Anisekonia in left unoperated eye after cataract surgery in right eye

[Phillie0068]

Had cataract surgery 5 weeks ago on right eye .  I have been a glaucoma suspect for years and within the last three onths my eye pressure began to steadily increase even with the drops being used twice a day.  My opthmologist at the hospital eye clinic stated I needed to be seen bya specialist in glaucome immediately for possible removal of cataracts with drainage system for the pressure rising.  I consutled physician he agreed that surgery neeed to be done done.  ASAP.  However, after the surgery on the one eye I Knew someyhing was wrong immediately afterwards .  I started getting unbalancing issues in the oppoiste eye which did not have surgery on.  I was told it was beaue I have a cataract i other eye.  I responded I never had this type of issue before why now.   I am a person that needs explanations and I began reading almost immediately after surgery.  It is then I stumbled upon this thing called aniseikona/anisometropia.  My doctor finally conceded this was the problem  and then hinted nothing could be done.  I was floored.  Subsequentially , he did mention about the eyes being a telescope and the brain.. etc.  But nothing that said he should have consuled me about this beforehand.  My right eye has a scar in back of the retina of unknown origins.   I hae Sjorens syndrome and Multiple scrolosis.  Uvitis is an issue with me that I have been seeing about for the last 5 years.  During my recover I have had bouts of eye pressure increasing up to 46 in both eyes.  After every immediate visit I medntioned about my left eye he would not even look at it.  That was a red flag I noted later about this whole thing.  It seems like he was only focused on my eye pressure that was constantly rising.  He was able to stabilize it after a few weeks but now I am left with this issue of not being able to focus correctly.  I know nothing about my eye measurements.  It is in my medical notes but do not know how to interpert them precisely.  I have seen an doctor of optometry and he feels that a contact would help until surgery on the other eye is done.  My issure is that I have Sjogrens and no contacts I have read would actually help because of the persistent dryness i have daily.  Additionally, I now know that the other cataract in on the left side is small and may not be the source of my issue.  I need guidance.  I have prayed and cried and I feel so left alone.  The surgeon I had has left the practice he was with to join another faw away.  Now he even is discouraging me from following up with him  I smell a big rat. But I need help.  Please help me doctor/patients anyone??

[Phillie0068]

Thank you sooo much.  I was feeling like a fish out of water.  Because I never knew of anyone after this surgery to experience this situation.  I will look in my files tonight and answer you in the morning.. Once again THANK YOU

[John C Hagan III, MD, FACS, FAAO]

Yes, while you are getting that info together let me add a little insight. Your description identifies an eye that has the potential to go completely blind. The surgery was done to save the eye. Sounds like it was successful.  Somethings these imbalances are not possible to avoid, however you should have been informed of it as a problem before surgery. You might think of it like a person that has a cardiac arrest and is in danger of  dying. If in giving live saving CPR his ribs or sternum are broke, that is 'collateral damage' that occurred to save a life. Your imbalance in refractive error (aneisometrophia) and unequal image size (aniseikonia) were probably collateral damage for the greater good of keeping your eye from going blind. That being said, go ahead and post the information. Most of these cases can be helped.

[John C Hagan III, MD, FACS, FAAO]

? lose interest? Problem solved?

[Phillie0068]

Hello dr. Hagan... I do have the information and  I will relay it as best I can  I am 67 years of age female.  Diagnosis SJogens Syndrome and MS..  After surgery the doctor refused to actually give me a prescription (said the optomitrist will provide(so I am relaying notes from my medical records what was stated.Manifest Refraction:  OD +0.25  Add +2.00  Distance 20/200  Near OU J1
OS  -700  Cyl +0.25 Axis  170  Add +2.00 Distane 20/40  
The VA OD:  DSC 20/200  sos  DCC 20/60  IOP:  TP, App  OD 15,22  OS 16,22

Best Glasses I can see out of from 2020 is as follow:  Rt. eye  Sphere -4.75  Cylinder +0.75  Axis 084  Dist VA  20/400  Add +3.00  Near VA  20/400

Left  Sphere -5.75 Cylinder _1.00  Axis  146  Dist VA 20/25-1   Add +3.00  Near VA J1+

Last eye glass prescription never filled 12/2021 is as follow
OD Sphere -4.50  Cylinder  -2.25  Axis  180  Add +2.75  
OS  Sphere  -4.50  Cylinder  D.S.  Add +2.75

Visaul Acuity OD  20/250  OS  20/30

I have given you all information that was provided as best as I could.  Hopefully, your response will be a little more promising than the last reply.  I am praying because I am now having so much dry eye issues, along with the blurriness in the left side which was my better vision.  Dr. wants to start on 'serum drops: in your opinion do they really work or just a last resort to dry eye puzzle.  Also having allergic reaction to the glycoma drops too.  I feel helpless, and just scared.
I do feel that I probably need a surgeon based in a  larger scale instirute like the eye institute here in my city.  I am currently seeing doctors at a hospital based place.

Thanks for all your help in this matter.

[John C Hagan III, MD, FACS, FAAO]

This will be a long post but You seem detailed oriented. I looked at your profile and it said you live in Chicago. I would get in ASAP to a major university eye center.  U of Chicago, Northwestern, Loyola Stritch. The soone your get in the better and you would need to take all your  records.

DRY EYES:  Read this:  https://www.medhelp.org/user_journals/show/2324863/Dry-Eyes-Update-2020?personal_page_id=67912    ; Your need to be started on Restasis or CeQua as soon as possible. As the article says my wife and I have moderately severe dry eyes. We were using artificial tears 6 times/day with only moderate relief. When we sent on Restasis it was the only drop of its kind. It is not a lubricant, it reduces inflammation on the surface of the eye and stabilizes the tear film NOTE  it take Restasis 4-6 months to full become effective. My wife have been on these drops for about 7 or 8 years and don't have to use any tears. CEQUA is more concentrated, works maybe 2 months fast, however it is quite a bit more expensive. There is one other drop in this catagory Xiidra. I don't like it, have not had success with it and tell people to avoid it. You may also need plugs put in your tear ducts. You will need to use artificial tears 4-6 times/day and a gel or oitment at bedtime.  There is no BEST drops what works for one may not work fo another. keep a list of the ones you have tried to find what you like.  These would be good to start:
https://www.justblink.com/products/blink-geltears-lubricating-eye-drops   or https://www.amazon.com/Refresh-Celluvisc-Lubricant-Single-use-Containers/dp/B0064FKL4U/ref=asc_df_B0064FKL4U/?tag=hyprod-20&linkCode=df0&hvadid=310135323596&hvpos=&hvnetw=g&hvrand=9654784071651922909&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9023228&hvtargid=pla-405661040808&psc=1&tag=&ref=&adgrpid=62847861838&hvpone=&hvptwo=&hvadid=310135323596&hvpos=&hvnetw=g&hvrand=9654784071651922909&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9023228&hvtargid=pla-405661040808    

VISUAL/IMAGE PROBLEMS. Did your right eye ever have good vision with glasses? 20/20?  If so there is a huge question why it doesn't see better. Even with glasses that RE is legally blind. You need to know why it is not seeing better. Was it always week? Is it glaucoma damage, do you have a macular problem? Did that RE have optic neuritis from your MS? That needs to be answered clearly. You are a high myope and that also carres risk. (incrased risk of retinal detachment, myopic macular degeneration and glaucoma).   The problem is your RE is no longer highly myopic with the IOL in it so images are much larger than your LE which has strong minus lens which make the image much smaller.  You can't wear contact lens due to dry eyes. There are really only several solutions none ideal.  1. you can see if you can put up with it. 2. You could put an occluser over your right glasses lens to block out the larger image from the RE  2. The best corrected vision in you LE is only 20/40. If that eye once saw 20/20 and has a cataract it may neec cataract surgery sooner rathr than later. If that happens the IOL in the LE will even out the images sizes.  3. If you can't get use to it, LE not not cataract surgery soon, and you don't want to wear an occluder you could ask about surface refractive surgery on your LE. That carriers a higher risk because of youc extremely dry eyes, high myopia and glaucoma.

You need a highly qualified team taking care of you: retina, glaucoma, cornea/cataract.  That can best be found in a highly regarded univeristy eye center.  My best advice is GET MOVING.  Remember you most important eye is the LE. Make sure the glaucoma is well controlled in that eye.

[John C Hagan III, MD, FACS, FAAO]

a FEW TYPOS THERE, SORRY, IT'S LATE AND IT HAS BEEN A LONG DAY

[Phillie0068]

Thank you doctor.  My doctor at Northwestern Hospital seems to feel that this will straighten out perfectly after the other cataract surgery in left eye.  I disagree because I don't have the answers I need.  I will write to him and advise I need a great team working with me to ensure the best possible decision

[Phillie0068]

The right eye has alwyas been my "weaker eye" .  I have never had for at least 40 years good vision out of that eye.  There is a scar on the retina that no one even at the university level could ever figure out.  Other than I had chicken pox as a child that went into secondary infection.  I had this child hood disease for three months and had to be hospitalized for two weeks it was awful.  But I was scared terribly everywhere.  I healed thank God, but doctors seem to think it looks like what happens to patients after having shingles as far as appearance on the retina.  Or an bad injury in which I never had.  I do have history of glaucoma on my mothers side, along with Macular degeneration.  My mom had the type where she had to indure injections in the eye every 6-8 weeks.  The left eye has been my saving grace.  I seemed to have had 20/20 to 20/40 as of recent.  However, that seems to be declining also.  I feel that things are happening to me so quickly, and the doctors seem to think its fine, or it will straighten out after you have the other cataract removed.  But I have had a gut feeling that there is something else happening.  I must get to the bottom of this.  I am going to an optician for the contact that doctors say I need.  However, I just cannot tolerate these things in my eyes. I even had the daily's that are the softest kind, and could not remove them from my eyes.  Having Sjogrens has numbed the sensations in my fingers.  So I will be dropping the idea of contact lenses for me.
The problem with this is that is take so long to get into these University level eye doctors  for evalustion.  I may just have to go to the Univ of Illinois on an emergency basis, and tell them my story.  Then I may get the help I know I so desperately need.

[John C Hagan III, MD, FACS, FAAO]

Aat this point it sounds like a second opinion would be the best option