Help locating a competent, trustworthy eye surgeon

[Capes55]

I'm a 53 year old male, high myope (-9 left eye, -10.5 right eye contact lens prescription) I have a mild posterior subcapsular cataract in my right eye.  It's causing me significant difficulty (tough to read, almost always in my field of vision, colors dull)  I need to take care of this soon.  I saw a local surgeon about a year ago, who told me I would have to go without my right contact lens for 3 weeks minimum so they could get an accurate reading for the iol power.  Due to schedule, I ended up going 7 weeks without wearing it. (It was very difficult with 1 contact in and 1 out) About 1 week before surgery, I became apprehensive and canceled the surgery.  At the time I could tolerate the cataract but it's really bothering me now and is affecting my lifestyle and attitude. The local surgeon then referred me to another surgeon in Houston who I saw last Summer.  He said it my condition wasn't bad enough at the time to operate but the cataract could develop quickly. My next appointment with him is in October, (they said that was soonest I could get in)

I've seen several retinal specialists in the last month who said my retinas look good. I've also seen 2 additional prospective local surgeons in the last 3 months . One said he thought I should wait, because my sight wasn't that bad yet (March 2008 20/30 right eye)  The retinal specialist I saw 2 weeks ago in Houston said it was now 20/50 but still a "mild" cataract.  The problem is I'm suffering and want to get it fixed as soon as possible.

About a month ago I saw yet another prospective local surgeon.  This guy is real experienced, a solo practicioner, does surgery 2 days a week, and is ready to do a lens implant in the next few weeks.

Here's my concerns:  He said that it is absolutely not necessary to take my contact out for 3 weeks or 1 week or 1 day to get an accurate reading from the IOL Master to calculate the IOL power. Also, today, he suggested implanting a Toric IOL to correct my astigmatism.  Since this is such a permanent thing, I don't want any chance of miscalculation.  This guy said he uses the latest version of the IOL Master and that the readings are accurate and that I would not have to go without wearing my contact for week(s).

So, WHICH DOCTOR IS RIGHT?  WHO DO I TRUST?  My goal is to be corrected to be slightly nearsighted, like -.5 or -1 if possible.  I do not want there to be any chance of being corrected beyond plano.

Also, this Surgeon suggested that I do my other eye soon after the 1st eye.  My left eye isn't giving me any problems yet, but it would be great to correct most of my nearsightedness in both eyes.  I realize that there's a small risk with cataract surgery and that because of my degree of nearsightedness an increased risk of retinal detachment. (right eye 29.1mm axial length left eye about 28mm)

I 'm trying to get to the point where I am confident there's at least a 90% chance that, other than a possible future yag procedure, that these IOL implants will solve my problem for life (another 30 or 40 years)

Any suggestions?  How do you find a competent, trustworthy, ethical, caring cataract surgeon?

[AnnaE]

Thanks for your comment about my vision loss.I would have had 20 surgeries to save my eye. The loss feels worse at some times than at others, The best I can do it to try to help others. My loss has made me more aware of other's feelings and experiences. If I am a bit pushy it is because I want you to have healthy eyes.

I am so glad that you do not have to worry abou lattice.

Thanks for your recognition, and I am most happy that you have your wife for support.

Please weigh everything carefully, and listen to the expert doctors who give you advic, like the ones on this forum.

Also, it is so good that you are taking care in finding a doctor/procedure.

Best,

Marianne

[Capes55]

Thank you for your comments.  You mentioned you were highly nearsighted with astigmatism.  How nearsighted were you?  Also, do you know your axial lengths?

One eye surgeon suggested a Toric IOL to correct my astigmatism, however my optometrist didn't think that was a good idea.  He said Toric IOLs have to be perfectly positioned and might cause problems, he recommended a "Plain Jane IOL" and to aim for being slightly nearsighted, like a minus 1 or so.

For me, being a high Myope,  if I became a -1 after surgery, it would be a miracle.  My primary concern is being high risk for Retinal detachment.  I realize the primary goal of cataract surgery is to remove the cataract, however it's almost miraculous for high myopes that much of their refractive error can also be corrected with the new lens.

Anyway, thanks again

[Capes55]

Thank you for your comments.  Concerning Lattice, the retinal specialist I saw in Houston on May 30 said in his report "Temporally, in the right eye there were a few chorioretinal scars, but there was no evidence of Lattice degeneration or any precursor lesions to retinal detachment in this eye.

In the left eye, he had a tilting of the optic nerve and no other pathology... he does not require any precataract surgery prophylactic laser"

I am sorry to hear about your eye issues.  Sounds like you've really been through a lot.

[John C Hagan III, MD, FACS, FAAO]

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[JodieJ]

If you do decide to proceed with the surgery on your right eye, you will probably do quite well post-surgery wearing a contact lens in your left eye.  My vision was surpisingly comfortable this way.  So you may be able to postpone surgery on your left eye until you really need it.

[AnnaE]

Do you have lattice degeneration?

[AnnaE]

Does it hold danger for people who make escess scar tissue? What are the odds for someone who is high myopic/never detached, in terms of a retinal detachment following cataract surgery--that's probably not an easy quwstion.

Can you please name a couple of the other highest risks that people face in having cataract/IOL surgery?

Overall what are the odds in terms of ANYONE having complications?

This must be the most widely discussed question on both forums.

Thank you.

[John C Hagan III, MD, FACS, FAAO]

The field of eye surgery and implant technology changes quickly and down the road there will be better IOLs and even safer surgery. By the way a cataract IOL is not minor surgery, it one of the greatest stories and triumphs in the field of surgery but it is a major operation with major complications possible.

JCH III MD

[2ndsight]

You seem like a person who researches things thoroughly and gets many qualified opinions, so I would say when you decide to do it, you will be well-informed as to the risks and benefits. Do all the reading you can about the various lens implants, especially their ability to correct myopia such as you have. Definitely go with the surgeon you feel most confident and comfortable with, one who answers your questions and concerns.

[Capes55]

Thank you all so much for your comments.  This was may 1st ever post on any kind of a forum.  Based on Dr. Hagan's comments, I may defer surgery as long as possible, but I believe it's inevevitable.  Currently, I can barely read out of my right eye, and the cataract, although small, is almost always in my field of vision, and therefore on my mind much of the time.  So, my quality of life is affected.  I've heard that cataracts rarely or never get better and over time almost always get worse get.  My wife and I are very health oriented,  have been avid exercisers for over 30 years, have never used alcohol or tobacco, and we have also been taking lots of antioxidants and vitamins for years.  My eye issue, I guess, is congenital.  I'm just more nearsighted than most people.

I am, however, very thankful that we live at a time in history, when cataracts can be cured with minor surgery, and even in my fairly risky case, the chances of long term success still seem to be over 90%.

Thank you all again for your help.  I would appreciate any other advice any of you could offer.

[AnnaE]

I am not a doctor. I am a community leader here and a retina patient. IF YOU SHOULD decide to have cataract surgery, Doctor Hagan sometimes advises that those with risk factors for RD see a retina specialist, before and after the surgery, and also for frequent follow-ups.

Anna

[John C Hagan III, MD, FACS, FAAO]

Unless your vision is a BIG problem I would defer surgery. You are in the highest risk catagory for retina detachment (middle age, highly myopic male with long axial length) your risk of RD could be as high as 4-7%.  I just helped manage a physician in his 50's that had RD following uncomplicated surgery.

Pluse you will have to have both eyes done your eyes will not work bother with one eye -0.50 and the other -9.50

If you wear gas perm CTL then you should go 2-3 weeks without contacts to get good corneal curve readings if you wear soft lens you need to go 1 week. Mistake to get corneal readings without leaving them out.

You will need to pick the surgeon you feel comfortable with. Don't be in a huge hurry to have surgery risk of RD is high compared to normal case (older person, non high myope and normal length eye).

JCH III MD

[2ndsight]

if more than one doctor has told you your cataract is not advanced enough to require surgery I would take that advice very seriously. Cataract surgery does not guarantee perfect sight afterwards and as you can read on this forum there are many patients with side effects and visual complications afterwards. The technology is improving every day and more new lenses are apt to come onto the market soon.

As far as the measurement issues my surgeon told me to take out my (soft) contact lens 3 days prior to surgery but he also said that accurate measurements could be taken without doing this. My surgery was very successful, my operated eyesight is now -.25 overall, but I wear glasses for reading and my vision is not without some minor issues.

[JodieJ]

Yes, I know it's awful to have to go without your contacts.  I'm not an eye care professional, but (in my case, anyway) I have concrete evidence documenting a significant change in my corneal measurements due to contact lens wear.  What type of contacts do you wear?  Hard contacts need to be left out of your eyes the longest to get accurate measurements--sometimes many weeks.  Toric soft lenses require less time, between 10 days and 3 weeks.  My eye measurements (taken by 2 different doctors) were very different 3 days without my contacts and 2 weeks without my contacts.  Soft contacts require somewhat less time out of your eyes than torics, maybe a week or two.  You may need to buy some cheap glasses.

You'd want your surgery done by an experienced, board-certified cataract/refractive surgeon.  You can find one at www.aao.org.  If you have 20/50 vision now and your cataract is bothering you, I don't see why you should have to wait till October to do something about it.  If you have significant astigmatism, a toric IOL sounds like a good idea to me.  You should also think about how you would like your IOLs set--either for distance in both eyes or for "blended" vision (intermediate in nondominant eye, distance in dominant).  If you do monovision now and like it, you should probably keep it.

I was also a high myope with astigmatism, and three surgeons told me that the formulas for determining IOL power would be less accurate for me than for someone with more "normal" (i.e., better) uncorrected vision.  You don't want additional error in the calculations due to inaccurate corneal measurements from your contacts.

Best wishes for an excellent outcome.

    

[AnnaE]

I would pay a small fee and find one at ****y.com. Tha's what I am doing. I have lost 80% of my vision in one eye, due to retinal detachment.

Dr. Hagan will be along soon to comment.