Tuesday, February 10, 2015

Lens Implant Problems after LASIK

Question: I have had LASIK surgery and I was told that as a result I have 50 % chance that the lensimplant would fail in cataract surgery.  Is this true?

Answer: Having any type of eye surgery, including LASIK, can make the calculation of the lens implant powers more challenging. That said, today, in the right surgeon’s hands using the sophisticated instrumentation, imaging methods and measurement systems and calculations it is possible to reduce the margin of error considerably. Further, having access to your LASIK preoperative measurements also can help mitigate error. By using multiple measurements and calculations to recheck the lens implant calculation it is possible to really manage this to a great extent. That said, the word “fail” doesn’t really apply as what would happen is that the optical power of the lens implant would be slightly or moderately miscalculated. You would do one eye first, check the results carefully and then in the worst case if the power were VERY far off, would need to have a lens exchange. Thus, “failure” is harsh but there is a reasonable likelihood of being slightly off power. Your best bet is to seek a consultation from a LASIK Surgeon who is also a Refractive Cataract Surgeon and is thus very familiar and has access to the most advanced measurement, imaging and calculation systems and formulae.



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.

Slanted Vision after Cataract Surgery

Question: I have had cataract surgery and my astigmatism corrected on my right eye 4 days ago. I went to the store and everything seems distorted. For example, I went to my optometrist's office and when I looked out, the floor looked like it was leaning to the right. I went down the hall and the floor looked like it was going uphill. Went to a fast food restaurant and the table I was sitting at looked like it was slanted uphill. Could it just be my brain trying to adjust to the new lens and no astigmatism?

Answer: What you are describing sounds like an artifact of the astigmatism correction however we are not clear whether the astigmatism was corrected with a toric lens implant or in an eyeglass prescription of using Limbal Relaxing Incisions (LRI) as part of your cataract surgery. Slanting can occur if the method or the amount of correction is considerably different than your preoperative astigmatism, but should nonetheless become unnoticeable after a short period of time. if it does not, or if it is accompanied by floaters, flashing lights or other distortions of your vision see your cataract surgeon for follow up in short order.  

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.

Cataract Surgery with High Myopia

Question: I am very nearsighted with. -12.5D contact lens prescription and I have a cataract in my left eye. I want to have a lens implant to correct my vision when I have the cataract surgery but I am really worried that I will have severe problems if the other eye is not corrected also for the vision. I have heard that the brain will have a hard time processing this drastic change. What could happen?

Answer: In order to avoid the imbalance caused by a huge difference in optical correction between the two eyes you will need to wear a contact lens in the right eye after having the cataract surgery and lens implant on the left eye. If you wear the contact on the right eye there should not be an optical balance problem. If you have even the beginning of a cataract in the right eye, the sooner you opt to have it removed, the better as this will allow for a perfect match of optical images when lens implants are in both eyes.

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 Allergy

Question: Can I been having an allergic reaction to the silicone lens implant material of the cataract lenses? A Bausch & Lomb Model LI61A0 (SofPort AO) lens implant was implanted and is made of silicone and PMMA. I had cataract surgery with the lens implants on 9/23/14 and 10/14/14.  Ever since then I have had excruciating eye pain. My eyelids hurt, pain at the crease of the eyelid, there is pain behind the eye. It feels like something is always underneath the eyelid. The pain radiates to my temples and across my forehead.  It hurts to move my eyes and eyelids. I am in pain constantly and am not getting any relief. Every specialist has dismissed me since they can't figure it out even after extensive blood work, a CT, MRI and Gallium Scan.

Answer: Although it is remotely possible, it is highly unlikely that you are having an allergic reaction to the silicone-PMMA combination of the lens implant material. These materials, along with the acrylic lens materials and collagen lens materials are highly biocompatible and have withstood the test of time for many millions of patients. That said, your complaints and intensity are not really within the realm of any typical cataract surgery post operative symptoms. As you did not specify the type of specialists you have seen, it is probably worthwhile to consider seeing an allergist to do some testing if you have not already done so as well as a neuro-ophthalmologist.

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 Lens Implant Blurry Vision

Question: I had cataract surgery and a toric lens implant inserted for correction of my astigmatism on December 11, 2014. Since then my vision is not any better for distance and is very blurry for intermediate, even worse than before my cataract and I still need readers for close up, which I was told I would still need. I feel like the wrong lens was inserted. The technicians measured my eye for the toric lens implant 4 different times! What should I do?


Answer: By now it would be expected that your vision should be stable and give you more or less the final vision correction your cataract surgery and toric lens implant will provide. However there are several considerations to note. First, you are correct that you will still need readers as toric lens implants do not correct near vision at this time-unless they are accommodating toric lens implants, and they do not correct intermediate vision either. 

But, your distance vision should be corrected quite well if your eye health is otherwise normal, the cataract surgery uneventful and the lens implant in the proper position and of the proper prescription. So, while your near and distance vision blur is not acceptable, it is the distance vision complaint that is more troubling. There are many reasons this could be occurring that may or may not be related to the lens implant itself and might be related to other factors that can only be determined by a thorough clinical exam. You should first discuss the blurry vision with your cataract surgeon and express your dissatisfaction, and give him/her a chance to examine you, explain and offer some suggestions on how to improve the vision. If the answers and course of action are acceptable then proceed. If not you may want to seek a second opinion from a cataract surgeon who is also a refractive surgeon and might have a different perspective on whether this is a refractive prescription or surgery issue to be resolved.



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.

Cataract Surgery Complications Cataract Surgery

Question: My 68 year old wife has undergone her second cataract surgery in the same eye. She has had a premium lens implant exchanged for a lens implant for distance vision only but the second surgery has not relieved the holes and cloudiness in her vision. She is nervous and fears she is losing her sight. We have decided not to progress with surgery in her other eye until she shows some improvement in the operated eye. She is going through extreme stress and trauma. Please help us.


Answer:  It is impossible to say what exactly is causing the symptoms of “holes and cloudiness” after the cataract surgery and lens implant procedure. However, these are NOT normal post operative symptoms and should be investigated. You do not say and may not know whether the first cataract surgery and lens implant procedure was unremarkable or if there were any complications such as a torn lens capsule or any retinal swelling. Thus, if you cannot get a clear and easy to understand explanation from your cataract surgeon you should seek a second opinion or even a third opinion with another cataract surgeon as well as perhaps a retinal specialist. Once the cause is ascertained you can them consider whether to and when to proceed with the second eye surgery.

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, 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.