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Post-cataract surgery farsightedness & astigmatism
Hi,
I posted three weeks ago about extremely blurred close vision after cataract surgery on right eye which was supposed to have been set for close vision (it was the far vision that actually improved, although nowhere near good enough to function without correction). Previous to cataract I had been extremely myopic (-7.0) all my life, had worn hard contacts for 48 years and had been corrected monovision for 20+ years with right eye for close vision.
Surgeon said everything looked great and sent me to optometrist for refraction. He said he could get me to 20/30 either close or far so we first tried close to maintain the previous monovision. Wearing the lens, I had a field of somewhat clear vision from about 5 inches - 7 inches. Anything closer or further was a blur. Obviously not workable. Next we tried correcting the eye for far vision with the goal of reversing the monovision. While the corrected right eye seemed to function ok for distances from about 4 feet to infinity, I soon realized that I was seeing details through a dilation-like blur and couldn't really drive safely or even watch TV unless I switched the left eye back to far vision correction.
Yesterday during another refraction, the doc did something that allowed me to see crystal clearly for the first time since the cataract formed. He told me he had discovered an astigmatism and will now try another "flatter" lens that will hopefully make the corrected far vision actually workable. I'm obviously hoping the third time's a charm.
Three questions. (1) What would cause a surgery/implant that was supposedly designed to correct for near vision to have just the opposite effect and make me extremely far sighted?
(2) Since I now have better uncorrected far vision in my right eye (and soon hopefully corrected as well), which now makes it the "dominant" eye, do you think that reversing my previous 20+ year monovision has a real shot? It would be great if it could because with my "close" lens in my left eye I can read the smallest print and not have to resort to reading glasses.
(3) Is it likely that the surgery itself caused the astigmatism? My yearly eye exams had never identified the condition.
Thanks!
I posted three weeks ago about extremely blurred close vision after cataract surgery on right eye which was supposed to have been set for close vision (it was the far vision that actually improved, although nowhere near good enough to function without correction). Previous to cataract I had been extremely myopic (-7.0) all my life, had worn hard contacts for 48 years and had been corrected monovision for 20+ years with right eye for close vision.
Surgeon said everything looked great and sent me to optometrist for refraction. He said he could get me to 20/30 either close or far so we first tried close to maintain the previous monovision. Wearing the lens, I had a field of somewhat clear vision from about 5 inches - 7 inches. Anything closer or further was a blur. Obviously not workable. Next we tried correcting the eye for far vision with the goal of reversing the monovision. While the corrected right eye seemed to function ok for distances from about 4 feet to infinity, I soon realized that I was seeing details through a dilation-like blur and couldn't really drive safely or even watch TV unless I switched the left eye back to far vision correction.
Yesterday during another refraction, the doc did something that allowed me to see crystal clearly for the first time since the cataract formed. He told me he had discovered an astigmatism and will now try another "flatter" lens that will hopefully make the corrected far vision actually workable. I'm obviously hoping the third time's a charm.
Three questions. (1) What would cause a surgery/implant that was supposedly designed to correct for near vision to have just the opposite effect and make me extremely far sighted?
(2) Since I now have better uncorrected far vision in my right eye (and soon hopefully corrected as well), which now makes it the "dominant" eye, do you think that reversing my previous 20+ year monovision has a real shot? It would be great if it could because with my "close" lens in my left eye I can read the smallest print and not have to resort to reading glasses.
(3) Is it likely that the surgery itself caused the astigmatism? My yearly eye exams had never identified the condition.
Thanks!
The IOL power calculations are not an exact science. Various measurements of your eye are plugged into a complex formula, which usually yields predictions that are reasonably close to reality. Using state-of-the-art equipment like the IOL Master to obtain the eye measurements increases the accuracy of the predictions. What explanation did your surgeon give for the large error in your calculations?
I'm curious about why your vision can only be corrected to 20/30. Does the astigmatism-correcting contact get you closer to 20/20? (I believe that cataract surgery can cause astigmatism.) Or is there some (possibly temporary) inflammation affecting your vision?
Given that your target was mild myopia and you ended up extremely farsighted, I'm wondering whether explanting and replacing the IOL would make sense in your case. In your place, I would get a second (and maybe third) opinion from (an) experienced, board-certified cataract/refractive surgeon(s) before doing anything to my second eye. (I could comfortably switch my near and distance monovision contacts, so you could probably do the same with monovision using implants. But I'd leave that issue on hold for now until the problems with your first eye are resolved.)
I'm curious about why your vision can only be corrected to 20/30. Does the astigmatism-correcting contact get you closer to 20/20? (I believe that cataract surgery can cause astigmatism.) Or is there some (possibly temporary) inflammation affecting your vision?
Given that your target was mild myopia and you ended up extremely farsighted, I'm wondering whether explanting and replacing the IOL would make sense in your case. In your place, I would get a second (and maybe third) opinion from (an) experienced, board-certified cataract/refractive surgeon(s) before doing anything to my second eye. (I could comfortably switch my near and distance monovision contacts, so you could probably do the same with monovision using implants. But I'd leave that issue on hold for now until the problems with your first eye are resolved.)
I think astigmatism is often overlooked in eye exams. I had a slight amount in my right eye and my previous eye MD never mentioned it until my vision started to blur due to my cataract, and we were looking for ways to improve my prescription.
After my cataract surgery the astigmatism (which I had never noticed before) seemed much more noticeable and still does. My current surgeon says the measurement (1 diopter) and the location are exactly the same as before surgery. I would have to agree with Jodie that surgery seems to enhance it in some way.
After my cataract surgery the astigmatism (which I had never noticed before) seemed much more noticeable and still does. My current surgeon says the measurement (1 diopter) and the location are exactly the same as before surgery. I would have to agree with Jodie that surgery seems to enhance it in some way.
Thanks Jodie,
Before I respond to your questions, let me share something with the board and Dr. Hagan that I have not brought up yet with my surgeon. While I was being operated on the surgeon requested something from one of the surgical assistants that I think was a pipette or something like that (I remember the word 'purple' was also used) to place the lens. The assistant looked on a shelf and it wasn't there, so he went out to another room, but still couldn't come up with it. The surgeon seemed quite angry about this, and said he would place the lens manually. Could this be a screw-up that caused my vision to be so far from what was aimed for? If so, is this a potential malpractice issue?
As to your questions: The left eye has no cataract, so no surgery on it was planned. Given what happened with my right eye I'd probably be very hesitant to do another cataract surgery unless I was totally unable to see out of it. Even if the IOL was the wrong one or wrongly placed, isn't it fairly hazardous to go for an explant and re-implant?
As to why the surgeon believes things went so far from what was planned, I haven't had a chance to ask him that yet. On my first post-op appointment about three weeks post-surgery he assured me every thing was fine and that I would be able to be refracted to good vision. I see him again on October 1 and certainly will be insisting on a answer. My optometrist agreed that it was a "very good" question as to why things went so haywire.
I have no idea why my operated eye can only be corrected to 20/30. I'm pretty sure though that that's been the limit for my non-cataract left eye for a number of years. If I can get clearer 20/30 vision with the astigmatism correction contact I'd be satisfied, especially if I can then use my close contact lens on my left eye to re-establish monovision and not need reading glasses for tiny print or low light. Are you saying, though, that I should be looking for 20/20 corrected in both eyes?
Thanks Again!
Before I respond to your questions, let me share something with the board and Dr. Hagan that I have not brought up yet with my surgeon. While I was being operated on the surgeon requested something from one of the surgical assistants that I think was a pipette or something like that (I remember the word 'purple' was also used) to place the lens. The assistant looked on a shelf and it wasn't there, so he went out to another room, but still couldn't come up with it. The surgeon seemed quite angry about this, and said he would place the lens manually. Could this be a screw-up that caused my vision to be so far from what was aimed for? If so, is this a potential malpractice issue?
As to your questions: The left eye has no cataract, so no surgery on it was planned. Given what happened with my right eye I'd probably be very hesitant to do another cataract surgery unless I was totally unable to see out of it. Even if the IOL was the wrong one or wrongly placed, isn't it fairly hazardous to go for an explant and re-implant?
As to why the surgeon believes things went so far from what was planned, I haven't had a chance to ask him that yet. On my first post-op appointment about three weeks post-surgery he assured me every thing was fine and that I would be able to be refracted to good vision. I see him again on October 1 and certainly will be insisting on a answer. My optometrist agreed that it was a "very good" question as to why things went so haywire.
I have no idea why my operated eye can only be corrected to 20/30. I'm pretty sure though that that's been the limit for my non-cataract left eye for a number of years. If I can get clearer 20/30 vision with the astigmatism correction contact I'd be satisfied, especially if I can then use my close contact lens on my left eye to re-establish monovision and not need reading glasses for tiny print or low light. Are you saying, though, that I should be looking for 20/20 corrected in both eyes?
Thanks Again!
I was assuming that your vision in that eye was close to 20/20 before cataract development.
I'm not an eye care professional, but I think that it's very unusual to target mild nearsightedness and end up extremely farsighted.
I assume that your surgeon was requesting the device to insert the folded IOL. I don't know whether his manual insertion technique may have contributed to your post-surgery astigmatism and blurry corrected vision. Perhaps there's a problem with the placement of the IOL.
It's my understanding that explanting and replacing a lens is no more dangerous than the having cataract surgery--if done by a skilled and experienced surgeon. Your results are not what I'd call "stellar," and I think you should get additional opinion(s). Your inability to get good corrected near vision certainly warrants further investigation. You'd want to see a surgeon who is experienced doing explants/treating difficult cases. You might try calling the ophthalmology department at the best teaching hospital in your area for referrals. Maybe Dr. Hagan has other suggestions for you.
I'm not an eye care professional, but I think that it's very unusual to target mild nearsightedness and end up extremely farsighted.
I assume that your surgeon was requesting the device to insert the folded IOL. I don't know whether his manual insertion technique may have contributed to your post-surgery astigmatism and blurry corrected vision. Perhaps there's a problem with the placement of the IOL.
It's my understanding that explanting and replacing a lens is no more dangerous than the having cataract surgery--if done by a skilled and experienced surgeon. Your results are not what I'd call "stellar," and I think you should get additional opinion(s). Your inability to get good corrected near vision certainly warrants further investigation. You'd want to see a surgeon who is experienced doing explants/treating difficult cases. You might try calling the ophthalmology department at the best teaching hospital in your area for referrals. Maybe Dr. Hagan has other suggestions for you.
MEDICAL PROFESSIONAL
1. What was your preoperative glasses RX in each eye before surgery?
2. What is your present post operative RX in each eye.
I'm not a lawyer and I don't give legal advise but is suspect it may have been a "shooter" or IOL inserter. Its possible to insert an IOL manually and get a good result. Sometimes the incision needs to be a littler larger but using a shooter is not standard of care.
Why don't you just get a second opinion about your situation from another Eye surgeon well know for cataract surgery expertise?
JCH MD
2. What is your present post operative RX in each eye.
I'm not a lawyer and I don't give legal advise but is suspect it may have been a "shooter" or IOL inserter. Its possible to insert an IOL manually and get a good result. Sometimes the incision needs to be a littler larger but using a shooter is not standard of care.
Why don't you just get a second opinion about your situation from another Eye surgeon well know for cataract surgery expertise?
JCH MD
Thanks again Jodie and Dr. Hagan for your concern. It's very much appreciated!
For Dr. Hagan: I have not worn glasses since I got my first contacts 48 years ago. Before surgery I had a -7.0 in my left (corrected for far) eye and a -6.0 in my right (corrected for near). Only the right eye was operated on and my current right lens is now +2.25. If it is of any help, the IOL is an ACRYSOF Model MA60MA, Power 3.0D, Length 13.0mm, Optic 6.0mm.
With the new contact lens in my right eye, I can use the -7.0 in my left eye which gives me ok (but somewhat doubled) far vision and decent reading in good light down to 12-15 inches. I'm using my left eye almost exclusively, though, in this case. With the -6.0 in my left eye I can read anything at almost any light level, but once I go beyond a few feet my right eye has to take over and the far vision, because of the dilation/blur effect (astigmatism?) is not good enough for driving or even watching TV.
I cannot read at all with my right eye with or without the corrective lens.
My surgeon is part of the largest most respected medical group in the San Diego area (Scripps) which also operates 5 hospitals. He performs numerous cataract surgeries in this capacity. If after getting my astigmatism correction lens I can get good enough far vision to reverse the monovision, would you still recommend getting another opinion as to why things went so differently than they were supposed to with the idea of aiming towards an explant/re-implant?
Thanks Again!
For Dr. Hagan: I have not worn glasses since I got my first contacts 48 years ago. Before surgery I had a -7.0 in my left (corrected for far) eye and a -6.0 in my right (corrected for near). Only the right eye was operated on and my current right lens is now +2.25. If it is of any help, the IOL is an ACRYSOF Model MA60MA, Power 3.0D, Length 13.0mm, Optic 6.0mm.
With the new contact lens in my right eye, I can use the -7.0 in my left eye which gives me ok (but somewhat doubled) far vision and decent reading in good light down to 12-15 inches. I'm using my left eye almost exclusively, though, in this case. With the -6.0 in my left eye I can read anything at almost any light level, but once I go beyond a few feet my right eye has to take over and the far vision, because of the dilation/blur effect (astigmatism?) is not good enough for driving or even watching TV.
I cannot read at all with my right eye with or without the corrective lens.
My surgeon is part of the largest most respected medical group in the San Diego area (Scripps) which also operates 5 hospitals. He performs numerous cataract surgeries in this capacity. If after getting my astigmatism correction lens I can get good enough far vision to reverse the monovision, would you still recommend getting another opinion as to why things went so differently than they were supposed to with the idea of aiming towards an explant/re-implant?
Thanks Again!
MEDICAL PROFESSIONAL
Once you are "happy" you don't need to keep digging. However if you are unhappy then yes I would get a second opinion. I would try and avoid IOL explant as that is a major eye operation. Better choice and safer choice would be contacts OR hyperopic lasik or CK (conductive kereatoplasty) on the undercorrected right eye.
JCH MD
JCH MD
Please go for a second opinion. It is very troubling that your right eye CANNOT be corrected for near vision with a contact lens (and it could be pre-surgery)--something is wrong (e.g., the lens is not completely unfolded or decentered or tilted, whatever). I doubt that hyperopic lasik or CK would work if a contact lens can't.
The incorrect power of your IOL is another issue. The power is off by at least 4 diopters!!! I'm wondering whether your surgeon may actually have implanted the wrong IOL by mistake! I've known several people who exchanged an IOL due to incorrect power, all with excellent results. You are still early in the healing process, when it's safest and easiest to do an exchange. So please don't delay in setting up (an) appointment(s) for second (third?) opinions. I don't think that you will ever regret taking this action.
The incorrect power of your IOL is another issue. The power is off by at least 4 diopters!!! I'm wondering whether your surgeon may actually have implanted the wrong IOL by mistake! I've known several people who exchanged an IOL due to incorrect power, all with excellent results. You are still early in the healing process, when it's safest and easiest to do an exchange. So please don't delay in setting up (an) appointment(s) for second (third?) opinions. I don't think that you will ever regret taking this action.
Hi Jodie,
Seems like you and Dr. Hagan have a markedly different view of the explant/re-implant option. I'll definitely get more professional opinions before/if I decide go that route.
I'm confused about what you mean Jodie by the incorrect power of my IOL; it being off by at least 4 diopters; and possibly having gotten the wrong implant. What should the power have been for a near-correction for me? What numbers are you comparing to get to a difference of 4? Also, do you mean I didn't get the lens for which I have the certification card or that I did get that lens but it's wrong for me? Sorry to be so unknowledgeable about this.
Finally, about satisfaction, I guess I am dissatisfied that I can't see anything close up in my operated right eye with or without a contact lens. (except for the lens that gave me a three inch long field of vision) Before the cataract I was the one threading needles for my wife which I could do with or without my -6.0 lens inserted. I'm particularly unhappy because everything was to be geared to that eye maintaining its near vision acuity and now I can read only with my left eye. But...if I can get a good far vision contact lens correction out of that eye, I'd have to think long and hard about going through the process again with anybody. Either way, though, based on what seems to be a strong consensus (including me) that something went wrong, I will probably pursue the issue to discover if/where there was negligence.
I'm supposed to get the new lens on Monday. Wish me luck!
As always with much thanks!
Seems like you and Dr. Hagan have a markedly different view of the explant/re-implant option. I'll definitely get more professional opinions before/if I decide go that route.
I'm confused about what you mean Jodie by the incorrect power of my IOL; it being off by at least 4 diopters; and possibly having gotten the wrong implant. What should the power have been for a near-correction for me? What numbers are you comparing to get to a difference of 4? Also, do you mean I didn't get the lens for which I have the certification card or that I did get that lens but it's wrong for me? Sorry to be so unknowledgeable about this.
Finally, about satisfaction, I guess I am dissatisfied that I can't see anything close up in my operated right eye with or without a contact lens. (except for the lens that gave me a three inch long field of vision) Before the cataract I was the one threading needles for my wife which I could do with or without my -6.0 lens inserted. I'm particularly unhappy because everything was to be geared to that eye maintaining its near vision acuity and now I can read only with my left eye. But...if I can get a good far vision contact lens correction out of that eye, I'd have to think long and hard about going through the process again with anybody. Either way, though, based on what seems to be a strong consensus (including me) that something went wrong, I will probably pursue the issue to discover if/where there was negligence.
I'm supposed to get the new lens on Monday. Wish me luck!
As always with much thanks!
Since your goal was to continue your long, successful experience with monovision and you wanted good near vision in your right eye, I imagine that your IOL target was about -2.0 D (maybe -2.25 D, since that is what you used previously). Your post-surgery vision is +2.25 D. which is 4.25 diopters from your target (the difference between -2.0 and +2.25). Usually, post-surgery vision ends up within .5 D of target--sometimes a little further away.
From another perspective, a pre-surgery contact lens prescription provides a rough estimate of which iol power you will need. My contacts were -6.75 before cataract surgery, and +14 IOLs brought me to plano. It doesn't surprise me that a +3 IOL would bring you well past plano into moderate farsightedness--a very undesirable place to end up. (Lower number powers correct more myopia.) I'm not an eye care professional and have no experience doing IOL power calculations, but I'm wondering why your surgeon didn't double check the calculations which predicted an IOL power of +3 for you. (I was also wondering whether the implant your received was meant for another patient. When I had cataract surgery, they verified the IOL brand, model and power twice--with my surgeon and with me.)
But the most distressing thing about your outcome in my mind is that your right eye cannot be corrected for good near vision, which was possible before surgery. This is absolutely something that warrants investigation. Perhaps it is due to some post-surgery inflammation, although your surgeon didn't seem to find any. There's also the issue of your strange "astigmatism" (a partially folded or misplaced lens??) My unprofessional conclusion: something went wrong besides the power calculations.
In your place, my goal would be on improving my vision (not on filing lawsuits, which would probably only increase my feelings of frustration). I think it's likely that your post-surgery vision problems are correctable, but probably not by your current surgeon. If your screen name indicates your geographic location, there are many fine cataract surgeons in your area. Please don't delay in setting up appointments with a couple of the better ones. The sooner you can be seen by an "expert", the better.
From another perspective, a pre-surgery contact lens prescription provides a rough estimate of which iol power you will need. My contacts were -6.75 before cataract surgery, and +14 IOLs brought me to plano. It doesn't surprise me that a +3 IOL would bring you well past plano into moderate farsightedness--a very undesirable place to end up. (Lower number powers correct more myopia.) I'm not an eye care professional and have no experience doing IOL power calculations, but I'm wondering why your surgeon didn't double check the calculations which predicted an IOL power of +3 for you. (I was also wondering whether the implant your received was meant for another patient. When I had cataract surgery, they verified the IOL brand, model and power twice--with my surgeon and with me.)
But the most distressing thing about your outcome in my mind is that your right eye cannot be corrected for good near vision, which was possible before surgery. This is absolutely something that warrants investigation. Perhaps it is due to some post-surgery inflammation, although your surgeon didn't seem to find any. There's also the issue of your strange "astigmatism" (a partially folded or misplaced lens??) My unprofessional conclusion: something went wrong besides the power calculations.
In your place, my goal would be on improving my vision (not on filing lawsuits, which would probably only increase my feelings of frustration). I think it's likely that your post-surgery vision problems are correctable, but probably not by your current surgeon. If your screen name indicates your geographic location, there are many fine cataract surgeons in your area. Please don't delay in setting up appointments with a couple of the better ones. The sooner you can be seen by an "expert", the better.
OK Jodie, one last clarification question and that's it, I promise. I tried to find the answer online, but after an hour or so of searching I've given up. Your previous answers have been invaluable to me and I feel bad taking up more of your time.
I now totally understand your assertion that my post-op vision is more than 4 diopters from where it should have been, which is way out of the realm of expectation.
You said my target was probably -2.0 or -2.25 and that my IOL power of +3.0 would be expected to bring me well past plano and into the farsightedness that I'm experiencing. Why? How do these numbers work? You mention that you got a +14 IOL which brought your pre-surgery -6.75 (I was -6.0 for near, -7.0 for far so we were pretty close) into plano. That sounds like I should have had even a bigger (+) number IOL than you did to get to a mild (-2.0) myopia.. Is this what you mean? If I'm right about this, how does a larger (+) IOL get me closer to plano, but still on the (-) side than a smaller (+) IOL which has yielded me a +2.25?
I'm usually not this dense--especially with numbers--but if you could try one more time to explain this it would be very greatly appreciated. From your comments it does sound like I definitely got the wrong IOL (measurement was way off or I actually got someone else's) and I may have had it wrongly placed as well. (manual instead of planned inserter). I'll definitely plan on consulting another cataract surgery expert soon.
All the Best!
I now totally understand your assertion that my post-op vision is more than 4 diopters from where it should have been, which is way out of the realm of expectation.
You said my target was probably -2.0 or -2.25 and that my IOL power of +3.0 would be expected to bring me well past plano and into the farsightedness that I'm experiencing. Why? How do these numbers work? You mention that you got a +14 IOL which brought your pre-surgery -6.75 (I was -6.0 for near, -7.0 for far so we were pretty close) into plano. That sounds like I should have had even a bigger (+) number IOL than you did to get to a mild (-2.0) myopia.. Is this what you mean? If I'm right about this, how does a larger (+) IOL get me closer to plano, but still on the (-) side than a smaller (+) IOL which has yielded me a +2.25?
I'm usually not this dense--especially with numbers--but if you could try one more time to explain this it would be very greatly appreciated. From your comments it does sound like I definitely got the wrong IOL (measurement was way off or I actually got someone else's) and I may have had it wrongly placed as well. (manual instead of planned inserter). I'll definitely plan on consulting another cataract surgery expert soon.
All the Best!
You are not dense at all--my explanations are confusing. I acquired most of my knowledge about cataract surgery online, so I hope somebody will correct any misinformation I provide.
The optometrist who used to moderate this forum posted the following (which can be found somewhere in the archives of the forum): To get a crude estimate of your IOL power (assuming a target of plano), start at 20 and add/subtract (depending on whether it's a plus or minus script) your glasses/contact prescription. (In your case, a near vision correction has already been factored into your -6 contact prescription--which compensates for your adjusted target of about -2 D.) So in your case, 20 minus 6 yields an estimated power of about +14 to get your right eye from highly myopic to mildly myopic (your target). According to this crude estimation method, a person who requires a +3 IOL would be wearing about a -17 contact lens pre-surgery. For someone (like you) who is much less myopic than -17 diopters, a +3 IOL would be expected to take them beyond mild myopia, then beyond plano, then beyond mild hyperopia--to moderate/severe hyperopia.
I'm a psychologist--not an eye care professional. But I'd expect that vision with the wrong power IOL could be corrected with a contact lens or glasses---unless something else was wrong. The fact that your right eye can't be adequately corrected for near vision indicates that there is another problem. Even if you can get (more or less) acceptable distance vision with an astigmatism-correcting contact lens, I suspect that there may be something more going on than just surgery-induced astigmatism. (Why couldn't an astigmatism-correcting contact lens give you good near vision?) This is why I feel so strongly that a second opinion from an expert is needed. And getting it sooner is much better than later. (I'm really curious about what that expert will say.)
The optometrist who used to moderate this forum posted the following (which can be found somewhere in the archives of the forum): To get a crude estimate of your IOL power (assuming a target of plano), start at 20 and add/subtract (depending on whether it's a plus or minus script) your glasses/contact prescription. (In your case, a near vision correction has already been factored into your -6 contact prescription--which compensates for your adjusted target of about -2 D.) So in your case, 20 minus 6 yields an estimated power of about +14 to get your right eye from highly myopic to mildly myopic (your target). According to this crude estimation method, a person who requires a +3 IOL would be wearing about a -17 contact lens pre-surgery. For someone (like you) who is much less myopic than -17 diopters, a +3 IOL would be expected to take them beyond mild myopia, then beyond plano, then beyond mild hyperopia--to moderate/severe hyperopia.
I'm a psychologist--not an eye care professional. But I'd expect that vision with the wrong power IOL could be corrected with a contact lens or glasses---unless something else was wrong. The fact that your right eye can't be adequately corrected for near vision indicates that there is another problem. Even if you can get (more or less) acceptable distance vision with an astigmatism-correcting contact lens, I suspect that there may be something more going on than just surgery-induced astigmatism. (Why couldn't an astigmatism-correcting contact lens give you good near vision?) This is why I feel so strongly that a second opinion from an expert is needed. And getting it sooner is much better than later. (I'm really curious about what that expert will say.)
Thanks for the quick tutorial. I understand it's only approximate, but it does give me a baseline of knowledge for my conversations to come. I totally agree with you that something else in addition to the wrong lens is going on and I plan on pursuing it post haste. BTW, I am also a psychologist by training and practiced for a decade or so before moving on to careers 2 & 3 and now retirement.
I'll let you know what happens after my new contact comes in and my next appt. with my surgeon (I'm going to move it up to this Wednesday rather than waiting until my scheduled one in two weeks. I feel, though, I need to give him a chance to give his opinion before moving on to a 2nd and perhaps 3rd opinion). And while I know it has nothing to do with getting things to be better, I'm afraid I do have a very low tolerance for medical professionals screwing up and then trying to cover up, so, depending on what the facts of the matter actually turn out to be, I'm not ruling out a legal investigation either.
You're the Best. Thanks so much again!
I'll let you know what happens after my new contact comes in and my next appt. with my surgeon (I'm going to move it up to this Wednesday rather than waiting until my scheduled one in two weeks. I feel, though, I need to give him a chance to give his opinion before moving on to a 2nd and perhaps 3rd opinion). And while I know it has nothing to do with getting things to be better, I'm afraid I do have a very low tolerance for medical professionals screwing up and then trying to cover up, so, depending on what the facts of the matter actually turn out to be, I'm not ruling out a legal investigation either.
You're the Best. Thanks so much again!
Your surgeon apparently knew how far off target your post-surgery vision was during your last appointment with him--and said nothing to you about it. He also saw no problems with your eye and sent you off to the optometrist. It is easier to fix a mistake early in the healing process. You might want to make some calls before your Wednesday appointment to get the names of the local "experts" who treat the most difficult (or botched) cataract cases. (I'm quite sure that your surgeon already knows who they are, but he might not be willing to communicate this info to you.) If your surgeon agreed to set up the referral appointment for you, you would probably be seen much sooner than if you referred yourself. I'd have no qualms about asking him to do this.
Nowadays people expect a lot from cataract surgery. In your situation, a good surgical outcome would allow you to continue monovision without the contacts. This might require a laser vision touch-up (but not a 4+ diopter change!) There may come a time when you become contact lens intolerant, and I don't think it would be wise to count on wearing contacts in order to have functional vision. Best of luck--and keep me posted.
Nowadays people expect a lot from cataract surgery. In your situation, a good surgical outcome would allow you to continue monovision without the contacts. This might require a laser vision touch-up (but not a 4+ diopter change!) There may come a time when you become contact lens intolerant, and I don't think it would be wise to count on wearing contacts in order to have functional vision. Best of luck--and keep me posted.
Well, I got the verdict and it's not good. The contact lens prescribed for my post-surgery "astigmatism" only made things far blurrier than the previous lens. I saw my surgeon this morning and he readily acknowledged that he "overshot" the goal of mild nearsightedness and instead produced moderate/severe far sightedness. His explanation was that the measurements for the power of the IOL were as good as could be done, but because my eyeball is so elongated it made it hard to get an accurate measurement. Is it really possible that one could get a measurement that winds up being off by almost 5 diopters, or is this totally outside the realm of any reasonable measurement reliability and instead indicates operator error?
He indicated that I couldn't expect to get anything better (a semi-blurry 20/40) for distance vision through contacts, but is referring me to a Laser Rx specialist to see if he might be able to improve things. I was dilated and my surgeon thought he detected a macular edema, which he though might be causing the blurriness, so he's also referring me to a retinal specialist and given me some Acular LS drops to deal with the inflammation.
He categorically rejected the option of explant/re-implant saying the the current lens was perfectly placed, and any attempt to remove it and implant another would incur a major trauma to my eye, especially since I have borderline high optic nerve pressure.
I will be asking these questions--and others--in other venues with other professionals, but would like to get your opinions on two things before I proceed.
(1) Given my situation, with a so-called highly elongated eyeball and a -6.0 correction (this was my monovision 'near' eye while my left 'far' eye was -7.0), can a power measurement of +3.0 for my IOL be considered a reasonable number to go ahead with? Or should somebody have known beforehand that such a power would throw me way into farsightedness rather than the mild nearsightedness that was the goal?
(1) Since I now have an implant that yields a corrected +2.25 (for far) - +3.0 (for a 3-inch field of vision close) that I probably will have to keep, is there any chance that even with Laser Rx I can ever get back to the good near vision I had pre-cataract and surgery, or is it corrected so far wrong with the IOL that nothing can ever bring it back to where it was supposed to wind up? What a Mess!
Thanks!
He indicated that I couldn't expect to get anything better (a semi-blurry 20/40) for distance vision through contacts, but is referring me to a Laser Rx specialist to see if he might be able to improve things. I was dilated and my surgeon thought he detected a macular edema, which he though might be causing the blurriness, so he's also referring me to a retinal specialist and given me some Acular LS drops to deal with the inflammation.
He categorically rejected the option of explant/re-implant saying the the current lens was perfectly placed, and any attempt to remove it and implant another would incur a major trauma to my eye, especially since I have borderline high optic nerve pressure.
I will be asking these questions--and others--in other venues with other professionals, but would like to get your opinions on two things before I proceed.
(1) Given my situation, with a so-called highly elongated eyeball and a -6.0 correction (this was my monovision 'near' eye while my left 'far' eye was -7.0), can a power measurement of +3.0 for my IOL be considered a reasonable number to go ahead with? Or should somebody have known beforehand that such a power would throw me way into farsightedness rather than the mild nearsightedness that was the goal?
(1) Since I now have an implant that yields a corrected +2.25 (for far) - +3.0 (for a 3-inch field of vision close) that I probably will have to keep, is there any chance that even with Laser Rx I can ever get back to the good near vision I had pre-cataract and surgery, or is it corrected so far wrong with the IOL that nothing can ever bring it back to where it was supposed to wind up? What a Mess!
Thanks!
PLEASE get additional opinions from one (or more!) surgeons in your area who are known to treat the most difficult and/or botched post-surgery cases. If your current surgeon refuses to refer you (or even if he does), call the ophthalmology departments of the better teaching hospitals in your area and ask for referral sources. (I'm not sure who you should speak with. You might start by checking online for the names of the senior faculty who specialize in cataract/IOL. If you can't speak with the doctor directly, try his/her secretary.)
Get a copy of your complete medical/surgical record, including all data used for your IOL power calculations (e.g., IOL Master output, etc.) Your new surgeon will need this information. I'd be inclined to stop by the office to pick it up in person rather than having it mailed.
All of us high myopes have elongated eyeballs. The available formulas do yield more accurate IOL power predictions (on average) for people whose vision is near the middle of the bell curve. You and I are in a similar range of high myopia (i.e., not really off the charts.) I was told that my power prediction might deviate from my target (-.5 D) by a diopter or slightly more in either direction. (As it turned out, a +14 IOL brought me to plano.) I do not believe that a deviation of more than 4 diopters from target (your outcome) would be considered reasonable/customary by anyone anywhere. As I stated previously, I really don't understand why someone in your surgeon's office didn't question the seemingly erroneous prediction that a +3 IOL was needed to replace an eye needing a -6 D contact lens pre-surgery.
I know little about laser vision correction. If your vision cannot be adequately corrected with a contact lens, I wouldn't think that you could expect much from any refractive procedure. (WHY can't your vision be adequately corrected? If the reason is macular edema, hopefully this can be treated.)
Again...please get at least one independent opinion from an expert. I hope that Dr. Hagan is still reading this thread; he may have some additional advice. Keep us posted.
Get a copy of your complete medical/surgical record, including all data used for your IOL power calculations (e.g., IOL Master output, etc.) Your new surgeon will need this information. I'd be inclined to stop by the office to pick it up in person rather than having it mailed.
All of us high myopes have elongated eyeballs. The available formulas do yield more accurate IOL power predictions (on average) for people whose vision is near the middle of the bell curve. You and I are in a similar range of high myopia (i.e., not really off the charts.) I was told that my power prediction might deviate from my target (-.5 D) by a diopter or slightly more in either direction. (As it turned out, a +14 IOL brought me to plano.) I do not believe that a deviation of more than 4 diopters from target (your outcome) would be considered reasonable/customary by anyone anywhere. As I stated previously, I really don't understand why someone in your surgeon's office didn't question the seemingly erroneous prediction that a +3 IOL was needed to replace an eye needing a -6 D contact lens pre-surgery.
I know little about laser vision correction. If your vision cannot be adequately corrected with a contact lens, I wouldn't think that you could expect much from any refractive procedure. (WHY can't your vision be adequately corrected? If the reason is macular edema, hopefully this can be treated.)
Again...please get at least one independent opinion from an expert. I hope that Dr. Hagan is still reading this thread; he may have some additional advice. Keep us posted.
Dr. Hagan, (or any other "cataract surgery expert") please chime in if you're monitoring this.
My surgeon called first thing this morning and said he spent most of yesterday afternoon talking with various colleagues in the area to see what might be done. It's clear he's very concerned and realizes the seriousness of the implant measurement error. He's changed his mind about not considering an explant/re-implant possibility, but wants to save it as a last resort.
After ruling out any retinal issues tomorrow with a retinal specialist, he's scheduled me to be evaluated next week by both the Laser refractive expert as well as another surgeon who has particular experience with inserting piggy-back lenses to see if my near vision can be made whole again with either of these techniques. (My surgeon feels they hold out hope where corrective lenses have failed) I'm insisting (and he agrees) that near vision be the objective, as I've realized that if a cataract started forming in my left eye, I would have no capacity for reading/writing which would basically shut down most of my life.
And BTW, Jodie, although you insist this is no real excuse (and I agree), he said my eyeball measures 30 mm which is 8 mm and 20 diopters above normal. I guess at this point (other than any potential negligence action) I don't feel I have the luxury to really pursue why the error was so large (although of course I am curious). I just want to find out how/if we can fix it. With seeing 3 other ophthalmologists in the next few days, I think I'll get a pretty good set of opinions on that. When we come up with a preferred alternative, that's the time I think I'll want to check in with at least one other outside opinion before we proceed.
I'll keep you posted!
My surgeon called first thing this morning and said he spent most of yesterday afternoon talking with various colleagues in the area to see what might be done. It's clear he's very concerned and realizes the seriousness of the implant measurement error. He's changed his mind about not considering an explant/re-implant possibility, but wants to save it as a last resort.
After ruling out any retinal issues tomorrow with a retinal specialist, he's scheduled me to be evaluated next week by both the Laser refractive expert as well as another surgeon who has particular experience with inserting piggy-back lenses to see if my near vision can be made whole again with either of these techniques. (My surgeon feels they hold out hope where corrective lenses have failed) I'm insisting (and he agrees) that near vision be the objective, as I've realized that if a cataract started forming in my left eye, I would have no capacity for reading/writing which would basically shut down most of my life.
And BTW, Jodie, although you insist this is no real excuse (and I agree), he said my eyeball measures 30 mm which is 8 mm and 20 diopters above normal. I guess at this point (other than any potential negligence action) I don't feel I have the luxury to really pursue why the error was so large (although of course I am curious). I just want to find out how/if we can fix it. With seeing 3 other ophthalmologists in the next few days, I think I'll get a pretty good set of opinions on that. When we come up with a preferred alternative, that's the time I think I'll want to check in with at least one other outside opinion before we proceed.
I'll keep you posted!
I'm very glad that things seem to be quickly heading in a positive direction for you. If a piggyback IOL or a refractive procedure can get you good near vision, that would be great.
Were your eye measurements done using an IOL Master? My best guess as to the cause of your 4-5 diopter deviation from target is measurement error. (You might ask the cataract/refractive consultants you'll be seeing what they think happened.)
Good luck with your upcoming consults, and keep us posted.
Were your eye measurements done using an IOL Master? My best guess as to the cause of your 4-5 diopter deviation from target is measurement error. (You might ask the cataract/refractive consultants you'll be seeing what they think happened.)
Good luck with your upcoming consults, and keep us posted.
I have another idea about what might have gone wrong with your power calculations. How long did you leave your contacts out before your eye measurements were done? There's no consensus, but probably two weeks without soft contacts is sufficient, several weeks (or longer) without hard contacts is needed in order to get accurate corneal measurements.
Hi Jodie,
Since I had worn hard contacts exclusively/continually for 48 years I too was concerned as to how long I'd have to leave them out before the measurement (The only pair of glasses I have are sunglasses from 25+ years ago that are pretty far off). Surgeon said three weeks, and that's exactly what I did. He did say I could put the lenses in again after the measurement for the 3+ weeks until surgery. That surprised me some, as I thought wearing the hard lens again would "reshape" the eye and make it different from what was measured. Could that be a factor in the huge measurement error?
Spent three hours getting "injected and inspected" at the retinal specialist this morning. Bottom line is no macular swelling, which, according to her leaves the IOL as the only explanation for uncorrectable near vision and "dilation like" blurring in corrected (20/40) far vision. My surgeon was there too this morning and based on the results has switched my eye drops to Xibrom which I'll take until I see the piggyback expert on Tuesday. Surgeon now seems to be thinking that piggybacking has a small chance and Laser Rx even less, so it seems like we are pointing towards the explant/re-implant option.
One interesting side note. Since my cataract surgery there's been no way I could get any reading level vision out of the right eye with/without contacts. Sitting at the computer now, about 18 inches away, with my corrective contact in I cannot read any of the letters on the screen including the large "Post Comment" Bar script. Starting last night, though, with my contact in and wearing my wife's +1.0 reading glasses, I can read all the words I'm typing with my right eye as long as I don't get closer than a foot or so, It only works when I have the contact in and it's still a little "dilated looking" like everything else, but I think I'll run over to the drug store soon and try different powers to see how good I can get it. I mentioned it to my surgeon this morning but since my eye was quite dilated and my contact was out we really couldn't put it to the test.
Stay Tuned!
Since I had worn hard contacts exclusively/continually for 48 years I too was concerned as to how long I'd have to leave them out before the measurement (The only pair of glasses I have are sunglasses from 25+ years ago that are pretty far off). Surgeon said three weeks, and that's exactly what I did. He did say I could put the lenses in again after the measurement for the 3+ weeks until surgery. That surprised me some, as I thought wearing the hard lens again would "reshape" the eye and make it different from what was measured. Could that be a factor in the huge measurement error?
Spent three hours getting "injected and inspected" at the retinal specialist this morning. Bottom line is no macular swelling, which, according to her leaves the IOL as the only explanation for uncorrectable near vision and "dilation like" blurring in corrected (20/40) far vision. My surgeon was there too this morning and based on the results has switched my eye drops to Xibrom which I'll take until I see the piggyback expert on Tuesday. Surgeon now seems to be thinking that piggybacking has a small chance and Laser Rx even less, so it seems like we are pointing towards the explant/re-implant option.
One interesting side note. Since my cataract surgery there's been no way I could get any reading level vision out of the right eye with/without contacts. Sitting at the computer now, about 18 inches away, with my corrective contact in I cannot read any of the letters on the screen including the large "Post Comment" Bar script. Starting last night, though, with my contact in and wearing my wife's +1.0 reading glasses, I can read all the words I'm typing with my right eye as long as I don't get closer than a foot or so, It only works when I have the contact in and it's still a little "dilated looking" like everything else, but I think I'll run over to the drug store soon and try different powers to see how good I can get it. I mentioned it to my surgeon this morning but since my eye was quite dilated and my contact was out we really couldn't put it to the test.
Stay Tuned!
It took longer than 3 weeks before my corneas stopped changing when I switched from hard to soft contacts. (Eventually I regained all my previous astigmatism.) But I really don't think that this the reason for your IOL power miscalculation.
If your near vision becomes clearer with readers worn over your contact, you should be able to get the same effect with a different power contact lens (without readers). It sounds like your near vision is improving with time--great news!
It's good to know that your surgeon has been devoting so much time and effort into finding a solution to your current problems. (Was it something you said?)
If your near vision becomes clearer with readers worn over your contact, you should be able to get the same effect with a different power contact lens (without readers). It sounds like your near vision is improving with time--great news!
It's good to know that your surgeon has been devoting so much time and effort into finding a solution to your current problems. (Was it something you said?)
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