iol exchange

[sirfin121]

I had cataract surgery on my left eye on 10/27/08. The IOL implant is Acrysof IQ 11.5D power . Surgery and recovery went very well (no health complications). However, vision results are not. I now have +1.75 with operative eye and -2.00 in nonoperative eye. I had Lasik 7 years ago and eye surgeon stated Lasik caused "miscalculations" of lens power. Causing some difficulties with paring of vision. Eye Surgeon has discussed possibility of IOL Exchange but overall opposes the idea. I am 45 yr old male in very good health. Can you give me your detailed thoughts on IOL exchange to correct the difference in diopters?

[JodieJ]

If your surgeon opposes IOL exchange, what is s/he suggesting that you do?  You are almost certain to develop symptoms of aniseikonia with your current vision.  These symptoms include headaches, photophobia, impaired depth perception, spatial disorientation, excessive tearing, and double vision.  Contact lens wear might eliminate these symptoms, but it may not be a good long-term solution.  I strongly suggest that you get another opinion from a board-certified cataract/refractive specialist, perhaps from a senior staff member at a teaching hospital.

[John C Hagan III, MD, FACS]

Long term you are going to be better off with a IOL exchange. While it is true that RK and lasik makes the calcuations more difficult there are now formulas specifically for RK and lasik patients  that can usually get the person -/+ 0.50 diopters of the desired target.

JCH MD

[sirfin121]

Thank you for feedback. I have appt scheduled on Monday 12/1/08 with Eye surgeon to discuss IOL Exchange options.

[John C Hagan III, MD, FACS]

Be sure and ask about the experience of exchanging IOLs as its more difficult to exchange and IOL than put one in the first time.

JCH MD

[sirfin121]

Dr,
What concerns should I be made aware of with IOL exchange? Even with the miscalculation of my recent cataract surgery RX (+1.50), I see no halos or double images, etc. Will IOL Exchange raise rick factors? What are risk factors?

[John C Hagan III, MD, FACS]

The IOL exchange is another operation, more difficult than the first with risks of infection, bleeding, retinal detachment, retinal swelling, vitreous loss.

that doesn't mean you shouldn't have the surgery. We take risks all the time we just don't think about them (driving, flying, exercising, not exercising, etc).

JCH MD

[sirfin121]

I had the IOL Exchange on 12/11/08. Extreme blurriness due to corneal swelling after surgery. Eye surgeon performed eye "tap" 3 days later to reduce eye pressure/swelling. Vision has cleared and vision has settled to 20/35. However, I am having other complication. Vision in operative eye goes "black" if I stand quickly, bend over, etc. Plus, I "see" wiggly movement in corner of peripheral vision. Vision even went out when I sneezed. He and the retinal Dr checked IOL placement and retina. They state everything is perfect. They are sending me to a neurological optometrist.
Any thoughts? Ever heard of this complication?  

[John C Hagan III, MD, FACS]

1. there is no such thing as a neurological optometrist. Perhaps you are being referred to a neuro-ophthalmologist an Eye MD with special training.

2. I would see a retina Eye MD to make sure the retinal is okay. The movement in the peripheral vision can in some cases be a retinal detachment.

3. You definitely need to get second and even third opinions about what's going on.

JCH MD