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Wrong IOL Lens?

I had cataract surgery on one eye on March 4th.  After two weeks, my vision is still 20/100 which is worse than before surgery.

A little background.  I was very Myopic (20/300).  I wore hard contact lenses for 20+ years and then had LASIK surgery in 1998.  For the last two years, my vision declined rapidly, requiring a new prescription every few months to compensate.  I went to two opthamologists that agreed that the problem was worsening cataracts.  My optometrist said it was old age (I'm 62).

My surgeon says that my eye will improve with time, the LASIK causes the cornea to act differently than doing cataract surgery on someone who has not had LASIK.  My optometrist says I have the wrong lens and it is so bad that it cannot be corrected with glasses, and it will not improve to anything acceptable over time.  His opinion is that my only option is to have the lens replaced.  How do I find a doctor that will calculate the lens requirement correctly?  I know replacing the lens is quite a bit more invasive than the original surgery, what is the timeline for being able to see and to resume normal activities?
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233488 tn?1310693103
MEDICAL PROFESSIONAL
I would discount what the optom said.

If you had a healthy eye and no problem other than the IOL power you should be able to see 20/20 with that glasses in front of your eye.  

There are several tests that you likely need: corneal topography to rule out irregular astigmatism; macular OCT to rule out macular pathology or edema.

They might be talking about intraoperative abberometry.

You might consider packing up all your tests and heading out to U of Oregon or U of Washington or Stanford Ophthalmology programs.

JCH MD
Helpful - 0
Avatar universal
OK.  I saw two additional eye doctors, one optometrist and one opthamologist that also does cataract surgery.  Here's what they think.

Optometrist:  Says vision is 20/100.  He managed to correct it with “a lot of prescription” to 20/30.  Refraction was +2.50 -3.50 x 095. Said I wouldn’t want to go through life with that much prescription.

He looked at the cornea and the retina and did not see any significant swelling/edema.  He thinks I got the wrong lens.  Probably due to error in calculation.  Only option is to wait until completely healed and then get the lens changed out.  The removal of the IOL requires a much larger incision and more risk/recovery than the original surgery.

Opthamologist: His technician tried to refract my eye and could not get anything useful. The doctor looked over all the results and indicated that he, too, is surprised by the result.  He put in the refraction that the optometrist had gotten (+2.50 -3.50 x 095) and I could see 20/30 again.  He thinks that there must have been some hidden astigmatism in the lens/cornea interface that was self-correcting.  The pre- and post-surgery measurements look at the surface/thickness of the retina (mine is normal) and the surface/thickness of the cornea (also normal for a LASIK patient).  There was no indication that this astigmatism was going to appear when the lens was removed.  He likely would have selected a very similar lens and had the same result had he done the surgery.

There is a machine that can measure the lens/cornea interface, but he is not aware of any in Central Oregon.  It is likely that this feature is also present in the left eye as well.

His advice is to wait.  When the refraction becomes stable, he advises to do a lens change using a Toric lens to correct the astigmatism.


Do you have any advice?  What is the recovery like in terms of being able to see and resume normal activities following a lens replacement?  What is the name of the machine that can detect abnormalities in the lens prior to surgery?  How do I find one?

Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
I would strongly suggest you discuss this with the surgeon and have an "end point refraction done"  It is important to know what your vision corrects to with lens and how strong those lens are.

If your vision does not come up with a refraction your problem may not be the IOL power but something like cystoid macular edema.

I would also strongly suggest that you get a 2nd and 3rd opinion not from an optometrist or the surgeon but from different Eye MD ophthalmologists cataract surgeons.

JCH MD
Helpful - 0
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