When evaluating surgeons to perform your cataract
journalist, Richard A. Knox, wrote the following questions for patients
anticipating cataract surgery to ask their ophthalmologist. The questions were
published in Boston and New York newspapers. Dr. Shingleton has taken this
opportunity to provide you with answers relevant to his cataract practice and
the specialized care he gives to all of his patients.
the questions written by Mr. Richard Knox have been answered by Bradford J.
How many cataract procedures do you perform
yearly? (should probably be more than 150).
Dr. Shingleton performs
over 2,000 cataract procedures per year.
Do you use a minimal incision
(3 mm or less), phacoemulsification and foldable intraocular lens
Shingleton uses a tiny incision ( <3 mm) with phacoemulsification and
foldable intraocular lens implantations almost exclusively for his patients with
If so, what proportion of your total cataract
operations are "sutureless" (or sometimes one-suture) procedures? (should be
well over 50%).
Dr. Shingleton performs over 90% of his operations without sutures.
Sutures are used for special types of incisions, cataracts, intraocular lenses
and and medical situations. Sutures are not a problem per se, the key issue is
the size of the incision. Dr. Shingleton always uses the smallest incision
possible for each patient.
If I am not a candidate for a small
incision, why not?
Dr. Shingleton will explain his choice for your type of operative
procedure with you. The vast majority of Dr. Shingleton's patients have
small-incision, sutureless surgery, but depending on cataract type and
associated findings, larger incisions may occasionally be
What is your surgical complication rate, and what is the
risk of the most important complications?
Dr. Shingleton has one of
the largest databases for cataract surgery results in New England because of the
thousands of cataract surgeries he has performed. Our goal is for excellence and
continual improvement in our surgical treatment and Dr. Shingleton is constantly
analyzing his data and fine-tuning his procedure. He is willing to match his
results with any surgeon in the country. Dr. Shingleton has developed a
consultation practice for cataract surgery and sees patients who are referred
from all over the world. Even with a large number of complicated and challenging
cases, his surgical success rate is extremely high. Bleeding, infection and
retinal detachment are the most important complications, but these are very
rare. The success rate for significant vision improvement in all Dr.
Shingleton's patients is over 95%
What portion of your cataract
patients need only reading glasses after recovery? (it should be a majority,
even over 90%, some specialists say).
Dr. Shingleton will design
your implant to best serve your needs. Some patients are focused preferentially
for the distance, and others are focused preferentially for near. Dr. Shingleton
also occasionally uses multifocal or accommodating lenses, which allows some
patients to do very well without glasses for both reading and distance viewing.
Your final refraction after the operation will be planned specifically for you,
your visual needs and what will balance with your fellow eye. For Dr.
Shingleton's patients who are focused for long distance vision, the vast
majority can see very well far away without any glasses and simply need reading
glasses. Dr. Shingleton also uses the Crystalens accommodating IOL and
multifocal IOLs to help many patients see well, both near and far, without
How long do you suspect my recovery will take? How soon can I
be fitted for a new permanent prescription for any glasses that I will need? (If
the answer is "several months", ask about an alternative offering faster
recovery with equal results).
It is very common for Dr. Shingleton's cataract patients to
see very well the next day after surgery or even the same day of their surgery.
However, even with the tiny incision required for phacoemulsification and the
absence of sutures, a short healing time is required for the eye to stabilize in
terms of its final shape. For people who need glasses after the operation, we
generally feel that about 4 weeks following the operation is the best time to get
their permanent prescription.
What is the risk that the lens capsule
might become clouded after several years? If this happens, do you perform a
laser procedure to correct it, or refer me to someone who does?
The rate of capsule
clouding is approximately 25%. This is a normal phenomenon that occurs even more
commonly in younger people. If this does happen, Dr. Shingleton will perform
your laser procedure in the surgical center. This only takes several minutes and
there are no limitations on activities. Most patients note significant
improvement the next day.
If I should have new or worse astigmatism
after surgery, do you perform astigmatic keratotomy to reduce it or would you
refer me to someone who is familiar with the procedure?
Dr. Shingleton has
extensive experience with treating astigmatism and utilizing astigmatic
keratotomies. He utilizes the technique when indicated and will consider it for
any patient who is suited for the procedure. This is often done at the time of
the cataract surgery. Astigmatism correcting intraocular lenses (toric IOLS) are
also used by Dr. Shingleton at the time of surgery to reduce astigmatism.