IOL Exchange?

[Sophiecate]

A week ago I underwent cataract surgery and monofocal IOL. Past history of Lasik in 1998. I was informed prior to surgery that this certainly complicates calculating the correction necessary in the IOL. Prior to surgery my vision in this eye was 20/70. One week post-surgery, I am 20/200. I am disappointed, as I know my surgeon is also. I know he did everything as correctly as he could; even showed me the 8 formulas and the results which ranged from 18.5-22.0 diopters. Since most of the formulas pointed to 22.0 diopter lens, that's what he went with. He discussed with me, doing a IOL exchange to a 19 diopter, as this appears to be what would be necessary to attain better distance vision, as I had felt I could use glasses for my bifocal needs. He did order me a new temporary lens in my current glasses, to sharpen my distance vision, and I should get that next week. The idea is for me to try the new lens for a couple weeks and see if it helps enough, would I just leave well enough alone and plan on glasses for both distance vision and some close-up correction (I can see fairly good at about 18 inches, but its sharper with some bifocal correction.)  I know the ultimate decision, whether to do a IOL exchange or not, will be with me, but I worry about complcations from removing the IOL and replacing it with another. My axis length in this eye is 28.0, and my original vision prior to my Lasik surgery in 1998 was -11.  Do you feel doing a IOL exchange is worth the risk?

[JodieJ]

Sometimes the decimal is omitted in the astigmatism amount.  Your astigmatism has apparently increased from .25 (which is minimal) to 1.75 diopters (which is significant).  Why?

Although there are individual differences in what people can tolerate, a difference in refractive error of more than 2.5 diopters between the eyes is too much for most people.  So if your second eye ended up slightly nearsighted (usually not a bad thing at all), you could have problems using both eyes together--even with glasses.

I'd assume that there's enough similarity between your eyes so that the results of your first cataract surgery would significantly enhance the IOL predictions for your second eye.  (You might want to get a second opinion from a different surgeon.)  The doctors who respond on this forum are experienced cataract surgeons, and they can give you better advice than I can offer.  I'd recommended posting again in a new thread.

[Sophiecate]

Thanks again Jodie. I went back and looked at the Rx written for my new eyeglass lens last week, and am wondering if the astigmatism reading is supposed to be -1.75, although I certainly can't see a . in between the 1 and 7. (However, my vision isn't so great right now.)
Your statement about the results of my first eye could be used for improving the IOL predictions for my second eye-I was wondering the same thing. Or is every eye so very different in the formulas?

I appreciate your comments, Jodie. Thanks again.

[JodieJ]

Your disappointment, frustration, and anxiety are completely understandable.  Your LASIK results seem excellent to me.  I don't understand where your current astigmatism came from.  (Maybe Dr. Hagan would know.)  I would hope that the results of your first eye could be used for improving the IOL predictions for your second eye.  It's my (non-professional) understanding that there are special formulas for post-LASIK patients.  If Dr. Hagan does not respond to your added information, you might want to post again as a new thread in order to get some professional input.    

[Sophiecate]

Thanks Jodie.
I don't have my readings that were taken in Jan 2011, before my cataract surgery, but I went back and looked at some past Rxs that I had been given. In 2004, it was -.50+.25 x105 and 6/09 it was -1.25+.25x095, if I am reading these correctly. I am sure I still have some swelling yet from my surgery, as its only been 9 days and I am still using Durezol drops.
I have had two small holes repaired by laser about 5 years ago by my retina specialist, whom I saw last fall before I scheduled my cataract surgery. He gave me the go-ahead and reinforced my choice of opthamologist. I have thought about checking with him again, just to get his opinion. You can understand my disappointment, frustration and the fear of having my second eye done.

[JodieJ]

I'm not an eye care professional, but I think your situation is a tough call.  You seem to be moderately farsighted with significant astigmatism in your affected eye--not a desirable state because your vision is blurry at all distances without correction.  (Did you have that much astigmatism post-LASIK?)  In your place, I'd consult my retinal specialist before making a decision.  With his/her approval, I'd probably go for an exchange performed by a very experienced surgeon.  (Would a toric IOL be possible in your case?)    

[Sophiecate]

Sorry-I meant to say I am scared to do the second eye cataract due to the outcome of the first eye's cataract.

[Sophiecate]

Thank you Dr. Hagen, My Rx my opthamologist wrote for my new temp. lens was +2.5-175-125. As I understand it, I should be at 20-20 with this new lens. One of my concerns is that I was scheduled to have the cataract in my other eye done in a few weeks; obviously we have put this on hold for now. With the result of my first eye, I am scared to do the second eye as the outcome of that one may be as unpredictable as the second. I would be great if it turned out to be good for distance, but I can't count on that either.

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

You omit critical information: 1. can your vision be corrected to 20/20 or 20/25 with glasses?  2. If so what is the glasses RX.

Only by knowing that can your question be answered.  for example if you need a -7.00 lens than yes you will need an IOL exchange. On the other hand if you're 20/20  with a -1.50 you likley will do fine leaving the IOL in and making some adjustments on the other eye.  If you don't correct to 20/20 then there is something else wrong with the eye.

JCH MD