Risk of RD post cataract surgery in severely myopic ROP patient

[Mayalu]

I lost my right eye due to ROP when I was a baby and it was removed. I am now 41 and have a cataract in my left good eye. I was recently examined by a retina specialist who said my retina is thin but no tears or RD. I am severely myopic, -19. I read a recent paper which gave a 23% rate of RD post cataract surgery in ROP patients - it also said something like 32% of patients had worse vision postop and 30% had no improvement postop. My vision is getting worse with glare, halos, double vision, etc and my SVA is 20/70 down from 20/30 so I really want to have surgery but am terrified that my retina will detach and I will lose my sight completely. Please tell me are the odds really that bad that there is a 23% chance of RD???.

[Mayalu]

The studies on cataract surgeries on adult ROP patients do differ significantly in their results. There was a study of only 10 eyes which was published 10 years ago which gave a result of 10% incidence of RD(1 eye). The study which I mentioned was published this year, had a larger sample size (66 eyes operated on at two different hospitals) and the result was 23% incidence of RD. I also recall maybe two other studies where the outcome was favorable, low incidence of RD but smaller sample size, under 20 eyes in each study. The first two studies(and I believe the others) had Dr. Michael Trese as a collaborator - he is the main authority on ROP I believe. I find it depressing that the older studies actually had more positive results than the newer, larger one. 23% is a pretty scary number to me.

I have seen three doctors(one of them a retinal specialist) who saw no reason to delay surgery - they all seemed reasonably confident that it would be successful. I have also been corresponding with Dr. Uday Devgan in LA who has written an article on cataract surgery in severely myopic patients. He has also successfully operated on ROP patients, including at least one who has one eye like me.  I have scheduled my surgery for Dec. 16 with Dr. Gregory Pamel. I am scared of the potential risk for RD but Dr. Pamel has operated on many ROP patients and he said none of them developed RD afterward. He has also operated successfully on myopic patients as high as -25D so I feel confident in my decision. He will be implanting a 3-piece Tecnis aspheric IOL. My SVA is actually 20/150 since when I took the test 2 months ago with my first doctor he did not tell me not to squint - the 20/70 result is from squinting. My doc said it is amazing I am still able to walk around, in fact 5 months ago I was hiking at 15,000 ft. elevation in Nepal. If my vision were stable and I knew the cataract would not get worse I would leave it as it is, though as you well know cataracts do not stabilize or get better - who knows what my vision will be like in 6-8 months. I will be going back to Nepal in a little under 6 months so think it is best if I have the surgery now so if there are any complications it won;t be likely to happen while I am there.

I had wonderful ophthalmologists when I was little and I was taught early on from when I was 6 years old to pay attention to floaters, flashing lights, blind spots, etc. so if I did have those symptoms I would go to the ER if I could not get an emergency appointment with my ophthalmologist. I will ask Dr. Pamel which ERs have 24hr on call ophthalmologists since I have heard stories of patients being told to 'come back tomorrow' because there is no opthalmologist available and in my case it is critical. According to my retinal specialist there is some minimal scarring on the periphery of my retina.

[Joan M Pernoud, MD]

I cannot comment on the paper you read as I have not researched that question but I have several thoughts:

1) Different studies have different parameters and even when they don't, studies often differ dramatically for often only speculative reasons.

2) Even if this study represented an accurate overall risk, it still may get to the point it is a risk worth taking if your vision is too poor for daily activities. I think you should get several opinions from ophthalmologists who can give you the attention your eye deserves. Don't do anything until you are completely comfortable with your decision.

3) Most retinal detachments are fixable especially if they are caught early and they do have symptoms and you and your doctor will be looking for them. My only concern is what the ROP has left or not left in your eye in terms of scarring. The procedure called vitrectomy releases scar tissue and should allow any retinal procedure to be a success if needed.