Double Vision After Cataract Surgery

Question: I have double vision after Cataract Surgery. What causes this? I this normal?


Answer: Double vision after Cataract Surgery is not a normal or expected occurrence unless you actually had it before the Cataract operation and just didn't notice it due to poor vision from the Cataract. Nonetheless, it needs a thorough investigation by your Cataract Surgeon. Double vision in one eye, or monocular diplopia, has an entire range of causes from improper positioning of the Lens Implant used to correct your vision to a problem in the Retina and many other possibilities. Double vision occurring only when both eyes are open, or binocular diplopia, has an entirely different set of causes that could span a number of optical problems but also systemic, medical, vascular or neurological problems-ALL of which need to be investigated. Or, what you are describing as double vision could be something as simple as an uncorrected refractive error like an astigmatism that can cause shadowing that appears as a doubled image in some cases. Your next step is to return to your Cataract Surgeon and carefully explain what you are experiencing and under what conditions and whether it is one or both eyes and how long you have experienced it. This is not a symptom that you should leave unattended.. If you do not wish to return to your Cataract Surgeon, then find a top cataract Surgeon in your area to provide and examination and 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 www.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 of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.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 Recovery and High Altitude

Question: Is traveling to higher altitudes advisable during Cataract Surgery recovery?


Answer: Cataract Surgery recovery from modern Cataract Surgery including "no needle, no patch, no stitch" surgery procedures is pretty patient friendly. If you are in good health and have had no other eye surgery concurrent with your Cataract operation-such as Retinal Detachment surgery-then assuming that your Cataract Surgeon has no restrictions, traveling to high altitudes should not pose any real problems or risk.

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 www.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 of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.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.

Vitamin D and Macular Degeneration

Researchers reporting in the April issue of Archives of Ophthalmology found that women younger than 75 who get sufficient vitamin D in their diets appear to have a reduced risk of Macular Degeneration, a leading cause of blindness. In the study, researchers say women under 75 who got the most vitamin D had a 59% decreased risk of developing Age Related Macular Degeneration (AMD) as compared to women with the lowest vitamin D intake. The research suggests that perhaps by using a common blood test called Serum 25 (OH) D it might be possible to identify those women at greater risk of developing AMD. Age Related Macular Degeneration (AMD) is a leading cause of vision loss and blindness in our aging population and affects some 8.5 million Americans over 40 years old.

Black Eye from Cataract Surgery

Question: I had Cataract Surgery on 3/15/11. I still feel some discomfort mainly at night when I am laying down and closing my eyes. It feels abnormal-almost like a quivering feeling below the eye. I had a black eye atter surgery and am still waiting for some of the bruising to go away. I am scheduled for the left eye tomorrow 4/12/11. Is what I am experiencing normal? The cataract Surgeon said to expect a black eye on the right eye.

Answer: Short term complications of Cataract Surgery such as a bruise can sometimes occur within the first 24 hours after surgery. If there was some factor regarding your overall health and medical condition that caused the Cataract Surgeon to use an anesthetic injection either alone or in combination with anesthetic eye drops it is possible to get a bruise or "black eye". The bruising is temporary and while it doesn't happen very often it can sometimes occur. By all means mention to your surgeon the other discomfort you are experiencing so that he or she can examine the eye and the tissue around the eye for anything untoward.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery-Does Age Limit Outcomes

Question: My 98 year old mother is reluctant to have Cataract Surgery. Is her age detrimental to a good surgical outcome?

Answer: The simple answer as to whether age alone limits the positive outcomes of Cataract Surgery is no. If your mother is in generally good health the type of modern Cataract Surgery that can be performed is "topical clear cornea no stitch phacoemulsification". This is a complicated way of saying modern Cataract Surgery in basically healthy patients can be performed with eye drops for anesthesia-no needles and can be performed with a very tiny incision that is so small and self sealing so as not to require stitches. So, modern Cataract Surgery is "patient friendly" even for someone 96 years old. However, there are other eye changes that happen as a result of the normal aging process that CAN effect the outcome of Cataract Surgery. In particular, Age Related Macular Degeneration (AMD) can impact the expectations one should have of Cataract Surgery. In addition any other health or eye problems, conditions or diseases including diabetes and glaucoma that your mother has may also impact the Cataract Surgery outcome-regardless of her age. The best step to take is to arrange a consultation with a top Cataract Surgeon in your area for a thorough examination. he or she should take the time necessary to answer any questions and be able to give you a pretty good estimation of what to expect in terms of outcome.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cost of Lens Implants and Cataract Surgery

Question: I need to have a Cataract removed. I have investigated the AcrySof®ReSTOR® IQ lens. I have Secure Horizons Insurance.What is the estimated cost out of pocket above insurance coverage?

Answer: When you state that you have "investigated" the AcrySof®ReSTOR® IQ Lens Implant it is important to be certain that you have first had a consultation with a top Cataract Surgeon who in fact has thoroughly examined you, discussed your lifestyle needs and your vision expectations and requirements of Cataract Surgery and Lens Implantation. Choosing a Lens Implant for vision correction after Cataract Surgery is not like buying a car where you can read about the manufacturers specifications and marketing hyperbole and get "sold' on it. Each type of near vision presbyopia correcting lens implant available today has very different optical characteristics and thus corrects the range of clear vision after Cataract Surgery in a different manner. This leads to different ranges of clear vision as well as producing different optical side effects and limitations for each one. Thus, the "brand" of near vision presbyopia correcting lens implant should be chosen after considerable discussion with your Cataract Surgeon. That said, assuming you have indeed had an examination and consultation and your Cataract Surgeon has selected the AcrySof®ReSTOR® IQ Lens Implant as being the best one to meet your vision and personal lifestyle needs it is the eye surgeon that sets the fees for the incremental fee to be charged for the AcrySof®ReSTOR® IQ Lens Implant, Each Cataract Surgeon determines their own fees and thus they should be able to tell you what they are. Generally, the incremental cost of a near vision presbyopia correcting lens implant ranges from $1,000-$3,000 above what is reimbursed by standard insurance and Medicare. However, THE DEDUCTIBLES, PERCENTAGE COVERAGE AND ANY CO-PAYS ARE UNIQUELY INDIVIDUAL TO YOUR INSURANCE AND YOUR SPECIFIC HEALTH INSURANCE POLICY and thus should be reviewed with you by the Cataract Surgeon's office and your insurance company.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery, Dry Eye and Vision

Question: I had Cataract Surgery with presbyopia correction surgery 4 weeks ago. My vision is extremely blurry. The eye is extremely dry and the pupil of the eye that had the surgery is larger than the eye that did not. Could the blurriness possibly be from the dry eye and enlarged pupil?

Answer: Dry eye after Cataract Surgery is not an uncommon symptom as it is thought that Cataract Surgery can either cause a temporary dry eye to occur or even exacerbate a mild preexisting dry eye condition. Dry eye can also cause blurred vision that typically gets better and clears upon blinking. You do not say that there is any pattern to the blurriness and you report that the vision is extremely blurry so the dryness might or might not be contributing to this. The fact that your pupil is "enlarged" 4 weeks after Cataract Surgery is not a typical finding and it needs an explanation sooner rather than later especially in light of the poor vision. There may be no relationship between your poor vision and the enlarged pupil or it may be significant and related. Speak to your Cataract Surgeon and ask for a clear explanation. If you are unable to get one that is satisfactory, it is completely appropriate to seek a second opinion from a top Cataract Surgeon in your area regarding the dryness, the poor vision and the enlarged pupil.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monovision Cataract Surgery for Near Vision

Question: I have had Cataract Surgery in my right eye for distance and love it. However I am having my left eye implanted with a reading lens or monovision Cataract Surgery. My question is do most people adjust the this type of vision easily. Do you know what percent of people do not like this.

Answer: The technique of monovision for near vision correction has been used for many years for patients wishing to avoid bifocals or reading glasses. Monovision contact lenses and monovision LASIK have proven to be an effective method of near vision correction for patients requiring correction of nearsightedness, farsightedness and astigmatism. The success with monovision in any correction is dependent of the physician taking careful measurements, doing careful calculations and attempting to determine the patient tolerance to "defocus". This can be approximated by doing an in office trial with a spectacle trial frame and lenses or through the use of contact lenses. It is more difficult to approximate and demonstrate when one eye has a Cataract that blurs the vision as it doesn't give a true demonstration. That said, when it can be demonstrated and is well tolerated by patients in the office trial the success rate is in the 80% range (Cataract & Refractive Surgery, Kohnen and Koch:  2008). In an older survey of the published literature without any standardized testing or screening the composite success rate of all publications was 73% (Survey of Ophthalmology, Jan, Aurora, Azar: May 1996).

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery and Bloodshot Eyes

Question: I had cataract surgery (right eye) about 13 months ago. An intraocular lens was inserted. During past year I tend to have minor 'blood shot' eye that usually it disappears in afternoon. What might be causing this?

Answer: A bloodshot eye after Cataract Surgery is not a common occurrence nor is it unheard of. The fact that it is a minor event is good.You do not say whether there is any irritation or discomfort with the "early in the day" bloodshot and this is important. You also do not say whether there is any discharge-either watery or sticky or whether there is any irritation or redness of the margins of your eyelids. There are many possible causes of some transient redness after Cataract Surgery including dry eye, minor eyelid inflammation or infection or chronic blepharitis, improper closure of your eyelids during sleep ad on and on, all of which can be investigated and diagnosed and a treatment plan recommended by your Cataract Surgeon. Your next step is to schedule a visit to your Cataract Surgeon and be sure to tell them all of the details of your complaint as well as making sure that they know all of the medications you are taking including OTC eye drops for the redness.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery Complications

Question: My mom-in-law had cataract sx two days ago. Today on a p/o visit, she was told she has a "major eye bleed". I worked in an Ophthamology Surgicenter for more than 15 years and absolutely do not remember this complication, ever. She's in surgery now to repair the stitch that never closed the incision. We were told she has a 1 in 30 chance of having vision in the eye when it is healed. How common is this complication? Are there any stats that show better odds? Thanks.

Answer: Cataract Surgery complications are generally pretty rare and typically less than 5% in otherwise healthy patients. Certain health conditions such as diabetes, glaucoma and other blood and healing problems can increase the complication rate but are still considered somewhat rare. Bleeding is a very unusual short term complication of Cataract Surgery. Bleeding inside the back of the eye is quite rare. A chorodial hemorrhage can infrequently and unpredictably occur during Cataract Surgery and for no apparent reason. Acute bleeding can occur in the choroid, which is the delicate pattern of blood vessels underlying and nourishing the retina. Although this complication, called "choroidal hemorrhage" is more common among elderly patients, it is truly unpredictable. In some cases of choroidal hemorrhage, the bleeding is localized, and patients do well. In more severe cases of choroidal hemorrhage, visual loss can be substantial.

While bleeding can occur inside the front of the eye where the actually surgery is being performed, this too is rare-especially since the tiny incision is made in the clear portion of the cornea where there are no blood vessels. If bleeding does occur it is usually limited to the surface of the eye where your surgeon can easily cauterize it and stop it immediately.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Should a Torn Lens Implant be Removed?

Question:
My wife just had cataract surgery and was informed that the implanted lens has a slight tear. Is it best to have it replaced?

Answer:   Whether to remove or explant and replace a torn or damaged lens implant (IOL) is really dependent on many factors. The vast majority of times it is not necessary. A minor tear or damage that does not effect vision, impact the position of the lens implant in the eye or its stability may not need to be removed at all. If the size or the position of the tear impacts vision by either allowing the IOL to not be stable and in the correct position or it is a tear that might cause irritation and inflammation then it might be worthwhile having a "lens exchange". No one, including the best Cataract Surgeons wants to do surgery that is unnecessary or doesn't have a very comfortable risk:benefit ratio. Thus the question of whether an explant and lens exchange is needed is really a decision to be made at the advice and direction of your Cataract Surgeon. If there is any doubt in your mind in his/her recommendation it is always appropriate to seek a second opinion from a top 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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Glaucoma Risks in Asians

Researchers from the Kellogg Eye Center of the University of Michigan reported on the incidence of Glaucoma in Asians in a study published in the journal Ophthalmology (March 2011). Racial-ethnicity risk rates help people and doctors plan for eye care and take extra precautions if appropriate. Since Asian Americans are the second fastest growing population in the U.S., a trend likely to continue for years to come, such risk information is very useful and helpful.


Of the various racial groups in the United States it is generally known that African Americans have the highest risk for Glaucoma of about 12% percent. The rate of Narrow Angle Glaucoma (NAG) was higher in Asian Americans than in any other racial group in the study and highest of all among Chinese and Vietnamese Americans. With NAG, the part of the eye that drains excess fluid becomes blocked and pressure builds up in the eye; the patient usually feels severe, rapid-onset pain and needs immediate treatment to prevent vision damage. The risk of Normal Tension Glaucoma (NTG) was three to 10 times higher in Japanese Americans than other Asian ethnicities studied.With NTG, the optic nerve and vision sustain damage even though the pressure within the eye remains within "normal" levels. Among Asian Americans, Open Angle Glaucoma (OAG) rates were highest among Japanese Americans (about 9.5 percent), followed by Indian and Pakistani Americans (about 7.7 percent).

Cataract Surgery Costs & Alternatives

Question: I have a cataract in my left eye that my doctor says is 'ripe' for surgery. I also have a less severe one in my right eye, but I am also extremely near-sighted so my doctor says I would have to have the right eye done two weeks after the left in order to function. My insurance pays 90% of the cost, plus a $50 co-pay and a $150 deductible; however, I can't get anyone - insurance company, eye doctor or ambulatory surgery facility - to tell me how much this would cost me out-of-pocket. Frankly, I'm strapped for cash and don't want to have the surgery only to find out I've destroyed my credit if I can't pay. Are there any alternatives to surgery? How long can I get away with progressively stronger eyeglasses (I get one pair free yearly from my union)?


Answer: First, your Cataract Surgeon seems to be giving you sound advice regarding the need to have the second cataract operation performed within two weeks or so. The optical imbalance created as a result of your extreme nearsightedness would probably make you very uncomfortable. I understand your frustration regarding trying to approximate exactly how much cataract surgery will cost you for co-pays and deductibles to have both eyes treated. It is indeed difficult to understand this. Regarding alternatives to Cataract Surgery you need to know that the only way to treat a cataract is to have it removed and to have an intraocular lens implant (IOL). Otherwise, changing glasses is a short term solution that while it might appear to alleviate the vision problem slightly and for a short time, it will not minimize the glare, halos and night driving problems you might be experiencing. The decision as to when to have Cataract Surgery is entirely up to the patient, however, strongly consider your safety, your driving and ability to function as you make the decision. Your best option might be to have a frank discussion with your cataract surgeon's office and explain that you will pay but depending on the amount due you may need to take some time to do so. And, have the same discussion with the surgery center.

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 www.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 LASIK. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Diabetic Retinopathy Screening Challenges

The eye health complication of diabetes, diabetic retinopathy represents a major cause of acquired vision loss in the United States today. Even with considerable effort at public awareness through ongoing public health campaigns as well as published medical and eye care guidelines that promote yearly retinal exams for patients with diabetes, we still have an unacceptably high number of patients who are not screened for diabetic retinopathy according to a report in Current Opinion in Ophthalmology (April 1, 2011). The authors recommend the development of novel methods to improve compliance with retinal screening exams among diabetes patients to preserve eye health and vision. The key to maintaining eye health and vision is early detection, diagnosis and treatment of diabetic retinopathy.

Worldwide Glaucoma Survey and Status

According to a recent article in Lancet (March 30, 2011) reporting on population based surveys, most medical practitioners have regular contact with adults who have one of the two forms of glaucoma: open-angle glaucoma or angle-closure glaucoma. The surveys indicate that one in 40 adults older than 40 years has glaucoma with loss of visual function, which equates to 60 million people worldwide being affected and 8·4 million being bilaterally blind. Even in developed countries, half of glaucoma cases are undiagnosed. Glaucoma is mostly asymptomatic until late in the disease when visual problems arise. Vision loss from glaucoma cannot be recovered, and improved screening and detection methods for glaucoma are needed. Glaucoma is commonly treated with daily eye drops, but adherence to treatment is often unsatisfactory suggesting that other treatment options such as glaucoma laser treatment, neuroprotective strategies and even gene therapy might be useful in the future. Preventing eye health damage and vision loss from glaucoma requires early detection, diagnosis and treatment for the long term preservation of vision.