Cataract Surgery - not informed of 3 focal choices

[shannon578]

Hi,

Sorry this is so long! I am extremely upset and have yet to receive an apology or a suggestion from the eye center, surgeon, techs or staff on this issue.

I had cataract surgery 3 & a half weeks ago, but was not told that there were 3 choices, near, intermediate & far, until 3 days ago (a little too late to be receiving this info).  I had informed them, prior to surgery that I was an Accountant and an avid reader, so I was more concerned with being able to read & work on the computer, without glasses and was fine with wearing glasses to drive. (I do not watch TV, my spare time is spent reading) Knowing this, they still only told me about the near & far options. Now that I had the right eye done for far distance, they have told me I can only do the left for near, intermediate or far. This means that I will have to wear glasses 100% of the time, as I still have problems with glare & halos. I have never worn glasses at home to read, do computer or house work, so I am very upset about the lack of information I received. Also, that the doctor and his staff did not take into account, what results that I that I was hoping to acheive.

If I had known about the 3 choices, it is rather obvious that I would have had one eye done for intermediate and one for near. Also, that is one suggestion or option the doctor or his staff should have mentioned, instead of only giving me the option of near or far. Then I would have only needed glasses for driving. I feel that I have totally wasted the money I spent for the surgery on my right eye. Obviously, insurance will not pay to have it redone, and I would have to pay the full cost, including the up-charge I paid for the "customized" lens. I need to have the cataract removed on my left eye as the cataract is advanced, however, I am currently able to work on the computer and read without glasses, so surgery will make me lose that ability, according to my doctor.

Does anyone know of an option to correct the result from the surgery due to the original choice for the right eye? I would appreciate any suggestions or ideas, as I am extremely upset and depressed about this whole situation. not only for the money already spent on surgery, but also now having to spend more money on surgery for my left eye which won't meet my requirements and then having to buy new glasses. And yes, they will most likely be expensive as they will need to be progressives, anti-glare and with transitions lenses. Pretty expensive outcome, due to not being provided with all the information and options available, from your doctor.

Thanks!

[John C Hagan III, MD, FACS, FAAO]

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[shannon578]

Thank you very much for all your input and comments. I really appreciate your time. Thank you!

[John C Hagan III, MD, FACS, FAAO]

Okay this has gone as far as I can take it. for one thing if your LE has 20/25 with current glasses and 20/40 with "Final refraction" you are losing ground, glasses are normally changed to make vision better not worse.  I have no further comments.

[shannon578]

The vision with my left eye with my current glasses is 20/25. With the final refraction it would be 20/40.

I haven't received a final refraction for the right eye since surgery. However, I currently see @ - 20/25 without glasses with that eye after surgery. I do have pretty good intermediate vision at 6 feet & can see my speedometer, my computer screen, and large print from @ 3 feet away.

[John C Hagan III, MD, FACS, FAAO]

well we're getting there. What is the vision with this lens at distance? What is the refraction on your RE? What is the vision on your RD with your right lens?

JCH MD

[shannon578]

Thank you

SPH / CYL / Axis / Add

My current glasses for my left eye are : -2.75 / -.25 /  105 / +2.50

The final refraction they have listed after my last appointment is:
-2.50 / -.25 / 089 / +2.50

Sorry I didn't list it correctly in my previous post.

Thank you very much!

[John C Hagan III, MD, FACS, FAAO]

It is not possible to give you any useful information unless you write a valid glasses RX or listing of your residual refractive error

You have to state plus + or  minus - in front of a spherical lens and on the astigmatism plus or minus   cyclinder power and axis direction  Then you need state if there is a reading add     and other information should be vision with and without glasses.

JCH MD

[shannon578]

Forgot to add, slight astigmatism of .25. I am going to test reading glasses prior to surgery, because anything lower than 1.50 most likely will not be acceptable to me.

Also, due to your advice about research, I did find out that the Cornea Guttata may be one of the reasons that cataract surgery did not have any noticeable affect on my problem with glare and halos, especially at night. In fact, I now have problems with glare from sunlight and when viewing my computer screen in the eye that had surgery.

I don't know if it's due at all to the other issues as my doctor did not give me an answer when I asked,  but I have trouble moving my eyeballs to follow the light when they ask. If I can see the light without moving my eyeballs, that's what I do. It is very difficult for me to actually concentrate on moving them when they want me to. They always have to repeat the exercise, and I have to concentrate to do it, as it hurts to move them. It continues to hurt the rest of the day & continues the following day. It's a deep pain in my eyes. I don't think it is eye strain, but am not sure what it is.

[shannon578]

My distance refraction is 2.75, in my progressives, and for the bifocal part which I never used they had +2.00, for the 2nd eye. My new doctor is recommending 1.50 for that eye. He would target 1.75, & due to the results of the 1st eye is assuming the result would be 1.50.  I currently am very near-sighted and can read at 20/20 on the reading chart, but I do hold books @ 8" away to read. He told me this would give me a a better range of focus and more of a blended vision result than mono-vision.

I knew from reading my patient copy that I received from my previous office visit that I had Cornea Guttata. However, no-one mentioned that and that it may have been one factor in the cornea swelling after the 1st surgery.

I also discovered, when I had a discrepancy with the billing, that they had done a cell count prior  to my 1st surgery. The right eye was 1,316 & left 1,430. They both are graded at +1.50 & my patient notes have changed from stating just Cornea Guttata to Cornea Guttata / Fuchs Dystrophy +1.5. Both Ophthalmologists are in the same office.

Should I be concerned that neither has mentioned this diagnosis or gone over this cell count with me,? My personal opinion is the 1st doctor should have gone over it prior to surgery and then after I had the issue with the cornea swelling. I will give my new doctor the benefit of the doubt and assume that he would think that my previous surgeon had gone over this information and explained to me,

Thank you!

[John C Hagan III, MD, FACS, FAAO]

Yes best of luck. What is your "refractive error"  i.e. your distance glasses refraction?

JCH MD

[shannon578]

Hi again,

I just found one of your old posts, which answered one of the questions my Ophthalmologist could not regarding, near, intermediate and distance. They kept saying the difference between near and intermediate was reading and working on the computer. Since there are a lot of variables in how people work I inquired as to the measurement in approximate inches and/or feet

I just found your post explaining " NOTE: 6 foot is not mid range.   Reading is about 18-20 inches and mid range is about 3 feet (think shopping, speedometer, computer)  6 foot is "falling between the gaps. Too far away for your mid range and even if one eye were set for distance and could see 20/20  six foot would still be blurred."

With my corrected eye I can see my speedometer, go shopping ,etc.. I can see the computer pretty well (black print on white background) at certain distances, sometimes even at 3 feet, but I have 23" LED wide screen monitor, so that probably helps a lot. However, I can't read menus or books at any distance, except in natural (sun) light.

From what I've been reading this is a fantastic result with a monofocal lens!

My normal reading distance is @10-14 inches for books, @ 17-18 inches for computers and menus, so I will take all of this info to my next appointment.

I just need to work with my new Ophthalmologist on the best target for the other eye.

I've also been reading your posts on cornea gluttata, as I've seen that mentioned in the patient copy I receive after my visit. Now that I've read some posts, I will ask for more information about the condition and my case, since no-one mentioned it during my office visits. It may be because it is mild and not an issue, but I'd rather ask, since it is listed as affecting both eyes.

Thanks again!





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[shannon578]

Dr Hagan III,

Thank you very much for taking the time to answer my questions.
I believe my Ophthalmologist is an excellent surgeon, but not an expert on the finer details, explanations and proper follow-up.

Prior to my surgery, he did not predict good results. When I called @ 5 hours after surgery because I had developed a cloud over my vision & could only see shapes, (I had waited a couple of hours to see if it went away) he called back & said the info I had been given stated to be patient. Actually, it stated 4 times to call if you had a sudden decrease in vision. When it continued the next day, I called their office at 1 PM. He was unavailable & the office wanted me to come in to have it checked out. I saw another Ophthalmologist who found out my cornea was swollen. That Ophthalmologist said he understood why I was concerned and that it was better to be safe than sorry, as it could have been something more serious.

My Ophthalmologist who did the surgery did not even tell me until my 1st follow up that my cataract was advanced, so I shouldn't have been surprised at that type of complication.

My last post op was the 2 week follow-up and I have no more scheduled, which according to your note is not the normal procedure. I only found out at this visit by asking the tech that the cataract in my left eye was as advanced as the one in my right eye had been. For some reason my Ophthalmologist had not shared this information with me.

Also, his stating to make an appointment with their Optometrist to get a refraction done for new glasses 3 weeks after surgery is also not the norm, so I cancelled that appointment.  

I am seeing a different Ophthalmologist and thanks to everyone will have done my research prior to my visit and be making an informed decision on my next surgery!

I really appreciate your responses. I believe you have provided me with valuable information, which has helped me make better decisions regarding my eye care!  I will be re-reading your blog information and more articles prior to making a final decision, prior to surgery. Thank you!

[shannon578]

Hi,
I paid $300.00 extra for the Acrysof IQ IOL which is a monofocal lens. According to their literature it is supposed to give you clearer vision and an extra 45 feet of distance vision over the standard mono lens. They used a 18.5D power. I do still have the same halos from street lights and headlights at night and also the glare from sunlight is uncomfortable. However, since prior to surgery I could only read holding books @ 3 inches away and with glasses my distance vision was 20/250, I am extremely grateful that I can see at a distance, although I will need glasses to drive, to read menus & to read books,etc.. When I saw him at my 2 week post-op(which was my last scheduled visit with him - my vision was between 20/30 & 20/40 - without glasses, probably closer to 20/30.

I only found out last week that the cataract in my left eye was as bad as the right eye, as it has not affected my vision like it did in the right eye. It can still be corrected for driving to @ 20/30. The only problems I have is the increase in the halos at night (which are the same as the one that already had surgery, so I don't know if surgery will help) and now occasional double vision with both eyes open when reading and working on the computer, which sometimes goes away when I shut the corrected eye.

I got my 1st pair of glasses when I was 9 years old, due to my being near-sighted so my distance vision has always been blurry. I was amazed when I first wore them and realized you could actually see individual blades of grass, when riding a bike. Even then, I took them off to read and do homework.

Currently, I am still able to read and work on the computer without glasses.
So prior to my visit to the other Ophthalmologist at the Center, I am going to take everyone's advice and keep doing my research. I will work with him based on my research to reach my original goal of being able to work on the computer, read menus, newspapers, books, etc. to arrive at the best solution for the surgery for the left eye, knowing that I can save up to have touch up laser surgery done on the right eye, if required.

[John C Hagan III, MD, FACS, FAAO]

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[flossy93]

I'm sorry about the disappointment and confusion you've had around your first procedure.  It is good that you healed well and don't have any lasting problems with the surgery.  

I am wondering what kind of IOL was used in the first procedure you had?  The doctor may have given you a card or some kind of data about which lens was implanted.

You mentioned that you had paid additional cost for a premium lens.  Just wondering which IOL you received in the first surgery.  

Good luck digesting all of this info and determining which refractive target choice to make for your second operation.  I know it's a lot to take in but you will be a better informed patient and can participate actively in decision making for the second surgery.

As Craig10x points out, there may also be 'tweaks' that could be made post-procedure if you are unhappy with the second procedure's outcome.  

Unfortunately with an existing cataract it can be hard to 'try out' different focus schemes before surgery, since you are probably having blurriness at all distances in the unoperated eye.  

I hope that by reading this website and the doctor's and other patients' comments you will learn some things to help you get the best possible outcome overall from the two procedures.

[John C Hagan III, MD, FACS, FAAO]

Remember your cataract surgery fee includes a "global" period usually 90 days post operative in which your office visits are included at no additional cost. Medicare does not pay for glasses test (refraction).  We generally delay glasses testing to 5-6 weeks post op.

Also patients with complications or other problems related to their post operative refractive error are generally seen MORE often than normal by our surgeons.

Best of luck. There is information in the article we linked you with about adjusting to full monovision   (distance and near with nothing for intermediate).  

JCH MD

[shannon578]

Thank you Anne & Craig for your responses. I really appreciate you telling me about your own experiences. You & Dr. Hagan have given me a lot of info to think about before deciding on what to do next.

I find it rather odd that my Doctor wanted me to schedule an appointment to see the Optometrist in their office for glasses 3 weeks after my surgery. I was supposed to see him last week. After reading articles, I learned that you wouldn't know the final results for @5 weeks after surgery. In fact, my 2 week post-op visit was supposed to be my last appointment with my Ophthalmologist, unless I decided to schedule surgery on my left eye.

[shannon578]

Thank you your comment and the link to your post. I wish I had seen it prior to my surgery. I agree that I should have done more research prior to my surgery. However, I was paying my surgeion for his expertise and experience. Unfortunately, neither my Doctor or his techs explained the options available.  

I also am truly grateful that I am able to see with my right eye. Although, contrary to the advice in your article, the eye he corrected for distance is my non-dominant eye and the one which has always been my reading eye". He told me last week that my brain will "self correct" and change the right eye to be my dominant eye. At this point, I'm not sure that I can trust his opinion.

[John C Hagan III, MD, FACS, FAAO]

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[Craig10x]

Monovision would be a good option for you...but i'd be a bit careful about having too much of a difference...originally i had full monovision and it was very difficult to adjust to and i felt too compromised in all areas (distance/mid/close) i am 20/20 in my dominant eye and they had me at -2.25 diopters in the non dominant eye...

I had a lasik touch up which brought me up to -1.0 diopters in that non dominant eye (which is more what they call "mini monovision") and it is a LOT better and much easier to adjust to...

Even now, sometimes i am not entirely happy and am considering going for another touch up and bring it up to 20/20 like the other eye...even though it will make me more readers dependent then i am now...

You'd be surprised how much you can miss seeing really sharp at distance and mid range (which is what you would have if you do both eyes to 20/20...

You can't have perfection with the technology as it currently is...but be careful what you choose!  

As far as glare...i do experience a little when watching tv (would have less if i went full 20/20 i can tell when i wear corrective glasses to simulate it)...

And starbursts...i see them at night, outside when looking at car headlights and street lights...it's a lot more common then you might think with iols...
but that aspect is not that hard to live with...

[John C Hagan III, MD, FACS, FAAO]

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[Anne102]

I forgot to mention that I also see glare and daytime and night time starbursts  while driving in my right post-surgery eye as well as in my left non-operated eye which still has a cataract.

Yesterday I saw an optometrist and she said when the second eye is done and I get my final glasses for driving the starbursts might go away.

So in about 5 weeks, after the second surgery, I will get my final driving glasses and will see what happens. If the starbursts remain I will just have to get used to it. I think this is called positive dysphotopsia. It could be much worse, it could be negative dysphotopsia.

[Anne102]

I do have some suggestions based on the fact that I am also interested in having good near vision for reading and intermediate for computer and not having to wear glasses around the house. And don't mind glasses for driving.

I learned how to read an eyeglass prescription and what the different distances meant in terms of diopters.

So when I went to see the surgeon I asked her what the exact refractive target would be for me with the above demands.

She suggested -1.75 diopters for my right eye and I would be able to use the computer and read without glasses, and threading a needle would require reading glasses.  I agreed to this.

She then said plano for the left eye, and I spoke up and said no, I don't mind wearing glasses for driving. Finally we decided on -.5 because I wanted to make sure I wouldn't loose any of my depth perception.

I have natural monovision, perhaps that is why the surgeon suggested monovision right away, without any trial of contact lenses.

There was no discussion of which eye was dominant, and I am getting distance vision in my non-dominant eye [according to my own testing].

One month ago I had cataract surgery on my right eye and ended up with -1.5 and  I also have .5 astigmatism in that eye.

The optometrist  said the .5 astigmatism gives me an extra -.25 adopters to add to the -1.5 result to give me -1.75 which is what I wanted.

Anyway I can read and use the computer and read piano music very well. For tiny print I do need reading glasses. If I sit far back from the computer the font is very slightly blurred.

When I read the consent form before the actual surgery I made sure it said mono-vision before I signed it.

Now you have the opportunity to decide upon the exact refractive target in diopters you want for the second eye. This can be done by trying out contact lenses in the second eye for vision at different distances.

It has been said on this board that many people like min-monovision, with one eye plano and the other set for intermediate, which is -1.25, which can also give you fairly good reading vision. There are many posts on this topic which can be searched for.

I have read that most people do eventually get used to monovision.

So you do have some options.

[John C Hagan III, MD, FACS, FAAO]

Before you read any more of this response read this article twice slowly and with comprehension.  (it appears on Today's Pulse second blue dot at top).

http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

You have to accept some of the responsibility for not spending time learning on your own your options. You have not wasted your money. You have had a successful operation and you see well apparently at distance and you see well at intermediate and near with glasses.  Appreciate what you have achieved. Many to most of the people visiting this website have conditions that cannot be helped and their vision not restored to normal even with glasses, medicine and surgery. Moreover some people have cataract surgery and have unusual but severed complications and end up with reduced or poor vision. Give thanks for that.

See a second and third Eye surgeon so you understand what options you have for the operative eye and the yet to be operated eye. Do your own due diligence in addition.

JCH MD