Unsuccessful Cataract Surgery

My husband had surgery on about 6 months ago to remove a cataract in his left eye. Prior to the surgery, he required the use of reading glasses, but had otherwise no visual impairments besides the cataract.

After surgery, he immediately knew that something was wrong. His vision out of his left eye was much worse than it had been before surgery. He now has almost 2 diopters of anisometropia and his vision is more blurry than before. Vision in his right eye has remained good, but he is now required to wear glasses all of the time due to the significant impairment in his left eye.

Does cataract surgery cause distance vision to decrease that significantly? Is it possible that the wrong lens was implanted? His surgeon wants to do an intraocular lens exchange and says that the implant is in good position and the rest of his eye has healed nicely. He has agreed to charge 50% of his fee for the second surgery, but we will still be responsible for the general anesthesia charges, the pre-op physical, etc. and we still haven't finished paying the over $2,000 for the first surgery!
HELP!

[Houman Vosoghi, MD]

He needs to explain why there is so much astigmatism in the left eye.  Especially if it wasn't there before.  Also find out what kind of lens was used.  You need a clear cut answer on why there is a difference from expectations.  Sometimes, miscalculations are do occur as we are only as good as our current equipment; but, the surgeon should be able to explain to you exactly what the problem is.

HV

[teri763]

His prescription shows OD Sphere 0.00 Near Add +2.5 / OS Sphere +2 Cyl -0.50 Axis 175 Near Add +2.5 if that makes any sense to anyone.

[FredZq]

You don't mention which type lens. I would find a better doc. I'd get two "second opinions" before I had anything done.

[teri763]

The surgeon is saying that he did nothing wrong, the lens implant is in good position and is healing well, but that "where the lens sits within the capsule can have a refractive impact" and that is why there is a change in vision. I have been trying for 2 weeks to get copies of his medical records and have not yet received them, so I don't know what kind of lens was used yet. Is it possible that the correct lens implant is sitting in a certain way in his eye and that it would make his vision change to a +2 where there was no prescription before?

[Houman Vosoghi, MD]

Unlikely to make that much of an impact but it is possible.  Get the records and get a second opinion before proceeding with surgery as the other writer recommends.  Also, I misread his prescription, there is not a significant amount of astigmatism.  The lens is just off by 2 diopters which happens rarely (but still could happen, especially if the eye has had lasik or RK refractive surgery before).

HV

[DavOD]

Why did the original surgery cost $2,000? Did your husband pay for a premium (multifocal or toric) IOL?

Presuming that the +2.00 -0.50 x 175 prescription in the left eye gives excellent vision, the anisometropia is causing the problem and it will remain a problem. If he has excellent vision, then we can assume that the IOL is positioned properly. The IOL power is inaccurate. Unless your husband had prior refractive surgery as Dr. Vosoghi mentioned, the calculation of the IOL power should be much more precise. It seems unfair to expect you to pay for a condition that has resulted from the improper IOL power calculation.

[teri763]

It was actually more than $2,000. We have a $5,000 deductible on our insurance policy.. ($850 to the surgeon, $1400 facility charge, $250 anethesia, $300 for pre-op physical) He did not opt for any premium lenses and the outcome was to be that he would retain his perfect vision for distance but would need reading glasses. He hasn't paid all of their bills yet and I've encouraged him to stop and wait until we find out more. I don't want them to turn it over to collections though and ruin our credit!

The +2.00 -0.50 x 175 prescription does work for him, but he now has to wear glasses all the time instead of just for reading. He did not have any prior surgery on his eye. I never thought of it that if the lens wasn't positioned properly that glasses wouldn't help, but it makes sense.

I am still waiting for his medical records. They were finally going to be emailed to me yesterday after WEEKS of runaround and I was told that my email rejected them due to file size. I work in publishing and have drafts of entire magazines emailed to me without any problem. Once I receive them I hope to know what lens was implanted.

Thank you for your response!

[DavOD]

Is your husband scheduled for cataract surgery on the other eye? The reason I ask: When he has cataract surgery in the second eye, the surgeon should attempt to balance the prescription with the first eye. In other words, leave that eye about +1.75. That will at least relieve the anisometropia he experiences while wearing glasses.

[teri763]

I think that we are going to opt for an IOL Exchange surgery to correct his vision in the first eye to get that corrected before we move on to scheduling surgery on the other eye. I did finally receive his medical records and we have scheduled an appointment for 7 January for a consultation with a different surgeon.

The lens he implanted is a +17.5D ZCBOO. I've been trying to research one report in particular and it's the printout from the Accutome A-Scan plus. The surgeon circled the +17.50 in the results column under IOL ZA9003 but implanted IOL ZCBOO. I'm not sure if the calculations for those two lenses are the same, or if that is where the miscalculation happened. I'll continue to research until our appointment next month.

[teri763]

I posted the Accutome A-Scan plus test results under my profile as a picture. If you have a moment, I'd appreciate if you could take a look. You can see surgeons notes on the right +17.5D ZCBOO - but in the first column where he circled the +17.5 at the top it says IOL ZA9003.

When I researched the differences in the lenses it appears to be minimal, but I am wondering if it's enough of a difference to cause a lens to be off by 2 diopters?