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Early Cataract surgery question and myopic options
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Early Cataract surgery question and myopic options

I don't know much about Cataracts, so forgive my ignorance.

My eye doctor just informed me that they are forming (my vision is very myopic, and is getting worse, and I am starting to see
"lights" around the edges of my eyes at night from time to time.)

He recommended cataract surgery "early on", but all my experience talking with others in the past is that the cataract needs to "develop fully" or become ripe before operation.  He then also said that the insert that they place in your eye develop scar tissue, which he has to go back and make corrections to with a laser in about 60 % of the patients within a 3-5 year period.  I don't know many cataract patients, but the ones I have known waited for their cataracts to get ripe, had surgery, and that was the end of it.  I never heard of any of them having to go back, but then, I never asked either.  I asked him that question, and he said that "new technology was leaning toward early removal" but I wondered about that.

Then he said that I also had an option once I decided to have the surgery of having additional surgery (i.e. laser) to put a "small incision" in my lens to replace or change it so that I would no longer have such bad vision.  But, I would still have to have reading glasses (I am over 55).  Well, I don't see why I would want the "second" surgery if I have to wear glasses anyway, other than the fact that I would be able to see without my glasses just around the house at night and stuff like that, but I don't believe in unnecessary surgery.

I would like some expert opinions on this topic.

Thank you.
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Hello, I'm the ophthalmology forum MD. My primary interest has been cataract surgery and I've done over 11,000 of these surgeries.

Cataracts are cloudiness of the lens of the eye. By far the most common cause is aging but other causes include injury, drugs such as cortisone, smoking, heavy alcohol use, diabetes, family history of cataracts at a young age.

The earliest symptom of cataracts is often glare and difficulty with night driving (especially in the rain or on blacktop roads). Also the most common type of catracts often makes the eye nearsighted (second sight).

In 97% of cases THE PATIENT should make the decision to have surgery NOT THE OPHTHALMOLOGIST.  There is no magic time to do cataract surgery. Some occupations will require a very small cataract to be removed exampls: commercial pilots, over the road truckers, people that work at night, taxi drivers. Other people may have very large cataracts and not need surgery, examples the very elderly that do not drive, don't read much and who have multiple serious health problems.

The idea of waiting till a cataract is "ripe" is antiquated and left over from the cataract surgery of the 1940s through 1960s when cataract surgery was a high risk operation and did not restore normal vision.

Since the development of intraocular implants and small incision-no stitch surgery cataract and intraocular surgery is the most common and successful surgery done on adults. In the US there are over 2,000,000 done per year.

Surgery should be done when the cataract is keeping a patient from doing the things that they must do or is keeping them from enjoying life. As I said this varies from person to person. In our practice we say "We don't want to operate on happy patients. If you're happy with your vision or at least 'satisfied' with it then let's wait until you're unhappy before we do surgery".

An exception (and this happens only occassionally) a patient may be satisfied with their vision but the cataract may be getting to hard. This increases the risk of surgery. If we see this happening we tell the patient. Better do the surgery now as 6 to 12 months the surgery will be more difficult and the chance of complication higher.

You can always get a second opinion if your ophthalmologist seems to anxious to operate on you and you're uncomfortable. Rarely is there a need to rush into surgery.

Now about the laser. Whe the cataract is taken out the sack that its in (the capsular bag) is left in place to hold the implant. This membrane frequently turns cloudy in the months and years after cataract surgery. It is technically not "the cataract coming back" as many people say. The symptoms of a cataract return when this happens. Surgeons call this a posterior capsular opacity or secondary cataract.

It use to occur almost 100% of the time. Now the frequency is about 30-40%. When the membrane gets cloudy enough to bother the person then they do not need another cataract operation. Instead a YAG laser is used in the office to quickly and painlessly cut a hole in the membrane. The healing is usually less than 24 hours, there are no restrictions on activities, it usually does not change the glasses prescription and almost never needs to be done a second time.

JCH MD
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Avatar_m_tn
I've recently had cataract surgery, the most recent one last week, and the surgery/healing process was fine.

I had Lasik about 8 years ago, and my doctor was very upfront about not being able to get accurate measurements for optimal vision for Lasik patients.

My first eye turned out very nearsighted. The doctor was going to make an adjustment to the second lens (going from a 20 to a 20.5), and said that I may end up with a monocular effect, which would be fine with me.

So far, though, the vision is the second eye is very similar to the first. I know it will continue to improve over the coming weeks, but right now it's very disappointing to think that both eyes will be as nearsighted as before Lasik.

I trust my doctor completely, but at what point do I say that the guesswork wasn't accurate and I think we can do better with a different lens?

Thank you,

JW
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233488_tn?1310696703
Lasik makes the IOL formula's less reliable, even under thebest of circumstance they're not 100%.  Doing an IOL exchange is not a little procedure. Most people let the eye heal, see how they do with glasses, if not happy then have superificial lasik if possible PRK   You can always get a second opinion. Also discuss in depth with the surgeon

JCH MD
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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
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