Cataract Surgery Lens Implants & Eye Surgeons for Cataracts Blog

Wednesday, May 1, 2013

Multifocal Lens Implants & Halos

Question: I have read that having a multifocal lens implant installed would lead to "halos" around lights when driving at night. First, how bad are the halos-do they impair your vision enough to make driving at night difficult? Second, if I get a lens that corrects my astigmatism and to see distance and near vision (computers, etc.) but I need glasses for reading, would that be considered multifocal enough to produce halos at night? If it does not produce halos-what type of lens implant would you suggest I use to accomplish-far vision, near vision and correct astigmatism and use glasses for reading? I am 76 years old.

Answer: First, multifocal lens implants are a very specific type of lens implant in terms of design. There are a few different designs produced by different manufacturers-each of which has somewhat different optical characteristics and thus differing tendencies to produce halos. Further, depending on your pupil size in bright vs. dim illumination, your results could be better or worse than what you have read-and could differ with each type of multifocal lens design. In addition, the shape of your cornea and its aberrations could also cause halos.

So, there is no simple answer. In order to choose the best multifocal lens implant for your vision requirements and the distances you wish to see clearly at requires a VERY thorough eye exam and consultation and measurements and cannot be accomplished by discussing pros and cons of the designs. So-your best bet is to schedule a consultation and examination with the best cataract surgeon who is also a refractive surgeon and FULLY explain that you do NOT want halos. Then be prepared to provide the measured distances that you wish to see clearly for…i.e. the actual distance of where your computer sits and where you hold reading material. From this information a refractive cataract surgeon should be able to offer you options that might be the most desirable 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 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, April 29, 2013

Cataract Lens Implant Wrinkle Complication

Question: My husband had cataract surgery in his left eye and now his vision is blurry. His cataract surgeon says the lens has a wrinkle in it and that a new replacement new lens will also wrinkle-also that laser is too dangerous as it may blind him. He also has glaucoma in his eyes. Can anything help?

Answer: While it is impossible to actually understand what has happened here there are some things to be considered. First, it is HIGHLY unlikely that the lens implant has wrinkle in it. It is possible however that the posterior lens capsule of the crystalline lens-which would have intentionally been left in place to support the lens implant-has a wrinkle. Wrinkles or irregularities of the posterior capsule after cataract surgery are usually quite successfully treated with a YAG Laser Capsulotomy. It is not clear why this might not be possible-if this is the issue-unless perhaps there were other complications during the cataract surgery. Probably your best next step is to find the best cataract surgeon in your area and schedule a consultation and examination for a second opinion. Make sure you understand EXACTLY what the problems are and what your options are-ask questions-make sure they are answered to you satisfaction.

Wednesday, April 24, 2013

Stop Taking Medicine Before Cataract Surgery?

Question: I am not sure whether to stop taking my medicine before my cataract surgery. I take Metaformin, Crestor, Azor and Metoprolor. One doctor says stop and the other says don’t stop. What should I do?

Answer: It is unfortunate that you are not clear on whether to stop taking these medications before your cataract surgery. BY NO MEANS SHOULD YOU STOP TAKING ANY MEDICATION WITHOUT THE EXPRESS CONSENT OF THE PHYSICIAN WHO HAS PRESCRIBED THEM. Your internist or family doctor who has prescribed this group of medications for diabetes hypertension and cholesterol ad lipid control MUST contact your cataract surgeon and discuss whether it is absolutely necessary to discontinue one or more of the prescriptions. You do not state whether you are also taking aspirin and this would be important as well. PLEASE ask your cataract surgeon and your internist to speak to each other and give you CLEAR instructions as only they can know the potential interactions between medicines as well as the exact type of surgery to be performed and whether the discontinuation is important.

Cataract Surgery Side Effects & Glasses

Question: I have questions about glasses and side effects after cataract surgery. I have been nearsighted w/astigmatism since grade school and have always worn corrective glasses. Since about 13 years ago I wear progressive addition graduated lenses. I am a healthy, active 74 year old male with no night blindness or glare problems at night. Will cataract surgery now increase such risk? Right after cataract surgery, what will I be able to use for glasses?

Answer: The answer to your question about glasses and cataract surgery really depends on what you and your cataract surgeon decide in selecting the type of lens implant to use to correct your vision. For example, it is readily possible to correct your nearsightedness by carefully measuring and calculating lens implant strength. It is also possible to correct your astigmatism during your cataract surgery by using toric lens implants for astigmatism. Further, by using monovision cataract surgery and lens implant techniques-even with toric lens implants-it may be possible to give you some help with intermediate and near vision with the just the lens implants and no glasses. Finally, there are now accommodating lens implants that also correct intermediate and near vision with astigmatism. So-the answer to your question about what glasses you use really depends on what type of lens implants you are good candidate for an what you and your cataract surgery ultimately decides fits your lifestyle the best. Any side effects of night blindness and glare at night should be limited if your eyes are otherwise healthy and your surgery goes unremarkably with the possible exception that if you elect to have a multifocal lens implant to correct both your near and far vision, some of these very complex designs do in fact cause some night vision disturbance in some patients. The best next step is to seek out and schedule a consultation with the best cataract surgeon in your area and discuss all of the lens implant options that might be appropriate for you. Then, carefully relay your expectation and desires for how you would like your vision correction to end up in terms of the need for glasses or not. By sharing this information with your cataract surgeon they will be able to help you make the best choices.

Lens Capsule Complication & Poor Vision

Question: I had lens implants 2 years ago there was a tear in one of the sacks now I can only barely see through that eye. It’s like I have sleep in it all the time it feels dirty. Is there anything I can do to sort it out? I have had no luck with the cataract surgeon to repair the damage.

Answer: Complications of lens implant surgery are relatively rare but they do happen from time to time. It is difficult to ascertain what exactly happened and whether the complication was limited to the lens capsule or “sack”, as you describe it, or perhaps was associated with other complications involving swelling in the macula, other adhesions, vitreous complications or a host of other possibilities. Based on the fact that you don’t seem to get much help from the cataract surgeon who performed the procedure, it might be worthwhile to find another cataract surgeon in your area and schedule a consultation for a second opinion. It might be possible to reconstruct the area that was damaged and perhaps rehabilitate some of the vision depending on the nature of the damage.

Dry Eyes after Lens Implants

Question: Two months after receiving bilateral toric lens implants for astigmatism, I feel like I have hard contact lenses in my eyes. My eyes ache and strain after the least amount of close work. I, also, see peripheral rings. My ophthalmologist says these symptoms are not a result of the surgery but that I have dry eyes and should use eye drops. This gives me no relief. Is there a solution to this problem?

Answer: Dry eyes after lens implants are not terribly uncommon. During any eye surgery procedure where an incision is made in the cornea-depending on the location of that incision-it is likely that some of the corneal nerves will be cut and will take time to be restored. These corneal nerves are responsible for providing innervations to the Lacrimal Gland for tear production. It can take some time for these nerves to regenerate and the tear film to once again become normalized. Thus, it might very well be that you have a post surgical dry eye in need of somewhat more aggressive treatment options including insertion of tiny punctal plugs, prescription eye drops called Restasis that help you to produce more of your own natural tears and ten of course artificial tear eye drops. If you are not satisfied with the explanation or care you are receiving then it is never inappropriate to seek a second opinion. In your case perhaps a consultation with a corneal specialist who is also a cataract surgeon might be useful.

Blurry Vision in Dim Light with Clear Lens Extraction

Question: I just had my Clear Lens Extraction operation 3 weeks ago and still have blurred vision if in dim light or darker places or at night. Is this normal?

Answer: While the Clear Lens Extraction procedure itself should not cause a reduction in dim light vision, the type of lens implant you had might very well contribute to this phenomenon. Pretty much all multifocal les implants-some more than others-do cause a reduction is contrast sensitivity as well as the sensation of reduced vision in dim or dark conditions.

Dizziness & Monovision Toric Lens Implants

Question: I have two toric lens implants for monovision-one set for distance and the other set for close vision but I still wear glasses for intermediate vision. I am very dizzy and have balance problems. Could it be the two different lens implants? Could they be replaced with other lenses to solve the problem?

Answer: Monovision correction with lens implants can be a very good option for many patients to help with correction of both distance and near vision. Some patients are simply unable to tolerate the difference in the correction between the eyes as we say that they have a low “tolerance to defocus.” This may very well be a cause of the dizziness and the balance problems but may not be the sole cause or even the primary cause. You do not state your age or general medical condition. If you have any risk factors or a history of vascular problems, high blood pressure or stroke this must also be ruled out as well. Further, the improper orientation of astigmatism correcting toric lens implants can also cause what you describe. If the problem turns out to be the monovision correction from the toric lens implants, depending on the length of time since your surgery it may possible to perform a lens exchange and correct both eyes for distance or you may need a LASIK procedure to create a distance correction for both eyes. All of this should be discussed with your cataract surgeon who can provide you with the information after a clinical exam and of course should you have any other risk factors mentioned above you should consult your Internist or family doctor as well.

Distorted Vision & Spots after Cataract Surgery

Question: I am 51 and I had cataract surgery two months ago. My vision has not improved and is worse. It is blurry both day and night along with being all distorted. I also have a lot of black spots and blotches in my vision. I can see this film moving all around when I look around. My cataract surgeon said the lens is fine it's just the gel that I'm seeing. What should I do?

Answer: It is difficult to know exactly what is happening without a careful clinical exam. However, from your description there are a number of things to be considered as to why your vision is distorted, blurry and you are seeing spots after cataract surgery. First, the inside of the eye is filled with a gel called the Vitreous. It is not uncommon for the Vitreous gel to shrink, collapse and pull away or detach from the retina after cataract surgery. In fact the studies suggest that more than 50% of patients who have cataract surgery do indeed experience some kind of Vitreous gel detachment or irregularity after cataract surgery.

This phenomenon called Vitreous Detachment can result is the spots and perhaps the distortion that you are experiencing. The risk is whether the Vitreous gel is also pulling on the retina and even causing it to tear or detach resulting in “distortion”. This needs to be carefully examined. Also, sometimes people with continued blurred vision two months after cataract surgery along with a Vitreous detachment might also be experiencing some swelling of the Macula area of the retina. One would suspect your cataract surgeon has ruled these problems out through a thorough examination. If you are not clear or are not satisfied with the explanation being provided by your cataract surgeon it is never inappropriate to have a second opinion. Based on the symptoms and concerns you relay one might consider a second opinion with a retina specialist rather a cataract surgeon at this time.

Monday, April 22, 2013

Cataract Surgery after Vitrectomy with Macular Edema

Question: I had a vitrectomy and got macular edema in 2011. I now need cataract surgery. Should I and can I have cataract surgery if I have had macular edema?

Answer: You do not state why you needed a vitrectomy in 2011 and what the underlying cause was. A common cause of macular edema is diabetic eye disease and this might also necessitate a vitrectomy as well if there was a hemorrhage from diabetic retinopathy. Whatever the cause, if you have had a vitrectomy with macular edema, your cataract surgeon will assess the likelihood of a good visual result from cataract surgery with your retinal surgeon if there is any question. If there is a need to treat macular edema before or after the cataract surgery, your surgeons will recommend this as part of getting you the best possible results.

Cloudy Vision after Cataract Surgery

Question: Is cloudy vision normal 10 hours after cataract surgery?

Answer: Some degree of short term blurry vision or cloudy is possible due to varying degrees of swelling or corneal edema, perhaps minor inflammation and swelling elsewhere in the eye and just the general recovery of the delicate tissue. Cloudiness or blurriness that persists without improvement for more than a few days does warrant discussion with your cataract surgeon.

Anesthesiologist for Cataract Surgery?

Question: I am having cataract surgery and was told I have to have an anesthesiologist and will be charged $400. I don't want an anesthesiologist for my surgery but my cataract surgeon and the surgery center say I am going to be charged the $400 for one to be there anyway because it is required by state law.

Answer: Depending on your cataract surgeon and your general health it is often the case that even though cataract surgery is typically done with only eye drops for anesthesia, it is necessary to have “stand by” or other anesthesia available. This is NOT your decision. It is a medical decision made by the surgeon, the surgery center and general medical and surgical practice standards that are often mandated by regulations at various state levels and sometimes even federal regulations.

Tuesday, March 12, 2013

Astigmatism Toric Lens Implant Cost

Question: What is the cost for astigmatism toric lens implants? What would be a general idea of the cost of range of what I should pay for toric IOL implants? It seems like they are very expensive. What should I expect to pay if I opt for this?

Answer: When you have astigmatism before having cataract surgery you need to realize that it needs to be corrected or else you just won’t see as well as you should after the cataract operation. There are three ways to correct astigmatism after cataract surgery.

First, you can simply have glasses with the astigmatism correction.

Second, you can have an additional eye surgery procedure called Limbal Relaxing Incisions (LRI).

Third, you can have an astigmatism correcting toric lens implant. ALL three have cost associated with them. Eyeglasses cost several hundred dollars and needs to be replaced every so often. LRI can also cost several hundred dollars and may or may not be covered by insurance and NOT by Medicare-and it may need to be enhanced at some future point. Astigmatism correcting toric lens implants-including the extra measurements and calculations and testing that is required for them-can cost between $1100-$1800 per eye depending on the amount of extra testing required as well as the individual cataract surgeon fee. Each cataract surgeon sets their own fee but in general that is the approximate range throughout the U.S. Astigmatism correcting toric lens implants are the most natural and stable and permanent way of correcting astigmatism with the best potential vision after cataract surgery.

Monday, March 4, 2013

Monovision Cataract Surgery & Lens Implant Result

Question: I had cataract surgery one week ago and I had a Tecnis® Lens Implant for near vision in my left eye, with cataract surgery planned in a few weeks for far vision in my right eye. The problem is that after one week my left eye is seeing well at a distance but blurry for near. Is this a mistake on my cataract surgeon's part with calculation or does this happen? I'm 63 years old and had been wearing one contact lens for years for monovision, so I was a good candidate and was looking forward to the same after cataract surgery. My cataract surgeon talked about inserting another lens (piggyback) to help but I am wondering what to do.

Answer: By a week or so after your cataract surgery and lens implant, if you were supposed to have the focus of the first lens implant set for near vision you should actually be experiencing the desired effect of blur at distance and greater clarity at near distances. If you are not getting this effect you need to bring it to the attention of you cataract surgeon prior to have the cataract surgery and lens implant in the right eye. Typically it should be possible to mimic the near and far monovision you achieved with contact lenses in the lens implant calculations.

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.

Removing Contact Lenses before A-Scan

Question: My father has thick cataracts and he is 87 years old. He presently wears Acuvue® Oasys® contact lenses for 2 weeks straight because he is disabled, then I put new ones in for him. Should he go without wearing his contact lenses for 2 weeks before getting an A-scan? One eye doctor says yes and the other said not necessary. Question 2: Would there be any other reason for using a toric lens implant on a patient that doesn't have astigmatism?

Answer: Generally speaking removing soft contact lenses 2 weeks prior to an A-Scan is usually not necessary. However, because your father wears the soft contact lenses for a 2 week extended wear period-and if he has some other even mild predisposition to corneal swelling as a result of reduced cell counts on the innermost layer of his cornea due to age-it is possible that that there is some corneal swelling and possible distortion. This would make it necessary to remove the contact lenses for some period of time prior to measurement and might explain the difference in opinion between eye doctors. You should follow the specific instructions of the cataract surgeon who is taking the measurements, selecting the lens implant and performing the cataract surgery. There would be no reason for using a toric lens implant in a patient who does not have astigmatism, however, again, with 2 week extended wear in a person with even mildly compromised corneal deswelling capability, there is the possibility that the cornea has become “warped’ mimicking the presence of astigmatism. This will typically resolve after the contacts are removed for a period of time.