PCO noted at time of cataract surgery...possibly causing myopia.

[Root710]

I had cataract surgery 3 1/2 weeks ago.  At that time they noticed a PCO, most likely caused by previous vitrectomy.  My monofocal lens was supposed to be set for distance vision.  However, I am having continued myopia with focus about an arms length.  The swelling in the eye from surgery is gone and the doctor thinks it could be the PCO causing the lens to be positioned too far forward.  My quandary is that the PCO can be removed but once that is done, there is no chance of doing a lens exchange.  So if the lens does not shift posteriorly, I will be stuck with intermediate distance vision in my dominant eye.  What is the likelihood of the PCO causing the myopia?  And if removed would the lens then shif to where it’s supposed to be.

Additionally the doctor placed a different lens than I had requested.  He placed a SA60WF, I had requested a ZCB00.  I was worried about glistening associated with the Alcon lens and the resulting possible decreased contrast sensitivity.  Additionally, there were a number of other factors that made the ZCB00 sound like a better quality lens.  He is willing to do a lens exchange but I don’t know if it’s worth the risk.

Lastly, I guess an option is to see what happens after the PCO removal and then have LASIK done if necessary.  I wanted to be able to drive without glasses.  The glare on the spectacle lens bothers me so much.

[Root710]

Hi Dr. Hagan, I was essentially blind in my left eye from the cataract. I could only see vague shadows and they could not get a refraction on me or improve things with glasses.  I had prior to the the cataract been 20/20 or close.  Had been a while since last refracted.

I understand what you are saying about the YAG removal of the plaque not helping the myopia.  At least that it may not be likely to help.  I have read that sometimes an attempt is made to polish the plaque away.  I wonder if I should consider the lens exchange and ask for this to be done at that time to get the refraction closer.  Then once healed have any remaining opacity removed with the YAG.

[JohnHaganMD]

Polishing away basically only works well at the time of surgery not second surgery.  You have not said what the vision is in your other eye and whether it needs glasses and if so what is the glasses prescription.   That is important. Will you provide?

[Root710]

Stupid autocorrect!! I know it’s Dr. Hagan but failed to proof read.  Sorry about that.  My other eye is a lazy eye because of a congenital cataract on one side of the lens.  I think the Rx is something like -1.75 with astigmatism of 1.5D.  I was able to pass the drivers license exam without glasses so the vision is at least 20/40 unaided.  Thanks for your help.

[JohnHaganMD]

Congenital cataracts usually are bilateral so it's possible, even likely that the opacity on the operated eye is part of that.  In any case doesn't change the recommendations.  Why did the operated eye have a vitrectomy?

[Root710]

Detached retina.  20/30 vision post repair.

[Root710]

The lens in this eye was clear previous to cataract formation post vitrectomy.  The congenital cataract appears to have possibly been a piece of iris being trapped within the lens or some other malformation.

[JohnHaganMD]

I'm not really sure I can add any more insights. If you had a RD in one eye, and it was not due to trauma you are at high risk for a RD in the other eye. Perhaps as high as 5-10% so you don't want cataract surgery on other eye till absolutely have to.  On the operated eye the more surgery that is done the greater the risk of complications:  infection, bleeding, re-detachment of the retina, macula edema and disappointment with the need for glasses (where you are now).   So avoiding a IOL exchange is big.  If glasses for driving meet your needs the smart thing to do would be to wear glasses for driving and avoid additional surgery, expenses and the chance of bigger problems. that's about all I can say.

[Root710]

Ok, thank you.  That’s what I wanted was just some real world expectations and practical recommendations

[cookie101101]

I just had a lens exchange from a Symfony multi focal in my left eye due to disabling starbursts and other visual weirdness (still have a Symfony in dominant eye). I was given an Alcon Acrysof Aspheric SA6OWF. Still have starbursts. Plus have some kind of low contrast thing going on since day one. Slightly better after a month. Both eyes together work well enough but there is some kind of distortion that I see coming from that eye in certain light conditions. I had an unexpected floppy lens during the procedure. The doctor used a ring to continue the exchange. He said it was the most difficult surgery of the day and there was a corneal transplant after me. I don't know exactly what I am seeing or if it will get better.  This is a long story short. I'm telling you this to illustrate that sometimes things just get worse. I was told and accept the risks and take all responsibility. It was my decision to proceed.  I picked the doctor from the list Dr. Hagan posted. I also researched him thoroughly and even talked to some of his patients. He is a very good doctor.  Things just happen.  

[Root710]

point well taken!!!  thanks for your input.  I hope things get better for you after perhaps more time to heal.

[JohnHaganMD]

There is medical wisdom in 'leave well enough alone"  If good vision with glasses...........wear glasses.   I saw man in office spent $8000/eye for "extra' and says he was told would never need glasses.  He's wearing $16,000 pair of glasses.  Obviously not our practice that did this to him

[JohnHaganMD]

PCO does NOT usually cause the IOL to move.  And when we do Yag capsulotomies it does not usually change the glasses RX.   I can't really answer your question but doubt Yag cap will make you less myopic.   What is your glasses RX and your vision with that? If you see 20/20 with glasses its doubtful you need yag capsulotomy and one of the risks of yag cap is increased risk of retinal detachment which is something you don't need.  You could always get an independent second opinion.

[Root710]

I am only 3 weeks post-op from the cataract surgery so I don’t an eyeglass prescription yet.  I had 20/20 vision in this eye with 0.5D astigmatism.  My cataract had grown so dense after my vitrectomy about 2 years ago, that they could not see thru the lens to view my retina and could not see the PCO as well.  When the doctor explained it to me after the cataract surgery, he said there was part of the lens adhering to the posterior capsule lining and he tugged on it to remove, but was worried if he pulled harder the capsule would tear.  I asked him if that was a type of PCO and he said yes and that the clump of tissue may be making the lens sit farther forward than expected.  Thus contributing to the myopia.  Nothing is in focus beyond about 4 feet max.  Again I don’t have glasses and was hoping to not need them for driving.  So I don’t know if this is something that sounds plausible or if it’s more likely B.S.  Does the crystalline lens ever become so mature that it fuses to the capsule or can it occur as a result of vitrectomy instruments touching the posterior capsule?

If I do need a lens exchange, how can this retained piece of lens or PCO be removed to ensure it doesn’t cause a problem with IOL positioning when placing a new lens?

[Root710]

I forgot to mention they also did LRI for my astigmatism.

[Root710]

After spending some time online researching my question some more, it appears that I have Posterior Capsule Plaques.  Which are remaining pieces of lens stuck to the capsule.  I think because of its bulk, these can cause a myopic shift.  So how will I know if the myopia will be rectified by YAG laser treatment?  Or will the laser simply remove the cloudiness and I’ll be stuck with the myopia since the IOL will be fibrosed into place by then?

[JohnHaganMD]

You won't know and I can't tell you.  Yes, I have done over 12,000 cataract/IOL surgeries and sometimes the capsule was opaque. I told the person at the time of surgery they would need a yag capsulotomy in a few weeks.  None of these changed the glasses RX  or moved the IOL.   If you had 20/20 vision why did you have surgery?   At your office visit they do a refraction and record you vision with that refraction even though they don't write the glasses RX till about 4 weeks post op. So you should know your uncorrected distance vision now and your office refraction and the vision with this  Rx.    Because of the uncertainly and unique aspects of your case you might want to get a second opinion.  Know that if your distance vision (20 feet or 6 meters) gets better your near/intermediate will get worse and you will need glasses to see TV, computers, read, etc.