cataract surgery with other factors

[toddL]

I went to my eye doctor recently because I was getting ghosting images in my right eye (1 main image but I would also see 2 to 3 ghost images of the main image depending upon my distance from the image/object) - my regular eye doc could not correct my vision to 20/20 so he referred me to an ophthalmologist who says I have:

- somewhat mild cataracts in both eyes (which he believes are causing my vision problems)
- I also have a condition called fuchs systropy with an endothial count around 2500 (which my regular eye doc thought might be what was causing my vision problem but wasn't sure...)
- I am also a borderline glaucoma candidate with eye pressures around 20 to 22 and so far have taken 2 somewhat inconclusive visual field tests to determine if I have suffered any damage to my optic nerve (the ophthalmologist decided to go ahead and start me on drops) - the eye pressure thing has been going on for about 2 years

- I am a 42-yr-old white male with a fairly high prescription (that I've had pretty much all my life)
RIGHT - SPHERE -11.25; CYL. +1.75; AXIS 090; ADD +1.50
LEFT - SPHERE -11.00; CYL. +1.75; AXIS 100; ADD +1.50

- the ophthalmologist wants to do the surgeries 2 weeks apart and believes he can come close to correcting my vision for distance with the new lens implants.

if standard cataract surgery has a 95% success rate - realistically, what on a percentage basis would my success rate be with these additional factors?

[Chuckles960]

May I try a slightly more technical explanation? Your eye has a lens in it that focuses images to the "screen" in the back of the eye (the retina). Just like using a magnifying glass to focus sunlight...the lens in the eye is fatter in the middle (it is a plus power lens, i.e. convex).

Now if you are myopic the lens in your eye is not focusing in the right place; the "screen" is too far away.. You now use a minus power lens in your glasses (concave...thinner at the middle, fatter at the edges) to correct for it.

During surgery you will get an IOL that combines the effects of these two lenses (one concave, other convex). It will still be a convex lens (fatter in the middle) but not as fat as the the natural lens you now have.

But because it is not as fat in the middle, the IOL leaves more space (your eye is now more loosely packed)  and your chances of retinal detachment are increased.

The lens you need is determined not based on what glasses you now wear, nor the shape of your current lens, but mainly based on measuring the distance from the IOL location to the "screen" (retina).

[Michael J Kutryb, MD]

First - I commonly have a retinal specialist do a complete dilated retinal exam on patients like yourself BEFORE cataract surgery to make sure there are no small hidden retinal tears or holes in the retina.

Regarding the IOL think of your eye as a camera.  The cornea is a fixed power lens on the front - the IOL will be a fixed power lens in the middle and the two lens together work to focus the lens on the retina.  On average the corneal power may be around 43 and the IOL power about 20 or so with a total focusing power of the eye around 62 or 63 diopter or so.  Now depending on the distance from the front of the eye to the retina you would need more or less power and this modification of the power is done with different IOL powers.  Usually a very large myopic eye needs much less focusing power in the IOL - the explanation may be above your head.  Basically your surgeon needs to very accurately measure the power of the cornea, and the distance from cornea to center of retina.  Then mathmatical formulas will tell the best possible IOL power to use - my wild guess is that you might need something like a +5 or +6 or +7 but you will find out exactly what you need after your measurements.  The ZEISS IOLMASTER is a machine that will give the most accurate measurments and the SRK-T (with Koch's modification for axial lengths greater than 27 mm) or Haigis or Holladay II formulas may give some of best possible IOL predictions.

[Michael J Kutryb, MD]

Your cell count does not sound that low - usually I think of 1000 or below being a very bad cell count.  You may have the number wrong.  Your chances of a safe, effective surgery should be in the high 90's percentage wise.  I don't see where a slightly low cell count or glaucma suspect will really have any adverse risk effect on your surgery.  The one factor that really will have an impact on your risk profile is high myopia - so you will have a significantly higher chance of retinal detachment (as high as 5% or so according to some studies.)  Also you have significant astigmatism and need to be prepared for probably wearing bifocals after surgery unless you have a really great refractive result from surgeon who also treats your astigmatism.  You should have 95% or greater chance of a good result.  Be prepared for the fact that you might not see 20/20 perfect because in my experience it is ot unusual for these highly myopic eyes with astigmatism to peak out at 20/25 or 20/30 due to mild myopic degeneration, floaters, or mild amblyopia.

MJK MD

[zensixties]

  Yes, both good explanations.  I'm 43 and more nearsighted than you.  I just had cataract surgery on my right eye and had a great outcome, virtually no problems (20/30).  My left eye will be done next week and the IOL will be zero power (which shows how nearsighted I am).   Then all I'll probably need is reading glasses.

[toddL]

Thanks to both responses they have done a great deal to help me begin to grasp how everything works together...

[toddL]

Thank you for your quick response it was very helpful - I believe I have my cell count correct but will double check...

- If you don't mind I have a few follow-up questions:

Should I have a pretest to determine the likelihood of retinal detachment - I thought I read somewhere that there was a dye test that could be done - the ophthalmologist dilated my eyes and did an exam but is this enough? - I do have a lot of floaters in both eyes but don't recall a huge jump at any one time - I also get flashes of light sometimes particularly in my right eye when I stand up too quick, the ophthalmologist says this may be more to do with my blood pressure, etc. which does run slightly high 130 to 135 over 80 - also sometimes think I see little pin points of light in my right eye when I'm working on my computer for example but when I kind of focus on where they are they disappear (not sure if I'm just getting paranoid on this last one) - fyi, I had a complete physical recently and am otherwise healthy.

- Does the Sphere number of my prescription measure the shape of my eye? Is there a machine or device that can measure the shape of my eye better than a standard eye test? - The reason I ask is my numbers have been changing a lot since I became 40-yrs-old or so (the sphere in my eyes for example have been running around 9.00 but when I went to the ophthalmologist he measured them at 11.25 and 11.00) - my eye doc has said in the past that my prescription changes may be due to my developing presbyopia and because I stopped wearing gas perm. contacts which had the effect of shaping my cornea - I guess my big question here is how the cataract replacement lenses work - I understand on a certain level how glasses and contacts work to correct vision but am having trouble wrapping my brain around what this new lens behind my eye does to correct my vision and how it works with my cornea... - if there is a 101 explanation you could give me it would be much appreciated (I am concerned I may get a too strong prescription or something and will develop headaches, etc.)

my apologies for the longwinded questions - I greatly appreciate you taking the time to answer them...