20869248 tn?1555086244

Can a misaligned Toric lens be rotated on 2nd exchanged lens?

I'm an active young 68, taking 0 meds. I've had EBMD for 5yrs, left eye worse, corrected to 20/3.  May 2018, the Dr. said I needed cataract surgery. The teck said I'd still need glasses for Standard or Toric. I have astigmatism. July, I had left eye surgery w Standard IOL. After, I was dizzy, off balance, fluorescent lights made me nauseous, vision best corrected 20/70. Sept I had lens exchanged for Toric. Best corrected 20/50. I was referred to see Cornea specialist, January 2019, I had SK. Best corected still 20/50 and now I hear the word "Wrinkle" mentioned.  Feb, I went to different ophthalmologist for 2nd opinion. He said the lens looked like it may have rotated from what he thought the lens should be 80° and mentioned wrinkle again. He suggested Yag. No thank you. He sent me back to ask the 1st surgeon what degree the lens position was set at. She said the lens was set exactly where she had set it at 69°. She has no interest in going back in the eye a 3rd time to rotate the lens. She also wanted to do Yag that day. I said No thank you. My vision isn't cloudy, just not focused. When I tilt my head down and look through the top corner of the lens it seems more clear/sharper. Is rotating this 2nd lens too dangerous?  I'm miserable, I still need my right eye done. Depth perception is off, driving is challenging, I can't read signs and night light streaks at 10 and 4 o'clock. I can't see to sew. run or bowl very well. The new RX glasses aren't helping. It's depressing.
Any suggestions will be certainly appreciated.
3 Responses
Sort by: Helpful Oldest Newest
177275 tn?1511755244
Pressed for time. Will answer in next 24 hrs.
Helpful - 0
177275 tn?1511755244
Something is really wrong. First after your surgery you should have been able to be corrected to 20/20 with glasses. If not a cause must have been sought:  did you have macular edema (macular OCT would be indicated); did you have corneal edemia or irregular astigmatism? (corneal topography and slit lamp exam), was the IOL in good position?  Generally the IOL would NOT have been exchanged until the reason for subnormal vision was determined. It was NOT residual astigmaism because if the astigmatism was corrected with glasses you should have seen 20/20.   EBMD = Epiethelial basement membrane disorder could cause your vision to be down but IOL exchange would not help that at all. If that was the cause you might have needed hypertonic eye drops/ointments or if not clear corneal scraping and bandage contact lens.   You need to find out where this "wrinkle is"  if on the macular it would show up on macular OCT and yag not help.  If the posterior capsule has 'wrinkle" that NOT usually cause a big problem and would never be a reason to do IOL exchange.   You don't say what your glasses RX are but your eyes are not going to work well together until the first eye is fixed and seeing well.    I don't think your interests have been well served.   Depending on where you live you need the best possible cornea/IOL/refractive surgery. Major cities usually have an opthalmoloogist that specializes in post op problems like you are having or you might go to a medical school department of ophthalmology and see one it that is available to you.  Where do you live?
Helpful - 0
Looks like Michigan:  Consider U of Michigan school of medicine Dept of ophthalmology,  Wayne state U Dept of Ophthalmology or Henry Ford Hospital Dept of Ophthalmology
Yes, I'm in Michigan near all those facilities.  Before the 1st surgery, the scans showed I had irregular astigmatism, at the slit lamp, EBMD was also noted. After the 1st standard IOL was in, the macular was clear. I had cornea edemia for 2 weeks. Another phase was then mentioned "surprise astigmatism".   I was told to use sodium chloride ointment 5% at night for the edemia. July I was referred to another dr for RK to see if that would help. I was told, no. So back I went to 1st Dr. she thought by doing lens exchange for the Toric lens would fix my problem. That didn't help. Still 20/50.  January went for the corneal scraping and contact lens bandage. 1 week Post Op edemia again, continued Rx drops Prednisolone and Ofloxacin.
4 week post Op vision still 20/50. Macular clear. I asked him why I still can"t see. His answer, "I can't answer that, but I can write you a letter to say you can drive". I was upset at his condescending reply.  
My current glasses RX is O.S. (spherical) -0.25 (cylindrical) +0.75 (axis) 055 and N.V. +275 both eyes
The right eye is -4.75  +100  093
I have appt with 2nd Ophthalmologist (Henry Ford) on April 22 to let him know the lens was set at 69 degrees. He will probably offer Yag again.  I'm very reluctant to have Yag done.
The 1st Ophthalmologist  trained at Wayne State, I'm not sure about going there for a 3rd opinion, they know her and her mother.  I finally have copies of all my before and after scans. I am willing to travel to get this nite mare fixed, at this point almost anything.
Thank you D. Hagan very much for your time, it is very kind of you to answer all our eye questions.
You are living a living a nightmare and the difference between eyes (aneisometrophia) will preclude eyes working together and glasses will not work.  The first IOL exchange was likely not indicated.  Not unless you could have been refracted to 20/20.   Hopefully the Henry Ford Ophthalmologist will be a cornea specialist.  You need corneal topography.If is the cornea may need surface laser (PRK).   If you have a chance come back and post what the HF ophthalmologist said/recommended.

I too had complex problems.  Dr. Richard MacKool Sr. was my savior.  He is located in New York City.
Hello Dr. Hagan,  I forgot to mention the 2nd  Dr.  said the Toric lens was set at about 70° and he said it should be 80°.  The original dr. confirmed it was exactly where she put it at....69°.  She does not want to go back in the eye a 3rd time,  because she did the lens exchange in Sept. She is only offering Yag.  My sight isn't blurry, just not sharp at 20/50. Before the 1st surgery best corrected was 20/30. If I tilt my head down to look thru the lens at about 2:00, things are a little sharper.  I know that sounds odd. Kinda hard to drive that way. My questions are, if the Toric lens is 10 ° off,  could PRK fix this?  Or is Yag my best option?
Thanks again for your time.
The point I'm making is that even if your toric is off axis a glasses test over the eye should be able to improve the vision to 20/20.  You apparently have never been able to see 20/20 with glasses testing since your surgery.   Right after cataract surgtery the posterior capsule should have been clear.   That's why you need a fresh set of Eye MDs looking at your eye especially one with expertise in post operative cataract surgery problems.  Another thing try pin hole vision.  You should see much better looking through a pin hole aperature if this is refractive problem.
I saw the second ophthalmologist again today.  He said there is no wrinkle this time, macular looks good/clear. Best corrected vision today 20/40. Again today he said my eye is "complicated".  I  had 1st cataract surgery in July with standard lens,that lens was exchanged in Sept to Toric for astigmatism, Cornea scraping done in Jan for EBMD. He said I wouldn't benefit to have more procedures done without great Risk, Except for Yag.  He told me to go back to original ophthalmologist surgeon and let her do Yag and "maybe that will help".
He DENIED saying in Feb, he thought the lens shouldv'e been set at 80 degrees and maybe it rotated. Why did he send me to original dr. to see where she put it? It's exactly where she put it: 69 degrees. He said no follow ups with him, go back to 1st Dr and let her do the cataract in my right eye.
I feel like I just got kicked to the curb. It's depressing.    9 months ago I could see to thread a needle, read and drive at night. I miss that.
Should I seek a 3rd opinion or have Yag done with my fingers crossed with the original ophthalmologist?
Thank you again Dr, Hagan for your time.
I really can't answer this for you. The actions of the two Eye MDs you are seeing seem bizzare and like neither has a handle on your problem.  Looking at the posterior capsule to see if a Yag will help is like looking at a window to see if its clean or dirty. Not rocket science. None of the two seems to have said "Your posterior capsule is very cloudy and is the cause of your vision being subnormal"    If you have the time and money I would suggest your get an independent 3rd opinion perhaps as I said the best medical center you can drive to in a reasonable amount of time. to make the most of your 3rd opinion take copies of your records from the other two ophthalmologists that have provided care.  Don't know how far away you are from Mayo Clinic but that is a world class "I got a problem no one else can figure out" type of place.
Thank you
Best of luck smk_crum   You deserve better.
I have appt at U of M for June 11. I also have obtained notes from 2nd opinion doc. Yesterday he denied saying the Toric lens  was off axis. His notes state otherwise. The lens is 66 degrees and Tomey axis is 82 degrees. And this info was never mentioned before to me.... possible CME per pt hx "leaking in the LE"  ......   Fine per OCT 4/22/19.  Not sure that means?  Still hopeful I'll be able to do my daughters wedding dress alterations.
Best of luck. Let us know how this turns out CME = cystoid macular edema a type of swelling that can develop in the reading part of the eye (macula) after cataract surgery especially complex or complicated surgery. Can get worse after Yag capsulotomy.  Treated with special drops.
Avatar universal
I have residual CME in my LE following a vitrectomy/ERM peel in 2015, followed by cataract surgery 18 months later, but my retinal specialist indicates it is improving on it's own slowly but surely.
Helpful - 0
Hello MrPresley, Is your vision clear? my best corrected 20/40- 20/50
@smcrum, absolutely...corrected in my LE is 20/20 and on a good day 20/15. I look at an Amsler grid every so often and don't have any significant issues to report. My RE has a baby cataract and non-symptomatic macular pucker but it's corrected to 20/20 as well. My LE (with a monofocal IOL) is totally clear, and two years after cataract surgery there is no indication yet of needing a YAG.
Have an Answer?

You are reading content posted in the Eye Care Community

Top General Health Answerers
177275 tn?1511755244
Kansas City, MO
Avatar universal
Grand Prairie, TX
Avatar universal
San Diego, CA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.