Cataract Surgery Lens Implants & Eye Surgeons for Cataracts Blog

Tuesday, May 28, 2013

Multifocal Lens Implants for Musicians

Question: I am scheduled to have cataract surgery in a couple of weeks. I am thinking about multifocal lens replacement with ReSTOR® Multifocal Lens Implants, which is the only multifocal, type my cataract surgeon recommends and will use. It will cost an additional $2,000 per eye. My concern is whether the implants will improve my vision enough to be able to focus on reading music from a little more than arms length to twelve inches or so without any distortion. I wear progressive lenses and I'm having difficulty reading music now. Progressive lenses don't work because as I move across the page, the focus wavers. Mono lenses are a problem because I have to read at different distances and I can't maintain my focus. Are the ReSTOR® Multifocal Lens Implants going to solve my problem reading music? What have you heard from musicians who have had this surgery?

Answer: If you are seeking clear vision at 12 inches through arm’s length, you are attempting to optimize the clarity for an intermediate range of vision. The ReSTOR® Multifocal Lens Implants might be able to provide you with this, but it may also require some adjustment of your distance vision and absolutely complete correction of any preexisting astigmatism that you have. Might is the operative word here as the ReSTOR® Multifocal Lens Implant is not typically recognized as having its nest performance in the intermediate range of vision. You really need to carefully discuss with your cataract surgery including providing him or her with the precise distances that are you seeking clear vision for. Regarding the other issue of distortion, it is not likely to be a problem with this lens.

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 after RK

Question: In 1994 I had RK (extensive - 16 cuts in right eye). I recently had cataract surgery on right eye but vision correction, even using the ORA System, was not totally successful. My cataract surgeon is now suggesting "piggyback" IOL to further correct vision. Should I consider this and what are the possible complications?

Answer: Cataract surgery and lens implants after RK is more complex than routine cataract surgery where there has been no previous corneal surgery. The complexity of the measurements and calculations diminishes the precision of the lens implant calculations and should there be a need for an adjustment and refinement of the final prescription, the previous RK incisions may limit the options. Certainly the use of intraoperative measurements such as ORA can be helpful but still the precision isn’t perfect. Generally there are a few options for achieving the desired refractive outcome including wearing eyeglasses, corneal laser eye surgery such as LASIK or PRK, a lens implant exchange or a piggyback lens implant. Your previous RK may preclude you from LASIK for sure. You do not state whether the residual refractive outcome requires correction for nearsightedness, farsightedness and/or astigmatism. This too will be part of the decision on the likely usefulness of a piggyback lens implant as if there is irregular astigmatism-somewhat common with RK-you may not achieve your desired outcome. It is also not clear from your description why one would choose a piggyback over a lens exchange-either could be appropriate but your description precludes knowing the best choice. So-the best advice and opinion is to follow your cataract surgeon’s suggestion. That said, the complications of piggyback IOLs are similar to primary lens implants with the added risks of a second surgery-as long as the primary was uneventful.

Monday, May 20, 2013

Multifocal Lens Implant for Bifocal Eyeglasses

Question: I am 58 and wear bifocals. It has been my dream for decades to be free of eyeglasses. This summer I am going to do it. It appears I have a choice of two methods to correct my vision:
Should I get a corneal transplant? Or should I get a multifocal lens implant? What are the risks and benefits to each?

Answer: Being free of eyeglasses is an admirable goal however you need to get more information about you vision correction options. Multifocal Lens Implants could very well correct your near and far vision-however it may depend on your prescription and exactly what your expectations are for seeing up close and intermediate distances. Further, for some reason you have stated that you are considering a corneal transplant for vision correction. Do you have some underlying corneal disease or problem that makes a corneal transplant medically necessary or are you simply confused? Before doing anything you need to go find the best cataract & lens implant surgeon you can and if you have some other corneal problem you probably want that surgeon to also be a corneal specialist. Schedule a consultation and absolutely take the surgeon’s advice on what your options might or might not be.

Tuesday, May 7, 2013

Cataracts with Astigmatism

Question: I have cataracts and astigmatism in both eyes. I have heard there is a procedure that can fix both. I am 65 and have health insurance. How much should I expect to pay after insurance pays? What is the success rate of this procedure?

Answer: If you have cataracts and astigmatism, and are in need of cataract surgery there are actually two ways to correct the astigmatism as part of the cataract surgery procedure. One way is to use an astigmatism correcting toric lens implant and the other is to have Limbal Relaxing Incisions (LRI). Most insurances, as well as Medicare do not pay for astigmatism correction and ask the cataract surgeon to charge for the incremental cost of the toric lens implant or the LRI procedure. In order to get the best results your cataract surgeon will need to take additional measurements that might include a corneal topography measurement, corneal thickness measurement, aberrometry and ocular coherence tomography-most or all of which should be part of the additional fee charged for the astigmatism correction regardless of which method is chosen.

Which method is better in your particular case can only be determined by the cataract surgeon after your examination and consultation as it may depend on the degree and orientation of the astigmatism correction you require as well as other factors regarding the health and stability of your cornea. Further, it is not possible to tell you what the out of pocket costs might be as they vary by cataract surgeon, geography and procedure as well as by your insurance co-pay ad deductible allowances as well. The best thing to do is schedule an eye exam and consultation with a cataract surgeon and they should be able to advise you of the scope of options and the fees involved.

Glare after Cataract Surgery

Question: My mother had cataract surgery about 5 years ago and to this day she has a lot of problems with glare and she can't stand going in the sun or into rooms with too much light. She has gone back to her cataract surgeon numerous times, but he has not been able to help her. I keep mentioning contact lenses to see if that would help. Do you think that contacts might help her?

Answer: First, it is important that you and your mother understand why your mother has continuing glare 5 years after her cataract surgery. The degree of glare disability you describe is not typical and should be evaluated. If you have been unable to get a satisfactory answer from her previous cataract surgeon then you need to find a top cataract surgeon in your area and schedule an examination for a second opinion. There are many reasons that there might be persistent glare problems after cataract surgery and with a thorough exam it should be possible to determine the cause and find possible solutions.

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.

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.