Refractive lens exchange in one eye

I recently had refractive lens exchange in my right eye. I am 52 and I did not have cataracts. I planned to have my left eye operated on 2 weeks after the right eye, but I was a little concerned about deciding if I wanted my left eye vision set for computer or reading distance. I decided to wait and started reading more about the surgery. In the meantime I have developed glare and I hope it is from capsular clouding (which I have been told I have developed). I know I need the YAG laser surgery but I am putting it off because of the incidence of retinal detachment I have read about. It has been almost 5 months since my surgery and I have to wear a contact in my left eye since I cannot tolerate the difference in prescriptions to wear glasses. I am now extremely afraid to have anything done to my left eye and I just want to leave it alone and do anything I can (other than extraction) to make my right eye nearsighted again just so I can wear glasses again. Is it possible to have PRK or some other surgery to accomplish that? Would a piggyback lens be an option? What are the risks for this? I don't want to wear this contact for the rest of my life, and if I could only wear glasses again I would be extremely satisfied.

[John C Hagan III, MD, FACS, FAAO]

No lasik to make you myopia again doesn't work well.

A piggyback lens is not a good opion.

Suggest you get a second and third opinion. Find Eye MDs near you at www.aao.org

JC HMD

[CC450]

Is there a reason that a piggyback lens is not a good option. Is there anything I can do other than doing something to the second eye? I cannot tell you how much stress I have thinking about that. I have had a second opinion. My original surgeon tells me I should go ahead with the refractive lens exchange in the second eye and the second opinion tells me I can do that or PRK. He also suggested a piggyback lens if the glare does not go away after the capsulatomy, but not to make me myopic again. I really do not want to mess with the second eye at all. Do you know anything about the glasses you can obtain to allow you to see with differences in refractive error?

[JodieJ]

I was a high myope and developed a cataract in one eye following retinal surgery.  (I was about the same age as you.)  I had aspheric monofocal IOLs implanted in both my eyes, two weeks apart.  I also had YAGs in both eyes.  I'm really happy with my outcome, and I don't have a problem driving at night on dark roads like I used to.  Yes, my statistical chances of having a retinal detachment might be a few percentage points higher than previously, but they are still fairly low.  There are many (worse) conditions for which I'm at greater risk, but I don't spend much time dwelling on all that.  (What happened to make your perspective change so radically?)

By adjusting factors such as the base curve and vertex distance of the lenses, it would probably be possible to get you back to wearing glasses comfortably.  However, if you are plano in one eye and -8 D in the other, you'd end up with glasses having one thin lens and one very thick one.  The optometry college at Ohio State University has a special clinic for prescribing these (iseikonic) glasses, although there are some eye care professionals everywhere who could do it, too, if that's the route you want to take.  

[CC450]

Hello. I was hoping you might see my post and comment. I have read many of your posts and I feel like you are a very good resource. I think there were a variety of factors that made my perspective change. I was initially so excited about the surgery. I think the first was the glare. I developed a temporal glare in low-light situations that is steadily getting worse. Sometimes it is a hazy glare (like streaking sunshine through a partially open window blind) and sometimes it is a flickering light--always from the temporal side and in low light conditions. I hope this is due to the capsular clouding. Do the symptoms sound familar at all? In full sunshine there is no problem. I keep hesitating because I know when I have the YAG procedure there is really no turning back. I also developed a thyroid disorder shortly after surgery that caused me to have a retracted eyelid in one eye and the other eye was droopy. I was convinced it had something to do with the surgery and that caused me a lot of distress. My eye doctor actually suggested a thyroid disorder may be the cause. I did not have Graves disease so after treatment for the hyperthyroid disorder that problem resolved on its own. I don't know if my anxiety is still from my illness (only 6 weeks out from radioactive iodine treatment) or from the fact that I have been reading a lot about complications and problems and now I am really tentative about doing anything else. I have recently started to see floaters in both eyes and I think it might be from eye strain. I used gas permeable contacts for over 30 years and I am trying to change to soft extended wear but the prescription is just not right even though I have been back 3 times. I think it might be the astigmatism and possibly reduced vision due to the clouding. I know they say I will just get used to them (floaters), but I work on a computer all day and see them every time I move my eyes. I am sure I will learn to live with it (or maybe they will get better when my eyes are not strained), but it is just another thing. It has been a rough 5 months and I just want to do the right thing. I wish I could say I had the surgery due to cataracts because then I would not be so angry at myself, but I just did it because I have worn glasses and contacts since I was 6 years old and my vision just kept getting worse. I really thought I was making a good choice at the time but now I am just not sure what to do next.

[JodieJ]

It's sounds like your health problems have really stressed you out over the past few months.  You don't have to do anything more to your eyes until you are ready.

Your ophthalmologist can tell whether you need a YAG, but I don't think it would be at all harmful to postpone it.  I found that the YAG made my vision much brighter, with improved contrast sensitivity.  It is totally painless and takes only a few minutes.  You can drive yourself there and back.

I'd been wearing hard contacts for a long time before they became too uncomfortable to continue with.  It took more than a year in soft contacts before all my astigmatism had returned.  Initially I could read the 20/20 line with regular contacts, but after a few months my vision was noticeably less sharp.  After a few more months my vision was too blurred to drive.  Fortunately, getting soft toric contacts solved that problem.  Your eye care professional can determine whether you'd see better with a toric contact.

Being able to function at least some of the time without glasses or contacts is a real gift.  I see it as something nice you did for yourself.  (And you deserve it, too!)  When you're ready, you can get your second eye done.

  

[CC450]

Thanks for your support. You have been very helpful. Do you think the glare symptoms I described could be caused by the clouding? My surgeon did tell me I need the YAG procedure eventually because I do have clouding, but he said it would not hurt to wait until everything else settles down.

[JodieJ]

Yes, I think that your glare symptoms are related to the clouding, and they should diminish after a YAG.  I know what you mean by "no turning back" after a YAG.  I had some of the same (irrational) feelings,  although I was happy with my outcome, and I certainly didn't want my old vision back.  It was a thrill to drive without glasses or contacts for the first time (which I never expected to be able to do.)  Before I got my IOLs, I couldn't even find my car without my glasses or contacts.

Your vision might not be quite as good as it's going to get because of the clouding, and possibly also because your contact is not quite the right power.  I think you have something to look forward to.

[CC450]

Hi--I hope you are still out there helping people with eye problems. I had the YAG and the second day everything was perfect. Now I see a shiny flickering glare over the front of my eye when light shines in on the temporal side. Did you ever have that and is that something my brain will adjust to? It's a little annoying and if I know it is common and that it will get better I won't be quite so obsessed by it. I am a little more than a week out from the YAG surgery. Also, I am thinking about moving forward with the second eye. Do you know if there is a particular type of IOL that would be good if I want to avoid this glare in my second eye?

Thanks!

[JodieJ]

I never experienced the type of glare that you're describing.  Dr. Oyakawa has said elsewhere that sometimes the YAG opening needs to be enlarged if glare results.  Why don't you re-post your post-YAG glare problem as a new thread directed to Dr. O's attention.

I think that an aspheric monofocal lens (like the Tecnis, ArcrySof IQ, or SofPort) would be best for avoiding glare.  It wouldn't hurt to get Dr. O's input on this as well.

Jodie