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Avatar universal

IOL options with impaired acuity after ERM peel

My eyes were both very myopic, around -9 each.  I’ve been happily wearing multifocal contact lenses for years.

Last April, I had a retinal detachment and an emergency vitrectomy – I got a scleral buckle and had a gas bubble. I almost immediately got a cataract.  I wanted to go with a multifocal IOL to correct the cataract, but then I developed a significant epiretinal membrane, which made hat inadvisable.  

A couple of weeks ago I had a combined second vitrectomy/membrane peel and monofocal IOL implantation.  They were aiming for -1 to -1.5 so that either I could decide to either use the eye for mini-monovision (get the other eye done plano later) or just have a consistent near/intermediate focus. Recovery from the membrane peel seems to be going ok – the surgeon says I’ve gone from 20/400 best corrected to about 20/80, though so far it’s not clear to me whether this eye will ever have sufficient acuity for easy reading.  The other problem is that we had a big refractive error – if I remember the numbers right, I’ve ended up about -4.5, but (at least with the stitch still in) wit about +2.25 of astigmatism.  The surgeon said that effectively leaves me around -3.5, an unhappy result.

She’s ruled out explantation of the IOL as too invasive because of the multiple surgeries, says that when things settle down I could do either a piggyback lens or have Lasik.

So here are the questions.

Has anyone had either a piggyback lens implant or Lasik to correct an IOL refractive error?  How did you choose the approach?

Any input on abandoning the mini-monovision plan and having both eyes done about the same, whether plano or about -1.5?  As a non-expert I would think that if I continue to have significant acuity problems with one eye, having both of them at about the refraction is probably going to give me better results.

As an alternative, has anyone ever heard of a strategy using one eye for everything and the lesser quality eye just for periphery/stereopsis?  I.e., not worry too much about where the “bad” eye ends up, and get a multifocal IOL (or just wear a multifocal contact) on the other.

Thanks for any thoughts.
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Avatar universal
There have been no further tears.  Though I've had occasional black speck floaters in BOTH eyes, the last dilated exam showed no issues with either retina.  I have mild PCO in the right eye (the one with more recent cataract surgery and tear), but the retina doc doesn't want me to do anything about it until I pass the three month mark from the tear.  So another retina exam in several  months before I can go back to my anterior practice and try to get a YAG treatment scheduled, which I"m quite sure will take at least a couple of visits there.  I'm not expecting huge improvements because the majority of my vision issues there are a result of the big greasy floater caused by PVD.

The more interesting stuff recently has been getting fitted for glasses.  The super expensive (even after insurance) progressive glasses fit by the opticians in my anterior segment practice never worked right  - I was much happier with the 1/10 the cost "spare" pair I had ordered online from Zenni.  The optician spent some time adjusting the frames and I gave it another couple of weeks, but near and intermediate vision were paltry, making reading and computer work difficult.  

He had fit me in what he claimed where the "latest technology," Zeiss Choice.  I dug into research and determined that these were NOT the latest and greatest, and they were known for narrow intermediate/near corridors.  I suggested a different Seiko lens, which is when I learned that my vision insurance dictated  lens brands and Seiko wasn't on the list.  So they then put me in what is actually a newer product from Zeiss, Individual 2.  These are great - I now like them better than the cheap internet glasses, though not anywhere close to 10x better.   I checked the relative costs of the two lenses and with the insurance price I paid I got not much of a discount at all with the Choice lenses, and much more substantial discount with the Individual 2 (they didnt' charge any more).

Lessons learned on buying progressive glasses:  Price does not equal quality.  Progressives bought off the internet (without a segment height measurement) at a huge discount can be prefectly fine, though if something does go wrong you're probably out of luck.  When being fitted for glasses prior to all the surgeries, I'd just assumed I was being given something relatively standard - but that' snot true.  Opticians push you toward what they want to see you in, maybe for good reasons, maybe for bad, but it's not transparent.  THey don't want to give you the information necessary to make your own informed choice as to the brand/model they're fitting you in.  Nor do lens manufacturers - it's very hard for a consumer to access any meaningful information at all on the differences between various types of progressive lenses.
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Avatar universal
My follow-up today revealed a horseshoe tear, was lasered.  Ouch.  The doc ise going to monitor very closely over the next few weeks as he thinks getting a tear after the Weiss ring separation is indicative of potential trouble.  Oh, and while the blood has mostly disappeared from my vitreous, and I'm not noticing the Weiss ring so much, I have a very large and cloudy floater that does makes the vision in that eye quite difficult.
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2 Comments
Hope everything has gone well and no more issues.  
Maybe your retina Eye MD can tell you if this big floater is blood.  The life of a red blood cell is 120 days so it can take  3-4 months for blood to clear from the vitreous.
Avatar universal
Spoke a little too soon.  The PVD continues in my right eye.  As I was playing a board game yesterday, I watched a long stringy black floater develop in real time - very disconcerting.  The doc called me back quickly and saw me first thing today.  The stringy floater has resolved itself into a ring (likely a Weiss ring) and my eye is blurry overall (he says it's blood, which hopefully should resolve).  The good news is no new retinal tears. I go in again in a week.

It's all so frustrating.  I know there's nothing to be done, but I really just want everything to stop.  Since I've had every complication known to man so far from every issue, I'm keeping my fingers crossed I don't get a tear or an ERM in what was (?) my good eye.
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1 Comments
Yes its hard to be philosophical when a string of bad luck comes along. I have a Weiss Ring in my RE. Took quite a while to get use to it.
Avatar universal
Thanks.  The hyperopic eye is the one where I had a detachment, two vitrectomies, scleral buckle, ERM peel and IOL implantation.  I originally had about a -3.5 refractive error, then PRK to correct that. Not an ideal result, but I'm assuming that the low error is not worth the pain and risk of a touch up procedure.  Would you agree?
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Avatar universal
Last week I noticed 4-5 new dark floaters in my right eye, the one that just had cataract surgery.  My retina specialist says my retina is still fully attached, but that my vitreous in that eye has separated substantially since the surgery.  It's not all the way there, so we're in wait and see mode, but hopefully it will all end up well without another retinal detachment.

One month after that cataract surgery in my right eye, my final prespection is:

OD: Sphere -0.50, Cyl -0.75, Axis 175, Add 2.25
OS: Sphere +0.50, Cyl -0.75, Axis 100, Add 2.25

So my left eye, the one on which I had PRK to correct the IOL refractive error, actually ended up being slightly OVER-corrected.  That explains the disparity I've noticed between my eyes.  Not ideal, but I can still get around without glasses - it's far better than it was before this all started.  

I've ordered a pair of fancy progressive glasses with high-end Zeiss lenses through my eye practice and plan to wear them all the time.  (I actually bought stylish frames on vacation to make me feel better about that.)  As my insurance kicks in for new pairs I'll buy them.  In the meantime I'm going go splurge on some cheap internet pairs just so I have something else to wear.

Unless the glasses don't work or the retina in my right eye doesn't hold up, this is my last update.  Fingers crossed!
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Avatar universal
Glad to hear of your progress /results!
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1 Comments
Thanks for the informative posts. And cograts for getting to the light at the end of the tunnel
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