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IOL implant for post RK

As a 70 year old post RK patient I am considering mini monovision with  the Tecnis monofocal lens.  Recently I learned of the ORA Wavetec system which, I was told,  helps the physician achieve a better placement of the  lens and supposedly a more accurate outcome. I don't understand this because I have believed that the physician inserts the lens and that is all there is to it.  I did not realize "placement " was involved.   Can anyone provide some information about this. Thank you.
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Avatar universal
KayakerNC is spot-on with his comments.  You may have unusual corneal topography as a result of your RK - that is similar to astigmatism, and the ORA Wavetec system will allow the doctor to more precisely visualize the degree of aberration caused by any asymmetry in the cornea, and how to place the lens to compensate for as much of that unusual topography as possible.  

IOLs that compensate for astigmatism have to be placed in a certain position within the capsule where the old lens was removed, if they are to work optimally.  If I were you I would take the time to try to find a doctor.

I was surprised the Wavetec website (for the manufacturer) does not have a 'Find a Physician' link, or I missed it if they do.  If you Google your location city or region and the words ORA Wavetec you may hit upon a practice advertising their use of the system, and you can call to see what IOLs they use.  It's a pain that the information is not more centralized, but you are doing exactly the right thing in understanding the procedure and options and your specific cornea issues post-RK before having the surgery.  Good luck!
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10949559 tn?1414050805
An IOL focuses the light that comes into your eye through the cornea and pupil onto the retina. Are made of a flexible, foldable material and are about one-third of the size of a dime. During the IOL implant, the eye's natural lens is removed using a high-frequency ultrasound device. Then a surgeon inserts a clear intraocular lens, positioning it securely behind the iris and pupil, taking the natural lens in place.
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Avatar universal
Thank you for your comment Lisa.  Presently, I am searching for a surgeon that routinely uses the Tecnis one piece monofocal lens (ZCB00), has had good experience with post RK patients, and has the ORA system. I do not know how important having the ORA Wavetec system is and I am continuing  to research this.   I recognize the challenge with post RK and therefore I do have reasonable expectations.  As an aside, I want to give special thanks to Dr. Hagan, Dr. Kutryb, and a few other physicians who have provided so much helpful information on this website.  Any thoughts or comments about post RK, ORA Wavetec or IOL's will be much appreciated.  Thank you.
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Avatar universal
I had cataract surgery in Sept 2014 using laser and ORA.  
ORA gives the surgeon the ability to check your eye after the cataract is removed and determine the power needed and degree of astigmatism.  This is (hopefully) more accurate than the calculations used before surgery, which are based on an "average" eye, and allows for a more satisfactory outcome.
You don't mention if you have astigmatism, but if you do, ORA will absolutely give better correction results, according to my surgeon.
It IS surgery, and finding the best surgeons and getting 2nd and 3rd opinions is a must!
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Avatar universal
Surgeons seem to not have reached a consensus yet on whether measurements during the operation are the yet up to the task,though it seems to make sense for a surgeon to take it as one data point if they have it available and are aware of its potential flaws. Since I haven't had prior surgery I haven't looked into the issue of how that plays into it, but  were is an article on the topic of using intraoperative measurements  from September from a trade journal which presents both sides of the issue:

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery....

Numerous studies demonstrate the feasibility of intraoperative wavefront aberrometry (IWA), and some surgeons argue that it can be used to guide the surgical refractive plan in cataract surgery.4-6 However, to date, the quality and precision of IWA have not been assessed systematically. We recently explored these vital parameters and concluded that the time is not yet ripe for clinical application of IWA....

Numerous studies demonstrate the feasibility of intraoperative wavefront aberrometry (IWA), and some surgeons argue that it can be used to guide the surgical refractive plan in cataract surgery.4-6 However, to date, the quality and precision of IWA have not been assessed systematically. We recently explored these vital parameters and concluded that the time is not yet ripe for clinical application of IWA.7"


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Avatar universal
https://www.youtube.com/watch?v=_qF880xRAVI

and

http://www.refractiveeyecare.com/2012/12/achieving-better-iol-outcomes-with-intraoperative-aberrometry/
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Avatar universal
Thank you very much for your information  KayakerNC.  I appreciate your reply and sharing your thoughts.  I am continuing my search for the right surgeon.  Frank
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Avatar universal
Thank you very much flossy93.  I appreciate your information and the helpful thoughts that you have shared.  It is difficult to find the right eye surgeon as you do not know their track record.  When I have called ORA Wavtec, I have found some individuals to be helpful.  At one point the  ORA person who answered the phone, provided a good reference.  But the reference that was provided is difficult to reach.  So far no luck with this.  For others with a similar search to mine, namely finding a  good surgeon, with successful post RK experience, who uses the ORA system, remains a difficult challenge. Thanks to people like you flossy, who respond to this issue, we can keep this posting active and maybe help others by doing this.  As an aside, I want to again thank Dr. Hagan and Dr. Kutryb for their helpful "post RK"  postings on medhelp.  
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Avatar universal
Thank you SoftwareDeveloper.  I really appreciate your thoughts and the website information that you provided.  This kind of information is very meaningful to the "search".  Thanks again.  
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Avatar universal
From my iol implant research, I am seeking an experienced "post RK" surgeon that uses ORA Wavetec and has considerable experience with the Tecnis monofocal lens.  I would be willing to fly, if necessary, to have this surgeon.  Hopefully, I am on the right track with this personal quest.  Please know that any other thoughts, as always, will be much appreciated.  Thanks again.
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Avatar universal
It is interesting that the original machine, the ORange, was FDA approved in 2009. But has yet to gain traction among eye doctors. Consider the following:

At a technical level, there are practical issues that make the measurement less accurate than ideal, especially for correcting astigmatism.

The ORA measurement is taken during surgery, after the cataract has been removed.

At this stage, the eye is unlike the normal state because:

1. There are things pressing on the eye, such as the lid speculum to hold the eye open
2. The corneal wound would be hydrated, causing changes to corneal curvature and changes to the axis of astigmatism
3. If a femtosecond laser had been used, the cornea might have been flattened (applanated) for a few minutes.
4. Once the eye has been opened, and aqueous exits, its shape is no longer the same as in normal situations. The surgeon can refill the eye with BSS or viscoelastic, but the pressure in the eye is very unlikely to be the same as in a normal state and the shape of the eye would be different also.

Now consider what the optometrist usually does to check spectacle power:

1. It is the first test of all to be done at the office, so that nothing touches the eye and affects the measurements
2. Many contact lens wearers are asked to remove their lenses some time before the tests to get more accurate readings. This is especially true for patients going for LASIK surgery

In other words, measurements are best done on an undisturbed eye.

I would not let a surgeon operating on my eye base his decision (about lenses and position of lenses) on measurements that are done while the eye is in a very abnormal state after having been poked and prodded and with fluid going in and out of the eye.
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Avatar universal
Thank you wanlien3.  I had not considered this before.  So many issues need to be taken into consideration and this issue is certainly critical.  
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Avatar universal
I had cataract surgery in Oct and November 2014 and had Tecnis inserted in both eyes.  I had 16-incision RK 30 years ago.  I went to 4 doctors before making a final selection.  My doctor did NOT use ORA, said it was unnecessary, but he had ALOT of experience with my kind of situation so I was comfortable. Both the surgery and recovery were textbook - I would recommend him.
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How are you doing now that a year has passed since your Cataract surgery?   Did you have any other procedures after the RK   prior to the cataract procedure?  I have 6 incision in each eye, I am 50 years old and have hyperoptic shift.
Avatar universal
For more detail on the issue, here are two articles where surgeons debate both sides of the issue (and the counterpoints echo the concerns posted above):

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery. "

http://bmctoday.net/crstodayeurope/2013/03/article.asp?f=pointcounterpoint-is-intraoperative-aberrometry-worth-the-investment
"Point/Counterpoint: Is Intraoperative Aberrometry Worth the Investment?"

It seems like part of the problem is that even the usual way of calculating lens power is based on lots of data regarding eye measurements and end results that were achieved in the past with different powers of IOLs. Since the eye is in a very abnormal state when operated on, it seems as though they probably will need a fair amount of data to assess how well IOL details  chosen based on measurements in that abnormal state turn out. I may be wrong though, it just seems like the existence of the controversy suggest that they don't have enough data yet.
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Avatar universal
Thanks for writing Cathy.  My eye surgery is similar to yours.   It is good to know that this worked out for you.  Thank you for confirming for me that ORA is not necessary.   Did you do mini-monovision?  Can you share any of your outcome experiences with me?   For example, do you have much glare?  How is your night vision?  Do you mind telling me what state you live in?  Thank you again Cathy.
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Avatar universal
I'm sorry Frank, I accidently mis-lead you.  I read "toric" rather than Tecnis.   I had TORIC monofocals placed in both eyes.  Went to 4 experts who had all done lots of cataract surgery on RK patients.  #1 wanted to do Tecnis, but putting a lens with concentric circles on an eye with 16 pie-shaped/wedge incisions sounded counter-intuitive to me. (Skipping past #2 and #3)....  #4 said that after placing MANY accommodating and multifocals in post-RK patients in the past, his post-op analysis indicated that while it can sometimes work for 4- and 6-incision RK patients, his results were very unpredictable for 8+ folks like me.   He recommended monovision with standard TORIC lenses.  I didn't want to hear that answer, but he had alot of experience with my kind of case. so I went with him.  My only complaint was I asked for distance vision in both, but due to the unknown territory of 16-incision RK, I ended up with 20/30 and 20/40.  However my near vision is perfect and I am almost 60 and was using -2.0 readers prior.  Take your time and good luck.
PS - glare is the same as before surgery.  I have the RK daily vison fluctuations - I get more "nearsighted" as day goes on....no difference there either.   I now start the day close to 20/20 and am easily 20/40-20/50 by end of day.  Same as pre-cataract surgery.  Oh yeah, and I live in Dallas.
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Avatar universal
Hi Cathy,   Thank you for the clarification on the toric lenses and for the good information that  you have provided .  It may be that I, too, will likely need to have  toric lenses as I have 8 and 7 cuts.  I agree with you about seeing a number of physicians before making a decision.  I have seen about 4 or 5 already and have another appt scheduled this month with a different physician.   I am going to stick with a monofocal, mini-monovision and play it safe (not opting for a premium lens).  Cathy,  thanks again for taking the time to write to me.  I am glad to hear that things have worked out reasonably well for you.   Best wishes, Frank
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177275 tn?1511755244
Since this is an older discussion thread you might want to leave a message on the page of the person you were asking the question of
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