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Reviews

Custom Cataract Surgery

CATARACT surgery raised to an ART; the GULANI Difference!

Dr. Gulani’s CLOUDY (Crystalline Lens Opacification Underway) concept:

As we age, our eyes undergo visual changes to result in poor vision, both, in quality and quantity. Think of our natural crystalline lens as being jelly-soft and clear as a diamond. Over time, it gets cloudy and hard. This stage of progressively decreasing vision is defined as cataract which usually has a certain level of opacity and blindness quotient impacting the patient’s lifestyle adversely. The causes of cataract besides aging (most common) are many including disease, trauma, surgical and inherited which may therefore have an earlier onset in life.

Symptoms:

Having seen a wide variety of Cataract patients from all over the world, the most common symptoms they have, despite their unique situations, include: blurred vision where their glasses or contact lenses are not of much help, difficulty reading, halos around lights, starbursts, double or distorted vision, difficulty driving at night, and vision fatigue. It is also important to know that many patients may actually not complain of any symptoms at all until sophisticated diagnostic technologies at our Institute detect Cataracts at the earliest stages using 3-D Cataract Densitometry that not only reveals the cloudiness of the Cataract but also its hardness, which therefore negates the doctor-to-doctor variability within diagnosis by providing indisputable data so we can promptly tailor the treatment path of such patients.

In fact, many patients come to us having been told by their eye doctors that their cataracts are “small”, “just beginning”, or “not ripe enough”, in other words, they are not “blind enough” to be helped. Dr. Gulani teaches eye surgeons that as long as safety protocols and ethics are met, there is no need to wait until a patient’s vision loss is severe, but in fact take the opportunity to not only remove their cataract but simultaneously correct their vision (nearsighted, farsighted, astigmatism, presbyopia) and any associated pathology with a long term approach of “visual freedom”.

Treatments:

With three decades of enviable success with all kinds of Cataract patients (simple to highly complex) from different parts of the world along with mastery of cutting-edge technology including new generation lens implants, Dr. Gulani has truly raised Cataract surgery to an individualized ART, which is why he does not agree with many surgical practices nationwide which offer confusing choices to patients. This “Would you like the Platinum, Gold, or Garbage Package” approach in many cases is a misleading approach of 3 or 4 options (limited to that surgeon’s capability and knowledge) whereas there are over 30 lens implant options in the USA and over 70 lens options worldwide, that Dr. Gulani is familiar with given his international privileges. In fact, always among first in the world to release new Cataract lens implants, he has even pioneered futuristic applications of such lens implants years before his colleagues worldwide in off-label applications for complex Cataract eyes, repeatedly proving the essential blend of art and science beyond technology.

What Lens for my Cataract surgery? – An Invalid Dilemma! Dr. Gulani explains in a lighter vein: click here.

With a major part of our practice devoted to second opinions and complication correction of Cataract Surgery done elsewhere, the most common cause was patients falling prey to these highly advertised and hyped “new technology LENSES.” Which, though an important part of the surgery are just one “Ingredient” in the entire “Vision Recipe” of your surgery where anatomy, physiology, optics, and technology all have to come together coherently for your best-tailored visual outcome.

Even if you have undergone Cataract Surgery in the past with your surgeon’s limited “LENS” options, you need not despair since Dr. Gulani has corrected numerous such patients by working on their implanted lens, exchanging that lens, or modifying the optics of their eye (very much like a camera) to make it match the optics of their lens using LaZrplastiqueTM, LenzOplastiqueTM, and various innovative surgery and technology applications among his proprietary KLEARTM System to bring you back to satisfactory vision, outcomes and in many cases back to 20/20.

     

Custom Designing Cataract Surgery:

Even though millions of cataract surgeries are performed throughout the world every year and it is called a “Routine” procedure by many doctors, Dr. Gulani teaches eye surgeons worldwide that “No Cataract surgery should be ROUTINE.”

Cataract surgery is an endeavor to help patients See what they have been missing & also an opportunity to plan for the BEST Vision they can have for the REST of their Life – Dr. Gulani

Dr. Gulani’s diligence in studying beyond superficial data, leads him to classify your cataract by:

  1. Anatomy: Subcapsular (Anterior/Posterior), Cortical, Polar, Nuclear & combinations.
  2. Physiology: ie. Diabetic, Radiation etc.
  3. Structure: Lacking Zonular support (Gulani “weak hammock” concept).

With such a dedicated outlook, Dr. Gulani encourages eye doctors to classify every Cataract patient into four categories and then individually plan to address all of their correctable visual issues using Customized Cataract Surgery with cutting edge technology and Lens Implants.

Gulani Cataract Surgical Categories:

  1. Cataracts with Associated Refractive errors (ie. Myopia, Hyperopia, Astigmatism, Presbyopia)
  2. Cataracts with Previous Eye Surgery (ie. Radial Keratotomy, Lasik. etc)
  3. Cataracts with Associated Pathology (ie. Fuchs disease, Corneal scar, Keratoconus. etc)
  4. Enhancing Previous Cataract Surgery (ie. Residual glasses, haloes, vision disturbance)

 Do remember, before your cataract develops you may have had glasses or contact lenses for vision errors and in some cases may have vision errors but never realized it so never wore glasses or contact lenses.

Additionally, by the time the ageing cataract develops we are surely over 40 years of age and that is when our lens also stops “zooming” in the eye (that is why people “zoom” with their hands and hold things far to read clearly). This condition is called Presbyopia (that age and stage when you need reading glasses).

Now, if you put these three problems together, you have a combination of pre-existing glasses/contact lens powers (like nearsighted, farsighted, astigmatism) and presbyopia and an opaque natural lens (cataract).

LenzOplastique™ (the “O” stands for “Optimized Vision”): Raising Cataract Surgery to an ART, Dr. Gulani’s relentless pursuit to design vision and lend artistry to surgery raises even cataract surgery to his proprietary approach called LenzOplastique™ where he personally studies all patient diagnostics and measurements including anatomy , physiology, optics and vision potential to diligently apply his vast array of lens based surgical technologies and techniques along with his “Vision A La Carte” concept to customize surgery in a holistic approach individually tailored to each eye no matter how simple or complex it is and also in combination surgical concepts.

Therefore, after studying your eye’s anatomy, physiology, optics and visual capacity in synch with your neural (Brain) potential becomes Dr. Gulani’s goal.

PREMIUM:

“Premium”, a word loosely used by many practices, to advertise and mostly propel technology hype to sell a limited variety of lens implants; the word “Premium” in our practice has multiple levels of evidential superlatives.

PREMIUM Service:

Your Premium experience starts with your arrival into our Institute where you realize you are individually greeted and cared for in a world class ambience with knowledgeable staff and state of the art diagnostic equipment. Always On-time, and one on one attention to become part of our worldwide “GulaniVision Family”.

PREMIUM Facility:

Our Surgical facility is the World’s First Cataract Surgery SPA that proudly carries the registered Trademark by the US Patent and Trademark Office (PTO).

No waiting in packed rooms or being rushed around on a conveyor belt of surgery with unknown people handling you. One patient at a time with our full attention, focused on you.

Patients who experienced our Cataract SPA stated it was “Like no Place on Earth.”- Scott (Kansas)

Leading eye surgeons who have traveled to see Dr. Gulani’s work and futuristic surgical suite have been thoroughly impressed and inspired.

PREMIUM Technologies:

I. LENS Implants:

Dr. Gulani is always among the first in the world with his international privileges and has experience with over 30 lens implant technologies. Contrast this with most other practices that advertise “Premium” Surgery offering you a menu card with  3 or 4 options (choices usually hyped up as Premium and Basic) to maybe represent Multifocal, Toric, and Monofocal lens implants since that is all that practice and surgeon may be limited to.

Just so you can understand the expanse of choices, Dr. Gulani has access to a wide variety of lens implants among nearly 30 that are US FDA approved in the USA and nearly 70 worldwide. When teaching Cataract surgeons, Dr.Gulani compares this aspect to cooking and describes lens implants as an “Ingredient” which though important, may not lead to a perfect result unless that “Recipe” for that “Vision” is well prepared. So rather than confuse patients with lens implant technologies, Dr. Gulani focuses on designing vision by targeting your brain’s ability for each eye to then fuse binocular vision for maximal freedom at most distances.

 For simplicity, Dr. Gulani divides Lens implant options for Cataract Surgery into the following:

  • Monofocal IOLs
  • Toric IOLs
  • Trifocal  IOLs
  • Multifocal IOLs
  • Progressive IOLs
  • Accommodating IOLs.
  • Pseudo-Accomodative IOLs
  • Adjustable IOLs
  • PiggyBack IOLs
  • Sutureless Sulcus IOLs
Dr. Gulani with late Dr. Fyodorov from Russia whose co-polymer lens implant invention was the original technology that evolved into the Visian ICL.

Dr. Gulani has been involved with different lens implant technologies for over three decades having interacted with the very pioneers of these inventions which continue to evolve into present and future lens implant concepts.

Additionally he classifies Lens Implants by location in the eye:

Dr. Gulani with late Dr. Jan Worst from Holland whose iris claw lens invention has evolved into the Artisan phakic implant.
  1. Anterior
  2. Posterior
    • In the Bag
    • Sulcus Fixated
  3. Suture Supported
  4. No Stitch

Furthermore, Dr.Gulani has access to more than one “Optical” platform in a single lens implant ie. Toric with Monofocal, Toric with Multifocal and even Toric with Trifocal etc.

The industry names for these lenses if listed would be an overwhelming list yet the commonly heard names include, ReStor, ReZoom, Tecnis, Symfony, Panoptix, Trifocal Toric, Dual Optics, Light Adjustable (LAL) etc. 

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There is no “One size, fits all”  Lens Implant so it is imperative for your surgeon to know how each lens implant optic works and how it shall perform in your eye once implanted in surgery.

II. LENS Removal Technology:

1. Computer programmed Ultra Sound technology with controlled fluidics and Real-Time feedback sensors underscores the State of the Art, Centurion® Cataract system renowned worldwide for its safety and effective profile for the full range of soft to hard cataracts in simple and complex eyes.

2. Femtosecond LASER: Introduced in the US in 2005 and FDA approved in 2010, is very similar in technology to the Femtosecond Laser Dr. Gulani uses in All Laser LASIK (Bladeless Lasik).

Having used six different Femtosecond Laser systems for cataract surgery abroad much before US FDA approval, it was clear to Dr. Gulani that this was a future direction albeit with further modifications that would occur over time (Gulani AC. Femtosecond Lasers in Catarct surgery. ASCRS, 2015). Four laser systems were eventually approved in the United States for performing corneal incisions, anterior capsulotomies, limbal relaxing incisions, and lens fragmentation in cataract procedures.

Dr. Gulani does not feel that FemtoSecond Laser itself improves vision endpoints especially given his vast experience and surgical skills but does advocate its use in certain situations where laser capsulorrhexis could be the Achilles heel and or rate limiting factor for that case scenario (Gulani AC. Femtosecond Laser in Refractive Lens Exchange: Surgical Treatment for Presbyopia; Slack Inc., Thorofare, NJ); 2016;109-115.)

3. Visulas YAG III Laser: At our Cataract Spa we are proud to own the Legendary ZEISS optics based Visulas Yittrium-Aluminium-Garnett Laser.

In most cases about 3months after surgery, the capsular bag of the cataract that holds the lens implant becomes hazy over time (since it was embryologically part of the cataract but left behind during surgery to support the new lens implant) and needs this special Plasma Laser that painlessly clears the capsule in a brief outpatient procedure.

III. Surgical Equipment & Materials:

During cataract or lens exchange surgery including LenzOplastique, a number of equipment are utilized including materials used in the eye to enhance surgery, increase patient safety and make results more predictable.

We go above and beyond in acquiring and using high-end, disposable material to further enhance patient safety despite higher costs rather than re-using beyond industry recommendations.

DROPLESS Surgery: Seeking to make post-surgical eye drops extinct; Dr. Gulani continues to lead the world of innovation and is often selected by Industry to perform the first of futuristic surgeries having performed and providing application of eye drops inside the eye during surgery (Dexycu®) and even immediately after surgery by inserting a small plug into your tear duct (Dextenza®). This way you may not need to use your eye drop bottles which can be a nuisance for a month.

Sealant ReSure® sealant is a new technology that can be applied to the patient’s microincision to further strengthen their opening and avoids stitches. Used in complex cataract surgery cases, this is another direction in which Dr.Gulani prides his continued quest for perfecting surgery while raising it to an ART

IV. Diagnostic Technologies:

Dr. Gulani’s world leadership and international privileges along with being an Industry Key Opinion Leader (KOL) allows to him to be on the cutting edge of technology beyond most surgeons in the nation and he provides that advantage to his patients to not only increase accuracy and satisfy his own passion for excellence but also because he believes that is the right thing to do.

Looking beyond just cataract or lens exchange parameters and understanding the entire eye like a camera with 3D imaging, he takes all these details to custom design surgery for best vision potential for each patient.

PREMIUM Surgeon:

Dr. Gulani’s premium planning for designer vision surgery.

Premium is a word that underscores your experience and relation with Dr. Gulani who despite having an unparalleled track record of success, goes above and beyond in his empathy and performance for each patient. A hallmark that patients from all over the world lovingly call the “GulaniVision Experience”

Right from speaking to you on phone before you fly to us to greeting you personally when you arrive to taking hours to study your situation, review all extensive diagnostics and then painstakingly make unique surgical plans to executing the surgery in his designer, US PTO trademarked Cataract Spa, he challenges his own self to perform with no false guarantees but with 100% commitment despite your level of complexity.

PREMIUM Surgery:

With his world famous surgical skills and focused precision, Dr.Gulani executes his custom-designed surgery for each patient using his 3-T plan (Gulani 3-T Protocol).

Unlike other practices that hype up technology and then offer the only technique their surgeon is limited to, Dr.Gulani without any bias first picks your vision Target and then appropriate Technology suited for that and finally designs his surgical Technique to achieve that target.

TARGET

After a detailed personal evaluation of your eye and all diagnostics along with having determined your best vision potential, Dr. Gulani teaches surgeons that there are two parts to cataract surgery today; one is the surgery itself and second, is the pursuit of the custom-planned vision goal (Target) best suited for each individual patient. Thus, he believes that cataract surgery should be an “Avenue” leading to that higher cause.

These Vision Target could range from Mono Vision, Blend Vision, Multifocal or Pseudo-accommodative Vision to differentially arranging each eye’s optics so they work together to provide the best Vision range (It’s the Brain that sees, not your eyes- Gulani AC).

Given the individual healing pattern of each patient, Dr. Gulani likes to reiterate that no surgery or technology can guarantee vision without glasses but every effort can be made to aim for that goal though safe surgery is still a first prerequisite.

TECHNOLOGY

Computer programmed, Laser focused & Diamond specific:

With a wide array of technology right from diagnostic to intra-surgical including computer directed and real time feedback enhanced ultrasound along with his personally invented Diamond instruments Dr. Gulani sets about to execute his custom designed plan raising technology at all levels driving for your best outcome keeping safety in mind. He therewith custom fits the technology to each patient rather than fit the patient to the surgery.

TECHNIQUE:

“No Needles”, “No Patch” & “No Stitch” Cataract Surgery:

Dr. Gulani performs cataract surgery as an outpatient procedure with no needles or shots, no stitches, no patch and also, no hospital stay.

Every step has been planned out from how he sits for your surgery to what direction he will approach your eye from (Sometimes, we have seen himself sitting uncomfortably to help patients who have very complex eyes and rarely we have even see him stand and operate).

The eye is numbed with drops to ensure comfort throughout the procedure. He uses sophisticated, computer programmed technology along with his invented Diamond instruments to customize the safe and accurate removal of your cataract.

Since cataract was a lens to begin with; its removal requires replacement with an artificial intra ocular lens implant (IOL) which is inserted through the microincision into the capsular bag of the cataract for support. Once inside the eye, the lens spontaneously unfolds as it is placed into permanent position. No sutures are required because the small incision that Dr. Gulani designed is self-sealing.

Gulani Custom Designed Premium Cataract surgery with Lens implantation usually takes about 15 minutes and is performed on an outpatient basis in our proprietary US PTO Trademarked, Cataract SPA. Each eye is done separately, usually about a week apart. Numbing anesthetic drops are used to decrease any discomfort.

Most of our patients fly back home the next day after their postoperative visit but if you are local, do plan for rest for two days and plan to resume work/driving within a week of surgery dependent on your individual case complexity which shall be relayed to you by our competent and compassionate staff.

Dr. Gulani’s Holistic Approach to Cataract Surgery:

Dr. Gulani approaches each eye like a camera in evaluating the optics of the entire eye and planning a surgery best suited towards perfecting vision for that eye individually.

Just like a camera, the eye has a cornea (viewfinder), the shape of which decides vision. Nearsighted ( Myopic) corneas are steep or more curved, Farsighted ( Hyperopic) corneas are flatter and Astigmatic corneas are shaped like a football (oval) as opposed to being shaped like a basketball (spherical). Thus nearly all cornea-based refractive surgeries (including Lasik Laser Vision Surgery) focus on re-shaping a patient’s cornea.

The next imaging structure in the eye is the lens (very much like the lens in the camera). You are born with a clear natural lens which over time (with age) becomes cloudy and is now called a CATARACT. Since this cataract was a lens to begin with, it needs to be replaced by an artificial Lens implant.

Many people after the age of 40 experience Presbyopia or blurred vision at near points, such as when reading, sewing or working at the computer and need reading glasses or “cheaters”.

Dr. Gulani likes to describe this as an age-related loss of the “Zooming power” (tele & wide like a camera) of your natural lens inside your eye.

Now, if you combine the analogy of a camera to a cataract patient, most Cataract patients do wear some glasses or contact lenses for associated Nearsightedness or Farsightedness and or Astigmatism and of course, they all have Presbyopia (since they are usually more than 40 years old).

For example, a cataract patient may be wearing Bifocal glasses for farsightedness, astigmatism and presbyopia (reading).

We thus see 4 visual factors affected here:

  1. Cataract (cloudy vision)
  2. Farsightedness
  3. Astigmatism
  4. Presbyopia

The fact that this patient has a medically significant cataract is confirmed. Now, instead of taking such a patient, calling them “Routine” and rushing them through a “Cataract surgery Mill”, Dr. Gulani suggests taking this opportunity and correcting all of this patient’s visual problems through that one surgery that they need anyways ie. Custom Cataract surgery.

Custom Planning for Customized Vision:

When designing a Customized Cataract surgery plan, Dr. Gulani performs a wide range of State of the Art diagnostic tests to determine his 3Ts.

Cataract Densitometry Analysis, 3-Dimensional Corneal Topography, Optical coherence tomography, IOL Master V, A-Scan Analysis, Refractive simulation & Scheimpflug Virtual Imaging.

Additionally, given Dr. Gulani’s combined knowledge of the technologies as well as the optics of the eye, he measures Higher order Aberrations along with Secondary Refractive errors and Optical Zones with Corneal Asphericity to further customize his approach.

Armed with all this information, he then dedicates a plan personalized for each patient.

So even in cases that are labelled as complex by other surgeons, when they have associated vision issues besides cataracts, that patient can elect to have cataract surgery as a combination staged plan using premium  lens implant along with corneal modification surgeries like LaZrplastique, Intacs, Cross Linking etc.

“Thanks again Dr. Gulani, for your expertise, compassion, professionalism, friendship and courage to do what you believe. You are the best!” – Dr. Jane C.

Thus this patient who could have landed as a “Routine” case, with “Routine” Cataract surgery now has a customized plan for their individual eye and vision goals.

Further categories of patients with Cataracts:

Category II: Patients who have had eye surgeries in the past to correct their vision (ie. Lasik, Radial Keratotomy etc) may present with either long term side effects of that surgery, gradually decreasing vision over time or need for modern technology fine tuning.

Their vision can be planned using Cataract surgery with specific, New Technology Lens Implants followed by staged, Advanced Laser Vision surgery to excellent visual outcomes.

After my cataract surgery, my field of vision was improved, my near vision was improved and driving at night is now easy. Dr.Gulani’s world renowned expertise is only matched with his personal touch for each patient.” – Dr. Don M (Radial Keratotomy & ReStor Lens implant)

Patients who have associated pathology ( ie. Keratoconus, Corneal scars, Fuchs Dystrophy) besides cataracts.

In such cases, Dr.Gulani plans for the endpoint of vision by first manipulating the optics of the eye using New Technology IOLs with Cataract surgery in preparation for Laser Corneoplastique, INTACS or Lamellar Corneal Transplants.

Dr. Gulani designed my cataract surgery using Toric Lenses. His drive for perfection raises the bar for all of us in the medical field.” – Dr. Bruce B (Fuchs Dystrophy patient)

Category IV. Patients who have undergone cataract surgery elsewhere and have a wrong IOL power in place, complication of the surgery or even those who simply want their cataract surgery of the past ‘Fine Tuned” to 21st century vision expectations.

In such cases, Dr. Gulani studies the case and plans to exchange their IOL for a modern New Technology IOL, “Piggy Backs” an IOL on top of their old IOL or even uses Advanced Laser surgery to correct their residual glasses prescription so they can see without any glasses or contact lenses.

Thus patients with previous cataract surgery can also hope to see without any glasses today.

“My vision is excellent! Dr. Gulani’s word is as good as gold!” – Gayle W (LaZrPlastique Surgery after Cataract surgery)

Being a world renowned Vision Surgery expert, Dr. Gulani is uniquely talented in both, Advanced Cataract & Laser Vision Surgery and uses this experience along with his in depth knowledge of the Optical system of the eye in selecting customized techniques with the full range of technology choices including combination surgeries to result in individualizing Vision goals thereby raising Cataract Surgery itself to an ART.

“I flew from San Francisco for the best cataract surgeon in the world. Thank you for your expertise Dr. Gulani”- Prem H, San Francisco.

“I traveled from New York to seek the Cataract surgeon who teaches other Cataract surgeons worldwide. I am amazed at my vision today”– Marvin G, NYC

Inventor of award-winning Gulani Series of Innovative Surgery Instruments, Dr. Gulani is a distinguished Teaching faculty for Cataract & Premium Lens Implant technologies for major conferences and publications throughout the world.

Is 20/20 vision guaranteed with Cataract Surgery?

Though Dr.Gulani’s results with Vision surgeries are legend and the reason patients fly from all over the world, we do not guarantee outcomes. His drive for each patient is relentless and yet there are many variables from diagnostic to surgical and then to healing patterns including but not limited to your personal healing pattern, how technology reacts to your eyes and how your neural (brain) acclimatizes to that vision.

Costs & Payment Plans

For Premium Technology and Services costs, you are welcome to ask our competent and compassionate staff who are always available to personally assist you. Also do remember, unlike your past medical experiences elsewhere, here, at Gulani Vision Institute, no one sells and there is no incentive for staff or doctor and we shall not proceed until all your questions are answered. You are not just a number, you are an individual we look forward to welcoming and assisting in your vision endeavor and are privileged to be your choice. You can take advantage of a number of nationally recognized payment plans which can help you pay for your Custom Cataract and Vision corrective surgeries with New Technology choices selected in your best interest.

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Our Location

8075 Gate Parkway (W)
Suite 102 & 103
Jacksonville, Florida 32216
Phone: (904) 296-7393
1-888-LASIK-16
Fax: 1-888-397-4699