Retinal Detachment Risk after Cataract Surgery with High Myopia

Question: I am a 49 year-old male, have had cataracts in my right eye for 7 years which is also extremely myopic with a -12.00 correction. Fortunately, my left eye vision has held up, and I have been able to function normally with my left eye vision for many years. Starting last year, my left eye started to develop cataracts.  I have been myopic my whole life, and my left eye has gone from about -6.5 before I developed cataracts to -7.5 now.  With correction, I used to see 20/20 in both eyes. Now with cataracts, my vision is 20/30 in the left, and almost blind with my right.  I have also developed presbyopia so I need reading glasses in both eyes.

Because I am relatively young and myopic, my ophthalmologists have told me that I am in the high risk category for retinal detachment after cataract surgery. Therefore, I have delayed my cataract surgery for as long as possible. Given that my left eye is getting blurry and my right eye cataract is are getting dense, increasing the cataracts surgery risks, I have decided to get cataract surgery soon.  Given that my left eye is still functional, I have decided to get a cataract surgery in my right eye first, with no plans on the left eye surgery, hopefully until many years later.

I was told that I am left eye dominant, so even with near-blindness in my right eye, I have lived a normal life. If I correct the right eye vision for distance thru the cataract surgery, I was told that I would have to wear contacts on my left eye to balance out the vision. 

My question is as follows:  If I don't wear contacts, but rather wear glasses such that the left eye correction is around -3 (versus full correction of -7.5), and right eye would have no correction (except for reading glasses), would I be able to function for reading and distance?  In other words, given that I am left eye dominant, but after the cataract surgery on the right eye, I will have distance vision on the right eye and partial correction on the left eye through glasses, would my brain be able to function or will I be too dizzy?  I'm just trying to see if I can avoid wearing contacts everyday and still function. Thank you so much for your advice!

Answer: It sounds like you are getting careful consideration from your ophthalmologists who know your situation the best. The decision to have the cataract surgery in the right eye first sounds like a good idea-BUT-you may want to have a thorough evaluation of your retina by a retinal specialist if you have not already done so in order to be sure the retina will withstand the cataract operation and to determine whether any prophylactic treatments of holes, tears, weakening or degeneration might help to reduce your risk of retinal detachment. After clearance by a retinal specialist you can be more confident that you have taken any necessary precautions. Regarding the -3.00 D difference after surgery, it is likely to cause headaches and possibly dizziness if you don’t wear a contact lens. You need to know that the best result is when both eyes have had the cataract surgery and thus while delaying the left eye surgery might seem prudent, it does make things even more risky surgically the longer you delay. Of course this is up to you and your cataract surgeon. You can try the eyeglasses with the -3.00 D difference and see if you tolerate it but it is questionable.

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.

Light Flashes & Floaters after Cataract Surgery

Question: I had cataract surgery 5 months ago on my right eye and am still bothered by flashes of light and floaters. I had been sensitive to sunlight and problems with night driving and my ophthalmologist suggested that I have cataract surgery to correct my distance vision.  I took his advice, he did the surgery and I have regretted ever since. My distance vision of course has improved but the flashing and fluttering that I am experiencing in the outer corner of my eye causes me much frustration. I also am experiencing more floaters than I previously had.  I have returned to his office and have been examined as recent as a month ago but he informs me that I have astigmatism and this is as good as I can expect. The eye examination was done without dilation.  My vision was so much better 5 months ago.  Please inform as to what my recourse is. 

Answer: You do not state whether your cataract surgery was uncomplicated or whether there were cataract surgery complications during your surgery that may have predisposed you to the ongoing flashes of light, floaters or fluttering. Assuming that it was an uneventful cataract operation it is not uncommon for many patients-perhaps 30-50%-who have cataract surgery, to experience a condensation, shrinkage and even a detachment of the vitreous gel, which does often cause the symptoms you describe. In almost all instances these symptoms pass after several months and become unnoticeable. These particular symptoms are not likely to be related to the astigmatism. In addition some patients experience some “light effects’ as they adapt to the vision with a lens implant. For you own satisfaction it might be worth considering getting a second opinion on the status of your vision with 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 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.

Maine Cataract Surgeons Launch New Web Site for Seniors

Eyecare MedicalGroup has launched a new web site with important patient information to help patients learn about eye diseases and surgery and in particular includes information about advances in technology, treatment and procedures that are especially helpful for senior eye problems. “The EyecareMedical Group cataract surgeons all felt strongly that we needed to use our web site to share information with patients who are at risk of suffering vision loss from cataracts. By understanding more about cataract surgery and lensimplants, we believe seniors will be able to make more informed decisions about their eye health and  not allow vision loss from a cataract to interfere with their daily activities, driving, mobility and overall quality of life,” commented Bruce Cassidy, M.D., a Cataract& Refractive Surgeon. “Further, as the choices of advanced technology lens implants have become more extensive, they have also become more confusing for seniors having cataract surgery. So, we wanted to provide them with easy to understand options," explained Robert Daly, M.D., a Cataract Surgeon &Glaucoma Specialist at EMG in Portland, ME. “As a group, we are quite dedicated to helping patients get the information and education they need. This is especially important when we consider age related eye problems such as cataracts, glaucoma and macular degeneration,” summarized Cataract Surgeon& Glaucoma Specialist Samuel Solish, M.D.

To learn more about Eyecare Medical Group inPortland Maine, cataracts, cataract surgery or lens implants, you may visit the new web site at www.eyecaremed.com.

Monovision Lens Implant & Distance Vision

Question: I had toric lens put in right eye during cataract surgery with no since I still have to wear glasses for distance. I'm considering monovision lens for left eye so I can still read without glasses. If I do this will glasses enable the left eye to see distance clearly?

Answer: First, if you still need to wear glasses with the toric lens implant for distance, you need to find out why and whether there is a solution to get you seeing better. It is important to know the reason and understand whether it has anything to do with the lens implant, the cataract surgery or the health of your eye-especially the retina. Second, if you now correct the left eye for near-NO-you will not be able to see clearly at distance with the left eye. You need to get better answers from your cataract surgeon and if you are not satisfied 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.

Multifocal Lens Implant Cost & Decision

Question: Why would a person having cataract surgery settle for monofocal lens implants and still have to use glasses, when he could have a multifocal lens implant? Why are multifocal lenses so expensive?  What is the difference between the different brands of multifocal lenses such as AcrySof®ReSTOR®, Tecnis® and the other brand names?  Medicare said they would pay for the monofocal lensimplant and if you want an advanced lens such as a Tecnis® Multifocal lens implant, the patient would have to pay the difference. Why would the difference be as much as $2500 dollars per eye difference?

Answer: First some patients having cataract surgery don’t mind wearing eyeglasses and thus don’t really see much benefit in electing to have a multifocal lens implant. Second, in order to have the best success with multifocal lens implants it requires careful patient selection in terms of optical characteristics, previous refractive error and overall expectations and ranges of vision the require. They are NOT for everyone. So NOT all patients get the option or choice of a multifocal lens implant-and thus they have to have a monofocal lens implant. Each multifocal les implant type has an optical design that works best for certain eye characteristics and which one to use is really up to the cataract surgeon-NOT the patient. Medicare DOES NOT pay for the correction of near vision or astigmatism after cataract surgery whether it be with eyeglasses, contact lenses or lens implants. This portion of the correction after cataract surgery is the obligation of the patient and NOT Medicare. The incremental fee for multifocal lens implants is the necessary fee to cover the costs associated with considerable incremental preoperative testing, measurement and calculations, plus the cost of the lens implant itself, plus any costs should a lens exchange or power adjustment be necessary. Most patients find this to be a bargain given the multiple long term cost of buying eyeglasses for their lifetime-to say nothing of the improved convenient day to day ability to see clearly at multiple distances.

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.

Risk of Cataract Surgery after Retinal Detachment

Question: I have had 3 surgeries for retinal detachment with laser, vitrectomy and gas bubble, since have developed cataract. What are the risks to my retina with cataract surgery?

Answer: There is some increased risk of having cataract surgery if you have had prior retinal detachments ad surgery. However, IF the retina is well attached, stable and otherwise free of holes, tears, thinning and other degeneration AND your retina surgeon gives you clearance to have the cataract surgery then you can proceed with the expectation of only minimal increased risk of a recurring retinal detachment.

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.

Crystalens® Near Vision

Question: I have high myopia, -7.25. Without my glasses I have very clear vision at 3-6 inches. I am planning to have Crystalens® Lens Implants, will I lose my clear near vision that I have now?

Answer: The fact that you are rather nearsighted does give you clear near vision at close distances. Once your distance vision is corrected after the cataract surgery and Crystalens® Lens Implants it is not likely that you will have the same level of clear vision at 3-6 inches. This could be overcome by your cataract surgeon intentionally overcorrecting your distance vision rendering you a bit nearsighted, however then your distance vision will not be clear. You need to have a thorough discussion with your cataract surgeon so that he or she can understand your preferences and take this into account in the final 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.

Symptoms & Images after Cataract Surgery

Question: Approximately a year ago I had cataract surgery after having had LASIK surgery about 13 years prior.  It's been a year now with my new lenses and I still experience the following symptoms at night: 1. all light sources display a flare at 12 and 5 o'clock, and 2. when viewing the moon, I see multiple images at both 12 and 5 o'clock. YAG did not help. What is going on?

Answer: You do not state whether you had cataract surgery with monofocal, aspheric, toric or multifocal lens implants and this might or might not be relevant. The fact that you had LASIK 13 years prior is possibly relevant in that if you did not have either custom wavefrontor wavefront optimized LASIK it is possible that you have some residual optical corneal aberrations from the LASIK that were not corrected as part of the LASIKtreatment. It could also be that the cataract surgery procedure induced these higher order aberrations including distortions called spherical aberration, coma and secondary astigmatism. Using an in office measuring system called an aberrometer, along with a corneal topography measurement-it should be quite possible to rule this in or out. This is the first place a refractive cataract surgeon can look. As you had a YAG Laser Capsulotomy with no improvement in your symptoms it would also be important to determine whether the lens implant is in the proper position in terms of centration. This too is a pretty quick clinical observation. If neither of these paths identifies the cause, then additional retinal testing might be considered. Now, if you have had an aspheric, multifocal or toric lens implant then it begs other questions that might relate directly to the lens implant design ad positioning. Once the cause is determined then your refractive cataract surgeon should be able to offer you possible solutions. 

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.

Halos with Multifocal Lens Implants

Question: I had LASIK surgery over 15 years ago.  I have been told by an ophthalmologist that multifocal cataract lens implants may create halos around lights.  Have you heard of this?  If so, how often and how bad can it be?

Answer: Multifocal Lens Implants are very complex optical designs of several types. Indeed depending on the optical design some do in fact cause haloes, the degree to which they cause haloes depends n the design, the pupil size, aberrations and other factors. However, it is possible that one of the designs may be of minimal if any problem for you. If you are wishing to consider a multifocal lens implant your cataract surgeon advises against it you may wish to get a second opinion and even a third as different surgeons may not be experienced with each and every lens implant design type. Then, you can make an informed decision

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.

Too Old for Cataract Surgery

Question:  My mother is 92 years old. She has a little heart trouble, but is generally pretty healthy. Her cataracts have left her vision very poor and getting worse. Is she too old for the cataract surgery?

Answer: The answer simply is NO-she is not too old for cataract surgery. Here is why. First if the health of eyes is otherwise good-especially the center of the retina or the macula-and her overall health is good she will most likely have a good result. But, the results are more than just her vision. Vision loss in seniors is a significant cause of physical and psychological decline. That is, vision loss in seniors really affects quality of life. Find the best cataract surgeon in your area and schedule a consultation for her. If the cataract surgeon feels that she will do well then strongly consider the benefits to her mobility, safety and social interactions improved vision can give her! Best of luck!

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 vs. Conventional Cataract Surgery

Question:  I need cataract surgery and my cataract surgeon performs both traditional surgery and laser cataract surgery with the LenSx. Which is better?

Answer: Both conventional cataract surgery and laser cataract surgery will provide good outcomes and results when indicated and performed by a skilled and experienced cataract surgeon. Lasercataract surgery does give the surgeon the ability to deliver a gentler and precise cataract operation in a reproducible manner by consolidating many manual steps under a surgeon controlled laser procedure rather. For eyes that have some concurrent eye problem, disease or condition such as cornea guttata, Fuchs Dystrophy, glaucoma diabetic retinopathy the ability to use lower energy settings and power to remove the cataract may very well be an advantage. In essence, follow 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.

Glaucoma after Cataract Surgery & Toric Lens Implant

Question:  I had cataract surgery and a toric lens implant only in my right eye just over a month ago and at my one month post op exam I was diagnosed with glaucoma in both eyes which I didn't have before the cataract surgery. Is this possible and way if it is and can it be corrected?

Answer: It is highly unlikely that you would get glaucoma in one eye after having cataract surgery and a toric lens implant in only one eye. It is sometimes possible to have a temporary increase in intraocular pressure (IOP) in the operated eye but it is usually transient. You should discuss this with your cataract surgeon ad if still not satisfied 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.

Wandering Eye & Cataract Surgery

Question: I recently had cataract surgery on my right eye and now have 20/30 vision. My left eye is almost totally opaque and wanders off to the left. My surgeon says cataract surgery would certainly result in double vision. Is this 100% likely?

Answer: If the opaque eye has been amblyopic and thus really functioned poorly prior to the lens becoming cloudy, then cataract removal wouldn’t cause diplopia but of course would result in limited vision. But, this would still allow a better view into the eye to monitor its health overall. If it has drifted more recently and the eye had good vision in the past, then there is the opportunity to rehabilitate it with cataract surgery and then perform muscle surgery afterward to correct the diplopia. You need to have a second opinion with a cataract surgeon is willing to offer you this option if t is possible in your case.

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 Causes Shadow & Drops of Water in Vision

Question: My inquiry is that since I had cataract surgery and a lens implant I have what "appears" to be drops of water, a shadow or something at the corner of my eye that is very frustrating.  Is this a common result of having cataract surgery?  Can anything be done to eliminate this condition? 

Answer: While it is impossible to tell exactly why you are experiencing this shadow or sensation of seeing a drop of water in your vision, it is something that patients report from time to time after cataract surgery and lens implants and is thought to be related to adaptation to the lens implant or “seeing” the edge of the lens implant. In any event it does seem to just fade away over time-which varies from patient to patient.

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.

Rhode Island Seniors on Medicare Advantage May Lose Access to Quality Eye Care and Surgery

Providence, Rhode Island (11/13/2013) It is estimated that about a 100 Rhode Island physicians have been dropped from UHC's Medicare Advantage plans also sold under AARP Medicare Complete.  Physician groups dropped include Koch Eye Associates, the leader in eye care and eye surgery in RI. Koch Eye Associates currently treats approximately 3,000 or 10% of the UHC’s Medicare Advantage members.  While United Health Care has the contractual right to shrink its network, in a small state such as Rhode Island it really threatens to limit access, quality and efficient care for seniors.

Why would UHC Medicare Advantage drop a group like Koch Eye Associates?

“We were shocked and disappointed to receive such a notice since we are a leader in eye care, have the only ophthalmic ambulatory surgery center in the state, follow best clinical practices and have an Electronic Medical Record (EMR) to ensure the integration of care both within our group and with physicians in the community. As a result of UHC’s terminations, seniors may have to travel to another state to get their care and even be forced to go to a hospital for cataract surgery,” commented Paul Koch, M.D., Medical Director of Koch Eye Associates.

Perhaps UHC made this decision without knowledge of the local market given a comment made by Jack Larson, UHC’s CEO of Community and State. “We are working to collaborate with a more focused network of physicians to help us provide higher quality and more affordable health care coverage to meet the needs of our members, and help them get more from their health plan benefits.”

Perhaps UHC is trying to reduce their membership of seniors since it appears they are not earning the same quality bonuses experienced by other Medical Advantage Carriers. They seem to be shifting blame to the government.  “Washington is squeezing payments to managed care plans like AARP's — collectively known as Medicare Advantage. The idea is to bring these private plans in line with the cost of original, fee-for-service Medicare,” said Larson.
 
Unfortunately UHC’s recent decision may make it necessary for many seniors to pay more out of pocket or switch doctors. “This is especially troubling for seniors who are on fixed incomes and are under treatment for serious eye diseases such as macular degeneration or diabetic eye problems that require continual care. Having any disruption of care at all has serious consequences. We will continue to see our patients with United Medicare Advantage. It is a shame that they won’t be getting the full benefit from their insurance,” further noted Dr. Koch.

What should seniors do?
1. Make sure you are evaluating your options for coverage.
2. Write to your state representatives asking them to advocate for maintaining access to quality providers and continuity of care.
3. Follow your physician’s advice on how to stay healthy and prevent illness since you are going to be faced with less choice and bigger health care bills in the future.

For additional information, contact:
Katie Carlisle, Medical Management Services Group, L.L.C., 733 Turnpike Street, N. Andover, MA 01845, Katie@aboutcataractsurgery.com, 978-470-8217

SOURCE: Medical Management Services Group, L.L.C.