade-Free Laser Cataract/Lens Refractive Surgery?

A cataract develops as part of the normal aging process. The natural lens in your eye will opacify with time to form a cataract. A cataract can cause blurred vision by obstructing, scattering and/or distorting the light that reaches your retina. This is a gradual process. Prior to the onset of an opacity that completely obscures light, the natural lens first becomes dysfunctional and loses its ability to focus. This results in the need for reading glasses. Furthermore, even before a cataract is formed, it is possible that an individual requires glasses at baseline to see far, to see near or to see at all distances. Refractive cataract surgery aims to minimize the degree of the eye glasses prescription as well as the dependency on glasses with interventions before, during and after the removal of the cataract during surgery. Refractive Lens surgery aims to do the same to minimize the degree of eyeglasses prescription, however the word “lens” is used to reference that this occurs before a visually significant cataract has developed – the surgery and the procedures involved are essentially the same, albeit usually with less risk because the lens is typically still soft and does not require significant energy to remove.

Both refractive cataract surgery and refractive lens surgery can now be performed with a laser, which results in blade-free incisions more than 95% of the time. In other words, metal blades are now often not necessary for laser cataract / lens refractive surgical procedures.

The natural course of an aging lens is that it will continue to develop dysfunction and opacity with time, ultimately resulting in increased degradation/blurriness to the quality of your vision. Cataracts are not yet currently treatable with medications and do not resolve without surgery.

Our Intelligent Systems Approach® greatly improves pre-operative diagnostic accuracy and intra-operative safety to result in superior post-operative vision.

Refractive Surgery vs Standard Cataract Surgery:

Refractive surgery is surgery that is designed to minimize the need for glasses. Patients with cataracts who often also need reading glasses, may require up to 3 or more different glasses prescriptions for vision at different distances. Any given individual might require one prescription for distance vision such as driving, another for intermediate tasks such as computer work, and a third for fine print near vision such as newsprint, depending on their visual requirements and their pre-existing visual architecture.

A person’s eyeglasses prescription after surgery is also typically different and not dependent on the glasses that they may have been wearing pre-operatively. For example, if an individual never required glasses to drive or to read their computer pre-operatively, depending on their visual architecture, with a standard cataract surgery, they may subsequently require glasses for these tasks after surgery which they did not before. Freedom from glasses and the need for glasses is not addressed with standard cataract surgery. Refractive surgery, which includes laser vision correction, is not covered by OHIP, and is considered similar in concept to cosmetic surgery.

The government provides for a standardized generic treatment pathway for cataracts (Option 1, Standard) that has been deemed to include that which is considered medically necessary. The Ontario government will pay for a patient to undergo this standard generic treatment, which can achieve a basic level of post-operative visual improvement. The standard generic treatment does not take into account refractive surgery or the fine-tuning of the level of the prescription of the eyeglasses that would be necessary after surgery for specific tasks.

Our ISA® Customized Bespoke Blended Refractive Component of Surgery goes beyond what is medically necessary to give you a decreased dependency on glasses.

Our ISA® Customized Bespoke Blended Refractive Component of Surgery goes beyond restoring a level of vision that is deemed medically necessary, to deliver vision with minimal dependency on glasses. Many patients value this because it allows them to enjoy their day to day activities, hobbies, and life in general to a greater degree.

Whether or not to proceed with ISA Customized Surgery is a personal choice that every patient needs to make for themselves and for their family.


Am I a Candidate?

It is important to know whether or not you are a good candidate for Blade-Free Laser Cataract/Lens Refractive Surgery. To know for certain, please visit us for an ISA Customized Surgical Consultation.

Potential refractive candidates begin benefiting from our Intelligent Systems Approach® at the consultation stage. Led by our Surgeon, our skilled team of Vision Care Associates performs meticulous measurements using 13 unique trusted and proven diagnostic tools in addition to administering an in-depth qualitative evaluation. The diagnostic measurements are refined and repeated as necessary, forming your ISA Customized 13-D Diagnostic Set, which will allow our Surgeon to achieve the most accurate representation of your unique corneal and visual system architecture. Drawing on over a decade of insight and sub-specialized education, our Surgeon analyzes and integrates your objective diagnostic information to develop a customized surgical plan for you.

The purpose of your refractive surgical consultation is for our Surgeon to assess your unique needs, make a customized surgical and refractive recommendation and answer any medically-related questions. How to proceed is always up to you. To assist with your decision-making process, our Patient Consultant will take the time to explain your options. In either case our Patient Consultant will answer any non-medical questions that you may have.

We assess key deciding factors at your surgical consultation to determine whether or not you are a suitable candidate for the different component options of refractive cataract surgery. These include:

● Personal & Professional Considerations

● Lifestyle, Habits & Hobbies

● Physical Anatomy & Characteristics of Your Eye

● Health of Your Eye

● Overall Health

● Family History

Some of the conditions that will affect these key deciding factors include:

● Medications

● Dryness of the eyes

● Age related conditions

● Eye inflammation or infection

● Corneal disease or scarring

● Diabetes & other systemic diseases

Advancements and research in vision correction for refractive cataract surgery have produced a multitude of surgical options. Based on our rigorous proprietary in-depth ISA assessment, our Surgeon will identify and recommend the specific option and relevant parameters that best suit your unique needs.

How is ISA® Customized Blade-Free Laser Cataract/Lens Refractive Surgery Performed?

Cataract surgery involves removing the opacified cataract lens and replacing it with a clear artificial intraocular lens. Our Intelligent Systems Approach® (ISA) will optimize your post-operative visual results. A routine procedure requires approximately 10-20 minutes per eye to complete from beginning to end. A topical anaesthetic will be applied to your eye so that you will not feel any pain. You will typically be awake and alert so you may feel some pressure. This is normal and to be expected.

Step 1: Refractive measurements are performed including the use of a swept source OCT to obtain a 3-D virtual model of the eye. These are combined with the knowledge of your visual architecture from our ISA® 13-D diagnostics and our customized algorithms to plan for the safest, most accurate surgical procedure possible. A Femtosecond Laser is then used to pre-treat and prepare the eye for the removal of the cataract/lens. In more than 95% of cases, we can achieve a Blade-Free incision.

Step 2: An advanced technology microincisional phacoemulsification instrument is used to gently dismantle and evacuate the cataract utilizing our ISA® Customized Surgical Technique.

Step 3: An artificial lens will be custom selected for implantation using the ISA® Customized Algorithm based on an individual’s lifestyle needs and the results of the ISA® Customized 13-D Diagnostic Set.

You will continue to benefit from our Intelligent Systems Approach® after surgery because our Surgeon will monitor your post-operative recovery and systematically measure your visual improvement to ensure long-term optimized results.

ISA Customized Blade-Free Laser Cataract/Lens Refractive Technology

Cataract /Lens Refractive technology has evolved significantly over the past 20 years to make it one of the safest outpatient procedures performed in North America. We use the most advanced and trusted technology and techniques at both the diagnostic and surgical stages to ensure that you get the safest and best possible visual improvement.

Diagnostic Technology

It is extremely important that the most accurate and detailed representation of your corneal and visual system architecture is obtained to allow for superior vision correction.

This representation is achieved through:

1. Obtaining accurate measurements and

2. Applying the ISA® Customized Algorithm for the systematic validation and weighting of each of these measurements to determine the unique ISA® Customized 13-D Diagnostic Set that best captures any given individual’s corneal and visual system architecture.

The diagnostic set is important because each diagnostic tool is uniquely able to measure along specific parameters. Utilizing a combination of tools, sometimes consecutively at different temporal points, is necessary to obtain the most accurate representation. The full suite of diagnostic tools will be discussed by our Surgeon and team of Vision Care Associates at your ISA® Customized Surgical Consultation.

Surgical Technology

There are numerous surgical technologies (ie. Femtosecond Lasers for Blade-Free Surgery); each produces optimal results under a specific set of surgical parameters. Applying the right surgical technology as optimized for your treatment and your eyes is necessary to produce superior post-operative results.

This is achieved through:

1. Using the ISA® Customized Surgical Technique to determine which specific cataract technology to use and

2. Applying the ISA® Customized Algorithm to determine which lens is uniquely suited to correcting your vision.

Our Surgeon and team of Vision Care Associates will discuss the best options for you and make a customized surgical and refractive recommendation at your ISA® Customized Surgical Consultation.

Lens Technology

Different lenses can optimally correct for different visual requirements; having the appropriate procedure, lens, or pairing of lenses is extremely important to achieving the best visual outcome from your cataract surgery. Using the ISA® Customized Algorithm, our Surgeon will determine the right lens for each of your eyes.

Optimized Monofocal Lenses

These intraocular lenses are typically optimized for asphericity, filtering of harmful light, chromatic aberration and accurate effective lens positioning when possible.

Adjustable Lenses

Adjustable lenses are monofocal lenses that allow for the refinement of your eyeglass prescription post-operatively.

Diffractive Lenses

Diffractive lenses utilize optical principles to divide light into two or more focal points so that you can see at those discrete focal points. This decreases but does not completely eliminate the need for reading glasses. Some diffractive lenses utilize the principle of diffraction to minimize chromatic aberration to increase contrast and clarity while maximizing range of vision.

Toric Lenses

Toric lenses can correct for astigmatism to ensure that your post-operative vision is fully optimized.

Accommodative Lenses

Accommodative lenses have the potential to enable vision at a discreet range of focal points. This decreases but does not completely eliminate the need for reading glasses. The mechanism of action of some of these lenses is currently under debate.

Combination Lenses

These combine the benefits of various lens types.

ISA® Customized Bespoke Blended Vision

Blended Vision is the use of one eye for distance vision and the other eye for intermediate vision. It can involve using a combination of different technologies, optical properties and surgical techniques including diffractive lenses, laser vision correction techniques and bioptics to optimize the result depending on the patient’s refractive error, visual architecture and vision requirements.

Arcuate Keratotomy (with or without Femtosecond Laser)

This is a corneal procedure used in combination with any of the above lenses to correct for astigmatism at the time of cataract surgery. It involves the creation of typically paired corneal channels that act to flatten the cornea and therefore decrease astigmatism in the location of those channels. These channels can be created with a Femtosecond Laser for increased accuracy, consistency, corneal structural integrity and a decreased chance of infection.

Our Surgeon will discuss the lens selections that are best suited for your visual needs based on the ISA® Customized Algorithm and make a surgical and refractive recommendation.

What to Expect

Our Surgeon, Patient Consultant and dedicated team of Vision Care Associates will be with you every step of the way to answer questions and to make sure you have the best possible experience and post-operative outcome.

ISA® Customized Surgical Consultation

There are 3 important components to your ISA® Customized Surgical Consultation. First, our Surgeon-led team of Vision Care Associates will meticulously measure your corneal and visual system architecture using over 13 different diagnostic tools in addition to administering a qualitative assessment of your lifestyle and overall health. Second, our surgeon will assimilate and integrate the numerical and qualitative diagnostic information to determine whether or not you are a good candidate for ISA® Customized Blade-Free Laser Cataract/Lens Refractive Surgery. Our Surgeon will make an objective surgical and refractive recommendation and answer any medically-related questions. Finally, to assist you with your decision making process our Patient Consultant will discuss your options and answer any non-medical questions you may have.

ISA® Customized 13-D Diagnostic Set

After choosing to proceed with surgery, our Surgeon-led team of Vision Care Associates will schedule an appointment to further refine our representation of your corneal and visual system architecture through multiple measurements using a combination of the diagnostic tools identified as being best suited to measure your unique eyes. The refining process involved in your ISA Customized 13-D Diagnostic Set allows us to examine all the different dimensions of your visual architecture to deliver unparalleled post-operative results.

Preparing for Surgery

To ensure that you have the necessary support at home, you should involve a family member or caregiver throughout the entire process and this individual should accompany you to all consultation and follow-up appointments.

It is very important to the health of your eyes that you administer your eye drops properly. To prepare for surgery, you should fill the prescription provided and familiarize yourself with the instructions.

Day of Surgery

On the day of your surgery you can expect the procedure to last about 10 – 20 minutes. Once finished, our surgeon will place an eye shield over your eye and you will be required to wear it for at least the first 24 hours after surgery.

After Surgery

You will be expected to wear the protective eye shield at night while sleeping for at least a week after surgery. You should wear protective sunglasses immediately after surgery since your pupils will be dilated, and you should continue to wear sunglasses to protect your eyes on an ongoing basis. You should also avoid strenuous activity such as heavy lifting or bending in your first week post-operatively. Do not allow tap water to make contact with your eyes and avoid swimming and hot tubs for the first 6 weeks after surgery.

It is important never to rub your eyes. Rubbing your eyes could potentially disturb the incision site, allowing bacteria to enter the eye, which may result in an infection.

ISA® Customized Post-Operative Eye Drop Schedule

Each person’s recovery is related to the severity of their cataract and unique to their individual physiology and health; your post-operative eye drop schedule will be custom designed to optimize your recovery. It is extremely important that you follow your customized post-operative eye drop schedule to maintain your newly improved vision and the health of your eye.

It is important to remember that you must continue complying with your customized eye drop schedule for the prescribed duration even when your vision has become clearer and your eyes feel significantly more comfortable, otherwise you may not be able to achieve your full visual potential.

In addition to your prescription eye drops, you will be instructed to use non-preserved artificial tears. Though not a prescription medication, artificial tears are very important to facilitating your eye’s healing process and comfort.