PSC Cataract & Tissue-Saving Lasik Questions!

[CraziED]

I'm a 24 y.o. male who has been diagnosed with posterior subcapsular cataracts in both eyes 5 years ago.

Last month, my left eye's cataract got worst and started affecting my vision, and visit a Eye MD I was suggested to undergo cataract surgery immediately. I was full of hope to either get a multi-focal or accommodating IOL. Alas, the Eye MD believed that just one eye is not suitable for such an implant, and the end result wouldn't be satisfactory, especially if I were to compare the vision quality between both eyes later on.

Furthermore, he wasn't comfortable with the idea that my left eye vision achieved 20/20 while my right eye was at 800 degrees, he said that even with glasses on, I would not be able to adapt to the drastic difference between both eyes - he suggested either toric contact lenses (which I couldn't wear due to frequent lens rotation), or LASIK to reach near zero degrees for the right eye. Is this a plausible reason to undergo LASIK surgery? Or is there more than meets the eye?

Therefore, 2 weeks ago, I under went tissue-saving LASIK for the eye without cataract complication to correct my vision which has the following reading

(from Lasik report):

SPH: -8.25
CYL: -23.50
AXS: 5 (degree)

Post surgery today (2 weeks later), a visit to the Eye MD found that I have a remaining of about 200 degrees of astigmatism. Is this a good outcome from a LASIK operation? Would I require an enhancement later on - since the Eye MD does not want to comment anything and just asks me to wait and see how it settles down?

For my left (Cataractous) eye, after pharco the Acrysof Toric IOL was implanted  with 8.0D and 2.25 D CYL. The report today  (2 weeks later), was that I have 0 Astigmatism but a positive power of +100. Is this a sastifactory outcome? Would LASIK or further surgery be required for me to achieve perfect distant vision? Reading glasses is definitely required for left eye reading?

Your suggestions is greatly appreciated!

[CraziED]

Thanks for the reply. I was just curious of the outcome, and wanted to know how well it went comparatively, as all my Eye MD would say is "wait and see". Glad that it's looking look.

After rechecking my Glasses Prescription, I found the following:

LEFT EYE after IOL implant is:

SPH: +1.25
CYL: Nil
AXIS: Nil

RIGHT EYE after tissue-saving LASIK is:

SPH: +0.25
CYL: -2.00
AXIS: 155 (degrees)

What do you think?
Thanks!


Cheers,
CraziED


P.S. As for why he suggested Lasik even though I have signs of cataract formation in the right eye...he said the good news was that it was almost not there yet. So...while the good times last, I suppose?

[Michael J Kutryb, MD]

Overall, your vision seems to be much better than before surgery.  

OK, for right eye s/p LASKI or LASEK, it sounds like you're doing fairly well but not perfect.  Follow your doctor's advice and let things settle down for a while and condider a laser enhancement if needed down the road.

For the left eye  with the acrysof toric - again it sounds like you're doing fairly well.  The +1.00 refractive outcome is fairly close to zero.  So the doctor did a good job.  Your pre-op cataract surgery was not  an easy one to correct.   I would have counseled you that there was at least a 50% chance that  you would still need distance glasses and would definitely still need reading glasses.  The surgery and implant are very good - there is no use served by building up unrealistic expectations.  Better to underpromise and overdeliver.  Overall, you're doing pretty well.  In the future, if you are really perfectionistic - you could consider laser enhancement on the left eye as well or just wear glasses part time.

As a side note - I was curious that you had LASEK even though you have a small cataract coming in the left eye??  What's the feeling from your doctor as to when you might need cataract surgery in the left eye?  Enjoy the improvements you've gained, right now - try to hold off more surgery if you can especially with your steroid responder glaucoma problem.

Michael Kutryb, MD

[CraziED]

Sorry, just noticed a typo. My LASIK Report should be:


SPH: -8.25
CYL: -3.50  *********(-23.50)*********
AXS: 5 (degree)

[CraziED]

Sorry for a double post. Just to add a few more pointers to my post:

a) I happen to develop Glaucoma post-op after using the following eye drops post-op:

Left: TobraDex & VigaMox
Right: TobraDex & Pred Forte

The major symptoms included rainbow halos and flashes several times throughout the day for about a week (in between doctor's visits).

Therefore I was given a IV dose of Diamox and Diamox (Oral) and Slow K (Oral) to use with Nyolol and Iopidine eye drops to lower the IOP. It was originally 40 and 50 and now is controlled to about 14 and 16.

So it is under control, and the vision quality is still quite blurry because of the remaining 200 degrees of Astigmatism on the right eye (LASIK), and the Acrysof Toric IOL (left) eye seems to be still quite blur for distant vision, though slight better than the right eye's distant vision.

Is this normal for an IOL distant vision to be still blurry even though it appears to have corrected the myopia and astigmatism with a positive power of +100 degrees?

Thanks!