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Cataract surgery after torn retina
I am getting ready to have cataract surgery and had the buckle surgery 3 years ago. Can anyone tell me what to expect? I am getting nervous because my retina specialists told me there was a bigger risk of my retina detaching if I had the cataract surgery. What will my restrictions be, how much time off from work will I need to take? I work from home, but I take care of kids, so last time I had to take an entire week off. Thanks for any info!

Christina
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233488 tn?1310696703
Everyone that has cataract surgery is at increased risk of RD. Becuase you have a buckle and have had the holes/tears sealed your eye is likely less at risk for RD than had you not had the surgery. Another problem is IOL power after a buckle. It takes special care on measurements and is not as accurate as non buckled eye.

Discuss at length with your retina specialist. Your other unoperated eye will likely have the larger risk of RD should it need cataract surgery.

JCH MD
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I am looking at cataract surgery in both eyes, one week apart after havingRD in both eyes in 2013.  There were two choices presented to me regarding cataract surgery and am not sure which to choose. Either traditional or laser.  It seems laser is more precise and less cutting but the surgeon felt that with my strong nearsighted eyes, traditional would be better. Any thoughts on this? What else should I be asking the surgeon, and what else do I need to know or ask? I am hoping to get another doctor to evaluate my eyes before doing anything. Thank you
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233488 tn?1310696703
A second opinion is a good ideal. Clearance by the retina surgeon to have the cataract surgery a great idea. Generally for experienced surgeons the Femtosecond Laser with the associated tools provides more precise surgery.

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Please let us know what you decide regarding traditional vs laser-assisted cataract surgery.  

I would be interested in the recommendation of the retina surgeon on whether he/she thinks the laser is better, as well as the reason the cataract surgeon gives for preferring the traditional style of surgery over the laser-assisted method.

Thanks in advance for sharing your doctors' feedback.  
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This post is also for flossy93 who wanted to know about this.

I have degenerative myopia and even had a CNV two years ago.  To make a very long story short, after researching the femtosecond laser-assisted cataract surgery, and after having found one private clinic which does this surgery where I live, I decided to go ahead and have it done.

I had my right eye (the eye NOT afflicted by a CNV and also my dominant eye) done on January 14.  It was miraculous!

I had the left eye done on January 21.  I already had distortion because of the CNV, and I still do, of course.

Another problem I have which has nothing to do with the surgery and which I have had for several years but could get rid of by wearing my thick coke-bottle glasses on a slight slant, is binocular double vision.  No one knows why I have it, but I plan to look into this.

Because I have such a long axial length (combined with other measurements), I was not a candidate for a toric lens for my astigmatism.  The femtosecond laser can do these cuts called limbal relaxing in a more precise way than when done by hand.  This is supposed to reduce astigmatism a lot.  Right now, I find there is not only the distortion in my left eye (which has nothing to do with the surgery), but I think it is a bit more blurry than it should be.  I don't know if this has to do with slight swelling or if the astigmatism was not reduced enough or what.  However, I have a follow-up appointment on February 3, and I will ask.

Anyhow, the surgeon who did the operation told me beforehand that although it does not necessarily reduce the risk of retinal detachment, there are less surgical complications.  I also read in every study I looked at that there is less swelling and less insult to the eye since the ultrasound is only used at the end to aspirate the cataract which has been previously broken up by the laser.

I just thought maybe this information might help you.
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Thanks so much for the helpful feedback, ValveJob.  It's great that you had such a wonderful outcome with the cataract surgery in your right eye.  I hope to have the same outcome when I need to have the surgery done.  

I have a quick question - was it ever explained to you WHY you couldn't have a toric lens implanted because of your long axial length?  It's wonderful that the limbal relaxing incisions could help with the astigmatism, of course.  Just wondering why the axial length and other measurements precluded you from a toric implant.

The info I've read online so far is that the laser-assisted surgery IS safer for high myopes as it reduces the total amount of ultrasound energy discharged within the eye.

The only thing I've wondered about is whether there's danger posed by the docking procedure in the laser surgery option.  There must not be, since it's used in high myopes without apparent problems (aside from the higher risk of RD which apparently is there with either cataract surgery method.  

As another high myope w/ a long axis I wondered if it's dangerous to have pressure fluctuations inside the eye caused by pressing the docking ring against the eye and then applying the vacuum to adhere the eye to the dock before the laser is applied.  I wondered if that kind of manipulation could increase RD risk.  It's great to hear your surgeon's view that it doesn't.  

Best of luck with the followup appt; I hope a reason for the blurriness can be identified.  Also good luck with the binocular double vision issue; I hope you can find a thinner eyeglass option now that you are post-cataract surgery that will fix the binocular vision as well as any residual astigmatism. Thanks again!
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All I can tell you is that even my own RS, when he saw the results of my A-scan, said "I don't even know if they make a toric lens for your measurements".  Then, when I discussed it with the surgeon, he said it was not possible.  I think that IOLs that thin (they were both a +3) are relatively new, and maybe it is hard to do all those special things like toric, accommodative, multi-focal, etc. with such a thin lens.  Who knows!

I hadn't even thought about the docking procedure.  On the contrary, I think I have read articles which even wondered if the laser-assisted method might pose less risk of RD.  As I say, it just posed the question, it did not answer it.

I will keep you posted about what happens when I eventually get new glasses.
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Good point on checking back with my original retina specialist, as well, though I feel he may say something like he knows most about the retina and....but it is worth giving him the details of what the rational is for the traditional method to him, as he did both of the surgeries for the RD'S on me ..he did feel they had healed well and the first surgeon confirmed this as well...I somewhat look forward to getting a second opinion, as I have an appointment yet this week with another doctor at a different clinic.  In fact a cousin of mine said I should even check with a third, as she just had surgery with one who is about an hour drive away for me...she even offered to drive me! So, I do feel as if I have options, ...so much to think about and evaluate. Thank you for all of the input, I have been reading as much as I can find.
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Thank you! I have read that stuff too... It is very confusing, and I intend to clarify his logic before I consider doing traditional...besides getting at least a second opinion yet this week.  Checking back with my retina surgeon as well.  In fact I also have a wonderful eye doctor, and I will also call her.  She is young, and very passionate and professional!  She did recommend the two surgeons I have appointments with, and I know she will talk to me about any of this as well...even though it isn't her exact specialty.
She actually called me both times after I had RD surgery to see how I was doing!  How amazing and special is that!?!  I do feel lucky, but this is all so SCARY, and the thought of losing any more vision is beyond frightening!
Thank you!
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Well, duh, for some reason it didn't occur to me that the reason you couldn't have a toric implant is because lenses with toric correction might not be made in the prescription you need.

Since the natural crystalline lens in a middle aged adult has an average refraction of about +20D and you only needed a +3D lens, you were well outside the typical norm for the IOL power needed.  Unfortunately I think that IOLs are similar to contact lenses in that companies only offer the broadest choice of lenses in the most common prescriptions.  Needing only a +3D implant must have meant that you were offered very very few options for the type of IOLs used.  

If you end up needing glasses for your binocular double vision problem, perhaps a correction for astigmatism can be added too.  Or perhaps you could wear a low-power toric contact lens if astigmatism is still causing the blurring in that eye?   Good luck and thanks again for the feedback!
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You are probably right about the reasons that there are not "premium" lenses for such a rare IOL prescription.

I am sure they can add a prism to other types of corrections like astigmatism, myopia and hyperopia.  I will discuss all this with my optometrist.  I just hope the prism is not ugly and does not make my dizzy!  Oh well, I'll just have to wait and see (no pun intended).
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To Flossy93,  ValveJob, and John C Hagan III, MD, FACS, FAAO and/or anyone else reading or responding to this forum or series of posts regarding Cataract surgery after Retinal Detatchment/RD.  Updating my status, and series of calls & doctor appointments, second opionions and so forth.  

I had RD Vitrectomy surgery the end of July-left eye/and weaker eye, and the second one was the first of September of 2013.  As high correction -9.5 or so, they said that RD is somewhat more likely with such a high correction/eye shape and so forth.  Once you have RD, then the cataracts grow...but all of you know all of this!

I did misunderstand the first doctor in what it was he wanted to do, and/or felt most comfortable with regarding my specific case for surgery and found that he DOES want to use the FEMTOSECOND LASER on my surgery, which I had taken away from the visit that he wanted to do the traditional only method of surgery on me, that was not the case!  He was mainly indicating that he reccomended the MONOVISION Cataract surgery lens implant which would correct distance only, requiring reading glasses more than likely for reading.  I called back to verify this, and why that would be the case.  He intends to follow up with my Retinal surgeon and get back to me after discussing with him, how he feels it would work for me to get a multifocal lens so as to not be dependent on readers for close up work.  I just turned 53 in December, and readers are helpful when I have only correction for distance in my contacts of about a 1-2 power on the "Cheaters."  It appears he uses the ReStor Tecnis Mutifocal /Crystalens lens for this surgery implant.  Of course the multifocal is extra and above what insurance would or will cover, but perhaps that is why the doctors don't automatically reccomend it, as it is costly and the ability to pay is an issue/or can be often times.   So, I am not sure if this is a good lens implant/company or if there is a better one, but that is where my first appointment is at for my surgery.  I will update on the second doctor and also on my eye doctor, as soon as I can get to that.  Thank you so much, everyone for your input, I find it all very helpful and reassuring!  
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...Continued from above-
To Flossy93,  ValveJob, and John C Hagan III, MD, FACS, FAAO and/or anyone else reading or responding to this forum or series of posts regarding Cataract surgery after Retinal Detatchment/RD.

The second surgeon uses the Brand named TECHNIS, as his preferred choice in patients he treats.  He gave the surgery risks, of hemorrhage & infection as being 1/1000, retina detachment of 1/700, and loss of eye as 1/10,000.  He gave a handout of what to do the day before surgery, and the day of, and after surgery---which is all pretty standard type of stuff one would expect.  He said he gives patients a sedative to be able to perform the surgery.

He did say I would be unable to, or should refrain from wearing my contacts for at least 2 weeks prior to having surgery!  This was a bit of something new for me, as that is the only way I can see!  (or at least see decently...my glasses are out of date, and since my RD my prescription has changed quite a bit besides!)  I believe in what he says, that the contacts can reshape the eye somewhat, but find it interesting that the other doctor didn't mention this.  Did any of your doctors say not to wear contacts prior to CAT surgery?

I feel as if I need to go and pick up a new pair of accurate glasses to wear, if I have to wear them for the next 2-3 weeks due to needing CAT surgery!  I don't feel comfortable driving, at a minimum as I can't read any of the signs, and have a difficult time seeing oncoming cars without lights on, at least until they get close to me.  Plus, when wearing my glasses my eyes feel tired all the time, and sometimes get headaches.  I am hoping I can get a pair very inexpensively, but feel even 2-3 weeks would be very difficult to not be able to drive and see to even do daily tasks.

Do any of you feel that the multifocal type of lenses are any more risk for future problems with the retina, do you?  

I do know, or at least have read how some see a halo effect or rings or something with them...Does anyone know more about those issues?

I feel it would be so nice to not have any glasses, or only if needed in very low light or extremely small print...  I believe my correction in my eyes is around -11-15 .  I think the correction in my glasses is only about a 9.

I did speak with my regular eye doctor, who talked over my first set of choices.  She did offer to speak with me again, anytime and also is willing to speak to either of the doctors I see for surgery.  The first doctor intends to speak to my retina surgeon, and didn't rule out speaking to my eye doctor.  The second opinion doctor didn't ask about my eye doctor at all, and didn't mention checking with my RD doctor.

I guess I didn't feel as comfortable with the second doctor, but then am not sure if the actual lens that one uses versus the other is any better.  Or even if one is a better surgeon than the other.  I do know the second surgeon has probably done more surgeries as he is at least 10 years older.

Not sure any of you can exactly say, as you haven't met them, but based on the information I have given here(and I apologize, as I am being so wordy on this!...) But thank you to any who are reading this, as I feel I am on my own a bit on it!

It seems I hear that Cataract surgery is no big deal, and common these days, but I still am very concerned and want to do the best thing, as this is my eyesight and it is permanent.

Thank you for any information or direction any of you can offer.


He also said he waits two weeks in between surgeries, while the first doctor I went to said ONE WEEK!  The first said, after I have the first surgery it will be difficult to wait a full two weeks, as it will be so awkward to see, with my operated eye being so good to see out of, and the one not-will make all very off balanced?!  I like it that he says it will be SO GOOD that I won't be able to WAIT!!!  I am ready NOW!
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Two comments on aspects of your post:

1.  Having good coordination between doctors is important.  That said, so is the level of experience the cataract surgeon has with the specific femtosecond laser platform they will use to perform the first part of the cataract surgery.  

I read a study stating success rates were higher and complications lower for doctors with more experience using the femtosecond platform to assist in the surgery.  Since laser-assist only been approved for cataract surgery for a short time (this varies by country) you may want to ask both surgeons how many cataract procedures they've done with the femto platform they use.  With your history you do NOT want to be patient #1.

2.  Re not wearing contacts before surgery; I corresponded with a -20D patient who was asked not to wear hers for THIRTY days to make sure the measurements for her implantable lens were as accurate as possible.  So if you can get away with two weeks, that would be good.  You will probably need glasses to cope.  If it's unsafe for you to drive, get rides, take taxis/buses, etc.  Don't drive if you can't see clearly!  

I don't know if the 'no contacts' rule also applies pre-surgery because of possible contamination/infection or any drops needed before the procedure.  You could ask.  

I agree that the wait between the surgeries will be difficult.  Since you would be unable to wear a contact during that time, you may need to have one lens removed from your glasses so your un-operated eye would have some kind of correction.  I know how difficult that would be, however (I'm a -17 in glasses).  You may find it easier to just leave that eye uncorrected, if your eye w/ the cataract removed is really good.  If you're a -11 to -15 the other eye would all be a blur.  Again, be very cautious with any driving during that window of time!

If I were you, I would do everything exactly as your chosen surgeon recommends, to give you the best possible chance at a good outcome.  You said it yourself:   "I still am very concerned and want to do the best thing, as this is my eyesight and it is permanent."  Good luck!
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I am a 53 year old female and had macular holes in both my eyes and vitrectomy surgeries to correct.  Cataract ts developed.  They recommended laser surgery less stress on the eye and better accuracy.  I also chose Crystalens to reduce my need for glasses.  I am myopic in both eyes -8.0 with slight astigamatism.  To get accurate measurements of my eyes I had to wear my glasses for 2 weeks.  They are an old prescription and I struggled to see but needed to get accurate measurements.  After that I was able to wear contacts until surgery.  I had my left eye done on 1/22/14.they performed LRI incisions.  When removing cataract my eye did not have the support for a crystalens due to previous vitrectomy.  They put in a Restor lens which I was not best candidate for due to the amount of light it lets into retina.  I could see right after surgery and marveled at my distance, intermediate and close vision.  Day after surgery I had 20/30 vision better than I have ever had.  I am beyond thrilled.  There was some concern first week as I could barely see pictures on walls and anything in a room in dim light.  But my pupil remained constricted.  They dilated my eye 1 week after and my vision is superb.  I do notice some halos on headlights with this eye driving but I am use to that I always had a problem driving at night.  I just don't look at them and as a car gets closer halo disappears.  I was to have 2nd eye done last week but dr. Wants to see how I do with this lens.  Next eye is scheduled for 2/26 and the plan is to use crystalens if possible.  If not we may lean towards a monofocal set for distance and I would need reading glasses.  Monofocal because I had the macular hole longer in this eye and see more distortion.  Monofocal would let in lots of light like the crystalens.  Will let you know how I make out with my right eye.  Have the laser surgery.  I am beyond thrilled with my vision!
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Thank you!  That is a good point, as to asking how many surgeries each has performed with my specific situation!  I will!

Also, as the first doctor said he is contacting my retina surgeon and then getting back to me... Well, it will give me an opportunity to ask then along with learn of any new info he may add after speaking with my RD surgeon.

I may also call both my RD surgeon and my eye doctor, after I have all info in hand and see if they have some input - or something I should be considering. Do you think that is alright to ask them...sort of how should I do this, which would you select?  I don't feel that is ethically wrong, do you?
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Thank you!
Wow, you must have been SO scared after surgery-1st week not being able to see well!  I can't imagine!  A week would seem So long, you must have been worried!  Thankfully, you seem to be doing very well now!  Your next surgery will be in about 25 days!  Yeah! How will you manage, like literally "one eyed?"  
I am excited to get the surgery, I just feel I need to have all the info, as it seems there are some choices, and certainly understanding the process and doing what is best for the unique circumstances that I have(& many are the same as yours and others-but never exactly) & what might be the right timing...and so on!  It is a bit overwhelming, but also I feel it could be great!  I just want to strive for the best possible outcome...though they have indicated fees increase with multifocal and what not!

My mom thought that vision correction should be considered medical and not cosmetic!  

Cosmetic applies for me, if anything but mono focal lenses are chosen.  Is that true for all?

I was born nearsighted and have worn glasses since I was 5, though the doctor said I surely needed them earlier than that!  Farsighted, a bit being 53 as well.

I appreciate your suggestions and sharing of your experiences!

This site has been a blessing!
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Believe me I thought cataract surgery was pretty standard but now with all of the lens choices and how do you want to see it is very confusing.  I too have worn glasses since age 6 and wish more would be covered by medical but it was not for me.  And this s the year I chose a higher deductible medical plan!  I will let you know what happens with eye 2.  Please update us with your decision and visual outcome!
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To fletch and valvjob, and others reading and assisting with all of these postings!  Thank you!  So, I am unsure if everyone reads all posts on here or only the ones they have commented on, and I don't want to be repetitive, so am posting here what I posted on a related one!...   "..."

I did have 2evaluations of cat surgeons, and now my second appointment, and had measurements taken with the one I am selecting for surgery.

"This  eye surgeon feels the mono focal is the best option for my eyes.  His comment in not trying to do too much, clarity issues that I - like others have or and could also experience,  along with  the measurements and photos taken on my eyes revealing a retinal cyst on my left eye.  (After leaving, now have more questions on the cyst and if that poses greater risk for another RD or if this cyst is just a result of having the RD in the first place?,?,!). It seems all is clear throughout the explanation, until you walk away and then think of a More Questions!  

Are you familiar with the cysts?  He also confirmed I have some loss of vision in my left eye, which my eye doctor had also confirmed.  So is this loss the same as the cyst?

He also feels there will be many upcoming improvements in eye care, and certainly I could be a candidate for one of them.  (Makes me feel good, yet who really wants more surgeries and/or the need to carry around a variety of glasses to adjust to different distances and usages?)

I am able to schedule in 4 weeks and then the very next week for the second eye.  

I was hoping to go in within a week or two, but the schedule is full and I am on a waiting list for the 12th of March and the second for two weeks later.

I feel I am ready now, and 4 weeks yet seems long, but I guess it really isn't.

Thank you for all of your help, and for reading my whiney posting!   "

I am so pleased that you are so satisfied with yours Fletch, as that really gives me Hope!
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