What are risks of IOL exchange?

[Candice7575]

A month ago I had cataract surgery with an IOL single lens implant distance vision in my right eye, however it was supposed to have been for an intermediate lens. By some communications mishap my doctor gave me the long distance lens instead.Wish I'd researched this earlier. I drive very little and 90% of my life consists of computer, reading and near-work where it's important to have clarity. Immediately after the implant I could no longer (a surprise to me) use my near vision in the right eye and of course the two are widely disparate. I have had a mild macular pucker for about 8+ years (hasn't bothered me much) so the surgeon said multifocal was not an option. I don't know why he gave me the long distance lens and I'm going pretty nutty now and have hot been able to find good accomodation with reading or computer glasses. My surgeon says he can replace the long distance with intermediate but at this point I have lost confidence & am going to seek other opinions in the area. Here's my question:  Generally speaking,  is IOL exchange a risky option?  is it done often? Are piggy back lenses a better option? I realize these are theoretical questions, I'm just trying to get a general idea at this point.  And I still have the left eye needing the cataract surgery. I have no other issues that I know of.  Thanks for any additional insights.

[JohnHaganMD]

macular pucker and ERM are the same.  I mentioned cystoid macular edema and this is a significant risk in future surgery.  You should have enough opinions to make an informed choice after you see the associate

[Candice7575]

Hello! I promised to write after my await appointment with the popular doc.I now have a second opinion But it’s not definitive.)  

Right Eye (where I have the single long distance lens & lost my near vision), Essentially, he had concerns about an IOL replacement with intermediate lens.  Reason:  worries that the combination of my “ERM” (macular pucker) and my EBMD (“epithelial basement membrane dystrophy-thickened basement membrane of cornea) might lead to CME (cystoid macular edema) or other unpredictable problems with a replacement.  

Left Eye: No definitive recommendation whether long or intermediate length but felt toric lens might not be a good option “(cyl on cct less than 1D) and EBMD in left cornea as well.

He referred me upward to his associate same practice who has more difficult cases and I’m to see him in 10 days).  (May 16)

I have a copy of the report which is how I know how to spell all these big words...!

Thanx for any additional insights and for reading this!

[Candice7575]

Whoops! Hope I didn't wear out my welcome!

[Candice7575]

Many thanks!   I know I had a lot of questions and your insights were very helpful. I'll check back in after my next appointments to advise progress and findings! Best wishes.

[JohnHaganMD]

sure, best of luck

[Candice7575]

Thank you Dr Hagan, I can't tell you how appreciative I am. I think you are right on-target. sorry to be so late reading this. Previously emails were sent notifying me of replies and this time=not. But I think you are right on target with your response.  Before this corneal abrasion happened last week I'd just seen a 2nd opinion doc who said exactly what you are saying, that the monovision, while safer, would not really work for me given the level of precision I need.  You are also right re the macular pucker check. I have my retina doc appt rescheduled to 4/20  (hopefully abrasion will be much more healed by then). And a consult with an excellent surgeon on May 2. Hoping he will become my doc. Q- I'm still wondering about the safety/time frame window of an IOL exchange, as Doc#2 said this should be done as soon as possible.  Of course meanwhile need to work on getting this darn abrasion to heal.

[JohnHaganMD]

It's generally true that an IOL exchange is generally done as soon after surgery as possible however even if its been several years most surgeons that do this type of work can atraumatically remove the IOL. Note many surgeons do not do IOL exchanges because it is relatively rare to have to do one.

[JohnHaganMD]

Okay some where along the way something was major error either in the measurements on your eye or not getting the IOL the surgeon wanted and an error there. Your RE has been left farsighted and that is almost NEVER done. If a person wants his/her eye set for distance the RX would be 0.00 not a plus number such as you have +1.75  and "intermediate RX would be -1.25 or thereabouts. You are not going to be able to wear glasses with such a huge difference between the RE and LE.      You really don't have full monovision because the RE has been left incorrectly farsighted.

You will need to let your cornea heal that may take 5-6 weeks.  You should probably also have a macular OCT to see if you have cystoid macular edema under the macular pucker.  Bottom line glasses and contacts are not likely to help and you likely will need an IOL exchange maybe even have two sets of measurements on the eye so that the correct IOL is put in the eye. You can expect surgeons that did not do the surgery to charge you but you should be able to work something out with the surgeon that did do the surgery so you are not paying extra for their miscalculations.

[Candice7575]

Thank you for this answer! I posted an answer earlier which I hope is sufficient. Generally speaking, I now have long vision from the right iol implanted during the cataract surgery & intermediate vision with the left eye which still has the cataract. The corrective glasses  I got (temporary) help me get by with my daily work but are not comfortable nor sharp). I've gotten 2nd opinions since Feb but am really awaiting the appt with a well-known 3rd doc in May (waiting period=over 60 days!) The other 2 surgeons had differing opinions: #1 thought I should NOT get the IOL exchange, but try out monovision alternatives, #2 thought I would not be happy with monovision given I'm a graphic artist & thought I should get the IOL exchange to intermediate.  Some disagreement as to what is the "safest" time period where the IOL exchange can be done. I await though the opinion of the third doc who is really my 1st choice. MEANWHILE, an unfortunate incident occurred. My existing doc, whom I plan to stay with till I identify a replacement suggested a trial of contact lenses duplicating the monovision alternative. I agreed to this, and it took place in his office this past week. But unfortunately his assistant didn't insert/remove the contact lenses properly because I've now ended up with a corneal abrasion & blurred vision.I've been told its temporary, taking a bout a week to heal. Not happy! I'll post about it separately.  The only other visit to report is a scheduled retina doc visit next week (I'm followed separately with a surgeon I like a lot to check on the macular pucker post-operatively.)  Maybe he can help me get into see the "popular" doctor sooner than May. (I mentioned the macular pucker in my first post since it affects my IOL options.)

[JohnHaganMD]

Once you provide the information we can give a much better answer

[JohnHaganMD]

We'll wait to hear from you

[Candice7575]

thanks, will do! I knew I'd need to have additional info.

[JohnHaganMD]

First of all to answer your question you need to post your present glasses RX for both eyes and your vision with and without the glasses and your age.

Then you need to read this article carefully.  I and others will post an individual response after you've done these two things:

Read: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

[Candice7575]

Age 71, current RX: Sphere R-+1.75, L-+1.00, Cylinder R: -;75, L: -2.00, Axis: R-95,L-90.  Am reading article now. Just re-found this link, thank you for your response.