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Should I risk for IOL after 24 yrs of Aphakia?
Hello all,
Let me describe my condition which is a little bit complicated: My cataract lenses was removed at the age of 6 months old but, they decided not to implant any IOL in my eyes and since then till now that I'm 24, I've been using glasses from when I wake up to when I go to bed and magnifiers for reading. Right now I'm using Windows magnifier 300x zoom. My glasses prescription is: R: +8.00 & L: +8.00 + 0.25x175. In addition, I have Amblyopia and Nystagmus (when the right eye is closed, the left one moves and can't concentrate, but when both are open, it is not that much visible). But, hopefully I am not diabetic and my eye pressure is normal. Up to now, I've visited 5 doctors who gave me somehow the same option: Monofocal IOL set for distance for both eyes + thin pair of glasses just for reading that I can get off the shelf or over the counter without prescription. Onc of them told me that after implanting the Monofocal IOL set for distance, I can then do the corneal inlay in 1 eye for my reading to completely eliminate the need for glasses. I have to mention that I don't like glasses and contacts and mono vision and thus, I don't like the idea of corneal inlay.
My questions are:
1- Do you think it worth going for the IOL after 24 yrs of using glasses? Right now, although I don't like glasses, but at least I can see with them well in near and intermediate. So want to go from the GOOD to the BEST, not from the BAD to the GOOD, which means I'm in a big dilemma.
2- Based on my eye condition, do you think there is any other way than monofocal IOL set for distance that could possibly completely eliminate the need for glasses?
3- Why my doctor did not gave me the option of Symfony? Is it RISKY in my case or completely IMPOSSIBLE? Because these two are completely different.
4- THIS QUESTION IS VERY IMPORTANT TO ME> For those of you who have implanted a Monofocal IOL set for distance, how is your near and intermediate vision? Do you need thin pair of glasses JUST FOR READING or for seeing ANY NEAR OBJECT? Do you see clearly without glasses, your face in the mirror, your watch or your cell phone to answer the calls? Do you see the edge of the lens or the holding gears or anything you haven't seen before? Do you feel it when you sleep? How does it perform in very hot weather like in sauna or very cold weather like -20c winter?
5- What do you think about corneal inlay?
Let me describe my condition which is a little bit complicated: My cataract lenses was removed at the age of 6 months old but, they decided not to implant any IOL in my eyes and since then till now that I'm 24, I've been using glasses from when I wake up to when I go to bed and magnifiers for reading. Right now I'm using Windows magnifier 300x zoom. My glasses prescription is: R: +8.00 & L: +8.00 + 0.25x175. In addition, I have Amblyopia and Nystagmus (when the right eye is closed, the left one moves and can't concentrate, but when both are open, it is not that much visible). But, hopefully I am not diabetic and my eye pressure is normal. Up to now, I've visited 5 doctors who gave me somehow the same option: Monofocal IOL set for distance for both eyes + thin pair of glasses just for reading that I can get off the shelf or over the counter without prescription. Onc of them told me that after implanting the Monofocal IOL set for distance, I can then do the corneal inlay in 1 eye for my reading to completely eliminate the need for glasses. I have to mention that I don't like glasses and contacts and mono vision and thus, I don't like the idea of corneal inlay.
My questions are:
1- Do you think it worth going for the IOL after 24 yrs of using glasses? Right now, although I don't like glasses, but at least I can see with them well in near and intermediate. So want to go from the GOOD to the BEST, not from the BAD to the GOOD, which means I'm in a big dilemma.
2- Based on my eye condition, do you think there is any other way than monofocal IOL set for distance that could possibly completely eliminate the need for glasses?
3- Why my doctor did not gave me the option of Symfony? Is it RISKY in my case or completely IMPOSSIBLE? Because these two are completely different.
4- THIS QUESTION IS VERY IMPORTANT TO ME> For those of you who have implanted a Monofocal IOL set for distance, how is your near and intermediate vision? Do you need thin pair of glasses JUST FOR READING or for seeing ANY NEAR OBJECT? Do you see clearly without glasses, your face in the mirror, your watch or your cell phone to answer the calls? Do you see the edge of the lens or the holding gears or anything you haven't seen before? Do you feel it when you sleep? How does it perform in very hot weather like in sauna or very cold weather like -20c winter?
5- What do you think about corneal inlay?
Best Answer
3 Comments
I also would not recommend corneal inlays or anything else newly available at this time. Try contacts and report back. If you can get a decent pair, your vision should be identical to what it will be after surgery. If you don't like it, you can try using a different prescription in each eye, but that's advanced. Try this first and report back. You will need a GOOD optometrist, not one of those cheap mass producing places, they won't devote the time you need. You can try calling doctors offices, and explaining your situation and see which doctor takes the time to talk to you and assure you he can help you. That's who you go see.
I like your last sentence! I am biting the internet right now! (:
First, Dr. Stein said that my vision will not become 20/20 after the surgery. Second, that's a charming thing of not needing any assistive device for reading if I wear reading glasses after surgery, but my far vision then, becomes blurry. It mean that I have to constantly put off and on my glasses, don't I? this is what makes me worried. I actually have persuaded myself to wear glasses till the last day my life and it's not a problem wearing reading glasses after surgery. Third, they told me it's gonna cost $400-500 for contacts. I actually had my first experience of contacts in the Bochner institute, but their sample lens was less than my eye's power, but it was a very brilliant experience. I felt like a free man for couple of mins. Forth, the other thing apart from all others that I have to be worried about is the determination of IOL power. I heard there is always a .05 D margin of error, even with IOL master.
First, Dr. Stein said that my vision will not become 20/20 after the surgery. Second, that's a charming thing of not needing any assistive device for reading if I wear reading glasses after surgery, but my far vision then, becomes blurry. It mean that I have to constantly put off and on my glasses, don't I? this is what makes me worried. I actually have persuaded myself to wear glasses till the last day my life and it's not a problem wearing reading glasses after surgery. Third, they told me it's gonna cost $400-500 for contacts. I actually had my first experience of contacts in the Bochner institute, but their sample lens was less than my eye's power, but it was a very brilliant experience. I felt like a free man for couple of mins. Forth, the other thing apart from all others that I have to be worried about is the determination of IOL power. I heard there is always a .05 D margin of error, even with IOL master.
oh and by the way, thanks for your time.
I am back with more information from my doctor. Actually, he wrote a report to my optometrist and explained everything with great details that I don't understand them fully. I got the letter from him and just uploaded it. Please if any body knows the details of this report and is able to, I'd appreciate your help to explain them to me. Here is the link:
http://uupload.ir/files/j5ez_report.jpg
http://uupload.ir/files/j5ez_report.jpg
8 Comments
Too small for me to read.
Since its a useful thing to do at times, I'll mention you should be able to tell the browser to increase the size of the image, I don't know which browser or OS you use, e.g. in Mac its often command + to increase, command - to decrease and command 0 to return to default, or open it in an application.
For future reference there are also online free OCR tools to convert images to text, reviews here:
http://www.makeuseof.com/tag/4-free-online-ocr-tools-put-ultimate-test/
For future reference there are also online free OCR tools to convert images to text, reviews here:
http://www.makeuseof.com/tag/4-free-online-ocr-tools-put-ultimate-test/
I'm not going to take time to proof read it, but out of curiosity in case I ever need one, trying
http://www.onlineocr.net/
Yields this result for the image, done in text so it loses formatting, which looks right at first glance but again I didn't check the numbers (a bunch of information is redacted):
Consultatiotl Report
Dear Dr. I had the pleasure of seeing 24 year old Current Clinical Information: Current History: New patient from Dr. RE: Congenital Cataracts/Aphakic/micronystagmus - Secondary implants OU VA no change, no pain. Wears glasses, doesnt like CL
on your kind referral.
Past Ocular History: Bilateral Congenital Cataracts at 6 months old Iran Bilateral Aphakic, Ambylopia
Medical History: . Good Health, NKDA (-) Latex
Family History: Sisters (2) - Congenital Cataracts
Current Medications: no gtts
Examination: VISION ASSESSMENT:Auto-refraction OD +7.75+0.50x105; OS +8.00+0.75x50.Keratometry OD 45.75x47.00@l00; OS 45.25x46.***@**** vision (cc) OD 20/60-2; OS 20/200.Near vision (cc) OD J4; OS J10.
INTRAOCULAR PRESSURE:Applanation OD 15; OS 16 [10:59].
OTHER EXAM:Pupil OS No RAPD.
EOM/Stereo Nystagmus.
ANTERIOR SEGMENT:Cornea OD clear; OS clear.Conjunctiva/Sclera OD white; OS white.Anterior chamber OD d/q; OS d/q.Angle OD l+pig (superior 3, nasal 3, inferior 3, temporal 3); OS l+pig (superior 3, nasal 3, inferior 3, temporal 3); Iris OD wnl; OS wnl.Lens OD aphakia, with good capsule & central capsulotomy; OS aphakia, with good capsule & central capsulotomy..
POSTERIOR SEGMENT:Optic disc OD wnl; OS wnl.Macula OD dry; OS dry.Retina OD flat; OS flat.
Impression/Plan: 15/16 @ 1100 . Microophthalmia, aphakic and ambylopia OS>OD. Has good capsule support, and central opening for a sulcus IOL +/- optic capture, with Artisan IOL or ACIOL backup (or scleral sutured IOL). Expl will need glasses -- near and possible distance, and VA limited due to amblyopia OS>OD = we made this clear. Could do LVC postop if desired. Expl there maybe some micromonovision. He will need glasses. Explained that re: driving, this depends on whether he meets MOT criteria. Discussed benefits, risks, alternatives, condition, wait lists, uninsured costs. Discussed the rationale and alternatives of optional non-medically necessary tests (+/- device) and pt wishes to proceed with these options. Discussed possibility of elevated IOP following surgery requiring drops or surgery. Discussed retinal detachment risk. Discussed vision limitiation due to bilateral amblyopia (PAM 20/70 and 20/100 OD and OS). Book OS secondary IOL (ZA9003 w/ Artisan BU)/+-Vit/+-IVK (Urout, 60min, dil, CVH --will need more sedation, get anesthesia consult) followed by OD 2 months later. Book IOLM/Atlas/Ascan. See in preop. Clinical Fellow with Ike Ahmed MD, FRCSC. /QM
Thank you for allowing me to participate in the care of this patient. Best regards,
Iqbal Ahmed , MD FRCSC
I I
http://www.onlineocr.net/
Yields this result for the image, done in text so it loses formatting, which looks right at first glance but again I didn't check the numbers (a bunch of information is redacted):
Consultatiotl Report
Dear Dr. I had the pleasure of seeing 24 year old Current Clinical Information: Current History: New patient from Dr. RE: Congenital Cataracts/Aphakic/micronystagmus - Secondary implants OU VA no change, no pain. Wears glasses, doesnt like CL
on your kind referral.
Past Ocular History: Bilateral Congenital Cataracts at 6 months old Iran Bilateral Aphakic, Ambylopia
Medical History: . Good Health, NKDA (-) Latex
Family History: Sisters (2) - Congenital Cataracts
Current Medications: no gtts
Examination: VISION ASSESSMENT:Auto-refraction OD +7.75+0.50x105; OS +8.00+0.75x50.Keratometry OD 45.75x47.00@l00; OS 45.25x46.***@**** vision (cc) OD 20/60-2; OS 20/200.Near vision (cc) OD J4; OS J10.
INTRAOCULAR PRESSURE:Applanation OD 15; OS 16 [10:59].
OTHER EXAM:Pupil OS No RAPD.
EOM/Stereo Nystagmus.
ANTERIOR SEGMENT:Cornea OD clear; OS clear.Conjunctiva/Sclera OD white; OS white.Anterior chamber OD d/q; OS d/q.Angle OD l+pig (superior 3, nasal 3, inferior 3, temporal 3); OS l+pig (superior 3, nasal 3, inferior 3, temporal 3); Iris OD wnl; OS wnl.Lens OD aphakia, with good capsule & central capsulotomy; OS aphakia, with good capsule & central capsulotomy..
POSTERIOR SEGMENT:Optic disc OD wnl; OS wnl.Macula OD dry; OS dry.Retina OD flat; OS flat.
Impression/Plan: 15/16 @ 1100 . Microophthalmia, aphakic and ambylopia OS>OD. Has good capsule support, and central opening for a sulcus IOL +/- optic capture, with Artisan IOL or ACIOL backup (or scleral sutured IOL). Expl will need glasses -- near and possible distance, and VA limited due to amblyopia OS>OD = we made this clear. Could do LVC postop if desired. Expl there maybe some micromonovision. He will need glasses. Explained that re: driving, this depends on whether he meets MOT criteria. Discussed benefits, risks, alternatives, condition, wait lists, uninsured costs. Discussed the rationale and alternatives of optional non-medically necessary tests (+/- device) and pt wishes to proceed with these options. Discussed possibility of elevated IOP following surgery requiring drops or surgery. Discussed retinal detachment risk. Discussed vision limitiation due to bilateral amblyopia (PAM 20/70 and 20/100 OD and OS). Book OS secondary IOL (ZA9003 w/ Artisan BU)/+-Vit/+-IVK (Urout, 60min, dil, CVH --will need more sedation, get anesthesia consult) followed by OD 2 months later. Book IOLM/Atlas/Ascan. See in preop. Clinical Fellow with Ike Ahmed MD, FRCSC. /QM
Thank you for allowing me to participate in the care of this patient. Best regards,
Iqbal Ahmed , MD FRCSC
I I
No body ever told me that I have Microphthalmia!! This was the first time I read it and it was so accidentally that I have flat retina. I don't know what it means? is it a bad thing for IOLs or not? found this letter. Also, I didn't know that I heard the Dr. saying to his assistance that he may use pediatric artisan. At that point I didn't understand why, but now I can kinda get it.
Again, I've uploaded this because I'm an ESL and the Dr spoke very fast and most of this text to me, is jargon that I don't understand; specifically the acronyms.
Anyway, I am so much fatigued and exhausted mentally because of thinking about my operation, that nothing is important to me any more. I will do this, but I uploaded this just as a last resort for better understanding my issues.
When I look into the mirror I don't see any abnormality such as small eyes. I don't know why the Dr thought my eyes are small. No one has ever told me that my eyes are small.
Again, I've uploaded this because I'm an ESL and the Dr spoke very fast and most of this text to me, is jargon that I don't understand; specifically the acronyms.
Anyway, I am so much fatigued and exhausted mentally because of thinking about my operation, that nothing is important to me any more. I will do this, but I uploaded this just as a last resort for better understanding my issues.
When I look into the mirror I don't see any abnormality such as small eyes. I don't know why the Dr thought my eyes are small. No one has ever told me that my eyes are small.
Okay so you can't suddenly become an ophthalmologist and there is an enormous amount of material there. I don't have the time to go through it sentence by sentence. Let me start with a conclusion Ike Ahmed MD is world famous, a great teacher, an honorable man and if you elect to proceed with your complicated case you could not find a better surgeon.
That said the risks of surgery are considerably higher than a routine cataract operation. Dr. Ahmed has a huge practice and see's a lot of patients every day. No way he has time to proof read every report he dictates every day.
That being said I think the letter has a few transcription errors. "Microophhalmia" means a small eye. I think it's likely "micronystamus" which means very tiny little jerky eye movements present with congenital cataracts. He state you have that in the first paragraph. Also in 4 it says in "history" secondary implants and you have not had those but that could mean that's why you are there. No easy answer on this. Please direct specific questions to Dr. Ahmed's office I can't point you one way or the other.
That said the risks of surgery are considerably higher than a routine cataract operation. Dr. Ahmed has a huge practice and see's a lot of patients every day. No way he has time to proof read every report he dictates every day.
That being said I think the letter has a few transcription errors. "Microophhalmia" means a small eye. I think it's likely "micronystamus" which means very tiny little jerky eye movements present with congenital cataracts. He state you have that in the first paragraph. Also in 4 it says in "history" secondary implants and you have not had those but that could mean that's why you are there. No easy answer on this. Please direct specific questions to Dr. Ahmed's office I can't point you one way or the other.
Thank you Dr. Hagan. It was a great help. You are absolutely right about Dr Ahmed. I am actually very lucky that we have him here. Hopefully he gave me an aptmt before the surgery for asking stuff and I will definitely ask him about it, but as soon as he said that I was a candidate with his confident manner, I understood that I wanted to proceed with whatever he says. Even now, when I think deeper I understand that my right eye does the main job of writing and reading and my left eye is just like an assistant to it. Which means that as my optometrist says, my mind suppresses the info that my left eye provides which means that Dr Ahmed is right with regards to Micromonovision. Now when I look at things I have one image of them. i.e my left eye sees exactly what my right eye does, but the very very tiny difference shows itself at the time of seeing something with details such as reading and writing. My hope is that after the op, this difference is not going to expand.
Anyways, we live by our wishes and progress by our decision and as they say, what doesn't kill ya, makes ya stronger, so I'm going to do this. I'll update my topic or make a new one after the surgery probably within the next 6-9 months.
Anyways, we live by our wishes and progress by our decision and as they say, what doesn't kill ya, makes ya stronger, so I'm going to do this. I'll update my topic or make a new one after the surgery probably within the next 6-9 months.
Well best of luck you are in very capable hands.
Thanks. Yes Dr Ahmed said he will remove stitches after 5 weeks and this confirms your opinion that the stitches are at the direction of astigmatism. So this makes me so happy. However I have another general question. Does cornea have anything to do with focal point and power? The reason is my left eye is less sharp in terms of focus although I am wearing my old pre surgery glasses. If they remove stitches does cornea get back to its original shape in general? Thanks.
12 Comments
No the cornea does not always return to its original shape and the shape of the cornea is the most important factor in glasses determination.
Hi Dr. Hagan,
I hope you're doing well. ON March 5th, Dr. Ahmed himself removed the stitches and measured my pressure and both eyes were 20. So he didn't put me on Combigan just for a week till I see my regular eye doc on March 12th. Then if the pressure continues, he said that I need to see him again. Now I have something that I should only talk about with you in private message. Is there any way I can message you? Hopefully things are getting better and Dr. Ahmed said I can see my regular eye doc for getting my new glasses prescription after 2-3 weeks coz I've just removed the stitches and eye is not stable yet. The good news is that he said my number has not changed; meaning that I'll be wearing +8 but the bad news is things have gone blurrier in my left eye. If before putting the lens, amblyopia was the cause of my brain's preference to choose the right eye 90% of the time to see through, now, this is not just amblyopia that causes my brain to do so. Now I noticeably understand that my left eye has become weaker. It is less sharp, less clear, less accurate. For example when without glasses I look at my Acetozalamid bottle, my right eye sees the bar code but left one does not and when I put on glasses, my right eye can see the lines of the bar code but the left eye sees only a black line and does not see the spaces between the lines of the bar code.
I am also going to see another Dr. just to make sure of everything but I would really appreciate if you could help me like before. It is about something that has my personal information on it so I can not share it here. So if I can message you that is better. Thanks so much.
I hope you're doing well. ON March 5th, Dr. Ahmed himself removed the stitches and measured my pressure and both eyes were 20. So he didn't put me on Combigan just for a week till I see my regular eye doc on March 12th. Then if the pressure continues, he said that I need to see him again. Now I have something that I should only talk about with you in private message. Is there any way I can message you? Hopefully things are getting better and Dr. Ahmed said I can see my regular eye doc for getting my new glasses prescription after 2-3 weeks coz I've just removed the stitches and eye is not stable yet. The good news is that he said my number has not changed; meaning that I'll be wearing +8 but the bad news is things have gone blurrier in my left eye. If before putting the lens, amblyopia was the cause of my brain's preference to choose the right eye 90% of the time to see through, now, this is not just amblyopia that causes my brain to do so. Now I noticeably understand that my left eye has become weaker. It is less sharp, less clear, less accurate. For example when without glasses I look at my Acetozalamid bottle, my right eye sees the bar code but left one does not and when I put on glasses, my right eye can see the lines of the bar code but the left eye sees only a black line and does not see the spaces between the lines of the bar code.
I am also going to see another Dr. just to make sure of everything but I would really appreciate if you could help me like before. It is about something that has my personal information on it so I can not share it here. So if I can message you that is better. Thanks so much.
The rules of MedHelp.org do not allow us to do private messaging, calls, texts. I am not your personal physician and we must adhere to the rules that prevent establishing a doctor patient relationship. So anything you do not feel comfortable posting publicly don't post and don't send me an email or call my office.
Dr. Hagan, you're right. I should not seek professional advice from you or other people here as I was not your patient and it is impossible to have an opinion on a patient without seeing him. However, as I am now in a very low mood (put yourself in my shoes to see what it feels like to have a misery for 25 years and by your own hands add to your misery), every bit of information can help me mentally to see the reality. So I have all my reports and eye tests from Dr. Ahmed. I thought you might be able to skim them and tell me your opinion; even if it is just 1 line. I don't want to take your time doctor and probably this will be my last request as I have understood that my left eye is not working like before and I will be stuck with it. You mentioned that there might be a chance that if they remove the stitches, things get better. Dr. Ahmed removed stitches and yes I have to wait. So please if you have 5 minutes, take a very quick look at this PDF file of my reports. If not, again, thanks for answering me during my half-done journey.
https://drive.google.com/open?id=1Z3e_uYk72M7FKxDnWxVC0PHqyjFQEm4F
https://drive.google.com/open?id=1Z3e_uYk72M7FKxDnWxVC0PHqyjFQEm4F
The tests don't show any swelling of the macula (cystoid macular edema) and the residual cornea LE is very small .75 diopters so glasses or contacts or glasses and contacts should be able to restore good vision.
Dr Hagan, I am happy that my vision is returning to me little by little and the fact that I came out of this hell with little damage (at least the kind of damage that is visible to me as a patient not a professional ophthalmologist), makes me feel lucky. However I still feel like my left eye has become weaker, things are smaller, especially letters, sharpness is gone but has gotten a little bit better, and far vision is not as accurate as it was. I now noticeably understand that my left eye sees the letters on bus signs or stuff like so differently, let's say stigmatized. Something that was not an issue before, but I should expect some bad changes after 2 hard operations. I saw my regular doc on March 5th and he said that my optic power is the same is before and that he probably is going to prescribe the same glasses. +8 which I now love!!! (Before I hated them!!!). Anyways, he gave me an aptmt to see him on April 4th for my final glasses prescriptions. But he mentioned that the astigmatism does not worth putting it into my prescription. I mean it is so low that my mind will not understand. But if he is going to give me the same prescription that I am now wearing to write these, definitely, I am not going to like it coz I know something has changed in my left eye. What do you opine on this? What should I ask him next time? Isn't it crazy if I have to wear the same glasses? Well doctor Ahmed confirmed that my optic power has not changed meaning it's going to be +8 again but is there other thing such as cylinder or any other thing that have changed? Also, may I ask you to please take a look at page 15 of my tests again which shows the IOL position? my regular doc said that it had been tilted just a little bit. That is why Dr. Ahmed's fellow prescribed another A-Scan to make sure it's in center. He said it is but I doubt as I could see the edge of the lens and this is something that I really didn't expect to happen that much soon after surgery. Thanks again.
Well your glasses RX may not have changed but that doesn't mean your vision has not changed, in your case apparently for the worse. It would be important to check your macula with OCT to be sure no swelling (cystoid edema) or macular membrane. You could have IRREGULAR astigmatism of the cornea sue to the cornea surgery and subsequent scarring. Irregular astigmatism in not corrected by glasses and could require rigid contacts. You can have a cornea topography to see if you do have that as problem.
Dr. Hagan, I'm gonna see my regular eye doctor on March 30th for my final glasses RX. He has OCT device ,but I'm not sure if he has corneal topography. Now is there anything special apart from these, that I can ask him in particular to see why I see things a little bit smaller in my left eye and why after passing nearly 3 months I'm still not happy with my binocular vision? You know, I am wearing the same glasses that I have worn for the last 15 years and only after surgery I feel like this. Of course I'll ask him to send a report to Dr. Ahmed and ask him to give me an aptmt to discuss my vision after getting my new pair of glasses. You see, for example, this is 0 zero, but to my left eye, when I look at it from the center part of my glasses it looks like the letter o (like oh my God)
Dr. Hagan, I'm gonna see my regular eye doctor on March 30th for my final glasses RX. He has OCT device ,but I'm not sure if he has corneal topography. Now is there anything special apart from these, that I can ask him in particular to see why I see things a little bit smaller in my left eye and why after passing nearly 3 months I'm still not happy with my binocular vision? You know, I am wearing the same glasses that I have worn for the last 15 years and only after surgery I feel like this. Of course I'll ask him to send a report to Dr. Ahmed and ask him to give me an aptmt to discuss my vision after getting my new pair of glasses. You see, for example, this is 0 zero, but to my left eye, when I look at it from the center part of my glasses it looks like the letter o (like oh my God)
No over and above the many posts and questions and ground we've covered I don't have any suggestions.
Dr. Hagan, I know I have become such a pain in the chest in this forum, but this has also created a mental setback for me. I really cannot take this misery anymore and if you see I ask questions or comment a lot that is why. However, I am so excited as I have found my answer myself! This condition that I am complaining about is called "Aniseikonia" where in one eye, in my case left eye, the image size looks different, in my case just a little bit smaller. In Wikipedia it says it can be corrected by glasses prescription and playing with parameters such as base curve, vertex distance and center thickness of the lens, however it requires that the optician be familiar with the formulas to correctly put it in the prescription. I think I was wrong about the fact that only astigmatism is the reason. Wikipedia says: "When this magnification difference becomes excessive the effect can cause diplopia, suppression, disorientation, eyestrain, headache, and dizziness and balance disorders." This is somehow what I experience. I'm wondering why Dr. Ahmed did not diagnose this, as he insisted that this is due to Amblyopia. Dr. Hagan, I swear to God that it is not due to Amblyopia and suppression in my left eye. Before the surgeries, the left eye COULD see similar to my right eye (the dominant eye), but the damn cortex of my brain suppressed the left eye, however, now the left eye CAN NOT see similar to my right eye and the damn brain suppresses it.
There is still one thing remaining: Why my left eye has become a little bit blurrier than the right one? You know that I am a professional Aphakic patient, as I've been this ways since the beginning of my life and I am totally used to blurriness and glare of light sources. However, after surgery my left eye seems to not see some details. For example, without glasses, the sign coma "," is visible to my right eye as a small black dot. I mean at least I can see that there is something there, but it is totally invisible to my left eye; as if nothing is there and I see only a white space between quotations marks " ". Another example is when I look at a pencil that someone keeps it in front of the window with the blue sky in the background from at least 10 meters away. Again, without glasses, the left eye does not even see it but the right eye perceive it as a line, not the actual pencil. Before surgery, both could see. Again, Dr. Ahmed, associated this with Amblyopia which I think is not right as I could see it before surgery. However, Dr. Ahmed said that after getting my finial glasses, I should ask my regular eye doc to send a thorough report to him and he is willing to see me if I have any issues. This at least shows a great amount of appreciation and that is why I really love this doctor as he does not leave his patient in the middle of nowhere. Although I know that I have to accept that I have done 2 hard surgeries and somethings will definitely be not the same as before. I have lost my binocular vision to some small degree and all my hope is now to be able to correct it with new glasses and if that does not happen, as softwaredeveloper once said, I have become statistics. Sorry Dr. Hagan to take your time and thank you again for reading these, but this April, I'll become 26 and I feel mercy for myself and for how I was not thankful for what God had given me. When I compare myself to my other friends with vision loss, I now understand how good my vision was and is and now I love my glasses!
There is still one thing remaining: Why my left eye has become a little bit blurrier than the right one? You know that I am a professional Aphakic patient, as I've been this ways since the beginning of my life and I am totally used to blurriness and glare of light sources. However, after surgery my left eye seems to not see some details. For example, without glasses, the sign coma "," is visible to my right eye as a small black dot. I mean at least I can see that there is something there, but it is totally invisible to my left eye; as if nothing is there and I see only a white space between quotations marks " ". Another example is when I look at a pencil that someone keeps it in front of the window with the blue sky in the background from at least 10 meters away. Again, without glasses, the left eye does not even see it but the right eye perceive it as a line, not the actual pencil. Before surgery, both could see. Again, Dr. Ahmed, associated this with Amblyopia which I think is not right as I could see it before surgery. However, Dr. Ahmed said that after getting my finial glasses, I should ask my regular eye doc to send a thorough report to him and he is willing to see me if I have any issues. This at least shows a great amount of appreciation and that is why I really love this doctor as he does not leave his patient in the middle of nowhere. Although I know that I have to accept that I have done 2 hard surgeries and somethings will definitely be not the same as before. I have lost my binocular vision to some small degree and all my hope is now to be able to correct it with new glasses and if that does not happen, as softwaredeveloper once said, I have become statistics. Sorry Dr. Hagan to take your time and thank you again for reading these, but this April, I'll become 26 and I feel mercy for myself and for how I was not thankful for what God had given me. When I compare myself to my other friends with vision loss, I now understand how good my vision was and is and now I love my glasses!
An unequal refractive error is called "aneisometrophia" any time the refractive error is unequal there will be some difference in the size of the images "aneisikonia" If an eye is hyperopic relative to the other the image will be larger, if the eye is myopic relative to the other it will be smaller than the other. This is such a basic part of optics that its not worth a 15 minute explanation. If you want to learn more about it there are a whole series of informative posts by JodieJ and how she used contact lens to make the image size close enough that her brain could 'fuse' the image.
Dr. Hagan, thanks so much for your answer. I will see Dr. Ahmed himself after 5 weeks and even for him my case seemed very unique and he said that I am his first patient asking for explantation. I accept this because the power of the IOL was right and he gave me what promised. 2 years a go at my consultation session, he said that I will need to wear glasses pot op and that my near vision will be good to work with PC and reading. It was kind of OK however, as I am now recovering and am getting back my vision with my old +8 glasses, I understand that glasses are far better than anything else for correcting a patint’s vision who has multiple conditions like Aphakia and Amblyopia and Hyperopia all together. Now the question that I have is a general one as I know that you should see the patient physically to have an opinion but you mentioned something that gave me some hope. You mentioned that in general removing stitches makes vision a little bit better. I want to know what are the hpes if I remove stitches? Is that generally removing stitches will correct adtigmatism caused by surgery or does it have any effect on glasses power? Every day I am getting better but my regular doctor said I have now 1 number astigmatism and I have to wait till they remove stitches for getting my new glasses. So generally speaking, if they remove stitches, cornea should get back
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If the astigmatism is in the direction of the stitch (steepest axis) then removing the stitch will reduce the astigmatism if it's at right angles it will increase and they probably won't remove the stitch. Most likely its the former.
Dr. Hagan, I did remove the IOL on 15th of January and am recovering from the surgery. I am actually so happy to have my vision back. I'm gonna love my glasses till I die! I'm gonna start my thread soon as I recover fully and will write all about my experience. I will see Dr. Ahmed himself on February 28th to remove the stitches. They have kept me on Combigan 2 times daily for pressure, Maxidex 3 times daily for corneal inflamtion, Prolensa 1 time daily till they remove stitches. I know I have to wait till Dr. Ahmed removes stitches, however I have some quick questions.
left eye is recovering well, but noticeably sees less sharp than right eye and the amount of glare from the light is more in left eye. You know that I have been Aphakic since the beginning of my life so for my glare around lights should be something normal, but my left eye is as if there is a layer of film that reduces its clarity. My right eye sees much more clear and there is no glare or halo around any light. According to the chart, I can see like before, but I am thinking that my left eye has lost its sharpness and does not see as well as my right eye. Noticeably, I understand that most of the job of doing detail-oriented tasks such as reading or writing is done by my right eye although my left eye sees the letters. They told me it definitely gets better and is not just because of endothelial cell loss coz I had 3500 cells per mm in my left eye and 3160 in my right eye before the surgery. I read somewhere that loss of endothelial cells might be one of the causes of blurry or less clear/sharp vision. The other thing I can blame is maybe the stitches are causing my cornea to not focus the light as it did before surgery. On the other hand, they say that if there is a damage to macula, then that might effect reading or writing or anything that requires vision. However, the fellow saw me today and said everything is OK. He said that even the warms and other floaters are gonna get better by time passing. I don't know. All I know is at least now I am more appreciative to my nice and beautiful vision. I have treated this eye so badly in spite of the fact that it always has provided me with good vision.
left eye is recovering well, but noticeably sees less sharp than right eye and the amount of glare from the light is more in left eye. You know that I have been Aphakic since the beginning of my life so for my glare around lights should be something normal, but my left eye is as if there is a layer of film that reduces its clarity. My right eye sees much more clear and there is no glare or halo around any light. According to the chart, I can see like before, but I am thinking that my left eye has lost its sharpness and does not see as well as my right eye. Noticeably, I understand that most of the job of doing detail-oriented tasks such as reading or writing is done by my right eye although my left eye sees the letters. They told me it definitely gets better and is not just because of endothelial cell loss coz I had 3500 cells per mm in my left eye and 3160 in my right eye before the surgery. I read somewhere that loss of endothelial cells might be one of the causes of blurry or less clear/sharp vision. The other thing I can blame is maybe the stitches are causing my cornea to not focus the light as it did before surgery. On the other hand, they say that if there is a damage to macula, then that might effect reading or writing or anything that requires vision. However, the fellow saw me today and said everything is OK. He said that even the warms and other floaters are gonna get better by time passing. I don't know. All I know is at least now I am more appreciative to my nice and beautiful vision. I have treated this eye so badly in spite of the fact that it always has provided me with good vision.
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Your endothelial cell counts are great. Your case is unique. I have not managed anything like this where IOL removed in favor of restoring aphakia. You will need to have your Eye MDs answer your questions.
YES! I did it! I put the lens in eventually and so far it's been great. I'm actually going to start the new thread soon after they take out the stitches and my vision becomes stable. Dr. Ahmed put the ZA9003 with +16.5 D in my left eye. I am really lucky to have him in Canada. You don't know how much nice he and his team is. The only problem is that I have to wait at least 10 weeks for my right eye to be done. But it feels awesome so far. I actually think that if the right is done and my vision is stabled in both eyes, I will no longer be wearing any glasses any more! But I don't want to jump into conclusion. This is only the third day after surgery so I must be patient. Oh and I'm really glad that my capsular bag accepted the lens. Actually, except than my current surgeon, everybody else told me that I don't have capsular bag support and artisan is the best option to go.
So guys if you're interested, stay tuned and I will post my new thread. Thank you.
So guys if you're interested, stay tuned and I will post my new thread. Thank you.
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Very happy for your success thusfar
Thank you Dr. Hagan. Actually there is still some double vision and astigmatism, but I know they'll disappear. Also I could feel the haptics, but I don't feel them now.
Sounds like headed in right direction
There is only 1 little thing and that might not be right, but I guess my left eye could see just a little bit better with the glasses. Of course it's very soon to talk about accuracy of vision, but that's just my assumption that +17 or even +17.5D was something that my left eye could easily accommodate. What do you think Dr. Hagan? Should I talk about this with Dr. Ahmed or should I wait for my right eye? The reason I say this is because there is a digital clock on our stove and I tested befor surgery with my left eye with glasses I could see it easily from 2.5 meters, but now I have to stand 1.5 meters to it to see it clearly. Or for example we have a 55" TV and I could read the subtitles of my favorit news channel in Persian easily from 3 meters away with glasses on my left eye (right eye closed), but now again I have to get to at least 2 meters to read. But good news is that even if I have lost a little bit of details and accuracy in favor of getting rid of the glasses, I still can tollerate it p and get used to it. They told me that in the worst case scenario, if I don't like them both, they can explant them, but this is what Dr's assistant said.
I can't tell anything about your vision with or without glasses from the IOL power. Remember monofocal IOLs have a single focal point of clarity. "Range" of clear vision is not determined by the IOL power but by things like how small and mobile your pupil is and a proprietary crafting of the IOL by the manufactuer.
In my second follow-up appointment with Dr.'s fellow, he asked me to see my optometrist to get the prescribtion for my left eye and send it to them so that they meassure the right eye's iol power based on that. It is becomming complicated. The fellow also said, unlike his previous statement, that they're going to leave the stitches in my left eye forever. Everything near and intermediate has sharp edge and far vision is destroyed, worse than when it was with glasses. I have an appointment with my optometrist next week, but I am assuming that I have to again wear new glasses to reach to what I could see with my old glasses, which defeats my purpose. Now this might be too soon, but can you tell me what are the risks of iol removal? The fellow said it is possible, but for significant issues.
You are right its too soon. Plus your own natural lens has been removed when the IOL was put in the eye. If you remove the IOL you will be "aphakic" and that is a terrible thing to be because you would need to wear contact lens AND glasses. So you do not want to remove the IOL, make your peace with glasses which will be progressive, multifocal lens (some people call these 'no line' bifocals.
My eyes were Aphakic before Dr. Ahmed put the lens in my left eye. So now only my right eye is Aphakic. But I think I don't like the lense so far so is there significant risks to extract it?
Always a risk including infection, bleeding, loss of eye. However they don't rise to "significant" I have never known anyone that was aphakic for a long time. Had an IOL put in and then wanted it taken out.
I don't know if you wore glasses or contacts before you had your surgery but if contacts you may get too old to manage contacts or you may lose your ability to wear contacts in the future.
Take off your glasses and contacts if you wear them and they look out of the aphakic eye and then the IOL eye. The IOL eye should be much the better of the two.
I don't know if you wore glasses or contacts before you had your surgery but if contacts you may get too old to manage contacts or you may lose your ability to wear contacts in the future.
Take off your glasses and contacts if you wear them and they look out of the aphakic eye and then the IOL eye. The IOL eye should be much the better of the two.
I saw my optition today and he said my eye pressure in iol eye has risen to 22 which is high and he gave me another apmt to see him once again before he determines the glasses prescription for iol eye to send it to my Dr. He meassured my eye and said that the power for iol is right. I don't know.
Optician
I'm assuming what causes my dislike is not the iol power, but astigmatism. I searched it online and saw an image of how it looks like (simulated vision with astigmatism) and the image exactly matches my vision in left eye and I guess that is my vision for far is kind of blurry. Here is the link: https://en.wikipedia.org/wiki/Astigmatism
So do you think if there is anyway to correct that apart from explantation Dr. Hagan? Also I just recently have started to see light reflections from the lens (it gets worse if I ook at the source of light at nights such as cell phone or keep my head up and look the ceiling or sky) and something like a black thread appears once I look a little bit down. Although I used the eye patch for one week after the op day and night, but I am assuming the lens is dislocated. What do you think? Of course I'll ask all of these from my optician and my follow-up visit from Dr's fellow, but mentally I'm not feeling well. Like an obsession for me.
So do you think if there is anyway to correct that apart from explantation Dr. Hagan? Also I just recently have started to see light reflections from the lens (it gets worse if I ook at the source of light at nights such as cell phone or keep my head up and look the ceiling or sky) and something like a black thread appears once I look a little bit down. Although I used the eye patch for one week after the op day and night, but I am assuming the lens is dislocated. What do you think? Of course I'll ask all of these from my optician and my follow-up visit from Dr's fellow, but mentally I'm not feeling well. Like an obsession for me.
residual astigmatism is easily corrected with custom glasses which will be much thinner than you aphakic glasses or with contact lens. I don't know why you would assume the IOL is dislocated. If it was your surgeon would tell you. Light reflections are common.
I had a pressure spike from 20 to 32 in a day an was referred to Dr's fellow. He prescribed Acetozalamide and and a drop. This reduced my pressure but scared me to death. I had never had an issue with pressure but fellow said that hopefully I've had some advancements and the probably will remove stiches to make my vision better if everything goes well. Since day 1 I've noticed light reflections into the lens, spicificicaly, at nights if I look at my cell phone. There is no halo though. The fellow said %99 of ppl feel these and they'll disappear. Now I have 2 questions: 1- what if these don't go away. 2- why I see edges a little bit sharp, spicificaly, when I read? What is this condition called?
I don't know why there are stitches in your eye. We rarely ever put stitches in. These unwanted light reflexes and problems are called 'dysphotopsia' No reason to "worse case" your problem and speculate on "what happens if....."
Thanks. They said stiches are to prevent my eye from leaking something and they're on my cornea. I don't know. Ok I wanted to know why I see edges sharp? For example at the time of reading or working with my computer or seeing something that has a lot of lines such as electricity towers next to each other or dry branches of trees. There is no problem with sky or clouds or anything that does not have edges, but anything with edges such as these letters have become sharp. Do you think it's a miscalculation of iol power or it goes away by time?
No that does not suggest IOL power calculation problem. It might arise from a number of problems including the stitches in your cornea causing irregular astigmatism. No way to tell if it will go away with time. Eventually they will take the stitches out.
Dr. Hagan I am more disappointed than ever. Today I went to the Dr's office and did Casia and UBM test and saw the fellow and he said IOL is perfectly centered and the black thread that I see is the edge of the IOL which I agree. He dialated my eye and meassured pressure which was ok so he got me off of Acetozalamide. He said they won't remove stiches. But after dilation and the drop for eye pressure test, I felt the edge of the IOL more and dysphotopsia got so much worse. He said I have to get the new prescription for left eye only, live with it for 3-6 months then if I don't like they will take it from there. Dr. Hagan I'm gonna call them on Monday and ask for explantation. I want to grab my head in my hands and cry as loud as I can. This was the biggest mistake I've done. I know it won't get better.
Dysphotopsia often does get better over time and many patients who are quite unhappy 3-6 weeks post surgery are very happy 3-6 months after surgery so don't lose hope. After 3 months if you are no better you should ask for a meeting with Dr. Ahmed (not his fellow) for a frank discussion of your options.
Dr. Hagan I have only 2 questions 1- if they explant the lens, are they going to stich my cornea again? 2- will my eye come back to its original stage or it has changed forever? Dr I am so much worried about surgically induced astigmatism which I did't think is going to get this much bad. Please be frank and tell me the reality. I will call them to see Dr Ahmed for explantation. Right now that I am writing this, both my eyes, even the right one which has not been operated on are in pain.
Neither question can be answered probably not by Dr. Ahmed and certainly not be me. At some point the stitches can be removed and any surgical induced-stitched caused astigmatism will be gone. the incision itself can cause astigmatism. As I told you usually no stitches are used. If needed usually one stitch is put in and that can usually be safely removed at about 6 weeks.
Dr. Hagan, thanks for replying. You might not beleive me but I am in such a stress that I am counting days to see Dr Ahmed to discuss my options because what the fellow said was not consistent. 1 day he said they will remove stiches, the other day changed his opinion and said no and now I am waiting for Dr's office to call me for an aptmt with Dr Ahmed himself. The fellow said I have to get glasses for my left eye which I think is not a good idea and my optician also said that he cannot add anything on top and lens power is so accourate. In the meantime, I have uploaded an image of my eye here which I want you to take a look and tell me what you think? Isn't this suture so big? Maybe my complaint is not astigmatism, coz I see things sharp but they are not in focus. I'd say it is %90 similar to my glasses. Here is the image:
https://screenshot.net/kyen9an
https://screenshot.net/kyen9an
That is one continuous suture. It's called a "figure of 8 suture" it would eventually be removed generally 6-8 weeks post op. It would definitely be causing some astigmatism now which would likely decrease after the suture is removed.
Dr. Hagan, I do apologize for asking too many questions, but the reason is because both my regular eye doctor and doctor Ahmed have a very busy office. I have an apmt with my doctor on November 22 and am waiting for Dr. Ahmed to review my request of explanation and give me a date to see me, which I know is going to be a long time from now. I have actually become a 1-eyed man and am still using my old glasses so you know that my left eye's vision with the old glasses is blurry now. Of course I can work with my right eye coz the left one was amblyopic, but my life has become such a mess.
Anyway in the meantime I have noticed that my left eye is much more red than the right. Here are the images of left and right:
left: https://screenshot.net/o20y1sl
right: https://screenshot.net/ooy9etz
Do you think is that something I should be concerned and pay for an urgent visit to my regular doctor?
The other thing is that I think neuroadaptation for me will not work. Disphotopsya is getting worse. I cannot tolerate it. I read somewhere on medhelp that your wife has exactly the same IOL (Tecnis ZA9003), is that right? Does she feel the same Dysphotopsia?
Thanks Dr.
Anyway in the meantime I have noticed that my left eye is much more red than the right. Here are the images of left and right:
left: https://screenshot.net/o20y1sl
right: https://screenshot.net/ooy9etz
Do you think is that something I should be concerned and pay for an urgent visit to my regular doctor?
The other thing is that I think neuroadaptation for me will not work. Disphotopsya is getting worse. I cannot tolerate it. I read somewhere on medhelp that your wife has exactly the same IOL (Tecnis ZA9003), is that right? Does she feel the same Dysphotopsia?
Thanks Dr.
The amount of redness in your operative eye is not excessive. Plus your op eye has a foreign body in it (stitch). With one eye aphakic and the other eye pseudophakic you would not expect your eyes to work well together. I'm sure your surgeons discussed this. No my wife does not have any problem with eyes working together or dysphotopsia but she is 2 months post surgery on both eyes. She did have for 2-3 weeks post operative.
Dr. Hagan, I've seen my regular eye doctor a couple of times and he said there is no issue with redness but said that my left eye became so dry so he prescribed Systane Ultra for hydrating it. But I've noticed that the redness is more because of Lumigan. I will see Dr. Ahmed on Dec 11th but till then let me ask you these. Although definitely I will ask Dr. Ahmed all of these as well, but I want to go there well-informed and my regular eye doc has also told me there is nothing to be worried about, but I appreciate your help, coz maybe there is something you can inform me I ask Dr. Ahmed about:
1- As I am now pretty sure that I want explanation, and as I know that by any intraocular surgery, there is an inevitable amount of endothelial cell loss, my question is, do these cells regenerate in the future or losing them is permanent?
2- Even before surgery, sometimes I felt burning near where eye reaches nose. I usually had that but never consulted anybody for that. Do you know what it could be?
3- You mentioned that after they remove the stitches, the sharpness of letters may get better and astigmatism gets better, but I've noticed something else. I think Dr. Ahmed has set the focal point to near, because I see far a little bit blurred. Maybe that is what I considered astigmatism and misleaded them and that is why they didn't remove my stitches till now. What do you think?
4- What is the device that keeps the eye lids in the surgery called? I thank that thing made my lower eyelid a little bit week and mad it go lower, because once I close my left eye now, I see a very slight light that comes in and I know it is because of the fact that both up and down eyelids aren't closed correctly.
5- I sometimes see a floater that starts in the bottom of my eye and travels to the left where the stitches are and disappears there. Before surgery, I used to see some floater very rarely but this thing happens couple of times a day and unlike past floater that very totally curcular black holes, this one is bright in center and black in peripherals. Should I be worried about it?
6- Apart from extreme risks such as blindness and retinal detachment, what are the things that have permanently changed in my eye due to the surgery? I feel pain sometimes but my usual eye doc said it's normal, but my eyes have never been this my tired in my whole life.
Dr. Hagan, I know this too long but your answers can help greatly. Thank you so much.
1- As I am now pretty sure that I want explanation, and as I know that by any intraocular surgery, there is an inevitable amount of endothelial cell loss, my question is, do these cells regenerate in the future or losing them is permanent?
2- Even before surgery, sometimes I felt burning near where eye reaches nose. I usually had that but never consulted anybody for that. Do you know what it could be?
3- You mentioned that after they remove the stitches, the sharpness of letters may get better and astigmatism gets better, but I've noticed something else. I think Dr. Ahmed has set the focal point to near, because I see far a little bit blurred. Maybe that is what I considered astigmatism and misleaded them and that is why they didn't remove my stitches till now. What do you think?
4- What is the device that keeps the eye lids in the surgery called? I thank that thing made my lower eyelid a little bit week and mad it go lower, because once I close my left eye now, I see a very slight light that comes in and I know it is because of the fact that both up and down eyelids aren't closed correctly.
5- I sometimes see a floater that starts in the bottom of my eye and travels to the left where the stitches are and disappears there. Before surgery, I used to see some floater very rarely but this thing happens couple of times a day and unlike past floater that very totally curcular black holes, this one is bright in center and black in peripherals. Should I be worried about it?
6- Apart from extreme risks such as blindness and retinal detachment, what are the things that have permanently changed in my eye due to the surgery? I feel pain sometimes but my usual eye doc said it's normal, but my eyes have never been this my tired in my whole life.
Dr. Hagan, I know this too long but your answers can help greatly. Thank you so much.
Lumigan is notorious for causing red, irritated eye. If you need to lower IOP Travatan-Z is much better.
1. No the cornea endothelial cells do not regenerate
2. No idea
3. I have no idea why they put stitch in and if you are going to explant the IOL it is a moot point
4. It's called an eyelid speculum
5. Single floaters without flashes of light and/or loss of peripheral vision are usually not serious but are annoying
6. Well for one you are aphakic again. You may not be able to wear contacts, you may develop swelling of the macula (macular edema), you may regret removing the IOL
1. No the cornea endothelial cells do not regenerate
2. No idea
3. I have no idea why they put stitch in and if you are going to explant the IOL it is a moot point
4. It's called an eyelid speculum
5. Single floaters without flashes of light and/or loss of peripheral vision are usually not serious but are annoying
6. Well for one you are aphakic again. You may not be able to wear contacts, you may develop swelling of the macula (macular edema), you may regret removing the IOL
I'm on Lumigan as well, one drop before bedtime each day.
I've had good results the past few months following Dr. Hagan's advice to take the Lumigan drop about an hour before bedtime and then just before bedtime to use a lubricating gel drop (such as Genteal) in each eye.
This has has reduced redness in my eyes significantly when I wake in the morning as well as help with the dry eye that I think the Lumigan contributes to a s well. I also use a lubricant eye gel daily drop in the morning and afternoon that also helps - Nanotears preservative free.
I've had good results the past few months following Dr. Hagan's advice to take the Lumigan drop about an hour before bedtime and then just before bedtime to use a lubricating gel drop (such as Genteal) in each eye.
This has has reduced redness in my eyes significantly when I wake in the morning as well as help with the dry eye that I think the Lumigan contributes to a s well. I also use a lubricant eye gel daily drop in the morning and afternoon that also helps - Nanotears preservative free.
Glad its helped.
My regular eye doc has prescribed Systane Ultra 4 times a day and said to continue Lumigan till I see Dr. Ahmed on December 11th. I am actually counting seconds to see Dr. Ahmed. Now that I am writing these, both of my eyes are so tired I just want to close them all the time. They feel heavy and as if they want to pop out of the eye ball. I visited my regular doc's office which has 3 docs nearly 4 times this past month and all of them said that my pressure is under control and I am just scared. But my eyes feel tired and I have the same feeling that I had the night before the pressure spike which went up to 38 and caused Dr. Ahmed's fellow to see me urgently.
You know what Dr. Hagan? exactly what I was afraid has happened. Because now my vision from my eye to 30-50 cm is sharper than what it should be and beyond that feels blurry. Which means I need a pair of glasses for far and near. My regular doc said that far prescription has become -0.75 with astigmatism!! I am hyperopic. How is that possible? I definitely will take this peace of plastic out my eye. I remember an Ophthalmologist back home years ago had told me that I should not rest assure that everything is ok just because I don't feel pain and I have to check my eyes once every 6-12 months cause I'm prone to high IOP and Glaucoma and told me that at some point of my life, I will encounter this issue, but if I put the lens in, I will probably trigger that sooner. Now I understand that he was right. At this point of my life (I am now 25) I am so desperate that the only thing that makes me confident and keeps me hopeful, is Dr. Ahmed! I think I have the best surgeon I could find and I am sure he will take this thing out with ease. I am counting seconds to see him to tell me that this is not glaucoma coz if it is, I will never forgive myself for what I did with myself. This website is very beneficial. I will start the new thread after explanation so other Aphakics know about my experience. Although I know my case is very very rare these days.
Now you might think I am not happy just because of focal point, but there are many things that I've learned about the disadvantages of IOL. And I have to thank God that Dr. Ahmed is so skilled that he tried his best and put the AC foldable 3-piece Hydrophobic Acrylic Aspheric Tecnis ZA9003 lens in, that requires only 2.5 mm incision. Nearly all surgeons I had seen before him wanted to put a PC rigid PMMA Single-piece Spheric Artisan/Alcon lens in, that required a 6mm incision.
My regular eye doc praised him so much and said that what he did is like magic, coz it very difficult and risky surgically to place an AC in my eyes and is actually amazed at how my eye accepted the lens in terms of stability. I am assuming that that is why others wanted to put Artisan. I am so lucky, coz if it was Artisan and I wanted to explant it, because of peripheral iridectomy, my eye would be deformed and only God knows how much astigmatism would remain in place. But I know that there might be a 20% loss of endothelial cells each time you open an eye through cornea so I am assuming that I will have losed nearly 60% after surgery. (20% at my childhood once they removed the cataracts, 20% this time for putting the lens in and 20% for taking the lens out.) This is life. Some experiences come in very pricey. Please stay tuned to this thread coz I will update as soon as I see Dr. Ahmed.
You know what Dr. Hagan? exactly what I was afraid has happened. Because now my vision from my eye to 30-50 cm is sharper than what it should be and beyond that feels blurry. Which means I need a pair of glasses for far and near. My regular doc said that far prescription has become -0.75 with astigmatism!! I am hyperopic. How is that possible? I definitely will take this peace of plastic out my eye. I remember an Ophthalmologist back home years ago had told me that I should not rest assure that everything is ok just because I don't feel pain and I have to check my eyes once every 6-12 months cause I'm prone to high IOP and Glaucoma and told me that at some point of my life, I will encounter this issue, but if I put the lens in, I will probably trigger that sooner. Now I understand that he was right. At this point of my life (I am now 25) I am so desperate that the only thing that makes me confident and keeps me hopeful, is Dr. Ahmed! I think I have the best surgeon I could find and I am sure he will take this thing out with ease. I am counting seconds to see him to tell me that this is not glaucoma coz if it is, I will never forgive myself for what I did with myself. This website is very beneficial. I will start the new thread after explanation so other Aphakics know about my experience. Although I know my case is very very rare these days.
Now you might think I am not happy just because of focal point, but there are many things that I've learned about the disadvantages of IOL. And I have to thank God that Dr. Ahmed is so skilled that he tried his best and put the AC foldable 3-piece Hydrophobic Acrylic Aspheric Tecnis ZA9003 lens in, that requires only 2.5 mm incision. Nearly all surgeons I had seen before him wanted to put a PC rigid PMMA Single-piece Spheric Artisan/Alcon lens in, that required a 6mm incision.
My regular eye doc praised him so much and said that what he did is like magic, coz it very difficult and risky surgically to place an AC in my eyes and is actually amazed at how my eye accepted the lens in terms of stability. I am assuming that that is why others wanted to put Artisan. I am so lucky, coz if it was Artisan and I wanted to explant it, because of peripheral iridectomy, my eye would be deformed and only God knows how much astigmatism would remain in place. But I know that there might be a 20% loss of endothelial cells each time you open an eye through cornea so I am assuming that I will have losed nearly 60% after surgery. (20% at my childhood once they removed the cataracts, 20% this time for putting the lens in and 20% for taking the lens out.) This is life. Some experiences come in very pricey. Please stay tuned to this thread coz I will update as soon as I see Dr. Ahmed.
Oh I forgot to mention that I have some pain in my eyes as well but the regular eye doc said its ok. I don't think so. We'll see....
"Peace of plastic?" you mean Piece of plastic. Your distance RX is -0.75 with astigmatism. "I am hyperopic, how is that possible" 1. Without furnishing the rest of the prescription (amount of astigmatism, direction and whether plus cylinder or minus cylinder notation) you cannot determine if you are farsighted or nearsighted for with an astigmatic RX it is determined by the spherical equivalent of the glasses RX. e.g. if your distance RX was -0.75 you are myopic if it was -0.75 + 3.50 axis 180 you are hyperopic. If it was -0.75 -3.50 axis 180 you would be myopic. In any case it seems, contrary to the norm, that you have not done well converting from aphakia to pseudophakia and your interests might well best be served by having IOL removed. Best of luck.
No. Actually it was out of my being youth and the fact that youths take risks that adults don't! Otherwise, I didn't have any issues with my vision before surgery, but now I have!
Yes, my regular optician said my prescription for far is -0.75. He mentioned something for astigmatism, but because my first intention is to remove the lens, I am not gonna fill the prescription.
Anyways, I have the last question before seeing Dr. Ahmed. (I know it's crazy, but we have only you here who answers questions, so thank you for answering my crazy questions.)
please take a look at my eye here. I've noticed a new-moon-shaped black line between the stitches:
https://screenshot.net/825rwfl
Do you think it could be an iridectomy? They didn't say anything about it. Could it be in my cornea?
Yes, my regular optician said my prescription for far is -0.75. He mentioned something for astigmatism, but because my first intention is to remove the lens, I am not gonna fill the prescription.
Anyways, I have the last question before seeing Dr. Ahmed. (I know it's crazy, but we have only you here who answers questions, so thank you for answering my crazy questions.)
please take a look at my eye here. I've noticed a new-moon-shaped black line between the stitches:
https://screenshot.net/825rwfl
Do you think it could be an iridectomy? They didn't say anything about it. Could it be in my cornea?
No its not an iridectomy. I believe its the inner aspect of the incision into the cornea through which the IOL was inserted. The incision is like a tunnel not straight in so the external incision and the internal incision are in different places.
I have an explanation surgery on January 15th. Dr. Ahmed said that I've gone myopic according to my regular doctor's report. -0.75 that can easily be corrected by thin glasses, but at the I was uncomfortable with that sample of -0.75 that my regular doc had put on my eye to test my vision. Anyways, Dr. Ahmed tried his best to convince me to do other surgeries to correct my dysphotopsia, such as removing part of my capsul (sorry I am not technical). I said no. He said for correcting my blurriness in far he can laser, but I said no. There was a doc from USA and another from China in the room. They did their best to convince me do other surgeries and said it is going to better, but I rejected. The reason is my close vision is over sharped and my far is blurred. They said it is a sulucus fixated iol (Tecnis za9003) and Dr. Ahmed confirmed that the line I showed you was the incision and that it is going to remain with me for ever, but it gets lighter over time. I forgot to ask why he stitched, but he said that it could be OK to remove em after 6 weeks. He said after explanation, there is no guarantee that I will have the same vision I had before surgery, but they try their best. The good news is that Dr. Ahmed confirmed I don't have glaucoma. He said it's ok to stop Lumigan, but said that Travatan-Z creates the same redness. He said each time opening the eye equals 5-8% loss of endothelial cells. As I was stressed, I coundn't ask many questions I had. For example I know that probably, viterectomy would be needed to remove a sulucus sutured iol, right? and also the surgeon may leave the haptics inside the eye for ever, is that also true? Dr. Hagan, there are some videos about sulucos suturing the iol but none of them have the cornea wound that I showed you and you correctly said it is inside aspect of incision. I still don't know why it should be there? why stiches? is there anything particular about my eye that made Dr. Ahmed stitch? Also I wanna add that Dr. Ahmed mentioned that the place of the iol in my eye made it focus in near and that they wanted to aim for distance, however, I think he wanted to kinda conceal something coz I remember him at the day of consultation he asked me my job and I said call center and he said we're gonna set for near and I insisted for far, but he again said near. I told him about this yesterday and after playing with words, he said that even if he had set the focal point for far, I would still be complaining which I think he is right, but I would be a little bit happier. The fact that he didn't even remember the focal point, made me feel like I was lost in between thousands of patients he operates. Dr. Hagan I did 7 different tests such as A-scan, Atlas, Casia, OCT, ECC, IOL master, UBM, and many more, some of them twice and I thought I am going to get at least something similar to my glasses. Nobody told me that the glasses I'm wearing is good for near, intermediate and far but the iol is good only for near which in my case, it is not even good for near in spite of the fact that it is set for near coz it is over-sharp. edges are so sharp that I can not read the monitor. Actually, my aphakic eye can read better that the psudophacick one. Dr. Hagan, please read these and tell me your opinions. Psychologically I am devastated. Dr. Ahmed said I'm overreacting but I know that my vision is exacerbated. I want my vision back. Oh and the last thing is that I told him about the fatigue and he said it is totally normal. He measured my pressure and OD was 18 and OS (IOL eye) was 12 which is because I had instilled Lumigan. Dr. Hagan, please read these and tell me what you think? I have an appointment with my regular eye doc on Thursday so please tell me if there is anything I should ask him. Thank you so much.
There is something I wanna add and that is in 2015, I saw an optometrist and this is his results:
OD: uncorrected 20/80
OS: uncorrected 20/160
Current glasses (which I have them now): OD=+8 OS=+8.25
BCVA: OD: 20/50 OS:20/60
Now the iol for OS is +16.5 and I can see 20/100, a great amount of vision loss. I have nystagmus and amblyopia in this eye.
OD: uncorrected 20/80
OS: uncorrected 20/160
Current glasses (which I have them now): OD=+8 OS=+8.25
BCVA: OD: 20/50 OS:20/60
Now the iol for OS is +16.5 and I can see 20/100, a great amount of vision loss. I have nystagmus and amblyopia in this eye.
I have gone as far as I can go. I told you that I have not have an aphakic patient that had an IOL put in that was unhappy and wanted it removed. Dr. Ahmed and his staff obviously feel the same. You might get a second opinion from an experienced refractive/cornea/cataract/IOL in your city before you have the IOL explanted. I will have no other comments. My parting suggest is get another opinion before explanting.
Thanks Dr. Hagan. I am determind to take this piece of plastic out of my eye. Today, 3 days after seeing Dr. Ahmed, my pressure was OD 18 OS 19 at my regular eye doc's office. He was against explantation. Anyways, at nights I beleive that my pressure goes up coz my eyes wanna pop out of the eye ball. Now my question is do you know if there is an IOP monitor device that I can buy to monitor my pressure at home like a blood pressure device that my mom has at home? I found this:
https://www.topcon.ca/product/icare-ic100-contact-tonometer
What do you think about it? Also, they said my eye fatigue and that I feel my eyes are heavy and wanna pop out is normal. I dont think its normal coz feels exactly like the feeling that I had at my pressure spike. And take into consideration that my pressure is on the edge (18-19).
https://www.topcon.ca/product/icare-ic100-contact-tonometer
What do you think about it? Also, they said my eye fatigue and that I feel my eyes are heavy and wanna pop out is normal. I dont think its normal coz feels exactly like the feeling that I had at my pressure spike. And take into consideration that my pressure is on the edge (18-19).
Dr. Hagan my sister told me that my left eye, the operated one, looks bigger than the right one. Can you please take a look at this image and confirm it wethear it is caused by surgery or is it another eye condition. If it is caused by surgery then explantation makes it worse.Thanks so much. Here is the link:
https://screenshot.net/474l8sv
https://screenshot.net/474l8sv
I will have no other comments. My parting suggest is get another opinion before explanting.
Software developer thanks for telling me about magnification. Also my computer crashed this week and I'm working off an iphone and laptop I don't usually use. IT tech coming tomorrow PM.
2 Comments
I'm guessing you checked if you were are on Windows rather than Mac, but for anyone else who hasn't seen it, its control + or control - to change sizes under windows. Or in some browsers you can right click an image. I suspect most know you can use your finger gestures to zoom on a smartphone, pinching reduces size and the opposite motion increases.
I'm PC all my kids MAC.
Now I want to update my topic a little bit. Just recently I visited Dr. Ike Ahmed, a well known complex surgeon in Canada. Actually, he is the last one and I will not going to see anybody else.
His opinion for me was Artisan and a back up lens, if I've understood correctly, in case any thing happens in the OR, otherwise, if the first lens is OK, the backup is useless. I guess he mentioned pediatric Artisan because my eyes are small. He said I have to consider all the risks including infection and endothelial cell loss, which the latter occurs for sure, as far as I know. i.e after 20 years, I will experience a 50% endothelial cell loss. This is just my guess based on what I've read. He also said that I certainly will be wearing glasses for every day use, but they'll gonna be very thinner and lighter than what I wear right now. Something interesting was that he said my left eye is 20/200 and right is 20/60, but Dr. Stein had told me my L is 20/200 and R is 20/50 which is enough for driving here in Ontario and that even now, he signs the paper for me to get the license if I want.
So I'm thinking why should I put my life in danger when I can reach 1 of my 2 goals (1- driving and 2-getting rid of glasses) right now before the operation? Realistically, If I can get the vision I have currently with my glasses, then the surgery becomes rational, even with its risks, but what if I lose?
Believe it or not, deciding is very hard for me because as our friends here on medhelp have mentioned, there should be something positive that every one has a lens in their eyes, right? And actually, that is what tempts me to do the surgery.
I will appreciate any opinion on this matter. I don't know how efficient Artisan is. So please if you have any experience, or you know anyone who has, share it with me. I am in need. Thank you.
His opinion for me was Artisan and a back up lens, if I've understood correctly, in case any thing happens in the OR, otherwise, if the first lens is OK, the backup is useless. I guess he mentioned pediatric Artisan because my eyes are small. He said I have to consider all the risks including infection and endothelial cell loss, which the latter occurs for sure, as far as I know. i.e after 20 years, I will experience a 50% endothelial cell loss. This is just my guess based on what I've read. He also said that I certainly will be wearing glasses for every day use, but they'll gonna be very thinner and lighter than what I wear right now. Something interesting was that he said my left eye is 20/200 and right is 20/60, but Dr. Stein had told me my L is 20/200 and R is 20/50 which is enough for driving here in Ontario and that even now, he signs the paper for me to get the license if I want.
So I'm thinking why should I put my life in danger when I can reach 1 of my 2 goals (1- driving and 2-getting rid of glasses) right now before the operation? Realistically, If I can get the vision I have currently with my glasses, then the surgery becomes rational, even with its risks, but what if I lose?
Believe it or not, deciding is very hard for me because as our friends here on medhelp have mentioned, there should be something positive that every one has a lens in their eyes, right? And actually, that is what tempts me to do the surgery.
I will appreciate any opinion on this matter. I don't know how efficient Artisan is. So please if you have any experience, or you know anyone who has, share it with me. I am in need. Thank you.
3 Comments
Dr. Ahmed is world known, respected and a nice man. Most of the posts in this forum are people having problems not coming her to post how happy they are.
yes Dr. Hagan. I agree with you 100% about him. He was really nice, talked to me for more than 20 mins!!!! (damn me with my poor English, he talked very fast, although I understood him, but there are things I have to see his lady assistants to ask. Plus, I made a mistake: he first tries the amo, if not works, then artisan) but his decision is a little bit strange. He wants to first use the amo tecnis za9003 and if it dose not fit, he takes it out and puts artisan instead. something very strange because as far as I know, I don't have capsular bag support. the amo tecnis za9003 goes to capsular bag.
I don't know. What I can do is just trust him and hope to see the future. He knows better than me.
I don't know. What I can do is just trust him and hope to see the future. He knows better than me.
I think his reputation is well deserved and well earned.
I cant advise on those types of lenses. I can however say that since your case seems to a little bit more complicated, go with the one that your surgeon recommends, as that is what he personally has had the best results with, and he will be the one who needs to get you through the operation without complications.
7 Comments
tnx. I've asked my doctor to postpone the surgery and have gotten appointments with 2 other doctors to get their opinion.
I also have to admit that because I don't have capsular bag support, my options are limited. Anyway, I hope I can find and IOL which is made of a soft material like acrylic and thus is foldable requiring only 2 mm incision, is aspheric and probably, intended for anterior chamber. I guess PMMA is old and will cause me troubles in long term. Unfortunately, both Artisan and Alcon AC are from PMMA that are rigid and require 6 mm incision that will increase the risk of after-op astigmatism. Plus, they are both spheric.
I also have to admit that because I don't have capsular bag support, my options are limited. Anyway, I hope I can find and IOL which is made of a soft material like acrylic and thus is foldable requiring only 2 mm incision, is aspheric and probably, intended for anterior chamber. I guess PMMA is old and will cause me troubles in long term. Unfortunately, both Artisan and Alcon AC are from PMMA that are rigid and require 6 mm incision that will increase the risk of after-op astigmatism. Plus, they are both spheric.
Keep us updated.
Off course man, I know how difficult it is to start and end this journy, because as softweredeveloper says, thoese who had good results usually don't visit here to explain their outcome, but I want to open another topic after op to explain everything I can.
oh I forgot to mention something: they actually confirmed what Anomalychick has said to me, that my eyes already have lost the ability to accommodate and there is no reason to fear about setting the iol for distance. They told me that it will be like my current vision or even better. I have to mention that I think both of these lenses require suturing which is another concern.
oh I forgot to mention something: they actually confirmed what Anomalychick has said to me, that my eyes already have lost the ability to accommodate and there is no reason to fear about setting the iol for distance. They told me that it will be like my current vision or even better. I have to mention that I think both of these lenses require suturing which is another concern.
OK. I've made up my mind to go for it! I have 2 options from 2 different Drs.
1- Alcon anterior chamber, they also told me after op, I'll be using a pair of 2.75 reading glasses either off the shelf or RX made.
2- Opthec Artisan
I personally like AMO products, but it seems my doctors don't. So which one should I choose? I don't know their differences, so could you explain just a little bit about their difference?
tnx for your time.
1- Alcon anterior chamber, they also told me after op, I'll be using a pair of 2.75 reading glasses either off the shelf or RX made.
2- Opthec Artisan
I personally like AMO products, but it seems my doctors don't. So which one should I choose? I don't know their differences, so could you explain just a little bit about their difference?
tnx for your time.
Thank you. I got some of my answers. That's what I needed to know.
If I've understood it correctly, then the thin pair of glasses that my doctor said that I'll use for reading, is not just for reading, but for seeing near. If that's how a monofocal iol makes you see the world, then right now I think my vision, despite of being 20/50 in R and 20/60 in L, is far better than with an iol. At leas I have the quality of vision. And besides this, Dr. Stein, said that even now I can drive according to the rules of Ontario and that he will sign the documentations for me. I think I have to completely forget about divorcing my glasses ):
There is something called bioptic driving. Sadly, my optometrist did not know anything about it. (my optometrist, unlike Dr Stein, told me that I don't have the accuracy for driving and that he is not going to sign anything for me.) I guess I have to work on that. The requirement for driving a truck here in Ontario is 20/30 or less. I remember a low vision specialist told me that if implant an iol, I may even be able to drive a truck!
Just recently, I met a guy who operated his cataract in 1 eye and got blind due to the infection of the lens. He was so afraid that he decided not to operate the other eye.
Guys, is there any type of lenses for glasses that don't collect eye fat and get dirty?; that don't get foggy in the cold weather?; that don't get wet in rainy days? like being water resistant?
If I've understood it correctly, then the thin pair of glasses that my doctor said that I'll use for reading, is not just for reading, but for seeing near. If that's how a monofocal iol makes you see the world, then right now I think my vision, despite of being 20/50 in R and 20/60 in L, is far better than with an iol. At leas I have the quality of vision. And besides this, Dr. Stein, said that even now I can drive according to the rules of Ontario and that he will sign the documentations for me. I think I have to completely forget about divorcing my glasses ):
There is something called bioptic driving. Sadly, my optometrist did not know anything about it. (my optometrist, unlike Dr Stein, told me that I don't have the accuracy for driving and that he is not going to sign anything for me.) I guess I have to work on that. The requirement for driving a truck here in Ontario is 20/30 or less. I remember a low vision specialist told me that if implant an iol, I may even be able to drive a truck!
Just recently, I met a guy who operated his cataract in 1 eye and got blind due to the infection of the lens. He was so afraid that he decided not to operate the other eye.
Guys, is there any type of lenses for glasses that don't collect eye fat and get dirty?; that don't get foggy in the cold weather?; that don't get wet in rainy days? like being water resistant?
Many technologies start out poor and improve over time, so prior poor history says nothing about future success. Whether or not the current inlay technology is indeed useful seems to be under dispute among surgeons, there are prominent surgeons who have inlays in their own eyes. Fortunately since I have no need of an inlay I hadn't needed to decide if its a risk I'd take, but there are surgeons on each side of the issue so I figure its useful for people to be aware of that.
A premium IOL seems a better option than an inlay, but for those who already have monofocal IOLs (or presumably the Crystalens/Trulign), and really want more near vision, then an inlay might be an option to consider, though they should first understand the risks and be aware that some more conservative surgeons don't like them.
The explantation rate mentioned by the article on Dr. Hagan's page seems to be higher than it has gotten to with the latest techniques and a good surgeon:
http://crstodayeurope.com/pdfs/0715CRSTEuro_rs_tomita.pdf
"Advances in Corneal Inlay Implantation Over the Years
Changes in techniques have a direct correlation with decreases in a corneal inlay's removal rate
... my overall explanation rate is somewhere between 1% and 2% within 3 years of implantation"
That page indicates a surprisingly high explantation rate in the Kamra study for FDA approval however, so I would be cautious and check on whether thats due to surgeons using old techniques or perhaps not selecting patients well. Some other articles on the topic:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/intracorneal-inlays-correction-presbyopia-and-low-hyperopia
"In short: New alloplastic materials are being used as intracorneal inlays to offer predictable and safe refractive surgical correction of presbyopia and low hyperopia. The major problem with such inlays is the wound-healing response following their insertion; however, they can easily be removed."
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/corneal-inlays-still-altering-landscape-presbyopia?page=0,1
“More recently we have built upon the work of these pioneers and hopefully the new devices have solved the earlier issues,” Dr. Pepose said."
Some other articles on the topic and the choices available:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/presbyopia-therapy-comparison-corneal-versus-lens-based-options?page=0,0
"Presbyopia therapy: Comparison of corneal versus lens-based options"
http://www.medscape.com/viewarticle/843449
"Hydrogel Corneal Inlay Promising in Pseudophakic Presbyopia"
http://www.eyeworld.org/article.php?sid=8157
"Laser or inlay? Helping patients with a new decision"
http://www.eyeworld.org/article.php?sid=7713
"Correcting presbyopia: Monovision or corneal inlays?"
http://www.eyeworld.org/article.php?sid=8235
"Presbyopia inlays at the outset: Getting the near view"
A premium IOL seems a better option than an inlay, but for those who already have monofocal IOLs (or presumably the Crystalens/Trulign), and really want more near vision, then an inlay might be an option to consider, though they should first understand the risks and be aware that some more conservative surgeons don't like them.
The explantation rate mentioned by the article on Dr. Hagan's page seems to be higher than it has gotten to with the latest techniques and a good surgeon:
http://crstodayeurope.com/pdfs/0715CRSTEuro_rs_tomita.pdf
"Advances in Corneal Inlay Implantation Over the Years
Changes in techniques have a direct correlation with decreases in a corneal inlay's removal rate
... my overall explanation rate is somewhere between 1% and 2% within 3 years of implantation"
That page indicates a surprisingly high explantation rate in the Kamra study for FDA approval however, so I would be cautious and check on whether thats due to surgeons using old techniques or perhaps not selecting patients well. Some other articles on the topic:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/intracorneal-inlays-correction-presbyopia-and-low-hyperopia
"In short: New alloplastic materials are being used as intracorneal inlays to offer predictable and safe refractive surgical correction of presbyopia and low hyperopia. The major problem with such inlays is the wound-healing response following their insertion; however, they can easily be removed."
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/corneal-inlays-still-altering-landscape-presbyopia?page=0,1
“More recently we have built upon the work of these pioneers and hopefully the new devices have solved the earlier issues,” Dr. Pepose said."
Some other articles on the topic and the choices available:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/presbyopia-therapy-comparison-corneal-versus-lens-based-options?page=0,0
"Presbyopia therapy: Comparison of corneal versus lens-based options"
http://www.medscape.com/viewarticle/843449
"Hydrogel Corneal Inlay Promising in Pseudophakic Presbyopia"
http://www.eyeworld.org/article.php?sid=8157
"Laser or inlay? Helping patients with a new decision"
http://www.eyeworld.org/article.php?sid=7713
"Correcting presbyopia: Monovision or corneal inlays?"
http://www.eyeworld.org/article.php?sid=8235
"Presbyopia inlays at the outset: Getting the near view"
The simulator link didn't work, but the images you posted are fairly accurate. Remember that for those of us who are older it's not much worse than we're used to, as presbyopia sets in. Most older folks who've had cataract surgery have monofocal IOLs set for distance. All of my friends who have, do.
There is no perfect solution today. If you prefer to see clearly close/intermediate do that. I considered it. It's frustrating (you can see my decision making process on my thread) but you just have to pick the available option that's right for you.
You're barking up the wrong tree getting annoyed at Dr. Hagan. He's a bit gruff sometimes, but giving his time and experience for free.
There is no perfect solution today. If you prefer to see clearly close/intermediate do that. I considered it. It's frustrating (you can see my decision making process on my thread) but you just have to pick the available option that's right for you.
You're barking up the wrong tree getting annoyed at Dr. Hagan. He's a bit gruff sometimes, but giving his time and experience for free.
Inlays have an extremely poor track record. They have ended up damaging the cornea, having to be removed. Yet hope springs eternal and new companies and new surgeons bring forth another version of a poor concept. They have not withstood the test of time, they have poor track records and the follow up on the "new and improved bad idea" is short. The physician-surgeon that wrote the article on my home page blog is one of the worlds best cornea/refractive surgeons.
Dr Hagan, this is my last comment directly to you. Although I understand and appreciate your concerns regarding inlays, but, first, my question was something else which was not related to asking your opinion on inlays. I already knew that. I've read your topic here on MedHelp. Second, although I myself don't like the idea of inlays, but you should know that KAMRA, is only one the 4 types of inlays available in the market today which has the least patient satisfaction. Raindrop is another promising inlay which is both bio compatible and has high patient satisfaction. Unfortunately it hasn't been approved here in Canada, I think only KAMRA was approved. Dr. Stein told me it's gonna be approved in 2016, but till now, it hasn't been. The Dr's article in the link you provided speaks about KAMRA and as SoftwareDeveloper mentioned in your topic :http://www.medhelp.org/posts/Eye-Care/Cornea-Inlay-for-Presbyopia--NO-WAY/show/2792415
not all inlays are like KAMRA in terms of patient satisfaction.
And for the last thing, I wish and hope you never get so desperate in your life that you need to beg info bit by bit from people and as Hafez wishes:
"In need of the physician’s care, thy body be not;
Vexed by injury, thy tender existence be not!"
not all inlays are like KAMRA in terms of patient satisfaction.
And for the last thing, I wish and hope you never get so desperate in your life that you need to beg info bit by bit from people and as Hafez wishes:
"In need of the physician’s care, thy body be not;
Vexed by injury, thy tender existence be not!"
Thank you for your time chazas. Your experiences for me are valuable.
There is a simulator of post IOL vision in this website:
https://www.mylifestylelens.com/premium-intraocular-lens-simulator/
Would you please take a look at it and tell me how much their simulation is correct and near to reality with your IOL implanted eye?
If the link didn't work please take a look at these 2 images I've uploaded:
http://8pic.ir/images/wbu6g0ifou38fk7008ck.jpg
http://8pic.ir/images/vpsffunarbnzjzaiwfa9.jpg
Both of them are simulation of mono focal IOL set for distance. In the second one, the guy is not even able to read the dash board but sees the street. Is it really like that with a standard far vision IOL?
Thanks again.
There is a simulator of post IOL vision in this website:
https://www.mylifestylelens.com/premium-intraocular-lens-simulator/
Would you please take a look at it and tell me how much their simulation is correct and near to reality with your IOL implanted eye?
If the link didn't work please take a look at these 2 images I've uploaded:
http://8pic.ir/images/wbu6g0ifou38fk7008ck.jpg
http://8pic.ir/images/vpsffunarbnzjzaiwfa9.jpg
Both of them are simulation of mono focal IOL set for distance. In the second one, the guy is not even able to read the dash board but sees the street. Is it really like that with a standard far vision IOL?
Thanks again.
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If you have IOL's set for distance, and your distance vision is then 20/20, at intermediate, you'd require one and half diopters correction. If you chose not to use it, each half a diopter removes approximately one line of vision. So your vision should still be 20/50. To be safe, lets say 20/60. At near, you'd be off 2.5 diopters, or 20/70, lets say 20/80. Is your current near vision really that much better than 20/80 wearing only your distance glasses and no magnifier? There is a reason why everyone has an IOL implanted.
If there are no complications, I cannot imagine that you would be worse off than you are now at any distance, even assuming that you are in the group that has the worst vision at multiple distances after a successful cataract surgery. Medicine can't promise you no glasses, but they can promise much better vision than you have now. Given your history, I would recommend using regular monofocals, and not going to multifocals or anything else new fangled. You had congenital cataracts ,which means its possible that your visual system didn't develop normally because your brain wasn't receiving clear input. This slight disability could become a serious issue if you had to deal with the reduced contrast sensitivity and quality of vision you'd have with multifocal IOL's or current accommodating options.
Now, there is a way to run a test. Go find yourself a good, patient optometrist, and get yourself a pair of single vision contacts for distance. They do make brands for aphakic people, I think one is called silosoft if I remember correctly. You also have a fairly low prescription (if you didn't have cataracts ,you would have been extremely nearsighted and needed thick glasses anyway) so you may be able to use normal brands too but I am not sure. This should be approximately what your vision will be like with monofocal IOL's, except with IOL's you may occasionally catch a reflection around the edge, but your vision should be the same. If your distance vision is not 20/20 in contacts, it wont be with IOL's either. But your prescription is only a +8.00, so contacts should be really close (at all distances) to what you'd have after surgery. Try that, and then decide to keep wearing contacts, have the surgery with monofocals for distance, or if you're unhappy, then you can keep beating your head against the wall on internet forums looking for a better solution.