Aa
Cataract
I had lasik in 2000 on both eyes. In Nov. of 2006 I had cataract replacement in my R eye. In July of 2007, I had cataract replacement in my L eye. I have worn readers since 1993. Since my cataract surgery, my R eye has 20/25 vision with a floater that is very bothersome. The retinol specialist suggested having my L eye cataract removed with the possibility that if my L eye was corrected, I would not notice the floater. I had my L eye cataract removed and have had no better than 20/80. The Dr. said my choices to improve my vision are: replace lens in L eye, have lasik in L eye, remove floater in R eye. How do I decided which is the right surgery? I am 54, good health, play tennis 3 times a week (not now, as I cannot see the ball) and am a photographer.
MEDICAL PROFESSIONAL
PS: Please let us know what these consults show and what the cause of your reduced vision is due to.
JCH III MD
JCH III MD
MEDICAL PROFESSIONAL
You need to run, not walk to a different place for your care. I would certainly not do any of these things without a definitive diagnosis. As I said see an independent retina surgeon and a cataract/IOL surgeon.
Your recommendations really, really sound bad to me.
JCH III MD Board Certified Ophthalmologist
Your recommendations really, really sound bad to me.
JCH III MD Board Certified Ophthalmologist
No one knows why I am only seeing 20/80 in my left eye. They want to replace the IOL on the L eye. They explained that do to the lasik, IOL measurements are not as tried and true. Before lasik, doctors knew exactly what lens to use when doing cataract surgery. Now with so many of us having lasik, there is a slight risk of people not getting the IOL lens that will give them the best vision.
My choices are
1) have the IOL replaced in the L eye.
2) have lasik in the L eye without replacing the IOL.
3) have the floaters removed by vitrectomy in my R eye.
My choices are
1) have the IOL replaced in the L eye.
2) have lasik in the L eye without replacing the IOL.
3) have the floaters removed by vitrectomy in my R eye.
MEDICAL PROFESSIONAL
I still need further clarification. Why does your left eye only see 20/80?
Which IOL do they want to replace or do lasik on? Right or Left?
JCH III MD
Which IOL do they want to replace or do lasik on? Right or Left?
JCH III MD
Thank you for your comments. I think I wasn't clear in my explanation. I have 20/25 vision in my R eye; only my L eye has 20/80. But when the floater in my right eye is in my field of vision, my eyes drive me crazy. I feel like my L eye then tries to compensate for the right eye and it's like a camera trying to focus...every time I blink or move my eyes, it feels like they are trying to refocus. When I read, with reading glasses, I constantly have to revisit words or lines as it is blurry.
I have had three (two in one clinic as one suggested I see his sr. cornea/lasik specialist) Eye MD surgeons look at it. All have both suggested the same surgeries...either lasik to imrove the eyesight or to replace the IOL. One believes that IOL replacement should be done first, the other two surgeons said I should have the surgery I was comfortable having. All surgeons say that my eyes are in great health, the surgery was supberb and there is no scar tissue. They also said that there are very few IOL replacements and I think I'm frightened to have another eye surgery. I have tried 7 pairs of contacts and two pairs of glasses and they help, but not completely. I think what I really want is reassurance that IOL replacement surgeries are done and people are happy with the outcome.
Thank you
I have had three (two in one clinic as one suggested I see his sr. cornea/lasik specialist) Eye MD surgeons look at it. All have both suggested the same surgeries...either lasik to imrove the eyesight or to replace the IOL. One believes that IOL replacement should be done first, the other two surgeons said I should have the surgery I was comfortable having. All surgeons say that my eyes are in great health, the surgery was supberb and there is no scar tissue. They also said that there are very few IOL replacements and I think I'm frightened to have another eye surgery. I have tried 7 pairs of contacts and two pairs of glasses and they help, but not completely. I think what I really want is reassurance that IOL replacement surgeries are done and people are happy with the outcome.
Thank you
MEDICAL PROFESSIONAL
It's not clear to me why you only see 20/80 in your left eye. A "floater" is not likely to cause this. Replace IOL or lasik are solutions for implants that have left a person markedly under or over corrected. Even then with an appropriate glasses Rx in front of the eye if your eye is otherwise healthy it should see better than 20/80. Too many things don't add up.
I would suggest an independent second opinion with a retinal Eye MD ophthalmologist and a third opinion from another cataract/IOL Eye MD surgeon.
JCH III MD
I would suggest an independent second opinion with a retinal Eye MD ophthalmologist and a third opinion from another cataract/IOL Eye MD surgeon.
JCH III MD
27 Comments
Dr. Hagan, I would like to ask you a question if you dont mind.... My mom is a 64 year old female and had cataract surgery around 4 weeks ago in her left eye and 10 days ago in her right eye....she has had great success with the right eye, even immediatly after the surgery, however the left eye has been giving her issues, ever since directly after the surgery and still 4 weeks out...she has the constant feeling of "having something in her eye" and with occassional twitching on her lower eyelid. Her cataract surgeon said everything looked fine, do you have any ideas of what the issue could be?
It a stitch was put it it could be the stitch. If "no stitch" would need to check lid to be sure eyelash not rubbing against eye or under lid. Sometimes a dry eye can have a foreign body feeling she can try artificial tears and also warm compresses to the lid. The lid twitch is called myokymia and usually goes away without treatment in several days to several weeks.
Dr. thank you very much for the help. She was no-stitch I believe. I also have just found out that she has not been properly shaking the prednisolne acetate bottle before having my father put the drops in for her. Could that have been an issue? Perhaps the medicine was not having the desired effect and basically only water was going into her eye? I recently discovered on the box that it says to shake it, and she is really beating herself up over the issue and is really not overly hopefuly that the issue will go away. She has also started to have watery eyes the past 2 days. I will make sure she starts a new botte tomorrow and make sure she shakes the bottle.
She doesnt think she has dry eyes due to the watering, but I will tell her about artificial tears
She doesnt think she has dry eyes due to the watering, but I will tell her about artificial tears
Also, Could she have done damage to her eye y not shaking the bottle beforehand? Thank you very much in advance.
Shaking is ideal to resuspend the steroid particles but some steroid will get in the eye. Not using steroid would not cause the foreign body sensation it would cause iritis: pain, redness, soreness to touch and sensitivity to light. One form of dry eye involves an eye that waters frequently, in that form there are tears but poor quality. It also is helped with artificial tears. Worth a try.
thank you very much for the time Dr. Hagan, I will update you when we know more
Best of luck. Try and reassure your mom she didn't ruin her eye. I have had patients that for one reason or another did not use pred forte steroid drops at all
thank you very much. Also, she said the prednisolone drops burn for about 2 hours after applying them. She also said she is allergic to sulfa drugs. Should she go back to using the prednisolone in the first eye done 4 weeks ago that she didnt shake the bottle beforehand? The pharmacist said to call her cataract surgeon monday to discuss that.
She still has a lot of floaters and flashes in the left eye, but not the right eye, and she had her eyes dilated and everything looked fine, no tear, etc.
She is seeing her opthamalogist on wednesday, do you think he would have her do an eye scan?
Her long distance vision is still not very good she says and she had it corrected so she can see for long distance. Up close is ok with reading glasses. Without glasses, she cant see clearly at about 30 inches.
She tried the artifical tears twice and then gave up, how long approximatly for?
She still has a lot of floaters and flashes in the left eye, but not the right eye, and she had her eyes dilated and everything looked fine, no tear, etc.
She is seeing her opthamalogist on wednesday, do you think he would have her do an eye scan?
Her long distance vision is still not very good she says and she had it corrected so she can see for long distance. Up close is ok with reading glasses. Without glasses, she cant see clearly at about 30 inches.
She tried the artifical tears twice and then gave up, how long approximatly for?
Do call the surgeon Monday. Sulfa allergy not problem with pred forte. Tears should give some relief within 15-30 minutes. Pred forte does burn some people and drops less likely to burn are available but very expensive
My mom very much appreciates the help, she would like to know if it is ok to cry (half joking). You have already been more helpful than her doctor.
Sure, weep away.
thank you Dr.
Dr., what above potential nerve damage from the surgery. Could there have been some nerve damage to her eye and that is responsible for the gritty, "something in her eye" feeling?
Not at all likely
I'm assuming the point was that its very unlikely there is any *permanent* nerve damage. I'm clarifying that to avoid any confusion if they see a source on the net talking about temporary nerve damage after surgery.
There seems to be large range of quotes for the incidence of dry eye after cataract surgery, and some dispute about how much each potential cause might be a factor. Some articles suggest its mostly exacerbating dry eye problems that existed beforehand, even if the person wasn't aware of them, and that in those cases it can take a few months to subside.
Unless I've missed something, I haven't seen anything ruling out nerve damage as a potential factor. This study from 2013 suggests the incidence of dry eye is low, and usually resolves in the first few months:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827040/
"Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6–16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively.
...
Another explanation for the dry eye pattern observed in the current study was the recovery process of the corneal nerves. Since the cornea is one of the most highly innervated organs, with about 44 corneal nerve bundles entering the cornea around the limbus centripetally [18] and larger nerve fibers that run from the 9 o’clock to the 3 o’clock position and bifurcate to achieve a homogenous distribution over the entire cornea, [19] it is vulnerable to any damage within that region. Temporal corneal incisions created during phacoemulsification can reduce the corneal sensitivity in the surgical area and other areas far from the incision site. [20], [21] The damage to the corneal nerves may expand when longer phacoemulsification time is needed to break up a dense cataract. [21] Neurogenic inflammation also can develop after corneal incisions. Inflammatory mediators can change the action of the corneal nerves and reduce corneal sensitivity. [22] Disruption of the normal corneal innervation or lacrimal functional unit feedback can reduce the tear flow and blink rate and cause instability of the tear hyperosmolarity and tear film. [1] With corneal healing postoperatively, new neurite cells emerge and after 25 days, neural growth factor is released to regenerate the subepithelial corneal axon. [22] Thus, the recovery of the corneal nerves may explain why the dry eye was seen early after surgery and improved thereafter. Even though, in theory, neurogenic inflammation may effect by feedback loop to contralateral eye, we did check the other eye as in general as screening and did not find any significant dryness developed after surgery."
There seems to be large range of quotes for the incidence of dry eye after cataract surgery, and some dispute about how much each potential cause might be a factor. Some articles suggest its mostly exacerbating dry eye problems that existed beforehand, even if the person wasn't aware of them, and that in those cases it can take a few months to subside.
Unless I've missed something, I haven't seen anything ruling out nerve damage as a potential factor. This study from 2013 suggests the incidence of dry eye is low, and usually resolves in the first few months:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827040/
"Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6–16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively.
...
Another explanation for the dry eye pattern observed in the current study was the recovery process of the corneal nerves. Since the cornea is one of the most highly innervated organs, with about 44 corneal nerve bundles entering the cornea around the limbus centripetally [18] and larger nerve fibers that run from the 9 o’clock to the 3 o’clock position and bifurcate to achieve a homogenous distribution over the entire cornea, [19] it is vulnerable to any damage within that region. Temporal corneal incisions created during phacoemulsification can reduce the corneal sensitivity in the surgical area and other areas far from the incision site. [20], [21] The damage to the corneal nerves may expand when longer phacoemulsification time is needed to break up a dense cataract. [21] Neurogenic inflammation also can develop after corneal incisions. Inflammatory mediators can change the action of the corneal nerves and reduce corneal sensitivity. [22] Disruption of the normal corneal innervation or lacrimal functional unit feedback can reduce the tear flow and blink rate and cause instability of the tear hyperosmolarity and tear film. [1] With corneal healing postoperatively, new neurite cells emerge and after 25 days, neural growth factor is released to regenerate the subepithelial corneal axon. [22] Thus, the recovery of the corneal nerves may explain why the dry eye was seen early after surgery and improved thereafter. Even though, in theory, neurogenic inflammation may effect by feedback loop to contralateral eye, we did check the other eye as in general as screening and did not find any significant dryness developed after surgery."
Im not sure what everything means up above...
Dr., my mom has an appintment wednesday with her opthamologist, but her surgeon discharged her. I told her she still needs to call the surgeon monday as well per your request.
Dr., my mom has an appintment wednesday with her opthamologist, but her surgeon discharged her. I told her she still needs to call the surgeon monday as well per your request.
In my opinion the person she should be seeing in the surgeon. But if she can't get in to see him/her see the non surgeon ophthalmologist
Sorry if the technical jargon in the post I made was confusing, assuming that is what was meant by "not sure what everything means up above". The point was that although the causes of dry eye after cataract surgery aren't entirely understood, it is true that some people think temporary nerve damage might be a cause (which was asked about). The key word there is "temporary", that as the doctor noted its not likely there is any sort of permanent nerve damage. Though some people say even temporary nerve damage isn't common, the issue is still up in the air.
The incidence of new dry eye problems after cataract surgery seems to be under dispute, some sources claim its common, while others say its most those who already had dry eye issues and perhaps weren't aware of it who see the issue exacerbated for a while.
The incidence of new dry eye problems after cataract surgery seems to be under dispute, some sources claim its common, while others say its most those who already had dry eye issues and perhaps weren't aware of it who see the issue exacerbated for a while.
My experience with dry eye syndrome following cataract surgery a week ago is I have noticed a slight increase in dryness or occasionally feeling like something is in my eye, but it's certainly no worse than that I ever experienced with daily wear contacts. It may be psychological to some extent too, or even possibly due to the three eye drops (besivance, diclofenac, and prednisolone) I'm using several times a day post-operatively. Like mattdawson's mother, I'm also allergic to sulfa, although in the past the extent of my reaction to it was no more than a mild rash. The artificial tears seem to work pretty well in my case for addressing the dryness.
for the left eye, surgury was done for her on 2/21, immediatly she had problems along her left outer lash line with pain, struggling to raise her eye lid up, the surgeon said it was just very early...give it time the surgeon said...underneath her left eye lid, there is still a feeling like there is a bug in the lower eyelid and under the eyelid as she puts it, her vision is like lookign through a screen in her left eye, almost 6 weeks out, she believes she should not be having these issues anymore, lots of floaters still and the twitching. Dr Hagan explained that floaters usually go away over time, but the left eye issue is still a huge problem for her. Very uncomfortable for her to close the eye
You know if things aren't going well and don't seem to be headed in the right direction you can always get a second opinion. When I find things in my practice headed that way I always try to recommend a second opinion before the patient and/or family wants one.
Dr. Hagan, yesterday she was diagnosed with blepharitis, with dry patches in her corneas, so she does have some issues that need be addressed. The doctor does not want her to use the tears drops. He gave her 2 different drops I believe, one very expensive, I believe that is the one you mentioned before. I will update you all soon... Thank you so much again
Okay well good luck
Have an Answer?
You are reading content posted in the Eye Care Community
Top General Health Answerers
Kansas City, MO
Grand Prairie, TX
San Diego, CA
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.
