Catarac surgey coming up

[Pete0629]

I am gathering information on catarac sugery. I have an astigmatism and cataracs. My vision is getting blurry more and more each week. I am 57 years old and scheduled to get the replacement surgery done in the next few weeks. I would like to talk to anyone about what to expect and how my vision will be afterward,. I am planning on getting the multifocal lens so I can see far and near.
I would appreciate any response.
Thanks
Pete

[Pete0629]

A related discussion, Disappointed66 was started.

[homecrafter]

A related discussion, IOL/ CATARACT was started.

[Pete0629]

Tim

So to make sure I'm reading you right. The incisional or the excimer laser would/should/could bring me back to 20/20 with, if I'm reading between the lines here, minimal risk or at least less risk than the yag( just learned the term). OR getting a perscription for glasses would bring me to the same place. is this correct? Not a combination of both?

The incisional is cutting on the eye? The excimer is with a laser?

Hmmm, I wonder why he didn't mention these options at our last meeting.

Pete

[Timothy D McGarity, M.D.]

Hi pete. I understand what you are saying. You mentioned that a "weak" glasses prescription would get right eye to 20/20. At this point I would offer you an enhancement to get the right eye to 20/20-incisional enhancement or laser vision correction. I would hold off on the laser to "polish" behind the lens, especially of a prescription will get youth 20/20. The ReStor lens will give you a broad range of vision, but it won't be as sharp is a single focus IOL or your younger-years-non-cataract near vision without glasses or distance vision with glasses. Again, that your right eye can get to 20/20, this means excimer laser or incisional enhancement would get you there too, along with glasses. Make sense? I would ask your doc about enhancement other than laser to polish behind the ReStor IOL. keep me posted.

[Pete0629]

Hi Tim

Thanks for getting back to me. I will say it is nice to have access to to you during the interim between doc visits. My right eye didn't have any astigmatism. I may have stated it did in earlier e-mails, getting confused some. The only astigmatism is in my left eye which hasn't had the surgery yet. My right eye seems to have settled in a " not quite where I want it to be" state. When working on the computer I have to pull it close enough so my left eye can see it well. This is where it gets weird, my right eye CAN see the computer words but they're hazy and not as comfortably seen as with my left eye. Now I realize if I had the other eye done it may improve with my " binocular vision" correct? But it's also scary because I am rolling the dice giving up my only clear ,or maybe comfortable is better, near vision in the process.My distance vision is ok, not great or sharp but ok.
Yesterday was cloudy all day. I had some discomfort seeing the road at a distance although I haven't worn my glasses, for help with my left eye, for a week or so now.
Question: My surgeon mentioned doing something with a laser that essentially , as I understood it, cleans off the back of the lens or something like that, to improve the lighting and vision. But he said he's waiting to do that because once he does this it makes it more difficult to explant the lens.
My delimma of choices--If I have the multifocal explanted and have the monovision implanted in both eyes I am, in my understanding, giving up any chance at near vision such as reading but an improvement of distance vision will entail, requiring glasses almost everytime I read, along with a reduction of starbursts and halos at night.
If I leave the multifocal in and at least have some near & distance vision without glasses with a possible improvement of both visions with both lenses implanted and a continued improvement as it heals, I end up needing glasses whenever I want sharp vision in either near or far distance. Is that a fair assumption?
Thanks for the help
Pete

[Timothy D McGarity, M.D.]

Hi Pete, sorry just now getting back with you. That's great news that your vision is correctable to 20/20. Too bad the first surgery couldn't nail down the 20/20 vision with the implant the surgeon placed. There are multiple factors involved in nailing down the 20/20 powered IOL, but if the correct power is determined for you and instead ends up after the surgery that you are still a little near or farsighted and have a little remaining astigmatism, then laser vision correction or LRI will typically correct this (so would a prescription for glasses, but you are trying to get rid of the glasses). I always discuss this with my patients. Usually the IOL I pick (about 95%) is very close to 20/20, but rarely it leaves them with a little bit of needed correction, then I perform laser vision correction or LRI or incisional enhancement. Other doctors approach it differently. I wish you the best of luck and it sounds as if you are keeping a positive attitude. I would recommend you stay the course with your doctor. Also, keep the post running!

[Pete0629]

I went to the surgeon this past Monday to determine how I am progressing. After taking several tests it seemed my vision in my right eye is at about 20/50. It was a relief to me that they were able to bring my vision back up to 20/20 with added lenses with glasses. They told me the lens they would have to put in glasses for my right eye, the one that had the surgery, would be a very mild lens. Not what I wanted to hear but it didn't surprise me and at least, like I said, I was relieved I could get my vision back to excellent eventually. The doctor said there wasn't really any indication of swelling in my eye anymore. For the first time he mentioned the possibility of an explant. He wants me to stay the course, other than reducing the prednisone to twice a day, for another 4 weeks to see if further improvement develops.

Fast forward to Tuesday, I woke up Tuesday and my vision was much improved! All day I could see much better, distance and near.  While driving I kept testing it, one eye open, one eye closed, one eye open, one eye closed. I'd put my glasses on then off, on then off. My right eye was about, in my estimation, 10% to 15% less than my left eye while I was wearing glasses, the best I had experienced to date. In fact my buddy and I rode our motorcycles yesterday evening well into the night, of which I was a little anxious about, with no real problems.Today was pretty much the same thing, although my near vision isn't as keen today, but still pretty good. If I could see another leap of improvement over the next week or two, 10--15 % then I'd be satisfied.

So the roller coaster ride continues but at least I've seen what seemingly is an improvement this week.
Pete

[Pete0629]

I have decent days and then, like today, I have to wear my glasses, which gives me the feeling of being crosseyed. Returning to work wasn't too bad last week although I didn't have to go out of town much last week. My vision is still not as good as when I wear my glasses. I can SEE but it's , for lack of a better word, limiting. Near isn't clear or precise, but I can make things out through the mixture of blurr and clarity. My distance vision? I don't have the keen distance I once had or currently have with my glasses, but again between the blurr and clarity it has been a challenge . I have read many things about multifocal lenses. In the brochures it says people that are very particular are not good canidates for the lenses. I would really love to have the committee that wrote that discription define for me their interpretation of " too particular" I define it as seeing comfortably, it continues to be a struggle and very much an energy drain for me to see. Also the neuroadaptation I have read and heard about. I'm beginning to wonder if it is the same thing as suddenly having one leg slightly shorter than the other and eventually your brain and body adapt to that change so you don't notice it as much,but in the final analysis is that really a neuroadaption or learning to finally accept less than what you once had.
I know I sound negative about this today and I apologize for my down attitude today.I have found this is very draining for me from day to day. I am not retired so I have to enteract with society in a very indepth way daily. No one wants to have this succeed more than me. I will continue to be patient and also realize I'm running against the clock for an explant IF that is what I eventually decide to have done.

On the positive side, I can see TV very clearly, anything with a lighted background, like when I have to read the eye chart, is easliy read. But as I have stated before when realife viewing enters the picture there are a lot more challenges.

I'll keep you all informed.
Pete

[TurtleJoe]

Hope your return to work was visibly acceptable. How are you doing?

[Pete0629]

Was a great time this weekend. Stayed at a hotel where they were auditioning for American Idol. I met a guy at the bar that had a friend in the contest. He called his friend over and he sang for me right in the bar. The place went silent as he sang and he was really good! His names Greg, remember it!

I was disappointed in that I couldn't see the baseball being pitched or follow it after being hit at the Cardinals game. It bummed me out so we left after the 4th inning.Also I went to my brothers fund raiser for a union he belongs to today and they had a golf game, closest to the pin deal going on. I have played it every year because my brother is one of the organizers. I hit 5 balls trying to get them as close to the flag as possible. I couldn't see the balls after I hit them, in bright sun, after about 40 yards, another disappointment.
I do see my TV screen and basic stuff but I am finding any finer focusing I need to do is just not there, so far.
Pete

[Pete0629]

Definately had bad morning Friday but after taking ibuprofen when I was leaving to st louis, of which I was driving alone, my eye did a 180 and I could see clearly. I handled the st louis 5:00 traffic with no problem. I could see really well the rest of the night. I am seeing pretty , although seeing my writing on my droid is difficult.
Sorry your patient didn't want to share doc but their choice, maybe they'll follow mine and see what they are going through is normal.
Pete

[Timothy D McGarity, M.D.]

Hi Pete, I tried to get my one ReStor patient from yesterday to comment, but he prefers to remain more private. I can honestly say that he is having some of the difficulties you are having, but I am confident he will make good progress too. Thanks for keeping us posted.

[cwatt1]

Hi Pete.

Sounds like things are gradually improving -- good news.  It took a week or two before my vision reached the point of being reasonably stable.  Multifocals require a period of neuroadaptation because of the dual focal points.  I think the fact that your vison improved while you were on the computer is definitely a positive sign.

[disappointed66]

Hey Pete,

Monos or multis, we are all pulling for you.    Being from New York, I am a Yankee fan, but the Cardinals are also one of my favorite teams.  Enjoy your weekend.

[Pete0629]

Well had a less than good day Wed. Couldn't see that well so I wore my glasses a lot. Taking the presnisone 4 times a day kind of affects me, makes me feel funny.
This morning, Thursday, I seem to be seeing better although seeing the computer screen isn't easy. I hoping for better vision over the next few days as I am driving to St Louis to meet my girlfriend, who's flying in, for a long weekend. As I had said before we will be seeing a Cardinal game and visiting an area that will have blues music, looking forward to it.

I am also going to try and find a really good pair of Oakley sunglasses. They have polarized lenses and I can see really clearly through them.

It's funny, now that I have been on the computer a little while I can see it much better, weird!
Pete

[Timothy D McGarity, M.D.]

Hi Pete, in my experience your vision will continue to improve. It can take weeks for your brain to fully adapt to this "new" vision system (multifocality). I would expect your vision to become clearer especially over the next 2 weeks. Also, the cataract surgery alone can take a few weeks to heal. During this healing phase the vision will fluctuate, but will continue to improve as you heal.
Best wishes,
Tim

[Pete0629]

Tim

I can finally post something a little longer. I have been in Springfield Illinois this past weekend helping my son and his buddy compete in a Blues & BBQ competition. We were very busy Friday and Saturday selling completely out of all the various BBQ he had made up.

Anyway, I did have a pretty good day yesterday seeing fairly well. Not as good or sharp as when I have my glasses on and looking through my left eye, which is 20/20 or really close to that. I did notice I could see better Friday night while at the festival. I noticed I could see further and closer, more comfortably, but I also noticed I couldn't see the individual bricks on the building diretly across the street, they were a blurr . Then Saturday morning I noticed I could read the newspaper plus I looked up at the brick building across the street again and noticed I could see the individual bricks clearly. I was pretty excited about that. But today everything is back to kind of a blurr.
So I am seeing the surgeon Monday at 9:30am. Unless I have a dramatic improvement I think it's best to postpone my second surgery until this eye stablizes, hopefully at a better level.

Do you feel I will see further improvement over the next week or two? I would feel better getting some sort of a timeline.
I would very much like to hear from anyone else that is just having this done. So hopefully your patients will post also.
Pete

[Timothy D McGarity, M.D.]

Hi Pete, still following this thread. Thanks for the update. I don't have many patients opt for the ReStor or any multifocal IOL. This is mainly due to cost, but also the potential side effects scare some away from it too. The vision during the first week can be poor. This is related mainly to the eye healing, but also your brain: adapting to multiple focal points and deciding which image to use (near, intermediate and far). I will be implanting a few multifocals on Wednesday of this week and I am going to encourage my patients to post their results here for others to follow. I wish you the best of luck and I feel like you are making good progress. Take care.
Tim

[TurtleJoe]

For us followers, Hurricane Pete is as important as Hurricane Irene.

[TurtleJoe]

Go get them Tiger. You have us all sitting on pins and needles.

[Pete0629]

Little update, seeing much better today, I could read the newspaper this morning.
Talk soon
Pete

[londonbridge]

I have to agree with what others and you yourself have said. Do not have second eye done before first eye is stable and do not do a yag as if you need an explant few doctors will want to risk operating when there is a hole in the back of the capsule. I had a Restor explanted after six months of misery and agonizing over what to do. I have a mono focal toric set for mid distance in my non dominant eye. Other eye still has small cataract and I wear a contact lens because the eyes are 7 diopters different and can't wear glasses to correct that amount of difference, only a contact. When I do second eye I will have it set for plano thus I will have blended mono vision. I am glasses free usually except for reading in dim light or to sharpen computer. This is very acceptable to me as I needed glasses just to see the alarm clock each morning.

Anyway there will be a resolution to your dilemma. Proceed cautiously and  if your need an explant I recommend mono focal and you can do a combination of distances to minimize your dependence on glasses.

[motorbird]

I'm a patient (though one who has done a lot of reading on the subject) not a doc so couldn't possibly make "recommendations" in Pete0629's particular case, but some patients unhappy with Restor have successfully had them explanted and replaced with Crystalens. The reverse seems not to have happened. Naturally I agree that monofocals are least likely to develop complications and if Pete0629 doesn't mind wearing specs to read and work at a computer then it's probably an easy choice. Personally I find total freedom from specs and contacts (and I was -10 both eyes) a revelation, a new way of life, and if this were now taken away from me I'd be very cross. However, if I had never experienced this new freedom I would very likely be satisfied with monofocals. There are no absolutes in this business (except the certainty that cataract and presbyopia await us all one day or another).

[disappointed66]

I would not have the touch up done.  If an explant is needed
having the yag makes it more difficult.. I agree with cwatt1 the sooner the better. A monofocal is always a safer choice. I was told to be patient.  It was not easy, One day at a time and the right decision was made by me, and I am sure you will do the same. Keep that positive outlook.

Disappointed No More