anisometropia after cataract surgery

[missycat1]

I had cataract surgery 6 weeks ago.  I had a strong astigmatism and farsighted and the cataract in the one eye was causing difficulty with driving day and night...Otherwise my inside, and close up vision were fine with my trifocals.   I had a Toric lens put in to correct the astigmatism. My post op vision was about 20/40 and seems to have gotten worse. I was told that the lens was in the proper place but had moved forward and thus the change from the initial vision improvement.   I was not given any information regarding the possibility of imbalance in the eyes after surgery..In fact the doctor told me all I would need was over the counter reading glasses...I questioned him regarding only having one eye corrected and he said it wouldn't be a problem..Needless to say it's been a nightmare..I had previously been treated with laser for narrow angle glaucoma and apparently the narrow space caused sever corneal edema after surgery...I was on prednizone drops for 5 weeks and the swelling has resolved...I'm presently wearing a contact in my non surgery eye and trifocals glasses which cause major distortions...The vision in both eyes is acceptable with the contact and the glasses as long as I don't move my head or only use one eye at a time,  but together it's wavy. Even as I type this I have eye strain..Also the surgery eye burns and aches..I'm using drops for dry eyes but that doesn't really seem to be the issue.. The ophthalmologic said the surgery is fine and dismissed me for three months..The optometrist seems to be trying to resolve the situation but with little success.  He tried a lens with a prism  and has changed lens's about 4 times.. The cataract in my other eye is nowhere near ready for surgery..I've read about Iseikonic  lenses and wonder if this could  resolve this situation but have no idea how to find someone who can prescribe them. I'm  just desperate for any solution other than surgery..I can function with  the contact and no glasses  but the eyes are not the same and I can't read well or do anything close up. Just function at a minimal level....I'm a healthy active 68 yr. old female and this has really devastated the my life.  I live in a smaller city and the choice of doctors is limited.  I'll travel anywhere to get this resolved...  

[missycat1]

...Two questions for you...1. Would you suggest that I make an apt to see Dr. Doane to get an assessment on the cataract surgery I had even though I do not intend to rush into a second surgery.  It seems to me that it would be profitable to have a doc either say the corrected eye is fine or give me options if it isn't.   2. Secondly, If glasses or contacts or a combination of both would improve my imbalanced vision are there doctors or optometrists  in your clinic who are able to accomplish that task..

From what I'm learning and reading there are glasses that will work but they are complex and require computer programs etc. There is a site called the lens-wizard which offers a lot of hope but it's in Canada...I need a clinic that will go the extra mile.

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

Thanks and Merry Christmas to you also.
JCH MD

[missycat1]

Thank you so much for the input..I'm going to limp along until we return from a month out west...Then I will probably indeed come to KC....Can't function well as is..Going back to the optometrist on Wed. to see if he can make any adjustments to the contact or glasses...Still have the burning and aching in the surgery eye but that could well be eye strain....You serve a great need in being willing to answer question..God bless you and have a wonderful Christmas.

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

I really can't tell.  We do not fit those type of contacts because of the low success rate. It depends a great deal on the refractive error of your two eyes and the visual acuity.

If you decide to come to Kansas City for a consult I suggest John Doane MD of our Discover Vision Center office in Leawood. He has a world famous reputation, editor of medical journal, author of medical books/articles, lectures the world over.

JH  MD

[missycat1]

   What is your thought on the Iseikonic  lenses  to help with this situation.  I'm going to see the optometrist tomorrow to see if he has any more ideas...Would like your input. Also since we are close to KC if I can't get the help I need here do you still practice in KC.   I'm in Springfield, Mo.

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

That's a decicision for you to make.  If you cover your unoperated eye, and are only using the operated eye and with glasses the vision is really good its not at all likely that removing the IOL is going to be recommended.

If when you do that the vision is not good then you need and explanation why.

JCH MD

[missycat1]

Thank you for the input.  I've been doing a lot of research and have come to the same conclusion, but I'm not ready to get surgery on a healthy eye.Another question..We have a month trip planned from Jan-Feb. I've read that if a lens has to be replace, repaired etc. that it's best to have it done before 3 months as after that it becomes more difficult.This will not be possible and now I fear that waiting until we return the middle of Feb. might make the situation more volatile.  So, bottom line, am I wasting my time and the optometrists time trying to solve the imbalance with a contact lens and glasses. I don't really know if eye no. one is fixed or not as I don't know what the expected result was to be. The doc. seems to be happy with the results as of the last apt. when I had my eye dilated, said it looked great and the slight rotation of the lens was withing the "5" margin...Do I need to get all his surgical records and take them to another doctor?      

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

First if you are quite far sighted they it would be normal to have trouble with the eyes working together after surgery. We always educate people on this. WE SAY: "your glasses are thick on both sides, we want to make you see better with cataract surgery but also lessen your dependence on glasses and make your vision without glasses better. Surgery will make it very difficult for your eyes to work together. So we will let the first eye heal, make sure you are very happy then we will do your second eye surgery. We compare this to two people balanced on a teeter totter. They both weigh the same. One person loses 50 lbs now the tetter totter is out of balance. That is what surgery does to your thick glasses" So you weren't prepared.

right now I suggest a second opinion. Find another cataract/refractive surgeon near you at www.aao.org or go to an ophthalmology department at a medical school.

You need problem clarified on your surgery eye, get it fixed. Your eyes will likely not work together till the other eye is done but concentrate on getting eye number 1 fixed to good vision.
JCH MD