Monday, January 26, 2015

Blurry Vision with Toric Lens Implant

Question:  I had cataract surgery & toric lens implants for astigmatism. My right eye is now 20/25 distance vision.  But my left eye is 20/80 distance vision & glasses can only correct it to 20/60. My cataract surgeon suggests leaving it that way or removing toric lens in left eye & implant a basic lens implant, then use glasses for distance and reading. Are there other options? I paid an additional $3500 total for toric lens and going to a normal lens implant seems a rip-off. The normal lens is paid for by insurance. But really if I can get better sight in my left eye I want care about the cost. Suggestions please. Thanks.

Answer: If your left eye is 20/80 with a best correctable vision of 20/60 with glasses, then you need to immediately find out why, as it is entirely possible that there is a reason that has nothing to do with the lens implant. You do not state how long ago your cataract surgery was. But, do you have posterior capsular opacification-which could be causing the blur. Do you have residual corneal swelling? Do you have macular edema? Do you have age related macular degeneration? Or one of many other possible reasons that need to be identified. You need to find out the cause of the 20/60 best correctable vision BEFORE making decisions about the lens implant exchange. Ask your cataract surgeon to identify and explain this to you and then make the decision. If he or she is unable to do so, get a second opinion.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Laser Cataract Surgery with High Myopia

Question: I have very high myopia, greater than 15 diopters of correction, and need cataract surgery. My plan is to have retina treatment prior to the cataract surgery. My question is does laser cataract surgery provide significant improvement in my case over conventional cataract surgery?

Answer:  First, the fact that you are proactively addressing any retina issues prior to your cataract surgery is a good, conservative plan. Once you are cleared for cataract surgery and in experienced hands, then your outcome should be good whether done with conventional cataract surgery or by laser cataract surgery. What we know is that laser cataract surgery offers greater precision and allows the surgeon to use lower power settings when actually removing the cataract by phacoemulsification. Thus, laser cataract surgery tends to be “gentler” on the eye overall. In consideration of this, IF you have the option of laser cataract surgery-OR any options to refine the outcome and deliver the procedure in a gentler manner, you should strongly consider taking advantage of these options.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Discomfort after Lens Implants

Question:  Two months ago I had an AcrySof® IQ Toric IOL, Model: SN6AT3-power 26.0D implanted in my left eye after removing cataracts.  According to the doctor all is good, BUT my eye feels heavy, at the bottom edge it feels like there is an eyelash or something in there and it gets blood shot very easily as well as it seems to blur over and I have to blink. In fact I am blinking a lot more than usual. I had same lens implant in my right eye with power: 22.5 D and there is no problem. Do you have any suggestions?  I appreciate your help.

Answer: Without a clinical exam it is impossible to tell why you are symptomatic. However, the types of symptoms you relay suggest that you have a dry eye problem. Typically we would see dry eyes in BOTH eyes but it is possible that due to the anatomy of your eyelids in the left eye or some temporary interference with the corneal nerves from the cataract surgery in left eye, this is the one that bothers you. You best next step is to visit your cataract surgeon and express the discomfort as you have done here. If he or she is not able to offer any help then seek a second opinion.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monday, December 8, 2014

Astigmatism Lens Implant Correction Calculations

Question: Can you use a toric IOL for cataract surgery that corrects down to 1.50, for astigmatism that is only 0.75?

Answer: Toric lensimplant calculation may not match the amount of astigmatism in your eyeglasses. Is the .75 the eyeglass refraction? Is the astigmatism on the cornea as demonstrated by the corneal topography? Is the astigmatism with the rule or against the rule? Is the placement of the incision going to impact the position or the degree of the astigmatism postoperatively? And there is more to be considered in the calculation. Please leave the calculation to your cataract surgeon and if you don’t feel confident with his or her choice then get a second opinion.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Sunday, November 23, 2014

Best Multifocal Lens Implant Results

Question: Why is it necessary to do both eyes if choosing multifocal lens implants?

Answer: Multifocallens implants and really any type of more complex lens implant design does seem to provide the best results only after them placed in both eyes. Within the brain you are accustomed to seeing with two eyes. by using a multifocal lens implant in only one eye it creates a less refined image quality with the visual cortex of the brain-just as your vision would be somewhat less precise if you needed bifocals and had only one bifocal lens place in your eyeglasses. Binocular vision helps the brain interpret images by sending more information. In most instances cataract surgery and lens implants in both eyes provide a better overall quality of vision and greater comfort overall as the two eyes are more closely balanced. Thus, even for those having routine simpler implants the visual result is better after both eyes have been done.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Toric Multifocal Lens Implant Vision & Optical Complaints

Question: I had cataract surgery in both eyes in Dec of 2013. I paid quite a lot of money for the Bausch & Lomb Trulign Toric Multifocal Lens Implants. I only have far vision in my right eye and intermediate vision in my left eye. I still have glare from lights especially at night. I have a different type of glare in my right eye that appears to be coming from the lens itself.  I notice yellow beams of light with color in it when bright light enters at an angle from the outside of my eye. I can't find any literature pertaining to this post-op condition. I am being followed up by my cataract surgeon. This just doesn't seen normal.  Should I obtain a second opinion?  What if anything can I do about this.

Answer: You are describing a number of vision and optical complaints that require further investigation. It is impossible to know the cause or causes without a thorough clinical evaluation that includes the actual surgery status and lens implant position, the preoperative measurements, the current refractive status, corneal topography, aberrometry, slit lamp microscopic evaluation and perhaps even retinal evaluation. At this point in time it would be worthwhile to consider getting a second opinion with someone who is specifically a cataract and refractive surgeon as from what you describe the complaints may have originated from a combination of the cataract surgery as well as the lens implant calculations, placement and design itself.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask CataractSurgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monday, November 17, 2014

Simultaneous vs. Sequential Cataract Surgery

Question: I was told that it is best to only have cataract surgery done one eye at a time and wait about a month between the two eyes. Is this correct?

 Answer: In general, most cataractsurgeons do prefer to do the cataract surgery and lens implant one eye at a time with a wait of anywhere between 1-2 weeks and 4 weeks between eyes. This gives them some sense of the healing process and refractive outcome and may give the surgeon information from which to modify or adjust the second eye procedure. Also, in the unusual instance where there should be an adverse event such as an infection or other complication it tends to be more manageable if only one eye is treated at a time. That said, there are instances and situations where in the cataract surgeon’s clinical opinion it might be better to do both eyes simultaneously rather than sequentially. The best thing to do is to listen carefully to the recommendation of your cataract surgeon.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Lens Implant Materials with Retinal Surgery Risk

Question:  I am considered legally blind in one eye and now need cataract surgery in my good eye. Years ago I had a vitreous detachment in that eye, and I have floaters. I read that silicone lenses should not be used in a person that may have to have vitreoretinal surgery down the way.  Because I had a vitreous detachment and have floaters, does that mean me?  My cataractsurgeon only uses a silicone lens which is the Bausch & Lomb L161AO.  I went to another doctor who uses the Alcon AcrySof SN60WF, but I read of a glistening from this lens.  Which lens would be better for me?

Answer: Certainly in any one eyed patient the cataract surgeon wants to be as cautious as necessary and will guide you to the best choice of lens implant. First, while you had a vitreous detachment you do not state whether the retina is in any way compromised with excessive thinning, holes or tears, or whether there are any tractional areas on the retina. This should be evaluated by your cataract surgeon and perhaps even having a consultation with a retina specialist might be in order. This information is the basis for assessing the risk of needing vitreoretinal surgeon and might lead to some preventative treatment options. Once ths is evaluated and discussed you can as the cataract surgeon and the retinal specialist to make a lens implant material recommendation for you.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask CataractSurgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Thursday, November 13, 2014

Monovision Lens Implant with Astigmatism

Question: Will a monovision lens implant for cataract surgery work if you have an astigmatism condition? If so, will an intermediate distance mono lens enhance the dominant eye long distance vision at all?

Answer: Depending on the amount of astigmatism and the expected amount you will have after cataract surgery, the astigmatism will most likely need to be corrected in order to have the best monovision cataract and lens surgery results. As it sounds like you are hoping to be either somewhat or completely independent of eyeglasses after your cataract surgery then using eyeglasses to correct the astigmatism is not a good option. There are really three options for you to consider-a) laser cataract surgery at which time the laser can possibly correct the astigmatism, b) an LRI or Limbal Relaxing Incision placed at the time or surgery or c) using a toric astigmatism correcting lens implants. Which is best really depends on your individual case and should be discussed with your cataract surgeon. Using an intermediate monovision lens implant correction will in likelihood give you sharper distance vision but will probably require you to use reading glasses for some finer close reading or near vision tasks.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Motion Sickness after Cataract Surgery

Question: I had cataract surgery on my left eye last Thursday. Since then I have been experiencing nausea, like motion sickness/sea sickness because the balance between my two eyes has been altered. Is this common?  What medication helps?

Answer: If there is now a significant imbalance between the vision or prescription in the operated eye as compared to the unoperated eye it very well could cause the sensation of motion sickness or vertigo. Your brain is trying very hard to adapt to the big difference between eyes and the only way to get rid of this in the immediate short term is to cover the unoperated eye. In virtually all instances the problem goes away as soon as the second eye is operated. You should speak with your cataract surgeon and explain the situation and he or she can counsel you on the timing to operate the second eye. Often it is only about 1-2 weeks if all is healing well.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, November 4, 2014

Floating Ring Shadow after Cataract Surgery

Question: After my cataract surgery and lens implant surgery I am having a problem with seeing a ring like floating shadow which moves with the lens. What is this and will it go away? 

Answer: Without a clinical exam it is impossible to know for sure but it sounds like what you are describing could be some annoyance as you adapt to seeing the edge of the lens implant. Sometimes the lens implant edge can scatter light and cause a shadow or other types of visual disturbances. If this is accompanied by an actual decrease in your vision or a bending or distortion of your vision you should visit your cataract surgeon at once. Otherwise make sure that you keep your follow-up appointments and ask your cataract surgeon about it if you are still experiencing this shadow. In almost all instances patients become accustomed the new lens implant in a matter of weeks or months and then forget about the shadow.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Astigmatism after Cataract Surgery

Question: I had cataract surgery on both eyes, six months apart. My vision was 20/20 after surgery. Afterward my eyes started blurring and I started seeing double. I went for a follow-up Monday and with my left eye I could not read eye chart. My eye doctor that did the surgery said it was because I had astigmatism in my left eye. He said he could prescribe glasses. I am not happy with this answer.


Answer: While it is not possible to know the exact reason that you have developed astigmatism after your cataract surgery, there are several possible reasons that could contribute. First, depending on the type and location of the incision used to remove the cataract and place the lens implant it is possible that during the natural healing process some astigmatism was induced. This could be even more likely if sutures or stitches were placed to close the incision. It is also possible that the lens implant itself has shifted slightly but this is much less common. Another somewhat common reason might be the formation of posterior capsular opacification whereby the capsule that was left in place to support the lens implant has become fibrosed and induced some optical aberration and cloudiness. All of these possibilities can be carefully investigated and each has a different way of being helped. If you are not happy with the answers your cataract surgeon has provided then seek a second opinion from another cataract surgeon in your area. 

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tuesday, May 13, 2014

Shadow Line after Cataract Surgery

Question: I had cataract surgery 2 days ago and now I am seeing a black shadow line in the outside corner of the eye they operated on. The line jumps back and forth making it impossible to read and I have trouble driving. A friend had the same surgery a year ago and he has the same problem. Can this be fixed?

Answer: In all likelihood you are seeing the outer edge of the lens implant used to correct your vision. Many patients experience this as they adapt to the new implant and vision. In almost all instances over time this will become completely unnoticeable. Please be patient and discuss this with your cataract surgeon at you next visit.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Spider Web Vision after Cataract Surgery


Question: I had cataracts removed and toric lens implants in March. The left eye was done first. I had severe astigmatism and nearsightedness. I was told that I would only need glasses for working on the computer and reading. However, while I'm waiting on my glasses, I find that I have developed some massive spider web like floaters in my direct line of vision. My cataract surgeon even could see that is where they are. My distance is getting worse and prior to the surgery, I could see to read slightly without my glasses. Now, I cannot see to read anything without help (using readers for now). Everything is cloudy, out of focus and I feel like I have made a grave error in having this procedure done. I feel like I'm losing my mind. Any help you can give me would be greatly appreciated.

Answer: Without a careful examination it is impossible to say for sure but it does sound like you are describing a common occurrence after cataract surgery called a vitreous detachment. In fact some 50% or more of patients having cataract surgery experience a vitreous detachment-but not all instances cause vision problems. The vitreous gel is normally adhering to the surface of the retina. With age the gel liquefies and separates-especially after cataract surgery-from the retinal surface. If this happens on the visual axis it can cause exactly what you are noting. The good news is that over time this disturbance does go away by itself with no treatment necessary.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Allergy to Lens Implant Acrylic Monomer?

Question: I work in a dental lab and am allergic to the monomer that is used to make dentures. This is an acrylic. Since the cataract lens is acrylic, will I be able to have a cataract lens? Or is this a totally different type of acrylic? This may seem like a silly question but I still want to ask.

Answer: First, not all lens implants are made from acrylic materials if you are very sensitive. Second, being allergic to raw unreacted monomer is much more likely than reacting to a miniscule trace of unpolymerized residual monomer that might be in a finished lens implant. The FDA holds IOL manufacturers to exceedingly strict tolerances and specifications regarding residual monomer-especially in implantable devices, thus the chance of an allergy are quite remote. However, discuss this with your cataract surgeon who can then choose a different lens implant material for you in order to avoid all risk if necessary.


Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.