Catarct Surgery after Retinal Detachment & ERM

[EyeOnYouNC]

I had a vitrectomy for a detached retina in my right eye in August  2013 and after 2 months my vision in the right eye began to blur.  I was told it was due to retinal pucker and had ERM/ILM surgery in early December 2013.  My vision in the right eye has never gotten better in fact got worse in the last week.  Went to a cataract consultation yesterday and was told the there might be an improvement but that they can't tell if my vision is impared from the 2 surgeries or the cataract which developed aggresively after the two surgeries.  I am concerned that I could have the cataract surgery and still not see any better.  The doctor could give me no real assurance although he thought it might be somewhat better.  Have been investigating pinhole glasses and Eyebright supplement.  Could either of these help me to postpone the cataract surgery.  Other suggestions? Why can't the doctors determine if my bleary vision is from the first surgery or the cataract?  Frustrated.  should I just get the cataract surgery and hope for the best?

[EyeOnYouNC]

Thank you both for your quick replies.  I had come to the conclusion today that I would seek a second opinion as you both suggested.  I have read some of the posts here and find am surprised to hear of all the problems associated with all the different kinds of eye surgery.  

The sad part of my story is that I went to TWO ophthalmologists within 4 days when I got some nasty floaters and was told it was PVD and not to worry about it, it was just a part of aging.  I was 63 at the time. After several weeks,  I realized that it was not getting better and went to yet another ophthalmologist who diagnosed the detached retina within 30 seconds  All this might never have happened if the first two doctors had sent me to a retina specialist or told me to come back in a week or two.  It's been quite an adjustment.  Thanks again  for being here and providing this service

[flossy93]

It's a shame you had a cataract develop after your two retina procedures, but as Dr. Vosoghi indicates, it's quite common, and the cataracts that do develop after vitrectomy tend to come on very quickly.  

The reason the doctors can't tell whether your impaired vision is caused by the cataract, retina damage (or some of both) is because of how the eye works.  The images being picked up by the photoreceptors in your retina are passing through both your natural lens (with its cataract) and the inner retinal layers which may have scarring or damage from the ERM.  One or the other of these elements of the eye can't be 'taken away' temporarily to see if your vision improves.  The only way to tell is with cataract surgery to remove the clouded lens.  

As Dr. V. suggests, it may be helpful to get a second opinion about how bad the cataract has become, and whether that doctor feels surgery is warranted to remove it.  In any event, you will probably need cataract surgery at some point because as the cataract continues to worsen, it eventually will obscure the ophthalmologist's view of your retina.  By then it will need to be removed so the doctors can safely evaluate and treat any future retina problems.

If the cataract is significant, it may even be obscuring their 'view' of your retina already.  This is where OCT testing is invaluable, although even that test can't always reveal whether impaired vision is due to a retina disturbance.  I had a normal looking OCT scan but have a retina-based vision problem in one eye.

Be aware that Eyebright, esp in ocular drop form, is not recommended for patients who have had recent eye surgery unless directed to use it by their doctor.  It doesn't sound likely to improve impairment from either the cataract or residual scarring or damage from the ERM.

Good luck with your future appointments, and please post here about what you learn in the future and what you choose to do.  I hope you find a solution and that your vision improves.

[Houman Vosoghi, MD]

Get a second opinion to see if the cataract is truly bad enough and if it is, might as well go for it.  It is not uncommon for a cataract to develop after one retina surgery, yet alone two.  Unfortunately, we frequently can't tell how much of decreased vision is due to cataracts in patients with retinal problems or a history thereof so no one can be sure for you until after the amount due to cataract is resolved and see what the vision is when the "dust has settled."

HV