Cataract Surgery Lens Implants & Eye Surgeons for Cataracts Blog

Tuesday, January 29, 2013

Toric Lens Implant Vision Blur & Sloping

Question: My wife recently had cataract surgery with a toric lens implant for astigmatism in her right eye. 10 days after her operation the vision is fuzzy-out of focus-and horizontal surfaces seem to slope to the right, and despite several attempts the cataract surgeon was unable to find any external lens or combination that would give any clearer vision. She can see clearly through a pin-hole mask and the macula, retina, and pressure are all good, and the lens seems to be correctly placed. They say come back in 6 weeks - what do you recommend?

Answer: There are many reasons that your wife may be experiencing blur that clears with a pinhole mask and also several others that might cause a sloping of her vision. Some of these are related to the healing process and should self limit in the next 6 weeks as your cataract surgeon suggests. Others may not clear and could represent complications that require more immediate attention and possibly intervention as they could involve the retina. While you state that the retina is normal, prudence suggests that a retina consultation is to be considered to rule out subtle swelling of the macula, fine epiretinal membrane formation and other subtle changes that might be contributing. A conservative approach would be to have the retina consultation now and then the waiting for six weeks will likely be a less anxious time.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Monday, January 21, 2013

Toric Lens Implant Rotation Problem

Question: I have just had cataract surgery and a toric lens implant for astigmatism in my left eye done. My cataract surgeon told me the lens had "rotated" about 10 degrees-how serious is this? Should I consider correcting this? How soon? I am doing my right eye next week.

Answer: It is possible to have a primary misalignment during the cataract surgery itself or in the unusual case a secondary rotation of the toric lens implant after the surgery. This is extremely rare with the Alcon AcrySof® Toric Lens Implant but is known to occur with other brands. In any event, there is no need to be concerned or to actually do anything to adjust the rotation unless it causes a problem with vision. A small rotation of 10 degrees-unless it is a very significant amount of astigmatism-should not typically cause too much vision disturbance. The best course of action is to follow the recommendation of your Cataract Surgeon.

Multifocal Lens Implants & Near Vision

Question: I am having cataract surgery but can’t decide whether to have multifocal lens implants. I do not always need my glasses to read and when I do I wear minimal eye wear for reading. Should I spend $7000 for multifocal lens implants as they might cause haloes around lights?

Answer: Since you are able to read pretty well with minimal correction, it suggests that you are mildly nearsighted in at least one eye prior to your cataract surgery. If you have cataract surgery and the lens implant prescription is calculated to render your distance vision as close to 20/20 as possible-thus eliminating the nearsightedness-you will no longer no able to see up close and read without bifocals or reading glasses. Your options are to discuss with your Cataract Surgeon the possibility of creating the same type of refractive errors that you have now so as to remain a bit nearsighted-which may very well require a mild correction for seeing clearly at distance-or to select multifocal lens implants which provide an extended range of clear vision. In some designs and for some patients they do experience glare and haloes although in most instances this goes away.

Vision without Toric Lens Implant for Astigmatism

Question: I need cataract surgery and have significant astigmatism but can’t afford a toric lens implant to correct the astigmatism. How much less "good" vision I will have because of this?

Answer: Depending of the amount and the orientation of the astigmatism you could have somewhat distorted or blurred vision for far and near. If you do not have a toric lens implant it is possible that you could have Limbal Relaxing Incisions (LRI) or else you will likely have to wear glasses to see clearly. When making the decision not to have a toric lens implant to correct your astigmatism make sure that you take into account the recurring cost of buying glasses for the astigmatism correction over the course of multiple years.

Cataract Surgery Glare

Question: I am a 57 yr old woman who had cataract surgery in my left eye on December 5, 2012 and around December 15, 2012, I noticed daytime and nighttime glare in the left eye. What is causing the glare in my left eye? What procedure(s) can be done to correct the glare in the left eye and how soon can it be done?

Answer: There are many reasons that you might be experiencing glare after your cataract surgery and lens implant procedure. It is really not possible to know what is causing the glare without a clinical exam. You do not specify the type of lens implant used to correct your vision which also could contribute to the glare. Some things to consider are residual inflammation, any compromise of the posterior lens capsule which has been left in place to support the lens implant, swelling or irregularity of the cornea and even a remote possibility of mild swelling of the retina. Your best course of action is to return to your Cataract Surgeon and express your concern regarding the glare. After an examination he or she will be able to tell you whether the glare you are experiencing is part of the healing process and thus transient or in fact needs medical, laser or surgical intervention.

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.

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.