Cataract Surgery Botched????

[Garrett1025]

My mother recently had cataract surgery and her eyes are worse than before.  It has been 2 months for one eye and 3 months for the other.  We went back to the surgeon today.  When I asked him what went wrong he said that nothing went wrong.  He said that the lenses did not set "where" they had calculated they would and this affected her vision in a negative way.  He said that they has healed nicely but they were either to far away or to near (he said but in the confusion I don't remember) the calculated location.  He said that neither he nor his staff did anything wrong and that this just happens sometimes.  He said that she could add another set of lenses over that set, have lasik or live with it and wear glasses.  All of the above choices were to be paid fully by my mother again.

Does any of this make sense to anyone of is the Dr just trying to cover up that he made a mistake?  

By the way, I mentioned that I wanted a second opinion and he literally lost his cool, said "you do that !!! and stormed out of the room.  Very unprofessional.

Please help.

[JodieJ]

In your situation, I would consult a different surgeon who would (hopefully) review your mother's options, explaining the costs/risks of each, and make recommendations.  If your mother hasn't already gotten new glasses, I think she should do so.  Just make sure than they can be remade within 60 days at no charge if her script changes.

There is something about your mother's problem that isn't clear to me.  Does she currently have poor vision in BOTH eyes?  It certainly makes sense that the lens implanted during the first surgery did not settle where it was predicted to, which produced less than good vision.  But her surgeries were a month apart, and I'd expect that her surgeon would have adjusted his calculations for her second eye.  (I'm not an eye care professional; maybe I'm missing something.)  

[John C Hagan]

When people say something is worse after surgery it does not always mean something bad. For example the most common type of cataract often causes the eye to become nearsighted. People can read without glasses often. Their far away vision is bad. If we do a successful cataract/implant operation and leave their uncorrect (without glasses) vision set for distance they can no longer read without glasses. Some people say the surgery made their reading vision worse. A better choice of words is the surgery made their vision different.


Sometimes when patients describe their eyes as red after surgery its because colors look much different. Cataracts dim the blue colors so many complain that things are "too blue" for a while.  If you mother's eyes don't look bloodshot to you I wouldn't worry.

Bottom line if you mother sees well with glasses I would be happy.

JCH MD

[Garrett1025]

Thanks for the input everyone.  I have a large family but no one has any experience in this procedure.  

So it is normal sometimes for the patient's sight to worsen after the surgery?  Also I forgot to mention that since her surgery she has a constant redness below her eyes.  I am not trying to "make" something wrong with her, but she is really scared about what to expect in the future.

Would it be worth the risk to even try the "additional" lenses?  

I figure that she is probably going to have to wear glasses even with a very successful follow up surgery, so why not leave well enough alone.

Thoughts?

[John C Hagan]

Hello Garrett,    Your mother's optical situation is not uncommon. Choosing an intraocular implant (IOL) power to give the best vision unaided by glasses is as JodieJ says not an exact science. It is much, much better than 5-10 years ago and it will be better 5-10 years from now. It will never be 100%. Like much of medicine we are sometimes a victim of our own success. There was a time in which patients were happy to go through a cataract operation without a major complications and wore regular glasses happily after surgery.

As we have been able to improve the vision without glasses some people expect to see perfect without glasses even though this is not possible for many people and something an ethical surgeon never promises or guarentees.  There are many variables (radius of curvature of the cornea, axial length of the eye, position of the IOL in the eye, etc) that can cause the actual result of surgery to differ from the "theoretical" values used in the pre-operative calculations. There is not even one forumula that surgeons agree is "best" to use for the calculations. As eyes become longer than normal or shorter than normal the possibility of under/over correction increases significantly.

Some eyes, because of astigmatism, are not correctable with the standard monofocal implants used in most surgeries. Even with the new multifocal "premium" IOLs that are used to try and get away from glasses completely for all distances often require glasses for certain tasks and certain distances (use the search feature and look at all the complaints).

Of course it is possible to have  gross miscalcuations due to error in data acquisition or data entry. These are rare compared to the normal "scatter".

Wearing progressive bifocal lens to achieve good vision is the expected and hoped for result of standard monofocal IOL surgery. Some people will see satisfactory at distance without glasses, others will see okay at near or mid range without glasses but this is a bonus not the expected result. We never tell our patients that they will be able to go without glasses. We tell them it often happens but we expect they will need glasses. Period.

There are certain circumstances in which if the difference is way to much to wear glasses (say a 4-5 diopter difference) that the information can be sent to a Medicare review or insurance review committee to authorize a LASIK procedure and have it paid for by insurance/Medicare (of course deductibles or co-payments would legally have to be collected). If glasses are feasible and wearable do not expect them to authorize the LASIK.

As to your physician's behavior, again Jodie J may be right. If you've gone to this ophthalmologist (Eye MD) for quite some time and he/she is generally even tempered and patient, I would cut them some slack. On the other hand if the physician is usually this way then I would seek not only a second opinion but a new ophthalmologist. I am a very patient physician and very even dispositioned but I have "lost it" on a few occassions with my patients. I always felt terrible afterwards and in most cases have called back to apologize the next day. More than one of these occured during a stretch where in addition to my professional responsibilities I was taking care of a sick parent and another member of my family was seriously ill.

Compared to some of the really serious sight threatening complications that are often posted here I think your mother has some really excellent options.

JCH MD

[JodieJ]

I know that making calculations for cataract surgery is not an exact science, and things don't always go as anticipated.  On the other hand, mistakes do  happen.  Without more specific information about your mother's situation, I don't think it's possible to say for sure why her outcome was so disappointing.

In my opinion, getting a second opinion is never a bad idea, although your mother's surgeon seems to have specified the possible options.  If your mother were to have an additional procedure (such as piggyback lenses), her insurance (or Medicare) would undoubtedly pay for it.  No insurance (that I know of) would pay for LASIK.  If your mother's vision could be corrected with progressive/bifocal glasses, this might be her best bet.  She would have needed progressive/bifocal glasses even with an excellent surgical outcome.

I agree with you that the doctor's stormy exit was inappropriate.  Doctors are people, too; maybe he was having a really bad day.