Cataract Surgery

[GuideDog]

I have had recent cataract surgery on both eyes and the outcome was not what I expected. I am not sure what I need to hear but what I am hearing from the doctor is not to my satisfaction.

I have Retinitis Pigmentosa and over the years developed cataracts in the center of both eyes. After meeting with my RP specialist it was recommended I have the cataracts removed. I was sent to a doctor who would be sensitive to my underlying visual condition. (Retinitis Pigmentosa)

It was determined that most if not all of the stigmatism was in the cornea and not the lens. It was recommended that I go with a toric lens. Since the toric lense is not covered by insurance I chose a non-toric lense.
I was informed that they would correct all my nearsightedness and I would only have to wear glasses for reading. I asked if I was left a little nearsighted and wore glasses or contacts would I need bi-focals for reading or additional reading glasses. The answer was no. So I made the decision for them to leave me a little nearsighted with the understanding I would still wear glass but not bi-focals.

After the right eye surgery I was very pleased with how well I could see. I explained to friends and family that it's like having high definition eyes. I can see at distance but out of focus at reading distance.
After the left eye surgery I was not able to focus at any distance. After the first week I was able to focus to read but could not see at distance. Basically I have mono-vision.
I was looking at the card for the lens implant the both the right and left lens are of the same power. I found this to be unusual because prior to the surgery my prescription was different in my left eye than my right.

I spoke to the doctor on the phone about my concerns and he recommended I give it some time and go ahead and see my optometrist to get some cheap glasses to get me by. I followed his orders and went to see my optometrist.
The optometrist examined the work and asked if I wanted mono-vision. I said no, I thought both eyes would be the same after the surgery. He then said, "We'll the good news is your stigmatism is gone and you won't need toric contacts. (The cataract surgeon said my stigmatism was in the cornea...how could it be gone?)

I went back to see the cataract surgeon and when I asked him about the stigmatism he just persed his lips and shook his head. He then said I still have some stigmatism in my left eye. He had four options for me.
1. get bi focal glasses to compensate for the difference
2. get bi or multi focal contacts to compensate for the difference
3. do the surgery again and implant a stronger lens. However, he does not recommend this due to risk of infection.
4. lasik surgery and re-shape the cornea to correct what the implanted lens did not.

I told him I need to think about all this before I make a decision.

I need help. I do not know what to do or where to go. I am afraid of having this procedure again by this doctor and I do not feel that just getting glasses to correct something that should not have happened is right.

Please advise.

Sincerely,

John Mark

[GuideDog]

Hello Dr. Oyakawa,

I meet wiht my opthamologist who moniters my RP. He said the doctor installed the wrong lense and their really isint much I can do other than live with it. He said the surgery to remove the lens has a far greater risk than the initial surgery. He did reccommend that I meet with the catarct specialist at UT Southwestern and get a seconded oppinion and he suggested that if I do decide to have surgery again to not go back to the surgeon who did the surgery to begin with.
He said the good news in the problem can be corrected with glasses or contacts.

Any feed back?

[GuideDog]

The optometrist is one I have seen for a while and the surgeon sends me back to him.
Not sure why, he could do everything in house but at this point I am more comfortable seeing my regular optometrist. I have scheduled an appointment mid-April to get a second opinion from a doctor at UT Southwester Medical Center in Dallas and I have an appointment with my ophthalmologist, who monitors the RP, next week.
I have requested my medical records from the surgeon and my ophthalmologist be sent to the offices of the doctor and my ophthalmologist. Hopefully they can shed some light on what I should do.
Thank you for the feedback. Have a great weekend.

[Ray T Oyakawa, MD]

I never do monovision for patients who had not done it before.  Not all patients will tolerate it.  Get a second opinion.  Why the split care between the optometrist and the surgeon?

Dr. O.