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Which Lens Implant Do I Use w/ Type 2 Diabetes?

I am 48 years old and have type 2 diabetes.  As a result of the diabetes I had leaky blood vessels in my macula that caused minor swelling behind the retina.  My Retinologist used a laser to sear some of the blood vessels to reduce leaking.  The swelling is nearly gone, things are, and have been stable for some time now.  She has given be the green light on cataract surgery since I can barely see through my right eye.

MY FIRST QUESTION is regarding the information that my eye specialist is using to calculate the specifications for the lens.  About six months ago, I had a refraction before the cataract got so bad that I could no longer see.  This was used for a new perscription for my glasses.  About a month ago, another refraction was done.  This time I could barely if at all tell the difference between different powers, since the cataract had gotten so bad.  When I ask the person who was doing the tests for the lens implant about which refraction they would use, the response was "we use the distance from the front of the eye to the retina, and information about the topograghy of the cornea to determine the perscription.  The refractions (taken earlier) have very little to do with the new lens selection.  IS THIS CORRECT, OR SHOULD THEY HAVE USED TO OLDER REFRACTION THAT WAS TAKEN WHEN I COULD STILL SEE WELL?

MY SECOND QUESTION regards the recommendation for which lens to implant.  I will be receiving financial assistance for the lens and doctor portion of the surgery, and I don't want to opt. for something that is less than best just because of my finacial situation.  I have a great need of near vision with the type of work that I do, and would rather wait and do things the best way, than settle for mediocre right now.  My doctor says that he is not recommending a premium lens because they have not been tested on people who have had laser surgery such as mine.  My other eye also has a mild cataract and I wear a very thick perscription.  The doctor says that I cannot wear wear the thick lens (nor would I want to), but that I should wear a contact.  He already expects that I will still have to wear glasses after the surgery, so will I end up wearing glasses and contacts at the same time?  DOES ANYONE HAVE ANY INSITE ON MY SITUATION.

Thank you,


1 Responses
711220 tn?1251894727
1)  The refraction is used for calculation of IOL power depending on the formula used.  If the refraction is used in the formula (Holladay II), then the previous refraction should be used.

2)  Regarding wearing glasses and contact.  It sounds like your left good eye is very myopic and has an early cataract.  You might ask your doctor to do a BAT test and see if the vision decreases to the level insurance will pay.  One option is a Crystalens which does not split light and will give you the same vision as a monofocal lens and some near.  Many doctors do not want to use Crystalens in a diabetic who may need retinal surgery due to the silicone material. I have put in Crystalens in proliferative and nonproliferative diabetic who have had laser treatments. One of my patients had PRP and macular laser treatments 6 or 7 times before Crystalens implant. I have also done retinal surgery before and after Crystalens implant.

The real question is the visual potential in the right eye.  It is probably not the best investment if the macular is damaged to the degree that it does not have a potential for good vision.

I am somewhat bothered by the fact that there is still persistent macular leakage.  Is the cataract so dense that more treatment is not possible?  Have they also considered Avastin injection?

I would recommend preteatment with Xibrom and predforte a few days before surgery and continue for two months post op no matter what type of lens you decide on.

A final note I would recommend you diabetes be in the best possible control before surgery.  HgA1c at 7 or less.

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