7439659 tn?1390838706

Should I change my IOL because of epiretinal membrane

First off, I am so glad I found this site ... a lot of good information posted by very helpful and intelligent people. I have also posted a couple of concerns and got some excellent responses.

My situation is that I got cataract surgery in both my eyes over the last month (corrected for near vision). The left eye is now very good but the right eye improved only slightly. My eye surgeon determined it's because of a epiretinal membrane in the right eye along with some thickening of the retina.  

My question is ... because the right eye is still blurry and also suffers from a difference in focal distance (objects in right eye appear closer than the left eye), would replacing the right IOL improve those problems? Also, if the eyes had originally been corrected for distance vision (instead of near), would that have helped to minimize the difference in the focal distance between the eyes?  

I am returning later this week for a follow-up exam and possibly to order new glasses, I'm just hoping that new glasses can correct these issues. Thanks in advance.

This discussion is related to Epiretinal membrane following cataract surgery.
7 Responses
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711220 tn?1251891127
You need to discuss this with your surgeon.  It seems the mainproblem is the ERM.  You can try a contact lens to correct the refractive error and see if it helps.  The doctor can refract you to see if the vision improves.  If it does not help significantly, you probably need surgery for the ERM.

Dr. O.
Helpful - 0
1932338 tn?1349220398
I had an ERM removed about 2 years ago...there is a great deal to consider before you would get the ERM/membrane peel Vitrectomy surgery.

Delve into this with your retina specialist and go into great detail.  What diopter is your Left eye post cataract SX?  If your eyes are more than approx. 2 diopters apart, they don't merge the images together well.  Sometimes it blend better with time, but sometimes not.

Review your OCT results in the office WITH your retina specialist.  Ask to see the thickness numbers of your retina...ask to see where he sees indication of the membrane...ask how bad it is tugging on your retina.  Is the membrane in the macula/central vision area?

Finally, get a second and third opinion if your insurance covers it.  I had Regence Insurance and they covered as many opinions as I wanted.  I got 4 and learned a great deal with each retina specialist.
Believe me, you want to be certain of your decision here so that you have no regrets.

Good luck and please keep us posted.  
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7439659 tn?1390838706
Thank you Dr.O for your reply ... my appointment is tomorrow and if my surgeon doesn't recommend a different course of action I will definitely suggest suggest experimenting with contacts to determine how well my vision can improve with corrective lenses.
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7439659 tn?1390838706
Luvtoski ... Thank you for the reply and sharing your experience.

Right now a membrane peel is something I'm definitely avoiding. I don't know what the diopter difference is between my eyes, but it's most annoying when trying to drive or watch TV.

I also don't have retina thickness numbers, I did get to see the OCT images from last year and also from week last where my doctor pointed out the thickness differences. But even after seeing the photos, as a patient I am not qualified to know the severity of what I'm viewing.

I have an appointment tomorrow and have my written list of questions to bring with me. Regardless of insurance coverage, if I don't see improvement or before I consent to more surgery I will take your advice and get additional opinions. Thanks so much for your input, it's most appreciated.

p.s. I didn't get to ski this winter ... hope you did ... lol
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1932338 tn?1349220398
Sounds like you are headed in the right direction Joe.

The thickness numbers can be mapped on the OCT results and the Dr. should be able to tell you how extreme the swelling is and/or if it is fluid/edema under a layer of your retina.
He should also be able to give you his opinion as to whether in his experience, he thinks it will subside some on its own.  My Retina thickness number in the critical macula area is about 480...and 250-300 is considered "normal".  Hence, post vitrectomy my thickness/swelling never went away even 2+ yrs post surgery.  So that is my new normal.

What happens with the membrane is that it tugs at the retina and causes "traction" for however long you have it.  They told me it's like pulling up on a tight bed sheet and then releasing it...the sheet never lays down as tight to the bed after being tugged up.

I had to reside to the fact that my new normal would have to be good enough as a second vitrectomy wasn't even an option or consideration.  Also, I've learned in life that it is sometimes best to "leave well enough alone".  

I did get a cataract within a month after Vitrectomy and had that new monofocal IOL put in.  Now my two eyes are about 2 diopters apart.  My good eye at far distance +1 diopter and my surgery IOL eye at -.75 (a bit nearsighted)  They didn't blend the images together well for around 6 months as the nearsighted eye produces a slightly larger image and the brain needs time to neuroadapt.

I am no expert but wanted to throw out some more of my experience in hopes that it would help in some way.  If you know what to ask the Dr. it helps...they only give you about 6 minutes of their time usually.  That was always frustrating to me because I was making life decisions on my vision based on that short Retina Sp. appointment.

Please keep us posted and keep reading/researchin as much as you can meanwhile.    
Helpful - 0
7439659 tn?1390838706
Good morning Luvtoski ...

It's unfortunate that we need to do so much of our own research but thank goodness we have the internet to help us. As you said we only get a few minutes with the doctor and they make life changing 30 second diagnosis decisions for us, so having as much information as possible beforehand is critical.

I appreciate so much that you take time to help and educate others, like me. Having lived through many of these issues you are more of an expert then you realize.

I am assuming that since you had a new IOL put in and still have a 2 diopter difference that corrective lens aren't a total fix. Right now my strategy is to avoid a Vitrectomy for as long as I can.

If I do not feel confident with the course of treatment after today's appointment I will look into getting a second opinion as you suggested earlier.

Thanks again ... will keep you posted.
Helpful - 0
7439659 tn?1390838706
This is an update on my progress. After two my more visits the doctor added prisms to my lens ... first to the problem right eye ... bringing things a bit closer ... then to tweak further adding to the right eye to push things out. This is not perfect, but has gotten the images from both eyes to be fairly close in alignment and minimize the double vision.  But because of the ERM, the right eye vision is still blurry and distorted. I am able to deal fairly well with this ... but watching TV and especially driving can be difficult. At this point I'm afraid that this is the best I can expect without having surgery. Hopefully time will also help my brain to better process the two images. My next follow-up appointment is at the end of April and I'll will post again if there are any new developments.
Helpful - 0
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