Post-cataract surgery and HRT question

[Carolyn7]

I had cataract surgery last year - Nov and Dec. Everything went well. I chose to keep nearsightedness, understanding that I would only need glasses for distance. Soon after the surgery I got my "interim" prescription which  was -2.5 and -2.25 (I hope these numbers make sense - I'm in Europe!) Definitely better than my previous prescription of -10. At 6 weeks I went for my final check and prescription - it was down to - 3.75 and -3.25 (and I now need glasses for reading too). I was surprised and somewhat disappointed at this final outcome - my doctor said

[Carolyn7]

Yes, the responses have been helpful and informative - thank you both!
Yes I do have endothelial dystrophy (I had forgotten the name above), so I guess I don't have the option of any additional surgery. I was reminded of this last week when I went back to see my regular opthalmologist. In fact the eye surgeon never mentioned it again in any of my follow ups. Today I went to the optomotrist to order my new glasses and he was surprised at the prescription. He said he'd never seen one that high for a new cataract patient - I was not happy but I guess there's nothing to be done now. He also commented on a blurriness in one eye (I had noticed this from day one after the surgery but the surgeon said it would go away - it hasn't). The optometrist suggested it might be the beginning of the "secondary cataract". I'm wondering now whether in fact it is to do with the reduced cells (would I have lost more cells during the cataract procedure and the surgeon didn't tell me??). If I DO develop a secondary cataract, is the YAG laser procedure going to put my corneas at even more risk? Thank you again for your responses!

[John82207]

Carolyn7- As an Eye Surgeon I have to say the form OD has given you great replies. The actual post-operative glasses prescription will be determined by the exact distance from the cornea that your implant "settles in at".  There is a certain amount of variability to this but in our patients when we shot for good uncorrected distance vision we get it in over 95% of our patients. Just because you are now a -3.00 doesn't mean you have to accept that.  Excimer laser surgery can be performed on patients that have had cataract surgery. If you elect this approach consider "modified monovision" with the dominant eye for distance and the non-dominant eye a -1.25 to -2.00 or so. Piggyback intra-ocular lenses can be inserted even in minus powers. Some surgeons in the US are actually going "back to the future" and performing two very small "radial incisions" that will change the prescription by about 1 diopter.  I would NOT consider this approach if you really do have reduced endothelial cell counts.           Best Wishes         Doctor JOhn

[Carolyn7]

Thank you for your response to my question. I also have the
condition where there are not enough corneal cells and I
understand this could deteriorate further over the years. Would this make the possible side effect of dry eyes from standard hormone replacement therapy any more problematic?

[Ag-i-doc]

unlikely.  "condition where there is less cells" sounds like endothelial dystrophy, a condition of the layer of cells on the INSIDE of the cornea.  does not really contribute to any "feeling" you have of dryness, etc on the outside.  only contributes to vision.

[Forum-OD-MP]

IMO it is highly, highly unlikely that HRT/steroid use caused your increase in nearsightedness after your surgery.  refractive changes after cataract extraction are common and unpredictable, and usually no one's fault and not due to any medication.

the measurements for iol power in cataract surgery are more of an estimated guess than most patients think.

the internet search that you did that stated that HRT can cause dry eyes was not talking about steroid use.  steroids do not usually cause dryness, and are actually used to treat dry eye symptoms in some patients.

i am sorry that you became more myopic after your surgery, but again i think its unlikely that any medication caused it.