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Wrong IOL Power
I recently had a IOL to move out of location in my right eye and had to be replaced. The old IOL had a power of 19D and they install a replacement IOL with a power of 29D. My vision is very clear and sharp at about 3 inches with no usable vision beyond this distant. My surgeon has confirmed that the new IOL installed was do to error in determining power of IOL. They have offered to replace this IOL or provide contact to compensate for the error and I have been told that Lasik surgery is not an option due to the extreme different in power.
This eye has had a total of four surgeries in the pass 5 years, macular hole, cataract removal, scar tissues, and replacement of IOL. All surgeries were performed by the same medical organization.
I do not want to use and pay for contacts for the rest of my life and the risks of additional surgery without compilations is very high especially considering the previous surgeries. What are your suggestions for dealing with this problem?.
This eye has had a total of four surgeries in the pass 5 years, macular hole, cataract removal, scar tissues, and replacement of IOL. All surgeries were performed by the same medical organization.
I do not want to use and pay for contacts for the rest of my life and the risks of additional surgery without compilations is very high especially considering the previous surgeries. What are your suggestions for dealing with this problem?.
Best Answer
An Implantable Collamer Lens (ICL) sits in the ciliary sulcus, the same place as other piggy back lenses. If there happens to be enough anterior capsular support (an intact rhexis) then any piggyback lens including a Sulcoflex or an ICL could be considered. However, if there is insufficient anterior capsular/zonular support (likely to be the case as the original IOL dislocated), then surgery would involve an IOL exchange.
You are quite right about the risks of future surgery. The corneal endothelium could be compromised further, then there is also the risk of vitreous and retinal problems, and if the IOL needs to be sutured then there could be issues about suture longevity.
It is very unfortunate but contact lenses are going to be the safest option. If you ever think about or wonder about further surgery, ask your doctor
1. What is your corneal endothelial cell count
2. What is your eye pressure
3. What is the state of your retina in that eye ie how much residual scar, is the macular hole closed, what is the visual potential of the eye
These would apply whether you are thinking about piggyback or IOL exchange surgery.
You are quite right about the risks of future surgery. The corneal endothelium could be compromised further, then there is also the risk of vitreous and retinal problems, and if the IOL needs to be sutured then there could be issues about suture longevity.
It is very unfortunate but contact lenses are going to be the safest option. If you ever think about or wonder about further surgery, ask your doctor
1. What is your corneal endothelial cell count
2. What is your eye pressure
3. What is the state of your retina in that eye ie how much residual scar, is the macular hole closed, what is the visual potential of the eye
These would apply whether you are thinking about piggyback or IOL exchange surgery.
Ask for a professional advice to make sure that you'll not be paying for the treatment which is not going to workout for your condition. Try scheduling an appointment for a different eye expert to see if they have the same evaluation.
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You have two choices outside of a contact lens-
IOL exchange
Implantable Collamer Lens
Both are invasive. An IOL exchance may produce better vision quality because the ICL requires an iridotomy be done to prevent glaucoma. It depends on how risky and IOL exchange would be in your case. Given the iol dislocation you mentioned im guessing your capsule is compromised or you don't have one. I don't know exactly how they have that new IOL in there and how difficult it would be to get it out and put a new one back in. If its the same risk as a normal IOL exchange done shortly after the operation, I would highly recommend that. If its too dangerous because you've already had other lens exchanges, your only real option would be an ICL.
Your safest option is a normal contact lens. I require contacts (can't wear glasses) after my cataract surgery and I'm contact lens intolerant, so I admit its not fun. I'm not a candidate for IOL exchange or a piggyback. I'm high risk for lasik or prk due to alreading having severe dry eye. I've been given the ICL as an option (It has been done, its just very rare that they need to) and while I am considering it, I am trying to stick it out with contacts as long as a can in the hopes something safer comes along.
Given that your eyes are now 10 diopters apart, contact lenses would probably be considered medically necessary by your insurance. (Mine are.) Usually insurance pays for them if glasses aren't an option for you. (With your eyes 10 diopters apart they definitely arent.) Its possible that contact lenses would not cost you anything.