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How Do I move on after cataract surgery?
Hello everyone, I am very much regretting getting cataract surgery done and am concerned what my vision will be like for the rest of my life. I am waking up with anxiety attacks in the middle of the night ever since getting this done, and it's ALL I can think about. I know it's early days yet (got this done in April) and know that I would have had to get it done irregardless in a few years (early onset and getting worse) - but still. I'm only 52! Why did no one bother to inform me about the side effects? i.e. dry irritated days, edge glare, trouble focusing my eyes on anything for more than a few seconds, and light sensitivity. It's like wearing a really irritating pair of contact lenses every day, except that you can't take the lenses out to get some relief! Will my eyes ever feel "normal" again? Some help, please, or suggestions about how I can move on....I just don't know what to do and I panic every day I wake up and realize I don't have my own lenses anymore. Thanks.
MEDICAL PROFESSIONAL
Where you truly ready for cataract surgery or did you pay cash for clear lens extraction? What implants did you have? Your symptoms are very unusual and I have only seen things like this in perhaps one in 400 cases or so. Something doesn't all add up. Didn't you have problems after the first eye and tell your doctor? If so, why was the second eye done? Where was your surgery done?
MJK MD
MJK MD
Why are you assuming that your current vision problems are something that you must live with? What does your surgeon say about your problems? If s/he doesn't have answers that satisfy you, then you should consult another experienced, board-certified surgeon. If you live in the US, you can find one at www.aao.org. If you post more details about your situation, perhaps Dr. Kutryb can advise you further. I'm not an eye care professional, but it sounds like some of your discomfort may be due to dry eyes, which can be treated.
Lorac0813, I just read a couple of your recent posts. It seems that your doctor suggested that you have cataract surgery before you really needed it, and now you are very much regretting having had the surgery. I definitely don't think that the problems you are having now will be long-term. As Dr. Kutryb suggested, your edge glare will almost certainly resolve on its own, so try not to focus on it. You mentioned that you don't have a follow up appointment with your doctor until June, but I think that you should call the office on Monday to set up something for this week--the earlier, the better. You might ask whether it would be all right for you to use OTC dry eye remedies (drops and lubricants, especially the type without preservatives)--they might make you more comfortable.
You must have been myopic before surgery (but probably not a high myope like I was), so it's natural for you to miss the good near vision that you were used to. But that loss need not be permanent. You will soon be able to regain it with monovision (after a few days of adjustment) or with multifocal contacts. Meanwhile, I think that you will be a lot more comfortable if you get some progressive glasses. Most optical shops will let you remake them at no charge if your script changes slightly during the first few weeks.
You must have been myopic before surgery (but probably not a high myope like I was), so it's natural for you to miss the good near vision that you were used to. But that loss need not be permanent. You will soon be able to regain it with monovision (after a few days of adjustment) or with multifocal contacts. Meanwhile, I think that you will be a lot more comfortable if you get some progressive glasses. Most optical shops will let you remake them at no charge if your script changes slightly during the first few weeks.
Hi Dr Kutryb, thanks for responding to my question. To answer some of your questions, I live in Canada, so my cataract surgery was covered by health insurance, I didn't pay anything. All I know about my implants is that they are the standard monofocal ones, corrected for distance. I should have been more specific about my eye problems - they are occurring in my left eye ONLY, my right eye is fine (had my right eye done first). My surgeon did tell me I could wait a few years for the surgery but not many, because I have (had) early onset cataracts and they were getting worse - which is why I chose to have this done now. I did call the office and told them my concerns about my left eye but they said everything I mentioned (glare, dry eyes, trouble focusing etc) was normal and I would have to live with it. And I guess my biggest regret is that I didn't think through my decision to be corrected for distance and now am missing my close vision terribly. My husband thinks I'm being a big baby about this but these are the only eyes I have and I think it's natural to be worried about them. If these problems I'm having will truly resolve on their own then I guess I just need to be patient?? Thanks for your thoughts.
2 Comments
For my cataract surgery in my RT eye, with a mild cataract, I had a monofocal iol put in. It's a real adjustment after, and the dry eye situation is apparently more frequent with women who are menopausal. I use non preservative dry eye drops daily, and will probably have to use them for the rest of my life.Dry Eye, after this surgery is common. I also had the flashy thing to my side vision, but after 7 months have gotten used to it. Don't focus on it, and your brain will eventually adjust. It's due to a reflection on the side of the lens when light hits it at about 30 degree angle. A bedside light, for me, makes it visible. But you just have to tune it out. After 7 months I'm used to it, but it was a real panic at first.
I had my RT eye set for a little closer vision, and then plan to have the LEFT eye corrected for perfect distance. That enables me to see the instruments on my car dashboard! The vision in my RT eye has gotten a bit better for close vision over the months after surgery. The eye takes quite awhile to heal and adjust.
All I can say is that in time you will get used to dealing with reading glasses. I've been wearing them for years, and still have to wear them for computer and reading, so I'm used to it.
The "glare" is there for me too, and things seem brighter. More light is getting into your eye now. I didn't get much relief from the halo of light around things, from having this surgery though.
You should definitely see your doctor for the inability to focus on things for very long though.
I had my RT eye set for a little closer vision, and then plan to have the LEFT eye corrected for perfect distance. That enables me to see the instruments on my car dashboard! The vision in my RT eye has gotten a bit better for close vision over the months after surgery. The eye takes quite awhile to heal and adjust.
All I can say is that in time you will get used to dealing with reading glasses. I've been wearing them for years, and still have to wear them for computer and reading, so I'm used to it.
The "glare" is there for me too, and things seem brighter. More light is getting into your eye now. I didn't get much relief from the halo of light around things, from having this surgery though.
You should definitely see your doctor for the inability to focus on things for very long though.
Thanks for sharing your experience. My wife recently had cataract/IOL surgery at our Kansas City Discover Vision Centers clinic. She has some glare, some dryness, some positive dysphotopsia under certain lighting situations. She is now 8 weeks post op. Has 20/20 vision at distance without glasses, with glasses 20/15, her eyes are comfortable and the white reflection she saw under certain lighting situations are gone. She chose monofocial IOL. She wears progressive multifocal glasses for best vision at all distances.
Hi JodieJ, thank you so much for your helpful comments. It really helps to talk to someone else who has had this done. I do think that I should have waited a few more years to have this done and I should have researched it more carefully. The surgeon I went to is very highly respected and recommended in the city in which I live, and when we talked about it he said that cataract surgery was a "breeze" and I would be back on my feet in a couple of days. That of course has translated into almost a month, and I still don't feel 100%, but I'm back to work irregardless. You say that the problems with my left eye should resolve in a month or so - I do hope you're right! About calling the office, I did call last week and was told my symptoms were normal and should go away, and that I would have to live with them if they didn't. I did ask if I should see him again (my surgeon), and they said no. So.
As far as dry eye is concerned, that has been a problem with both eyes and I have been using Refresh Tears every hour on the hour but it doesn't seem to be helping. I did call the office about that, as well, but they didn't seem concerned and told me to use the natural tears, which of course I was already using. Sigh. Dr. Kutryb suggested punctal plugs, which I will look into, and oral flaxseed oil, which I have just started om his recommendation.
When you talk about monovision, do you mean correcting one eye with a contact lens set for close? I did have a question about that earlier and Dr. Hagan responded to me with the same information you gave me, so thank you so much for that. I'm not sure how I would respond to monovision as my vision was driving me crazy for the 2 weeks between surgeries...but maybe I should give it more time.
JodieJ, do you mind if I ask how old you are, and when you had your cataracts removed, and what your vision is like today, and did you eventually stop worrying about your eyes?? Thanks.
As far as dry eye is concerned, that has been a problem with both eyes and I have been using Refresh Tears every hour on the hour but it doesn't seem to be helping. I did call the office about that, as well, but they didn't seem concerned and told me to use the natural tears, which of course I was already using. Sigh. Dr. Kutryb suggested punctal plugs, which I will look into, and oral flaxseed oil, which I have just started om his recommendation.
When you talk about monovision, do you mean correcting one eye with a contact lens set for close? I did have a question about that earlier and Dr. Hagan responded to me with the same information you gave me, so thank you so much for that. I'm not sure how I would respond to monovision as my vision was driving me crazy for the 2 weeks between surgeries...but maybe I should give it more time.
JodieJ, do you mind if I ask how old you are, and when you had your cataracts removed, and what your vision is like today, and did you eventually stop worrying about your eyes?? Thanks.
From my perspective, dry eyes are a post-surgery problem requiring evaluation and treatment, and you have every right to insist on an appointment with your surgeon within the next few days. If needed, some treatments such as Restasis and punctal plugs require a doctor's prescription. Although it's great that free advice is available online, you should not have to rely on this method. It's outrageous, IMO, that your surgeon's staff is telling you to wait till June when you need treatment now.
Monovision would involve correcting your non-dominant eye for near vision with a contact lens. It works very well for most people who try it. Or you could experiment with different power contacts to fine-tune a modified monovision correction. Another possibility would involve wearing multifocal contacts in both eyes. An experienced optometrist should be able to suggest something that will work for you.
I'm about a year older than you. I developed a cataract as a result of having retinal surgery (to remove an epiretinal membrane.) Because of the exposure to oxygen during the retinal surgery, my cataract developed much more rapidly than normal. I really hated the blurred yellow vision it caused, plus it made my affected eye increasingly nearsighted. It seemed like every other week I was at my optometrist's office getting a new (and stronger) contact for that eye. By the time I finally had the cataract surgery, I couldn't even see the big "E" on the eye chart with my old glasses (which had given me 20/20 vision in my affected eye just a few months before.) So I was actually looking forward to having cataract surgery, and I was pleased with the results. (At least the experience of having worsening cataracts will not be in your future!)
Monovision would involve correcting your non-dominant eye for near vision with a contact lens. It works very well for most people who try it. Or you could experiment with different power contacts to fine-tune a modified monovision correction. Another possibility would involve wearing multifocal contacts in both eyes. An experienced optometrist should be able to suggest something that will work for you.
I'm about a year older than you. I developed a cataract as a result of having retinal surgery (to remove an epiretinal membrane.) Because of the exposure to oxygen during the retinal surgery, my cataract developed much more rapidly than normal. I really hated the blurred yellow vision it caused, plus it made my affected eye increasingly nearsighted. It seemed like every other week I was at my optometrist's office getting a new (and stronger) contact for that eye. By the time I finally had the cataract surgery, I couldn't even see the big "E" on the eye chart with my old glasses (which had given me 20/20 vision in my affected eye just a few months before.) So I was actually looking forward to having cataract surgery, and I was pleased with the results. (At least the experience of having worsening cataracts will not be in your future!)
Hi JodieJ, thanks so much for your emails and for your advice! I hope I'm not writing this email twice, I had replied to you but I wasn't logged in so I don't think it went through.
I called my surgeon's office today and INSISTED on an appointment, and I have one for tomorrow already! So I will let you know how that goes. I will let him know the horrible problems I am having with dry eyes, as well.
Thanks for your advice about monovision. I will try that a little later down the road. I am finding work a bit difficult right now because I need reading glasses all the time, whereas before, now and then I could take a break from the glasses. Mind you I'm just using cheap readers from Wal-Mart so maybe that makes a difference.
I am glad your cataract surgery went so well! My vision problems weren't as severe as yours but mind you I didn't want to wait until they got so bad - that was one of the reasons I had the surgery in the first place. And you're right, at least I won't have to worry about cataracts in the future!
JodieJ, thanks so much for responding to my emails, and for your advice. It's nice to know that someone cares! Although my problems haven't gone away, at least I'm taking some action and who knows, maybe in time they will go away, or maybe they are fixable in some other way. You have given me hope!
I called my surgeon's office today and INSISTED on an appointment, and I have one for tomorrow already! So I will let you know how that goes. I will let him know the horrible problems I am having with dry eyes, as well.
Thanks for your advice about monovision. I will try that a little later down the road. I am finding work a bit difficult right now because I need reading glasses all the time, whereas before, now and then I could take a break from the glasses. Mind you I'm just using cheap readers from Wal-Mart so maybe that makes a difference.
I am glad your cataract surgery went so well! My vision problems weren't as severe as yours but mind you I didn't want to wait until they got so bad - that was one of the reasons I had the surgery in the first place. And you're right, at least I won't have to worry about cataracts in the future!
JodieJ, thanks so much for responding to my emails, and for your advice. It's nice to know that someone cares! Although my problems haven't gone away, at least I'm taking some action and who knows, maybe in time they will go away, or maybe they are fixable in some other way. You have given me hope!
Ok, I was kind of ok with getting my eyes both done for distance but after hearing Lorac
I am getting a bit worried. I wanted great distance vision and good night vision and the left eye with a cataract is driving me crazy it is so cloudy.
But now I am thinking should I not have it done at all or have it set for blended vision instead?
I had the right dominant eye done for distance last Wednesday and have my one week check tomorrow. I don't know what to ask for.
I noticed today that my vision which was pretty good the day after surgery, like 20/25 even with the pupil still somewhat dialated, now is a little bit blurrier but I can see the computer better so it has changed somewhat. Why would that be since it's supposed to be set for distance?
I'm getting worried. I had not heard of all these problems and am getting kind of scared. The world of color is back however and I am grateful for that.
I can see down the road ok but the speed signs take getting a little closer to focus than I think they did yesterday but I noticed I could see pretty well as it was getting darker before I came home. I am grateful and just praying I make the right choice for the other eye and that I don't have many side effects. Any thoughts?
Thank you.
I am getting a bit worried. I wanted great distance vision and good night vision and the left eye with a cataract is driving me crazy it is so cloudy.
But now I am thinking should I not have it done at all or have it set for blended vision instead?
I had the right dominant eye done for distance last Wednesday and have my one week check tomorrow. I don't know what to ask for.
I noticed today that my vision which was pretty good the day after surgery, like 20/25 even with the pupil still somewhat dialated, now is a little bit blurrier but I can see the computer better so it has changed somewhat. Why would that be since it's supposed to be set for distance?
I'm getting worried. I had not heard of all these problems and am getting kind of scared. The world of color is back however and I am grateful for that.
I can see down the road ok but the speed signs take getting a little closer to focus than I think they did yesterday but I noticed I could see pretty well as it was getting darker before I came home. I am grateful and just praying I make the right choice for the other eye and that I don't have many side effects. Any thoughts?
Thank you.
Oh, one other thing. I have read that one of the most important drops after surgery is the
Acular. I have been very good about putting in the drops, all of them but they say they won't give me any more of the Acular after a week's worth and I have read that some take them for at least 2 weeks. Should I try to get more?
Also, I have heard that the Pred Forte can be slightly dangerous in causing pressure in the eye, etc. Should I be worried about being on that for 4 weeks?
Thank you again.
ALso, taking Zymar antibiotic drops.
Acular. I have been very good about putting in the drops, all of them but they say they won't give me any more of the Acular after a week's worth and I have read that some take them for at least 2 weeks. Should I try to get more?
Also, I have heard that the Pred Forte can be slightly dangerous in causing pressure in the eye, etc. Should I be worried about being on that for 4 weeks?
Thank you again.
ALso, taking Zymar antibiotic drops.
It's probably best to follow your doctor's instructions with the Acular and Pred Forte. I was on farirly high doses of Pred Forte (6+ drops daily) for a number of weeks following retinal surgery due to severe inflammation from misplaced sutures (done by a resident). My eye pressure stayed low, but it was monitored. I was told that more than 3 months on Pred Forte may cause cataract development (obviously not a concern for you.)
Hi telya, from my own personal experience, if I had to do it again, I would have gone the monovision route (one eye corrected for distance, one eye corrected for close). I mean, it's wonderful to drive and shop and walk around without glasses, but I need reading glasses for everything else - reading, computer work, even filing my nails! I think the most annoying thing is having to fumble for your readers in order to look at a label on a store shelf. However, that being said, it's a personal preference and I know just by reading the posts on this site that most people getting cataract surgery opt for the distance vision. On a personal note, many of my friends who have undergone PRK or LASIK have been corrected for distance, and they couldn't be happier. Just think really hard about your decision and make sure it's the right one for YOU.
Can't help you where the drops are concerned, I'm in Canada and my drops have different names than yours. Good luck with your second surgery!
Can't help you where the drops are concerned, I'm in Canada and my drops have different names than yours. Good luck with your second surgery!
Hi JodieJ, I just thought that I'd let you know how my appt with the surgeon went yesterday. He checked my eye very thoroughly and said there doesn't appear to be a problem. He did tell me to come back if my problems haven't resolved in a month or so. So I will do that. Unfortunately he couldn't recommend much for the dry eyes other than what I am already doing. Thanks again for all your advice and help, I hope to stay in touch with you via this forum!
Hi,
I can understand your panic..i just had my operation 2 weeks ago...first few days were awful and like yourself ihad huge anxiety...but day by day things have improved ...I was -20 in left eye and am now +.0.25 and 1.5 astimatism...whilst op has gone well being very myopic i had great near vision ...sadly now I havent ...but tht is price you pay for having good distant vision.but this can be corrected with glasses...at moment i am using cheap reading glasses ...but am told once i have correct astigmatism and prescription lenses things will be much better...In your case if the op has gone well ..just give some time to adjust ...i am sure things will work out well.
Good luck
I can understand your panic..i just had my operation 2 weeks ago...first few days were awful and like yourself ihad huge anxiety...but day by day things have improved ...I was -20 in left eye and am now +.0.25 and 1.5 astimatism...whilst op has gone well being very myopic i had great near vision ...sadly now I havent ...but tht is price you pay for having good distant vision.but this can be corrected with glasses...at moment i am using cheap reading glasses ...but am told once i have correct astigmatism and prescription lenses things will be much better...In your case if the op has gone well ..just give some time to adjust ...i am sure things will work out well.
Good luck
What you are describing is identicle to what happened to me 3 months ago . I just posted to one of the doctors for some answers. No reply yet. My surgery has been 11 weeks ago and I am no better. It was simple cataract surgery. I did not want any fancy lens...Just give me back what God gave me. I now have large Black Viteous detachmants with lighted Halo's/wavy lines with suspected Retina tear. I was suppose to remain near sighted. I am now farsighted. They cannot do surgery on me as I am a heart patient and on Plavix. The stress has caused severe angina attacks. I had to find new doctors as the group I was seeing would not acknowledge my discomfort. New eye doctors did. I feel your pain. I feel your frustration. I feel you sadness. I feel your anxiety. My church is praying for me. I will add your name. God Love You.
P.S. I am severely nearsighted and you are not a big baby. Tell hubby to call me and I will tell him the same as will my hubby. And, to think the original surgeon wanted to do my other eye in 3 weeks!!!!! I need my detachements fixed first that they could not see or acknowledge.
I could relate to the NBC news last week with Robert Bazell about Lasix surgery and Lasix doctors.
I could relate to the NBC news last week with Robert Bazell about Lasix surgery and Lasix doctors.
Hi indi1664, thank you so much for responding to my email! It helps so much to know that other people have gone through what I am going through. This is a HUGE life-changing experience and I don't know that I will ever be the same again. However, it is slowly getting better....I guess I just need to hang in there. I hope you're right, that once I get prescription glasses things should be better. Hopefully these headaches I've been having every day will go away then. Thank you again!
Hi Texheart, thank you so much for your email! It really struck a chord with me when you said "just give me back what God gave me". I've been feeling that way as well. I am so sorry to hear that you have been having such problems, they make my problems seem very insignificant. I hope your new doctors can help you! Thank you and your church for praying for me...I've been praying to God every night since I got this done so I will add you in my prayers as well. Thank you again for your heartfelt email.
Hi again,
I just had my normal eye test...and yes i will need glasses...but you will be truly amazed once you have the correct prescription ...I was shocked...clarity and I have gained about 20-25 % in my distace vision ,,that is aamazing and things are clearer ...but before this eyecheck...I have been feeling exactly as you are...so again bit of time and I am Very ceartain you will feel better and you will be amazed.
The reason for your hadaches is probably because you currently have an a minor prescription imbalance with your eyes...anything nearing a diference of +/- 3 diopters between the 2 eyes will give you headaches...but that is NOT A PROBLEM...as this than can be corrected so EASILY with glasses...I know you are gonna be totaally amazed ...once this is sorted out.
have faith in god ...he has taken care of you thus far ..I am sure he wont fail you now.
or in future...Good Luck
I just had my normal eye test...and yes i will need glasses...but you will be truly amazed once you have the correct prescription ...I was shocked...clarity and I have gained about 20-25 % in my distace vision ,,that is aamazing and things are clearer ...but before this eyecheck...I have been feeling exactly as you are...so again bit of time and I am Very ceartain you will feel better and you will be amazed.
The reason for your hadaches is probably because you currently have an a minor prescription imbalance with your eyes...anything nearing a diference of +/- 3 diopters between the 2 eyes will give you headaches...but that is NOT A PROBLEM...as this than can be corrected so EASILY with glasses...I know you are gonna be totaally amazed ...once this is sorted out.
have faith in god ...he has taken care of you thus far ..I am sure he wont fail you now.
or in future...Good Luck
Hi indi,
I do hope you're right about the right pair of glasses making all the difference! If I can get fitted with a pair that lets me see close AND far, so much the better. I am still worried about night driving, though, haven't done any since my surgeries but when I'm out with my husband at night, (he is driving of course) I find it really distracting because of the glare around the headlights and street lamps. How have you found night driving since your surgery?
I do hope you're right about the right pair of glasses making all the difference! If I can get fitted with a pair that lets me see close AND far, so much the better. I am still worried about night driving, though, haven't done any since my surgeries but when I'm out with my husband at night, (he is driving of course) I find it really distracting because of the glare around the headlights and street lamps. How have you found night driving since your surgery?
Hi Jodie,
I’m a 56 year old male with newly discovered macular pucker in his right eye, which occurred this March. I have yet to see the retinal specialist here in Montreal, Canada, but two ophthalmologists here have said it is macular pucker. I'm slated to see the retinal specialist here June the 3rd, and given how much in demand these specialists are, I may be faced with making a decision about surgery fairly quickly in order to get into the queue. With my right eye, I can only see the big E at the top of a Snellen eye chart, so, I'm close to being legally blind in the right eye and surgery would be justifiable. I cannot drive or read with this eye. Fortunately, my left eye is unaffected so far, but the risks of bilateral macular pucker are around 30% so I feel I need to restore the right eye as much as possible in the event the left goes. My understanding of the Montreal retinal specialist is that he is highly competent. Both ophthalmologists independently recommended him. However, he may not use the FILMS technique, and I might begin the hunt again for a surgeon who does it. Given that delay may produce poorer macular restoration as the retina remains folded longer, I have been searching in the meantime to find a surgeon in Canada who uses the FILMS, (Fluidic Inner Limiting Membrane Separation) technique, the fluidic lifting of the epiretinal and ILM membrane as performed in Alabama, rather than the mechanical method of peeling off the ILM (Inner Limiting Membrane) with forceps. Despite wide searches, I have been unable to find a surgeon in Canada. The medical associations will not divulge their membership or the techniques each uses, which means calling up each, one at a time, an impossible task, to find the needle in the haystack.
I spoke with a representative at the Retina Specialists of Alabama, LLC
http://www.maculasurgery.com/Facilities.htm
about their procedure for the epiretinal FILMS peel and the price for such surgery is between 40 and 60 thousand dollars U.S., somewhat out of my range. And, I was told, that the FILMS technique is not even done there in the majority of cases, even if you pay for it as a possibility. It may be a procedure suitable for a membrane growing just over the macula, whereas perhaps most membranes are more widespread on the retinal surface and therefore require the manual peel. Despite this, why other surgeons in North America do not use the FILMS technique for its several advantages puzzles me.
One of the possible post-op effects of epiretinal membrane peeling is an increase in cataract formation, the cataract usually occurring within two years. Given your experience with the gradual formation of the yellowing cataract, multiple visits for eye contacts, would it be wiser to accept the inevitable and ask for the cataract surgery at or around the time of the peel?
A rather persuasive and convincing write-up on the Alabama macular pucker surgery follows. Perhaps it is too good to be true.
“The current method employed for removal of both EMP and the macular ILM consists of cutting and then grasping, or directly grasping, the macular EMP/ILM with specially designed micro-forceps, 1 mm in maximum diameter, and slowly pulling it apart from the neural retina. This is done with great care in order to avoid engaging the neurosensory retina.
One problem with the current method of tearing and peeling away the macular ILM is the physical trauma associated with pulling on the ILM until it separates thereby unavoidably stressing the underlying nerve tissue, sometimes causing irreparable nerve damage with worsened vision than may have been present preoperatively. Accordingly, the surgeon may proceed slowly and carefully but if too slowly the retina may be injured from light toxicity coming from the fiberoptic probe inside the eyeball enabling the surgeon's view. If the surgeon grasps too shallow then his movements are ineffectual, adding to the time of surgery and the chance of light toxicity. If the surgeon grasps too deep, permanent nerve damage and hemorrhage results. The difference is usually a matter of microns of forceps movement, causing the surgeon's mindset to be what has justly been described as "nerve-wracking." The mass of the forceps, although ever so small, often obscures the surgeon's view, further adding to the chance of surgical damage to the retina. As a result of the above factors, complete traction release is the exception rather than the rule. Finally, even in the unusual case of complete traction release, the nerve tissue will usually require several months to resume a smooth contour with best vision returning. Thus, for some twenty years, the removal of epimacular proliferation so as to restore central vision in the eyes that are approaching legal blindness has remained a vexing problem for vitreoretinal surgeons worldwide. The potential surgical risks and the uncertain benefits, as well as the high level of skill required to perform such surgery has caused many surgeons to be reluctant to intervene until vision is substantially lost. This has been true, despite the knowledge that persistence of EMP causes permanent destruction of nerve function at the center of vision, such that visual acuity is only partially restorable, and progressively less so, as the EMP is allowed to persist.
. . .
Briefly, the present invention is directed to a method of separating the ILM layer of the retina from the neural layer of the retina in order to remove the macular internal limiting membrane and all EMP on its surface. The method comprises inserting a hollow microcannula, considerably smaller than any such cannula heretofore, which is shaped at its distal end to conform tangentially to the surface of the retina, between the retinal ILM and the neural retina. After the microcannula is inserted, a sterile fluid is injected at a pressure of about 25 mm Hg through the microcannula between the ILM layer of the retina and the neural layer of the retina. The fluid pressure lifts the macular internal limiting membrane layer away from the neural layer of the retina, separating it in the process of lifting away and allowing for its easy forceps removal from the eye without inflicting any physical trauma upon the neural retina. The lifted macular internal limiting membrane is removed by grasping the free-floating macular internal limiting membrane with forceps and extending the macular internal limiting membrane separation as distant from the fovea as desired before tearing circumferentially about the fovea and removing from the eye. The present invention allows for the removal of the macular internal limiting membrane without mechanically peeling or tearing it away from the fovea, so as to minimize foveal traction and the resultant physical trauma to the fovea. Moreover, the present invention simultaneously actively smoothes the underlying distorted and wrinkled neural retina by an intentional build-up of localized pressure within the confines of the developing FILMS cyst of which it is the posterior border. Thus, visual recovery, the ultimate surgical goal, is substantially accelerated as compared to the months needed for passive, spontaneous retinal smoothing after forceps traction removal. The preferred substance for use in practicing the invention and achieving complete removal of the macular internal limiting membrane is sodium hyaluronate (Healon.RTM.), as manufactured by Pharmacia & Upjohn Inc. or chondroitin sodium hyaluronate (Viscoat.RTM.) as manufactured by Alcon, Inc.
. . .more to come. . .
I’m a 56 year old male with newly discovered macular pucker in his right eye, which occurred this March. I have yet to see the retinal specialist here in Montreal, Canada, but two ophthalmologists here have said it is macular pucker. I'm slated to see the retinal specialist here June the 3rd, and given how much in demand these specialists are, I may be faced with making a decision about surgery fairly quickly in order to get into the queue. With my right eye, I can only see the big E at the top of a Snellen eye chart, so, I'm close to being legally blind in the right eye and surgery would be justifiable. I cannot drive or read with this eye. Fortunately, my left eye is unaffected so far, but the risks of bilateral macular pucker are around 30% so I feel I need to restore the right eye as much as possible in the event the left goes. My understanding of the Montreal retinal specialist is that he is highly competent. Both ophthalmologists independently recommended him. However, he may not use the FILMS technique, and I might begin the hunt again for a surgeon who does it. Given that delay may produce poorer macular restoration as the retina remains folded longer, I have been searching in the meantime to find a surgeon in Canada who uses the FILMS, (Fluidic Inner Limiting Membrane Separation) technique, the fluidic lifting of the epiretinal and ILM membrane as performed in Alabama, rather than the mechanical method of peeling off the ILM (Inner Limiting Membrane) with forceps. Despite wide searches, I have been unable to find a surgeon in Canada. The medical associations will not divulge their membership or the techniques each uses, which means calling up each, one at a time, an impossible task, to find the needle in the haystack.
I spoke with a representative at the Retina Specialists of Alabama, LLC
http://www.maculasurgery.com/Facilities.htm
about their procedure for the epiretinal FILMS peel and the price for such surgery is between 40 and 60 thousand dollars U.S., somewhat out of my range. And, I was told, that the FILMS technique is not even done there in the majority of cases, even if you pay for it as a possibility. It may be a procedure suitable for a membrane growing just over the macula, whereas perhaps most membranes are more widespread on the retinal surface and therefore require the manual peel. Despite this, why other surgeons in North America do not use the FILMS technique for its several advantages puzzles me.
One of the possible post-op effects of epiretinal membrane peeling is an increase in cataract formation, the cataract usually occurring within two years. Given your experience with the gradual formation of the yellowing cataract, multiple visits for eye contacts, would it be wiser to accept the inevitable and ask for the cataract surgery at or around the time of the peel?
A rather persuasive and convincing write-up on the Alabama macular pucker surgery follows. Perhaps it is too good to be true.
“The current method employed for removal of both EMP and the macular ILM consists of cutting and then grasping, or directly grasping, the macular EMP/ILM with specially designed micro-forceps, 1 mm in maximum diameter, and slowly pulling it apart from the neural retina. This is done with great care in order to avoid engaging the neurosensory retina.
One problem with the current method of tearing and peeling away the macular ILM is the physical trauma associated with pulling on the ILM until it separates thereby unavoidably stressing the underlying nerve tissue, sometimes causing irreparable nerve damage with worsened vision than may have been present preoperatively. Accordingly, the surgeon may proceed slowly and carefully but if too slowly the retina may be injured from light toxicity coming from the fiberoptic probe inside the eyeball enabling the surgeon's view. If the surgeon grasps too shallow then his movements are ineffectual, adding to the time of surgery and the chance of light toxicity. If the surgeon grasps too deep, permanent nerve damage and hemorrhage results. The difference is usually a matter of microns of forceps movement, causing the surgeon's mindset to be what has justly been described as "nerve-wracking." The mass of the forceps, although ever so small, often obscures the surgeon's view, further adding to the chance of surgical damage to the retina. As a result of the above factors, complete traction release is the exception rather than the rule. Finally, even in the unusual case of complete traction release, the nerve tissue will usually require several months to resume a smooth contour with best vision returning. Thus, for some twenty years, the removal of epimacular proliferation so as to restore central vision in the eyes that are approaching legal blindness has remained a vexing problem for vitreoretinal surgeons worldwide. The potential surgical risks and the uncertain benefits, as well as the high level of skill required to perform such surgery has caused many surgeons to be reluctant to intervene until vision is substantially lost. This has been true, despite the knowledge that persistence of EMP causes permanent destruction of nerve function at the center of vision, such that visual acuity is only partially restorable, and progressively less so, as the EMP is allowed to persist.
. . .
Briefly, the present invention is directed to a method of separating the ILM layer of the retina from the neural layer of the retina in order to remove the macular internal limiting membrane and all EMP on its surface. The method comprises inserting a hollow microcannula, considerably smaller than any such cannula heretofore, which is shaped at its distal end to conform tangentially to the surface of the retina, between the retinal ILM and the neural retina. After the microcannula is inserted, a sterile fluid is injected at a pressure of about 25 mm Hg through the microcannula between the ILM layer of the retina and the neural layer of the retina. The fluid pressure lifts the macular internal limiting membrane layer away from the neural layer of the retina, separating it in the process of lifting away and allowing for its easy forceps removal from the eye without inflicting any physical trauma upon the neural retina. The lifted macular internal limiting membrane is removed by grasping the free-floating macular internal limiting membrane with forceps and extending the macular internal limiting membrane separation as distant from the fovea as desired before tearing circumferentially about the fovea and removing from the eye. The present invention allows for the removal of the macular internal limiting membrane without mechanically peeling or tearing it away from the fovea, so as to minimize foveal traction and the resultant physical trauma to the fovea. Moreover, the present invention simultaneously actively smoothes the underlying distorted and wrinkled neural retina by an intentional build-up of localized pressure within the confines of the developing FILMS cyst of which it is the posterior border. Thus, visual recovery, the ultimate surgical goal, is substantially accelerated as compared to the months needed for passive, spontaneous retinal smoothing after forceps traction removal. The preferred substance for use in practicing the invention and achieving complete removal of the macular internal limiting membrane is sodium hyaluronate (Healon.RTM.), as manufactured by Pharmacia & Upjohn Inc. or chondroitin sodium hyaluronate (Viscoat.RTM.) as manufactured by Alcon, Inc.
. . .more to come. . .
. . .cont'd. . .
The present invention allows surgeons to operate, for the first time, inside the human retina (intraretinal) rather than above its surface. In so doing, it enables the surgeon to gently, predictably, and rapidly remove the ILM and all EMP adhered to the neural retina. The gentleness of the invented method eliminates risk of mechanical traction from pulling on the nerve fibers. The speed of the method, typically 4 minutes as opposed to 15 minutes, substantially reduces the risk of light toxicity. The predictability of the method allows for a more certain benefit from the surgery. Moreover, the method affords a significant decrease in the surgical skill level needed to treat traction maculopathy and makes visual recovery more rapid, more certain, and more complete. The sum effect is to enable patients suffering visual loss due to traction maculopathy of any type to seek and find earlier and more certain relief from distorted and reduced visual acuity, while the associated neural retinal abnormality is still reversible.”
Some of the advantages seem, less retinal damage, lower light toxicity because of shorter operation time, shorter recovery period, and a better flattening of the folded retina because of a locally produced fluid cyst which applies greater pressure to the retina to flatten it. That’s why I’d like to find it in Canada, if I could, as our medical system might cover it here. But, I cannot yet find anyone up here who does it.
Some other issues in considering macular pucker surgery are:
a) the type of stain used by the surgeon to highlight the membrane for removal. Tryphan Blue does not cause toxicity to the retina while Indocyanine Green (ICG) does. Some surgeons still use Indocyanine Green.
b) the size of the surgical instruments used. Gauge 23 and 25 sized instruments are smaller than Gauge 20. The smaller the instruments, the lower the trauma to the eye and the shorter the recovery period. More surgeons are moving to the smaller instruments it is said.
c) In the event of a post-operative retinal detachment, some surgeons use gas and others use silicone oil to stabilize the retinal membrane against the eye’s surface. However, the silicone oil can cause damage to the retina and requires a subsequent operation for its removal. The inert gas seems preferable.
d) Some surgeons peel away only the superficial scar tissue, but this scar sits stuck on the ILM (Inner Limiting Membrane). It has been found that a peeling of the ILM with its scar tissue attached above gives better results.
e) It is the vitrectomy which causes potential lens cataracts (an oxygen effect?) and possible retinal tears, post-operatively, yet surgeons routinely do the vitrectomy. I suppose this is because of the possible recurrence of membrane formation if certain vitreous cells (glial cells) are not removed via vitrectomy.
So, there are questions to be asked prior to surgery. The surgery is very delicate and results vary depending on the techniques used.
My best to the group and the difficult situations each is being faced with. You have to be a little pushy and try to get informed in order to find the best care possible. The specialists are very busy, but I believe they will respond if asked pertinent questions and are informed of the difficulties each person is going through.
Nevertheless, even with all the best information you can find, the eye remains a work in progress and a mystery in many ways. The cause of macular pucker is still largely unknown, idiopathic (no known cause).
The present invention allows surgeons to operate, for the first time, inside the human retina (intraretinal) rather than above its surface. In so doing, it enables the surgeon to gently, predictably, and rapidly remove the ILM and all EMP adhered to the neural retina. The gentleness of the invented method eliminates risk of mechanical traction from pulling on the nerve fibers. The speed of the method, typically 4 minutes as opposed to 15 minutes, substantially reduces the risk of light toxicity. The predictability of the method allows for a more certain benefit from the surgery. Moreover, the method affords a significant decrease in the surgical skill level needed to treat traction maculopathy and makes visual recovery more rapid, more certain, and more complete. The sum effect is to enable patients suffering visual loss due to traction maculopathy of any type to seek and find earlier and more certain relief from distorted and reduced visual acuity, while the associated neural retinal abnormality is still reversible.”
Some of the advantages seem, less retinal damage, lower light toxicity because of shorter operation time, shorter recovery period, and a better flattening of the folded retina because of a locally produced fluid cyst which applies greater pressure to the retina to flatten it. That’s why I’d like to find it in Canada, if I could, as our medical system might cover it here. But, I cannot yet find anyone up here who does it.
Some other issues in considering macular pucker surgery are:
a) the type of stain used by the surgeon to highlight the membrane for removal. Tryphan Blue does not cause toxicity to the retina while Indocyanine Green (ICG) does. Some surgeons still use Indocyanine Green.
b) the size of the surgical instruments used. Gauge 23 and 25 sized instruments are smaller than Gauge 20. The smaller the instruments, the lower the trauma to the eye and the shorter the recovery period. More surgeons are moving to the smaller instruments it is said.
c) In the event of a post-operative retinal detachment, some surgeons use gas and others use silicone oil to stabilize the retinal membrane against the eye’s surface. However, the silicone oil can cause damage to the retina and requires a subsequent operation for its removal. The inert gas seems preferable.
d) Some surgeons peel away only the superficial scar tissue, but this scar sits stuck on the ILM (Inner Limiting Membrane). It has been found that a peeling of the ILM with its scar tissue attached above gives better results.
e) It is the vitrectomy which causes potential lens cataracts (an oxygen effect?) and possible retinal tears, post-operatively, yet surgeons routinely do the vitrectomy. I suppose this is because of the possible recurrence of membrane formation if certain vitreous cells (glial cells) are not removed via vitrectomy.
So, there are questions to be asked prior to surgery. The surgery is very delicate and results vary depending on the techniques used.
My best to the group and the difficult situations each is being faced with. You have to be a little pushy and try to get informed in order to find the best care possible. The specialists are very busy, but I believe they will respond if asked pertinent questions and are informed of the difficulties each person is going through.
Nevertheless, even with all the best information you can find, the eye remains a work in progress and a mystery in many ways. The cause of macular pucker is still largely unknown, idiopathic (no known cause).
I have very mixed feelings about the FILMS technique, which (as far as I know) is not used outside the Alabama hospital where it was invented. My surgery was done by a top American retinal specialist, and he did not seem to view FILMS very highly when I asked him about it. Per a post in the Google group sci.med.vision, neither did the faculty at the prestigious Wills Eye Institute. However, for whatever reasons, the FILMS website gets a lot of hits from Google and other search engines.
My retinal surgery was done with 20-gauge equipment (my surgeon's choice), and it restored the acuity in my affected eye to 20/20+. It did not involve ILM peeling, which (per my surgeon) is generally reserved for cases in which a macular hole is present. I've read that macular pucker surgery is now done in cases where pre-surgery vision is better than 20/30; in the not-so-distant past, only cases where vision was 20/70 or worse were treated. (Some of the above quoted text about mainstream surgical technique may be dated.)
Despite the excellent acuity in my affected eye, the image size in that eye (central vision) is about 2-10% larger than in the fellow eye. This condition (retinally-induced aniseikonia) is probably attributable to residual damage from the pucker, although it could have been caused by the retinal surgery. My image size difference was not considered noteworthy by my retinal surgeon, although it has caused me to have binocular vision problems/discomfort (mainly excessive tearing). There is no data on the frequency of post-surgery retinally-induced aniseikonia, although there are many reports of cases in the literature and on online forums. Through email correspondence, Dr. Steve Charles in Memphis suggested that peeling the ILM might prevent/resolve the aniseikonia (point "d" above). So perhaps the FILMS technique is really valuable after all, but has been overlooked in mainstream surgical practice. However, Troy52, I'd be very reluctant to rely on any technique that was not backed by some solid research.
(Lorac0813, I apologize for this intrusion on your thread. I've been following your posts, and I keep hoping to read about improvements in your symptoms.)
My retinal surgery was done with 20-gauge equipment (my surgeon's choice), and it restored the acuity in my affected eye to 20/20+. It did not involve ILM peeling, which (per my surgeon) is generally reserved for cases in which a macular hole is present. I've read that macular pucker surgery is now done in cases where pre-surgery vision is better than 20/30; in the not-so-distant past, only cases where vision was 20/70 or worse were treated. (Some of the above quoted text about mainstream surgical technique may be dated.)
Despite the excellent acuity in my affected eye, the image size in that eye (central vision) is about 2-10% larger than in the fellow eye. This condition (retinally-induced aniseikonia) is probably attributable to residual damage from the pucker, although it could have been caused by the retinal surgery. My image size difference was not considered noteworthy by my retinal surgeon, although it has caused me to have binocular vision problems/discomfort (mainly excessive tearing). There is no data on the frequency of post-surgery retinally-induced aniseikonia, although there are many reports of cases in the literature and on online forums. Through email correspondence, Dr. Steve Charles in Memphis suggested that peeling the ILM might prevent/resolve the aniseikonia (point "d" above). So perhaps the FILMS technique is really valuable after all, but has been overlooked in mainstream surgical practice. However, Troy52, I'd be very reluctant to rely on any technique that was not backed by some solid research.
(Lorac0813, I apologize for this intrusion on your thread. I've been following your posts, and I keep hoping to read about improvements in your symptoms.)
Hi JodieJ, no worries about you and Troy52 intruding on my thread! I did start to read through them but you both got a little too technical for me...I'm always amazed by how much knowledge people on this forum have about the human eye!
I was on vacation last week so my eyes got a well-deserved rest from the computer. The dry eye problem is slowly getting better, I've gone from putting drops in every hour to about 4 times a day - a HUGE improvement for me! I'm also now off all of my prescription drops so maybe that is making a difference as well. First day back at work today and my eyes were fine.
As for my other problems - the edge glare and the reflection/shimmer off of my left lens - unfortunately, those problems have not diminished. I find I still need sunglasses in stores - especially the big box stores like WalMart - and most definitely need them outside and to drive. I've stopped wearing them in the house but only because I got really annoyed being "in the dark" all the time! I find that when I read, I need to make sure there is no light source on my left hand side - that makes it tolerable.
My surgeon did tell me to come back in a month or so if there was no improvement, and I will do so, but I'm just not sure what can be done for me at this point. Your thoughts, JodieJ? I know that you are not an eye "professional" but I do value your input and advice - you seem to be very knowledgeable. THanks....
I was on vacation last week so my eyes got a well-deserved rest from the computer. The dry eye problem is slowly getting better, I've gone from putting drops in every hour to about 4 times a day - a HUGE improvement for me! I'm also now off all of my prescription drops so maybe that is making a difference as well. First day back at work today and my eyes were fine.
As for my other problems - the edge glare and the reflection/shimmer off of my left lens - unfortunately, those problems have not diminished. I find I still need sunglasses in stores - especially the big box stores like WalMart - and most definitely need them outside and to drive. I've stopped wearing them in the house but only because I got really annoyed being "in the dark" all the time! I find that when I read, I need to make sure there is no light source on my left hand side - that makes it tolerable.
My surgeon did tell me to come back in a month or so if there was no improvement, and I will do so, but I'm just not sure what can be done for me at this point. Your thoughts, JodieJ? I know that you are not an eye "professional" but I do value your input and advice - you seem to be very knowledgeable. THanks....
Hi ,
I am very sorry didnt comeback earlier....I still am not driving as I have not got the correction glasses at moment...as i am due for rgt Eye operation quite soon...than i will get Multifocal glasses for reading,computer work and for driving....In terms of glare or any night vision problems ...Thankfully i have no problem...but just need the correction glasses....perhaps when you have your correction glasses ...might be prudent to get photochromic lenses...these will adjust to light conditions....get some info on this from your Opthalmologist...but i am still confident once your eyes settle down ...this as get older can take a touch longer..perhps 6-12 weeks...than you get the correction glasses i think you will be absolotely fine.
I sense you are allredy feeling a bit better and just a touch more time and you are gonna be feeling grrrreeeeeeeaaaaaatttt...
Take care
Indi
I am very sorry didnt comeback earlier....I still am not driving as I have not got the correction glasses at moment...as i am due for rgt Eye operation quite soon...than i will get Multifocal glasses for reading,computer work and for driving....In terms of glare or any night vision problems ...Thankfully i have no problem...but just need the correction glasses....perhaps when you have your correction glasses ...might be prudent to get photochromic lenses...these will adjust to light conditions....get some info on this from your Opthalmologist...but i am still confident once your eyes settle down ...this as get older can take a touch longer..perhps 6-12 weeks...than you get the correction glasses i think you will be absolotely fine.
I sense you are allredy feeling a bit better and just a touch more time and you are gonna be feeling grrrreeeeeeeaaaaaatttt...
Take care
Indi
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