IOL moved too far forward in the few days following cataract op. Advice needed.

[rossagrant]

Hi there,
I had a cataract removed from my right eye just 6 days ago and at first thought everything was fine. My near vision was amazing, far beyond what I had ever had before, however my distance vision was increibly blurred. I waited for it to clear up over the first few days and on seeing my surgeon for a check-up, he told me the lens is too far forward and as it is a high prescription lens that even a small shift could make a big difference.
I have been given drops to relax the muscles in my eye and dilate my pupil for 5 days in the hope that the lens may fall back but not seeing any big changes 3 days in.
I am due to see the surgeon again in 2 days and was just wondering what to ask him/ what options are available.
Could the IOL power be out?
Could the lens be repositioned surgically?

By placing a -1.75 eye glass over the eye my distance vision di clear up a lot and he said LASIK would be an option to fine tune it but I have heard of nasty side effects of LASIK including lack of night vision which is a problem with me. I suffer from retinitis pigmentosa which means I only have limited night vision anyway and really dont want to lose any more.
Please give me some advice and words of encouragement as i'm feeling pretty low about the whole thing. Any comments would be gratefully received!
Kindest Regards
Ross :)

[Michael J Kutryb, MD]

Your situation is not unusual or weird.  I'm not exactly sure that the implant really moved forward because you were nearsighted since day one.  I suspect more that you just have an implant about 2 to 2.5 diopters too strong.  In the case of an implant which moves forward (which I have recently seen) the patient was 20/20 at distance at day one but then changed to 20/60 distance at 1 week with huge improvement in near vision (nearsightedness.)  Regardless, you are nearsighted now (about -1.75.)  You have three basic options:  leave it as is and wear glasses (my first preference), have an IOL exchange for a lower power implant (second  preference), or Lasik or PRK surgery to correct nearsightedness (I recommend this least among the three - but it is a legitimate option that will cost you at least $1500 cash.)

The dilating drops will likely not work at all - I wish it was that easy.  IOL exchange is a definite option - but you have to be a good candidate.  My recent patient had a lot of "positive vitreous pressure" and the problem is that if you replace the implant - it will probably move forward also (which you can allow for in your IOL calculation) BUT what if it doesn't move forward - then your calculations might be off.  So if there really was movement of the IOL then IOL exchange gets a little less attractive.  Finally, remember that you had a successful cataract surgery - no complications.  That's a blessing.  You can always wear glasses to see your best.  That's not such a terrible thing.  Discuss all these options in great detail with your surgeon.  He owes you plenty of time to talk with you - after all, even he admits that the result is different than expected.  Good Luck.

MJK MD

[rossagrant]

Thanks so much for your advice! The surgeon has said that the LASIK surgery would be free of charge in this case so there would be no extra costs involved, however I'm concerned of the effects that LASIK can have on your night vision. Having Reinitis Pigmentosa is bad enough at night and I don't want this hindered any further. What are the risks of lens exhange and is it safer the sooner it is done? Any advice would be great! Thanks once again!
Ross :)

[Michael J Kutryb, MD]

Lasik or Prk might be your best option here because there is some question as to whether the IOL moved forward or not.  That question would not matter because you would leave the original IOL in place and perform lasik or prk on the cornea for the residual refractive error.  I commend your doctor for the honesty and willingness to improve things at no cost.  I think that's great.  I suspect you will be very happy with results.

MJK MD

[rossagrant]

With Lasik and PRK affecting night vision/ acuity would a lens exchange not be a better option in my case? I really don't want to lose anymore night vision or does this not always happen in these procedures? Thanks so much for your help so far, it really is much appreciated!
Ross :)

[Michael J Kutryb, MD]

With wavefront guided laser treatments and larger treatment zones - glare and halos are less of a factor.  The new lasers are much, much better.  IOL exchange would normally be my first choice BUT in your case with possible movement of the IOL, will the new IOL sit back in bag or move forward???????  Take that variable out the equation by doing LASIK or PRK.  If lens didn't move than IOL exchange is best choice - but only your surgeon knows the situation and what is best for you.  If he's willing to pay for it, LASIK or PRK sounds like a very nice choice here vs IOL exchange.  Just my opinion, and I can't really make recommendations or your particular case.

MJK MD

[rossagrant]

Thanks so much for your time, you have been such a help. I will discuss this with my surgeon tomorrow and let you know what happens! Thanks again!
Ross :)

[rossagrant]

Right, have been to see my surgeon and he thinks the way to go is to laser off the -2.00 prescription I am now at with this eye.
The strange thing now, however, is that after waking up yesterday morning I seem to be able to see very clearly in daylight. When i am in daylight I am no longer short sighted and have very good distance vision, yet in darker rooms or dim lit places I go right back to being short sighted again. Everything becomes very blurred. Any ideas why this is happening and will this be eliminated with the laser surgery? Thanks again!
Ross :)

[Michael J Kutryb, MD]

You're losing me - I'm confused by your symptoms.  Talk to your surgeon,
MJK MD

[Onnieellen]

A related discussion, IOL moved too far forward in the few days following cataract op. was started.