Exchanging len after the 5th month of cataract surgery

[kdrts]

I had cataract surgery on Oct. 2013 for mini mono vision.  This means my dominant eye should be set for distance and non-dominant eye set for reading.  Dr put a reading len in my dominant eye.  Dr. told me to wear glasses and refused to exchange the len.  He said it is too risky to do it. Insurance company would not pay another dr for consultation until 90 days after surgery.  This is my 5th month with the wrong len.  Now, I found a dr that would do the exchange len in Feb.  Based on what I read, it would be a challenge to exchange len after 3 months of implant.
I am concern because I have passed the 3-month window for exchanging basic len.  Does anyone know of people who had implant len for more than 5 month before doing exchange len? I would love to hear about their experiences because it may help me to alleviate my anxiety or cause more anxiety.  I like to be prepared for whatever outcome I will encounter.  
Also to the eye professionals out there -- What will happen if the dr cannot put the new len in the sac where the present len sits?  How would that affect the eye and my vision?  I am very nearsighted.
Thank you for reading.

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

Good luck to you
JCH MD

[kdrts]

Thank you for your time in responding.

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

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

1. The problems of your eyes working together should have been anticipated. See above article.
2. I cannot tell you how surgery would affect your macula. Best person is your retina surgeon
3. there are no large scale studies on lens exchanges and there is no definition of what is "Success" often the surgeon is happy after and IOL exchange and the patient remains disappointed.

JCH MD

[kdrts]

Hi Dr. Hagan,

Thank you for responding so soon and clarifying the specialty of cataract surgeons.  

Actually, ONLY my dominant eye had surgery in which the doctor set it to near vision.  I refused to continue the process due to my disappointment on the result of the first eye.  Thus, my non-dominant eye did not have surgery yet.

It was my mistake.  I meant to have mini mono vision with one eye distance and one eye intermediate.

If I have exchange len done by an ophthalmic surgeon, will my eye have new scars?  Can you tell me how new scars will affect my vision and how it will affect the general health of my eye in the long term?  

The last thing I want is macular detachment.  Prior to surgery on my dominant eye, I had  -11.75  -0.75 x 175. I am being monitored by a retina specialist on epi-rential membrane.  Will a second surgery on the same eye increase the chances of macular detachment? What is the percentage of risks I should be on the look out for as an indication of particular caution?

I know cataract surgery has around 98% success.  What percentages of success does exchanging len have?

Lastly, I read dominant eye should be for distance and non-dominant for near.  Otherwise the brain will not adjust.  Presently, I have near vision on my dominant eye now and am wearing a contact len with some intermediate distance (Acuvue 2  D -8.00) on my non-dominant eye.  In other word, my “mono-vision” has been flipped unintentionally. I feel comfortable with this vision except I don’t have distance.  Do you think this is workable in terms of implanting intermediate iol lens in a non-dominant eye?  Actually, how far (i.e. 6 feet, 10 feet) can one see with an intermediate len?

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

You had mono-vision not mini-mono.   True mini-mono is one eye for distance and other for intermediate (distance bias) or one eye for intermediate and one eye for near.

The reason that not all cataract surgeons do IOL exchange is that it is relatively rare (much less than 1%) of the cases that need it.  Some cataract surgeons specialize in post operative rare complications like needing IOL exchange, scleral fixation of dislocated IOL, etc.

I would seek out this type of ophthalmic surgeon.  You should also look into having lasik on the "reading eye".  You could correct the reading eye to distance, then have both eyes set for distance and wear progressive bifocals for near and intermediate. That way the IOL does not have to be exchanged. Often you can get your insurance company to pre-certify the lasik and pay for it.

JCH MD