Cataract Surgery Lens Implants & Eye Surgeons for Cataracts Blog

Wednesday, January 9, 2013

Nervous & Anxious about Cataract Surgery

Question: I have been told I will require cataract surgery in the near future for both eyes. My concern is that I am extremely phobic about any near or actual eye contact. I literally have to take valium before a routine eye exam. So can this typically be done in hospital with some minor anesthesia? There is no way can I keep eyes open with someone closely approaching or touching my eyes. Please comment and give advice?

Answer: Modern cataract surgery is typically performed using only eye drops for anesthesia and with some oral medication such as Valium to help patients stay relaxed. However, if you are phobic, anxious or fearful you need to discuss this with your cataract surgeon who very well might suggest any one of a number of other alternatives-as well as possibly even more traditional anesthesia. Keep in mind that the “lighter’ the anesthesia, the quicker and more comfortable the recovery. Also, modern cataract surgery is pretty quick so you won’t experience the fear or phobia for too long-thus it might be possible to use more than eye drops but less than complete sedation.

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.

Eye Watering after Cataract Surgery

Question: My mom had cataract surgery in September 2012 and still has an issue with extreme watering of that eye. The vision is fine and there is no sign of infection. This was not an issue before surgery. Any suggestions?

Answer: Eye watering after cataract surgery can be due to a range of issues including dry eye, turning in of the eyelid-called entropion, eyelash problems-called trichiasis, a constriction or blockage of a tear duct-and on and on. The best thing to do is schedule an examination and consultation with your cataract surgeon and explain the issue. If you do not get satisfactory answers then seek a consultation with a cataract surgeon who is also a corneal specialist as they will be more inclined to evaluate the eye surface and tear film from a different perspective.

Laser Cataract Surgery & ReSTOR Multifocal Lens Implants

Question: I had LASIK surgery with cataract removal and ReSTOR® Lens Implants in both eyes in past 2 weeks. One eye sees clearly for distance, but still blurry near vision. The second eye done one week ago is still very blurry for near and far, my cataract surgeon says they are not worried, but I am. I can't see well at all, reading and all activities are an issue. Can someone tell me approximately how long this takes as I was told I would have clear vision at all distances?

Answer: First, it is not likely that you had LASIK surgery. It is more likely that you had laser cataract surgery, cataract removal and lens implants using the ReSTOR® Multifocal Lens Implant. If this is the case, and you and your eyes are otherwise healthy then one would expect that there would be rather good distance vision in each eye within just a few days after the surgery on that eye and that there would be at least decent near vision for reading and close vision tasks within a couple of weeks as you adapt. The multifocal lens implants do require and adaptation period to see comfortably, however one would expect some consistency and improvement in relatively short order. Your cataract surgeon may not be concerned because he or she sees the eyes quieting down and expects a good outcome but perhaps in a slightly or moderately greater length of time. That’s said, if you are not happy with the vision after your cataract surgery and lens implants within a 4-6 week period you deserve to have an explanation and plan to improve it that is reasonable.

Thursday, December 27, 2012

Blurry Film after Cataract Surgery

Question: I had cataract surgery in October and my left eye continues to blur or get a film over it. If I blink hard enough this seems to help. It also hurts at times. Is this normal? Should I visit my eye doctor or cataract surgeon?

Answer: Without a clinical exam to fully understand the range of possible reasons that you have a blurry film after your cataract surgery that clears when you blink, we can only offer the following consideration. What you are describing sounds like an abnormality of the tear film or the eye surface. This is not uncommon at all and occurs in as many as 30% of the patients having cataract surgery. It is often attributed to dry eye or inflammation of the eyelid margins called blepharitis although there could be many other reasons. Your best course of action is to return to your cataractsurgeon and ask him/her to evaluate your situation. In almost all cases there multiple ways to improve the eye surface and tear film depending on the actual cause. Be patient as it does require some trial to find the best therapeutic approach.

Cataract Surgery with Diabetic Retinopathy

Question: I have a question about having cataract surgery if I have diabetic retinopathy. I have been diagnosed with diabetic retinopathy and am currently undergoing laser treatment. I am also beginning to develop a cataract and will need cataract surgery for this as well in the future. Are there any restrictions for cataract surgery if you have had laser treatment for diabetic retinopathy?

Answer: Cataract surgery and lens implants for patients with diabetic retinopathy can be performed successfully for the majority of patients but the ultimate results do depend on the overall health ad condition of the retina in terms of the progression and degree of treatment that has been rendered. First, it is critically important that a very careful and meticulous preoperative retinal evaluation confirm the level of vision that should be expected. One of the more common findings in diabetic retinopathy is the presence of Diabetic Macular Edema (DME) which can have a considerable effect of the level of best corrected vision that can be achieved-with or without cataract surgery. It is likely that your eye surgeon rendering the diabetic laser treatments is evaluating you for Diabetic Macular Edema with fluorescein angiography and ocular coherence tomography (OCT) testing. The presence of DME might actually be one of the reasons you are having diabetic laser treatment currently.

Diabetic Macular Edema is often treated with laser and/or vascular endothelial growth factor (VEGF) inhibitor injections such as Lucentis® as well as other medications. One of the concerns that many diabetics have is their susceptibility to slow or poor wound healing and infection. Modern cataract surgery is typically performed using eye drops for anesthesia rather than injections and through a very tiny self sealing incision-often between 2.2 and 3.0 mm. The precision and the architecture of this tiny incision allow it to close and heal without sutures in most cases. So, modern cataract surgery is actually quite “wound healing friendly” and requires no real modification in technique for diabetic patients. Depending on the stage of diabetic retinopathy at the time of your cataract surgery and lens implants, it is possible that your Cataract Surgeon or Retinal Specialist might place a vascular endothelial growth factor (VEGF) inhibitor injection such as Lucentis®, Eyelea® or Avastin® into the vitreous gel as a preventative and/or therapeutic measure. Assuming that you will not have had any retinal or vitreous hemorrhages prior to cataract surgery, and that the vitreous is otherwise healthy, other than these considerations and as long as any presence of macular edema has been accounted for in the setting of expectations for your ultimate vision after the cataract operation-you should have a relatively routine cataract surgery experience.

Thursday, December 13, 2012

Toric Lens Implant Rotation

Question: I had cataract surgery and an astigmatism correcting toric lens implant for a moderate cataract almost 6 months ago. I complained that my vision was way off after cataract surgery and I could see better when I tilted my head a lot. My cataract surgeon found the toric implant to be and said it needed to be corrected, which lead to a second surgery on same eye. I have been complaining for the whole time since then to my eye doctor and my cataract surgeon that my vision became blurry and I am not able to focus both eyes together-my vision is terrible. Now, my Cataract Surgeon tells me the toric lens implant rotated again and he will not reposition it as a thick haze has developed which makes it difficult to read and see with that eye. They recommend I have a laser treatment in the surgeon's office to help get rid of the haze, but once I do that I cannot have the lens repositioned. I am at a loss of what to do, as my vision is so terrible and I can no longer read. I have asked my eye doctor to send me to another eye specialist and surgeon for second opinion and recommendation but he said I have to finish with my current Cataract Surgeon. Help - is there something that can be done to improve my vision since the second time toric lens rotated it is still off.

Answer: Most Cataract Surgeons would not go back yet again and reoperate to correct the rotation of the toric lens implant-too much surgery. A YAG Laser Capsulotomy would BE THE LAST STEP to be taken after all other options for correcting your vision have been explored. There may very well be posterior capsular opacification or a secondary cataract causing the haze-or there may be other problems with the lens capsule causing the haze. It needs to be carefully determined. Also, a very careful refraction and examination of the amount and direction of the astigmatism present on your cornea needs to be observed. Further, a careful and thorough examination of your retina, especially the macula, needs to be performed to be certain that there is no swelling causing the distortion of your vision. One would suspect that the initial toric lens implantation was performed “off axis” as these lenses do not typically rotate excessively as you describe-but it could happen. You should find the best Cataract Surgeon in your area and seek a second opinion.

Retinal Detachment Risk after Cataract Surgery

Question: I am concerned about my risk of retinal detachment after cataract surgery. I am 75 years old, myopic, 75 yrs old and had retinal tears in each eye 13 years ago. What is the chance of retinal detachment after cataract surgery?? I am not ready to have cataract surgery yet but it is causing many sleepless nights

Answer: If it has been 13 years since the repair of your retinal tears-and they were treated with a laser at that time-one would assume that they have been well sealed and the retinas are stable and well attached. To confirm this you should have a consultation with your retinal specialist prior to your cataract surgery who can then clear you for the cataract operation. Once these precautions have been taken, it is likely that with an experienced Cataract Surgeon performing your procedure you will have a safe and predictable outcome.

Secondary Cataract Development Timing

Question: I have a question about the time to develop a secondary cataract. I am a 56 year old woman who had cataract surgery just 3 months ago in my left eye and 2 months ago in my right. My vision was perfect immediately after surgery--20/20 at distance and I could read without glasses pretty well. Now my close up vision is blurry and my intermediate vision in my left eye is also getting blurred. I am told this is due to a secondary cataract. Does this sound right? Do they happen this fast?

Answer: A secondary cataract, which is called posterior capsular opacification or “PCO”, is not an uncommon occurrence after cataract surgery and lens implants. In fact in some reports as many as 30% of patients having cataract surgery actually develop posterior capsular opacification. While the timeframe for the development of PCO can vary widely, it is possible for it to occur in patients a few months after their cataract removal. Depending on the density of the cataract removed, the difficulty of the actual procedure and many other factors can accelerate PCO formation. Fortunately, PCO is readily treatable with a YAG Laser Capsulotomy-a painless, quick and very effective laser treatment that produces almost instant improvement of vision.

Monday, November 26, 2012

Reading Glasses after Cataract Surgery

Question: I am 51 years old and have been advised that cataract surgery and a lens implant is needed in my left eye. I recently switched to multifocal contact lenses (-9.5 power) and am disappointed to have been told that I am not a candidate for a premium multifocal lens implant IOL and that I will need to wear reading glasses after the surgery. My doctor said this was due to the shape of my eye. Is there any hope of me consulting with another cataract surgeon and being told that cataract surgery can leave my free of needing reading glasses?

Answer: Your disappointment with not being a good candidate for a multifocal lens implant after cataract surgery to avoid having to wear reading glasses is understandable-especially in consideration of your adaptation to the multifocal contact lenses. It is not clear from your description what part of the “shape of your eye” is the issue-and you don’t state whether you are wearing rigid or soft lenses, so it is difficult to offer much more than some general comments. First, if you are a rigid gas permeable lens (RGP) lens wearer this could very well complicate the precision and accuracy of the measurements and calculations used for the lens implant. If you had induced astigmatism or other shape changes from the contact lens wear this could be a challenge. With less complex lens implants, the calculations are still subject to this variation, however with the multifocal lens implant the lack of precision will lead to a much greater level of dissatisfaction if it is present. You do not say if the shape of your cornea is otherwise normal or regular and thus one suspects that you might have a great deal or natural or induced astigmatism-which also could make the successful implantation of a multifocal lens implant more of a challenge as the astigmatism would ten need to be corrected after the cataract surgery either with a Limbal Relaxing Incision (LRI) or LASIK surgery in order to obtain full functioning and vision correction. If there is any doubt in your mind it is never inappropriate to get a second opinion. Find the best Cataract Surgeon in your area who is also a LASIK Surgeon and schedule a consultation. By finding a Refractive Cataract Surgeon you will avail yourself of the best information regarding your complex optical situation along with the need for cataract surgery.

Tuesday, November 13, 2012

Starburst after Cataract Surgery

Question: I had cataract surgery one month ago and had a toric lens implant. Immediately after surgery I have experienced a horizontal star burst with 4-6 long flares/rays at night while driving with oncoming headlights. Halogen and LED lights produce the most vivid star bursts. My cataract surgeon thinks this may be caused by a wrinkle or crease in the back of the capsule. He suggests a laser procedure to remove a section of the capsule to eliminate the crease. This sounds reasonable to me. What are your thoughts?

Answer: The type of visual symptoms that you are describing are very possibly due to a crease or wrinkle in the posterior lens capsule that is left in place in order to support the lens implant. This does happen from time to time and is immediately alleviated with a YAG Laser Capsulotomy which should in short order eliminate the starburst if this was the cause. While it is possible that there are other causes this is a logical place to begin and you should follow the direction of your Cataract Surgeon.

Multifocal Lens Implant for Artist

Question: I have poor distance vision and am due for cataract surgery shortly. An artist by profession I need good all round vision. However I have not coped well with multifocal spectacles and wonder whether the Lentis Mplus Multifocal Lens Implant that I have been offered may not suit me. I do not wish to experience alterations in my color vision or my area of vision to be restricted. I already suffer with glare and halos and poor night vision and was hoping that cataract surgery would get rid of this. Would I be better off choosing a standard lens implant and using glasses for close up work? What would my mid-distance vision be like?

Answer: As an artist you certainly have more demanding vision requirements than the average person, thus your caution and concern in choosing a lens implant after cataract surgery is well founded. That said, multifocal lens implants are very complex optical systems and ALL multifocal lens implants have optical limitations which do present some compromise to vision quality depending on their specific design. For this reason you should strongly consider having the lens implant with the BEST possible optics even though it may require that you wear eyeglasses for near or intermediate vision. This will likely be an aspheric wavefront optimized design that minimizes or eliminates aberrations including spherical aberration and chromatic aberration. Please discuss this with your cataract surgeon who can assist in the choice of lens implant and help you determine the working distances that will require eyeglasses.

Toric Lens Implant for Astigmatism

Question: Does the toric lens implant for cataract surgery totally remove astigmatism?

Answer: Toric lens implants for astigmatism correction after cataract surgery “correct” but do not “remove” astigmatism. If the astigmatism is regular and caused by the shape of the cornea being unequal in curvatures, toric lens implants are quite effective at correcting the vision if they are measured properly and implanted correctly.

Floaters after Cataract Surgery

Question: I had cataract surgery in October with an AcrySof® IQ Lens Implant. I told my cataract surgeon that I was seeing floaters ever since the eye surgery. The floaters seem to be getting worse. What should I do?

Answer: Floaters after cataract surgery and lens implants are not uncommon. In most cases the floaters are the result of changes in the vitreous gel inside the eye. This can be due to a vitreous condensation, liquefaction or detachment-called Posterior Vitreous Detachment (PVD). If the floaters are increasing or if you see distortion, bending or bowing or bubbling of your vision-especially if there are flashes of light, it would be important to return to your cataract Surgeon and have a thorough examination of the retina and the vitreous to be sure there is no traction, tears or detachment of the retina.

Multifocal Lens Implant Vision Problem

Question: My father had cataract surgery and multifocal lens implant about 18 months. He is 85 and active and is still having problems seeing with the lens implant that was used. He has symptoms that sound like a decentered or dislocated intraocular lens implant. The eye doctors at the facility had some problems inserting the lens implant at the time of surgery causing swelling to occur. They told him this would get better over time and that his vision would improve. Swelling went down but vision did not improve. He has returned for several visits and they tell him everything is fine, but his vision in the eye is still not correct.

Could there be a problem with the lens implant or some other issue that they are not discussing? I am planning to visit the doctor with him in the next 2 weeks and wanted to know if there were other questions I should ask or if there is anything that can be done to correct the problem. He can't drive at night and they have told him to get regular glasses to correct the vision problem.

Answer: Unfortunately it is impossible to know from your description the actual nature of the vision problem. Is it glare, halo, blur-at what distances-far, near, intermediate? You state he cannot drive at night-why? Glare-halo-blur? Or something else that might suggest a problem not with the lens implant itself but perhaps with the capsule left in place to support the lens implant. Was the cataract surgery itself complicated-was the capsule ruptured? You state there was “swelling”. Where was the swelling-the cornea or retina? As you can see there are MANY questions that need clarification through a clinical examination and then explained to you as the reason for your father’s difficulty with the multifocal lens implant. Or, it just may be possible that this is as good as his vision can be with the multifocal lens implant as, depending on the type of multifocal lens implant, they do often present a number of potential vision compromises which are exaggerated if the lens is not centered perfectly. That said, you certainly should be present and discuss the possibilities with the cataract surgeon after the next visit and exam. If the discussion does not give you a reasonable explanation and path to improvement-if possible-then find the best cataract surgeon in your area and schedule an appointment for a second opinion.

Wednesday, November 7, 2012

Monofocal Lens Implants for Near Vision

Question: Can I have a lens implant that is focused so that I have to wear eyeglasses to see clearly at distance but when I take them off I can see clearly to read? What is the distance that the reading capability kicks in and I'd have to remove my distance glasses? Would these lens implants reduce glare at night or halos around lights compared to multifocal lens implants?

Answer: The simple answer is yes you can have a monofocal or aspheric lens implant that is calculated in prescription strength so as to allow you to see clearly for near vision such as reading. This would then require that you wear eyeglasses to see at distance as you would be rendered “nearsighted” by the les implants. The distance that the near vision would be clearest would be a matter of you discussing this with the eye surgeon and determining the approximate distance at which you wanted it to “kick in” as this is a mathematical and optical calculation that is adjustable.