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Corrective Surgery After Retinal Detachment - 2 Options

I am asking this question on behalf of my girlfriend. She had two surgeries about 6 months ago for retinal detachment on the left eye. One of these was a vitrectomy and this procedure results in formation of cataracts. She now needs cataract surgery. She was also told that, during the cataract surgery, they can also improve her myopia for that left eye. However, she has a choice to make. Her right eye (the one that did NOT need retinal surgery) is -10. She was told she has the choice to have the left eye improved to either 0 or to, for example, -5. A correction to 0 would mean she would need to wear a contact lens on the right eye, while a correction to -5 would mean she would stick with eyeglasses. Her eye surgeon explained that this choice was up to her preferences - the surgeon seems to think that both options are equal from a strict medical perspective. Do any of you have experience with having to make this choice? Any feedback welcome.
3 Responses
Avatar universal
I considered doing the correction to 0 for my left eye during cataract surgery and using a contact lens for my right eye, but opted instead for correcting my left eye to approximate parity with my right eye and using contacts or glasses for distance correction for both eyes.
1 Comments
e4e
Hello again. I have two more questions if you are willing to give more details. My girlfriend's "good eye" (the one without the detachment) is -10. If you are willing to let me know, what was your right eye's number? Second, how did your choice to go the "parity" route work out for you? I appreciated that you may not want to answer these questions and, of course, I understand that.
177275 tn?1511755244
You and your girlfriend need to put some time into this.  Start by reading this very carefully:
https://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;

Your girlfriend is highly myopic which disposes to retinal detachment (RD)  With a RD in one eye the chance of a RD in the other eye is very high, as high as 10-15%     Also let me assume that prior to the RD her glasses were the same RE -10  LE -10   Can I also assume that your girlfriend is less than 40 and wears single vision, i.e. NOT bifocals?  If so no mater which of those options she chooses she is going to have a LOT of problems with the eyes working together.  Anytime there is more than 1.5 diopter difference most people cannot adjust.  So I do not buy the premisce that if she is -10 RE and -5  LE that she will be able to wear glasses comfortably. ALSO VIP:  She will likely have a monofocal IOL put in her LE. That means even if she could wear -10 and -5 the operated eye WILL NOT BE ABLE TO READ.  After IOL put in eye it cannot focus so the operated eye will need a bifocal.    That makes glasses even more difficult to wear with bifocal (no line) on just the LE. Not many people can do that.   There is not simple, easy option.   She could have surface PRK on the RE to reduce it. Surface laser does not carry the RD risk that regular LASIK does.  I would suggest you get a second opinion before cataract surgery. I suggest you find a cornea surgeon that specializes not only in cataract/IOL surgery but refractive surgery. To deal with her problems you need MORE than a standard cataract surgeon you need a cornea/refractive surgeon. DO THIS BEFORE SURGERY. this is very difficult problem not as simple as has been represented to you.
4 Comments
e4e
Thanks for the reference article, and for your clear response. If you are willing to field follow-on questions, here is one that comes to mind right away: (1) assuming that her LE was -10 pre RD (I will check), why, given what you say, would surgeons suggest a correction to -5 or even 0 that would result in such a large difference between the eyes - why not simply "restore" the LE to -10?
being -10 is a horrible thing. The vision without the glasses is terrible, the glasses are extremely thick and make everything look much smaller than it really is.  We would never want to leave anyone -10.  Even if that is what you chose the eye still cannot focus up close and will need progressive no line bifocals which will make it for the eyes to work as a team.  -5 makes no sense to me since without glasses the vision is still bad (assuming the RD and vitrectomy did not leave damage to the retina such that it can no longer see 20/20)      There is no 'good choice' and people make different choices. One that has worked well for some of my patients in this situation.  Do bad eye (LE) target about -1.00  See how the eye recovers (with damage to the retina the vision may not be perfect even after the cataract is removed, especially if this was a 'macula off" retinal detachment.  Then after the eye has healed and the vision and refractive error is know (generally about 4-6 weeks)  have the good eye have surface laser (PRK) on the good eye usually aiming for zero (plano) if better distance vision without glasses is desired or -2.00 if better near vision without glasses is desired.  
e4e
Thanks for the feedback. I should correct an error in my initial post that misled you. I misunderstood my girlfriend's account of what her surgeon recommended. The surgeon did NOT recommend going to -5 (something that understandably puzzled you, given what you have written). Thank you very much for your time. By the way, her detachment was indeed Macula-OFF.
Okay.  Consider second opinion. Going to be difficult on many levels. Best of luck
Avatar universal
@e4e my non-operative RE is -6.o and my LE, which had a vitrectomy performed to correct an epiretinal membrane 3 1/2 years ago, was set at -4.5 with a monofocal IOL during cataract surgery about 2 years ago.
4 Comments
Mr P is a success story.  Note difference in two eyes is 1.5 diopters right at the range that most people can tolerate.  Also -4.50 is much much better than -10  
I believe I am a success story as well :).  Mine was similar to Mr. Presley, my right non operative eye was -3.50.  My left eye that had vitrectomy for RD was set to -2.50.  Was very pleased after I got new prescription.  Few months later I did had to have intervention on my right eye (vitrectomy for retina tears).  Cataract consult on that one coming up in the next week.  But until this happened I was very pleased.  My left eye isn't what it used to be before all this, but it always was the weaker one.  It has performed well being my primary eye while going through the issues with my right (driving fine..etc).
Jim is indeed a success story as well. He's ahead of me by having had a vitrectomy performed on both eyes instead of just one. I will continue to monitor my RE for any changes that may require intervention. It has the same condition (epiretinal membrane) that necessitated the vitrectomy on my LE, but so far it remains non-symptomatic. It did have a peripheral horseshoe retinal tear that required laser treatment the first time I ever visited my retinal specialist, but I have not required any such treatments since.  One common experience in all of this is the accelerated development of a cataract following vitrectomy, mine took a little more than a year to develop to the point of needing surgery.  My RE has a minor cataract but needs nothing done about that so far.
Thanks for your participations Mr P and Jim.  I would again strongly suggest a second opinion with  cornea/refractive/cataract surgeon.
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