post cataract problems

[MarcelMc]

Had cataract removed from right eye 10/9 and same lens inserted as was put in other eye in 2003. Eye was hazy, out of focus, and closed involuntarily. Had YAG 11/19. Eliminated hazy but eye is still out of focus and closes.I had opted for monofocal IOL that would allow same reading, computer, & needlework ability (& planned to get glasses for driving). But, vision very different in right than in left--feel out of focus and slightly nauseated and eye continues to close. Was checked a wk ago by retina MD specialist who said eye is healthy. Surgeon says the same. Will this difference clear up with time? Still using Prednisone with Tears. Extremely upset. What can I do?

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

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[kg17]

If glasses work to correct your visual problem, and you are willing to assume the risk of additional surgery and expense, you astigmatism might be corrected with limbal relaxing incisions or LASIK.  You could then have your dream.

[MarcelMc]

Doctor, I appreciate all your attention to my problem--and wanted to tell you my latest (see above). But I also want to commend this form of communication as being a new/great way to help individuals get rid of their '"dreams."Some dreams are based on fallicy or improbabiliy.My particular dream was that since 2003 I haven't worn glasses inside my wonderful home!  I've worn glasses ever since I can remember and suddenly---but, life is cruel. My doctor says "hey, I haven't lost my eyesight"  I think you said the same to me!  If the Internet does anything good, it is letting me tell you ('cause no one else is listening) that my dream dies hard!  I've spent my life taking care of others--and you know what? they all wear glasses!  Just like I used to do!  Even my eye doctor, and those he's sent me to, wear glasses so: how dare me to think I could continue the party that was set up June,2003! Hey, I'm having a hard time but thanks for listening--no one else is, at this point! Everyone says, join the party!  You're not unique!  It's hard to fall back into the pack--but I guess I Have to! I'm trying to focus on taking my granddaughter to Paris the beginning of April (no matter the exchange rate!) so I guess I'll live through this----but please, NO Ophthamologist  should ever assume that "settling" for less than was expected from a cataract surgey is Not Problem--
as my doctor said to me today: hey, you aren't blind!  He's right, of course, but I expected so much more and now I have to settle for so much less.

[MarcelMc]

Saw my surgeon--he says my astigmatism is the problem--he either  couldn't see it before surgery or there wasn't one before. Says this precludes putting in any other lens. Wants me to get back into glasses, use them, see if the pain goes away (maybe I'll stop noticing it if I can see), and then maybe consider lasix (which he doesn't do).Know he had trouble with my small pupil during surgery--could this have caused the astigmatism? So, after 3 mon. I'm basically where you told me to be--in glasses fulltime if I want to see.He referred me to others, all for nought, although I did learn that I don't have MD.One wanted me to climb into the MRI box to see if I have a brain tumor! Glad I balked. Thanks, Doctor, for reading and answering--you helped me know what was ahead altho' I didn't want to hear it. Actually, my surgeon should thank you, also.

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

Since the problem has been identified as an irregular cornea I would search out the leading cornea specialist in your area (you can also use www.aao.org) make an appointment for a second opinion.

Ask for copies of your records from your present surgeon to take with you. These will be very helpful. Don't be surprised if there is a modest charge to photocopy for you.

Discuss your problem, complaints and observations with the cornea Eye MD. Have the consultant look at your eyes before the techs put any drops in your eyes and extremely important before the pupils are dilated.

Your consultant will probably want to do a corneal topography but bring up the subject proactively and tell him/her you want on on both eyes.

Discuss treatment of irregular corneal astimatism with lasik and contact lens.  

I believe a fresh look at your problem with a corneal/refractive surgery specialist is likely to be most helpful.

Let us know what the consultant says.

JCH III MD

[MarcelMc]

Back again. Saw my surgeon's partner yesterday at the request of my surgeon.He told me I have "irregular corneas" in both eyes. No one's ever told me that before.He says this IC prevents putting another lens in with any success.I asked why my left eye has such wonderful vision with the same lens and IC.Answer: not as much IC! Should I have been checked for "irregular corneas" Before the Surgery? Seems the cause prevents the cure.The "sore" feeling, the "veil in lower AC"and blurry continues.  His Tech gave me careful eye tests for glasses but no one would give me the script. Like Alice, I'm getting curiouser! I hope your calm voice is still out there, doctor--I'm really a calm, level headed person normally but my eyes are essential to me. Can't do without them.

[John C Hagan]

It's good that you do not have AMD or other pathology. Hopefully you are just very slow healing.  It seems the retina doctor feels a very careful glasses test may be the answer. Next time in to your regular surgeon ask for a glasses test by their senior technician or the doctor himself.

JCH III MD

[MarcelMc]

My surgeon said the 1st retina spec wrote ltr saying I have AMD altho he didn't tell me that. So, he sent me to another one--just saw him--he says no real AMD--just spots typical for my age. He, too, can't explain the blurry vision-said he would send recommendation for refraction to my surgeon--wouldn't give me a copy--so,bottom line: I don't have to worry about AMD but can't change the blurry, according to 3 drs. now.May be helped with proper glasses.Does unexplained "blurry" happen to alot of people after cataract surgery? It never occurred to me, I'll admit. I've always been a rediculous optimist!

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

While your vision may not be as good as you want the chances of going blind are indeed quite small. Let us know what the retina consultant finds.

JCH III MD

[MarcelMc]

Just saw my surgeon.He says the lens is good and there must be another reason for my blurry vision. Glasses won't correct the blurry.He is sending me to another retina/nerve specialist next week to find the problem.Extremely discouraged. I may be losing the eyesight.

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

I'm sorry but I can not think of a connection that would be so pressure dependent. I believe you will need to return to the surgeon for a repeat exam.

JCH III MD

[MarcelMc]

I'm back again because of another problem that has surfaced.  Just spent about an hour in a grocery store with the usual lower temperature (AC) and after about five minutes my right eye started seeing a large hazy spot, as though my cataract was back.I wonder if it's the colder air causing some kind of buildup. I had YAG a week ago and cataract was taken out 10/9. I don't think this can be corrected with glasses? It made me feel unbalanced--out of focus again. Could parts of the cataract left behind be coming together again? Or could the YAG treatment not be sufficient for eliminating the haze?  It seemed to, until I ventured out today.

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

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[MarcelMc]

I'm definitely getting the message, kg17.  I'm sad that you are slowly losing your vision--it should not be happening to you and I understand your wish that you were in my position of opting for glasses--but you don't have that option, apparently--the science isn't moving fast enough for you, and that's just plain awful.I hope for new, quick discoveries for you.Some day something awful like that will happen to me. I hope I can be as gracious.
When I found this forum, I was excited by the opportunity for knowledge & advice while I put in the "wait time"before I can go back to my surgeon. Thus far I've learned that 1)my understanding of what could happen in my surgery was at best, misguided and at worse, deliberately misleading; and 2) I'm not blind, I didn't die, I Probably don't have a horrible eye condition--I say Probably but I'm not positive of that--and, 3) hey! count your blessings instead of your disappointments!  This is sounding more like a spiritual revival than the informative, medical discussions I expected!  The message seems to be that I have "some nerve" entering into this forum of participants who have encountered "Real" problems with their eyes. My "eye problem" isn't a problem, apparently, in the view of the forum. I do appreciate the time you and the doctor have given me and I think it time I let you both move on to the "real" problems others are having with their eyes.

[kg17]

I understand your frustration.  How difficult it is to look at the successful outcome of others' surgery and wish for the same.  But really, you do have a choice in what viewpoint you select regarding your situation.  As a person with pathological myopia that has slowly stolen my vision beyond what can be adequately corrected with glasses, what I wouldn't give to have vision that could be corrected with glasses....or surgery....or voodoo magic.  But life is what it is.  There are those that are better off and those that are worse.  Be grateful for what you have or you can choose a life of bitterness.  

[MarcelMc]

Doctor, I suppose I'm an opthomologist's worst nightmare but I only wish to have the same thing that hundreds of thousands of people want when they line up for Lasix--an option not open to me because of the cataract.I always knew I would require glasses for long vision; i.e., driving, shopping, etc.I was lead to believe that if my right eye was implanted with the same lens as my left, I would not need glasses for my favorite things; i.e.,computer work, reading/researching, etc. I was naive, but not stupid. Others do get these desirable results.  You say that "it's hard to conceive as having good vision with glasses is not enough".Well, there's a lot of others like me out there. Considering your field of expertise, I understand the need to point out that the procedure could have blinded me, or I could have suffered a horrible side effect, leaving me disabled. I'm sure doctors know that these things happen and are glad when they don't. However,  I still aspire to good close-up vision without glasses (although I now know it probably won't happen) and am not ashamed of this wish.  When arthritis robbed me of the use of one hand, I wished the hand to be restored to it's best possible use even though I do have another hand. It was.  I thank you for making me realize that my expectations were actually without proper foundation--perhaps my surgeon couldn't bring himself to "burst my bubble."  

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

You can consult a refractive surgeon to see if some refractive procedure might improve your uncorrected vision.

It's hard to conceive as having good vision with glasses is not enough. We have hundreds of posters with catastrophic complications from surgery that have left them with very poor vision that no glasses will fix, we have hundreds with diseases that can't be cured that have very poor vision that glasses don't help.  Picking a IOL to leave a person with good vision without glasses is not always but and is always in ineact science.  

Seeing well with glasses is not really that much of a sacrifice in the real world. Be grateful for what you have.

JCH III MD

[MarcelMc]

I appreciate your answer, Doctor, though it didn't help me sleep! Now I know it was unrealistic for me to assume the right eye (my dominent eye) would resemble my left eye when each had the same lens. My assumption was never challenged before the second surgery although .I signed statements re bad things possible in surgery. I'm now free of cataracts--but my vision without glasses is worse and it ruins my world of computer work, reading, etc. You are probably right--my choice consists of getting and wearing new glasses (the very thing I was trying to avoid) or be basically blind in one eye when it comes to "my world." I'm sure I'm not the first patient who wants her cataract back! Maybe I could have lived with it longer had I known that this would happen. I hope I don't have to settle for your solution--but my surgeon may offer only the same. Has anyone out there had a second surgery to correct this situation?

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

Think about it this way. If 5 people buy new $150 NIKE running shoes then line up and run a half mile some person will finish first and some will finish last (or maybe not finish at all) even though they are wearing the same, top of the line running shoes. Everyone understands that some people are faster, stronger, smarter than others.

It's the same with implants. When you get a new implant you don't get a new eye. Another other problems like macular degeneration, glaucoma, diabetes, hypertensive eye disease, amblyopia will still be there. Also pair organs are not clones. Most of us hear better out of one ear and most of us see better out of one eye (eye dominance).

So its not reasonable to explect the vision will be exactly the same.

Even if eyes are both healthy the same IOL may give different uncorrected vision due to differences in the lenth of the eye or the radius of curviture of the cornea or the position in the eye that the IOL rests. Very minor changes in any of these makes a big difference. Each 1 mm difference in the axial length of the eye makes about a 3 diopter difference in the post op refraction.

You probably need to get a refraction and then get no line bifocals and wear them when you want to see as good as you can for as many distances as possible.

JCH III MD

[MarcelMc]

Thnks SOO much for responding.Retina Specialist said No swelling & "normal degeneration" for 71 yrs.Then had YAG and Dr. now "weaning" me off Pred. Haze gone but eyesight still NOT like other eye that has the same lens implanted.Both have S140NB Diopter 20.0.Card says target refraction -2.50.Left eye excellent for computer, reading, needlework but right eye (implanted 10/9) only clear when I hold something up close to my eye to read.Seems out of focus and I feel an imbalance.It didn't occur to me that the same lens would NOT produce the same vision in my other eye! DOES THIS HAPPEN TO OTHERS? Or do I need to put another lens in? Or must I accept the vision I now have.I APPRECIATE your responding--it helped me sleep last night a bit!

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

From the two MDs that have examined you need some straight answers;
1. Have I had a complication? Am I still on prednisone because there is swelling in my macular (cystoid macular edema or CME). If you have CME, which is the most common reason for the visual acuity not recovering to expected level, why am I not taking a non-steroidal anti-inflammatory such as Acular?

2. If I have not had a complication why am I still on prednisone?
3. If I have not had a complication why don't I see better out of my eye.
4. May I have a copy of the retina surgeons consult?  Have them explain what you don't understand.
5. If you don't get the answsers that you feel comfortable with and understand get a third opinion from an ophthalmologist of your choosing.

JCH III MD