Thank You, Jodie. Yes, I was beginning to think I was crazy. I truly did. Every single thing I mentioned to the first surgeon and his Techs, I was told was very normal. It was not normal. How some lasix eye doctors can do this to a patient is beyond me. What is wrong with picking up a phone and calling the patient when he and his partner have been informed of a potential problem. I needed help.
I still cannot thread a needle or read clearly. But, I am thankful for Doctor No. 2 and Doctor No. 3. God Bless Them. Have a beautiful Sunday.
I'm so glad to know that you have finally found a competent and caring doctor after your miserable experience. I'd hate for you to be left with the impression that the rude, defensive, and irresponsible attitude/behavior of your original surgeon is the norm for patient care. I hope things go well for you from now on.
Thanks so much for the well wishes. I wish them back to you also. I am such a novice when it comes to eye terminology. The Retina specialist called me today. Can you believe and on a Saturday. He wants the right cataract removed as soon as I get over the heart woes and then he wants to see me 2 weeks after I have the rt. cataract removed. They are still concerend that i may have a tiny tear in the retina along with the PVD. If I had known or been told by the original Lasix doctor about all the post op problems that could occur, I would never of thought of having any type of eye surgery. Sress over all these mishaps can be a killer. The retina doctor said there was a bad communication problem with my first eye doctor. He should of been forthcoming and upfront with me. He was not. Wishing you three ladies "good eyesight".
Jodie, I'm glad that you were so pleased with your cataract surgery and that your retinal surgery had some positive results. I hope that, one day soon, you will come across a solution to the image size difference and also some comfortable bifocal contacts for intermediate vision. I really admire the way you have gone about finding solutions to the extent possible, and so generously help other people find them as well.
Having been severely myopic since the age of 9, I have never dreamed of trying to find my car without glasses or contacts! (I probably would have climbed into someone else's car and sat on their lap.) I'm certainly looking forward to acquiring this capability.
My very sincere thanks and best wishes to you, Jodie.
texas2step, I'm glad you are finding better medical advice for your eyes but sorry about your heart problems. Good luck to you too.
Hello ladies, I wrote some time back about my post op cataract problems, and how the door was close on me by the surgeons after my one month, post op visit.
I found another doctor and he was very kind and felt badly for me as he DX me with Large Posterior Vitreous detachment. He gave me the name of a retina/vitreous doctor and also called him. Hubby and I went there. He confirmed the detachment and felt my frustration and sadness. He offered me surgery and told me to think about it as this could go away in months or a few years. (Second eye doctor said the same thing) I was so out of it in his office that I never asked what he would do. But, I have to say that the second and third eye doctors were God Like. They both treated us well. So unlike the first place that never told me I had this. Just wanted to update you ladies. Thanks for listening. It has been a very stressful month. I had two severe angina attacks over this that landed me in the ER room. I go for a heart cath on Monday. Vision problems can take the best out of a person. Good Luck to both of you.
In an email, Dr. Charles (retinal surgeon in Memphis) suggested that a second procedure involving ILM peeling might eliminate my image size difference. I consulted a couple of top retinal surgeons about it last year, both of whom advised against it. (Both seemed dismayed that I could read the 20/20 line post retinal surgery, yet I STILL wasn't happy.) So I'm not thinking of doing anything else. I wear the aniseikonia correction prescribed for me online by Dr. de Wit of the Netherlands (contact lens over glasses to decrease the image size in my affected eye). I haven't been wearing my bifocal contacts much lately; they're not that comfortable and I miss having intermediate vision.
Before cataract surgery, I was so nearsighted that I couldn't find my car without contacts/glasses, Now I can actually drive it. I hope you'll be as pleased with the results of your cataract surgery as I am. And your retinal surgery should sharpen your vision considerably.
What you say makes a lot of sense, as usual. Thank-you, Jodie. I'll just try to think positive now.
Do you mind if I ask whether you are finished now with medical procedures for your eyes? Other than really missing monvision for near/intermediate vision, are you doing well with your eyes and your vision? I sure hope so.
What type of vision correction would work best probably depends on lifestyle and what someone's used to having. In all honesty, I don't think I'd be satisfied with any single focus. Something like -1.0 to -1.25 would give you good intermediate vision and some reading ability. But you'd need glasses for many activities, including driving, reading the overhead signs at the supermaket, seeing what they're ringing up on the register, etc. Maybe your best bet would be to stagger the power slightly, as your doctor suggested. But as I said before, even if your post-surgery vision isn't ideal, it's almost certainly going to be an improvement over what you have now.
Thank-you very much, Jodie. I really would like to have monvision too. From wearing monovision contacts, I know the power difference is ok for me but I'm sure you're right about the advantage of allowing my left eye to compensate for the right. The cataract surgeon must have been thinking of the same thing when he said before that the most he would recommend would be to stagger the power slightly.
Do you think you would have found something like -1.0 or -1.5 in both eyes more satisfactory - for more near/intermediate vision?
I hope that Dr. Hagan reads older threads--he's in a better position to address your questions than I am.
1) Bulging eyes??? I've never heard of this, and I've never known (or noticed) anyone who had it.
2) I think the issue of which correction would work best for you is something you should discuss with your cataract surgeon. (It might help to get input from your retinal surgeon, too.) My target for cataract surgery was -.5D, but I ended up plano. Having both eyes plano is great for driving, watching movies in the theater, and spectator sports. Otherwise, the loss of near/intermediate vision drives me crazy, and I almost always wear my progressive glasses or (sometimes) bifocal contacts. (I do have a friend who also has both eyes plano, and he wears his drug store readers less than 5% of the time.) I don't think I'd be much happier with both eyes at .5D, though. It's been three years now, but I still miss my monovision contacts.
3) I think that astigmatism between 1.5D to 2.0D would significantly affect your vision at all distances. Your cataract surgeon can advise you about this.
4) One of the aspheric lens models--I think it's the Bausch & Lomb Sofport (sp?)--is supposed to work well even if its slightly off-center and/or tilted. The patient education video at tecnisiol dot com suggests that aspheric IOLs are the best technical innovation since sliced bread. However, the few independent studies that I could find comparing conventional vs. aspheric lenses told a different story. Most people who had a different type lens in each eye couldn't tell the difference. And among those who claimed they could perceive a difference in their vision, more people preferred the conventional lens! I've heard that aspheric lenses are better at reducing glare, but who knows? Your cataract surgeon will recommend what s/he feels would work best for you.
I really appreciate your encouragement, Jodie, and the information about compensation by a good eye. It's very kind and generous of you to take the time to send me these messages. As you probably can tell, I'm trying to be calm and logical but am feeling quite anxious and uncertain. It must be the same for many of the people who post on this site. - trying to make decisions about such a small part of our anatomy, that affects our ability to function so much. If you have any further thoughts at any time, I appreciate them more than you know.
I feel that I shouldn't impose on you so much, but wondered if I could ask you some more questions. If you don't have time to answer, or not right away, I understand completely.
1. Do spherical lenses show in any way or make your eyes bulge out? I know this is a funny question but an article I read said that aspheric lenses (which are flattened on the top I think) are better for cosmetic reasons.
2. For compensation by the good eye to work, do you think I should ask the doctor about correcting both eyes to plano? Or would correcting both to -.5 be a good goal as it would allow some intermediate vision as well as this compensation? I know the amount of correction is not precisely predictable in any event - which might be another reason to aim for the same for both eyes - although I wouldn't want the poorer right eye to accidentally end up stronger.
3. With spherical lenses, is it possible that I might not need LRI to correct astigmatism of -1.5 to -.2 D? I think I recall Dr. Hagan saying that up to 1 D of astigmatism could be corrected just by the way the lens incision is made - which might leave me with quite a small amount. Also, an article mentioned that, to get the benefit of aspheric lenses, astigmatism correction must be precise, from which I'm inferring that it doesn't need to be as precise for spherical lenses. It would be nice to avoid LRI because another article mentioned that they can cause dryness which I already have from mild pterigia.
4. I'm also thinking that conventional spherical lenses might be better for me because they don't need to be centred and tilted quite as precisely as toric and aspheric lenses - so subsequent surgeries would be less likely to affect them. Does this make sense to you?
Thanks so much, Jodie. I'll talk about these things with the cataract surgeon of course but think it will help both him and me if I know a little more before I see him.
I have another thought about about your targeting a modified monovision correction with IOLs; then I promise to stop overwhelming you with additional information. At this point in time, it's unknown what your vision will be like post retinal surgery. (The literature says that vision generally improves by about two lines on the eye chart, although the affected eye may always have some residual distortion.) By chosing (modified) monovision, you would not have the benefit of letting your "good" eye compensate for any impairment in vision in your affected eye. (This ability to compensate is the advantage of having both eyes corrected to the same target.) This is something that you might want to discuss with your doctors before making a decision.
I've had several eye problems, too; learning about them is how I acquired my technical vocabulary. I hope your cataract surgery goes as well as mine did. My results exceeded my expectations; not being myopic has really been an (unanticipated) gift. Best wishes.
Jodie, thank-you for your message and comprehensive information. I'm happy too that your references were not censored.
My retinal surgeon did say that he would remove the ILM. I think this reduces the chances of recurrence of the ERM. If it might also correct the aniseikonia, that would be a a real bonus.
I'll try to see a pediatric/strabismus ophthamologist - hopefully they can fit me in before the cataract surgery. I also wore contact lenses with monovision (until recently developing pterigia - which is why the cataract surgery is being done first) so it would be good to rule out other causes such as phoria. (I may have eye problems but my vocabulary is increasing by leaps and bounds.)
Aniseikonia secondary to an ERM is described in the medical literature as a "not uncommon" problem. It's been hypothesized that the wrinkling of the macula changes the photoreceptor distribution, thereby altering the image size in the affected eye. Surgery to peel the ERM doesn't necessarily fix the image size problem or the associated symptoms (e.g., headaches, double vision, etc.). Through email correspondence, Dr. Steve Charles (a retinal surgeon in Memphis, TN) suggested to me that peeling the ILM during ERM surgery might be beneficial in that regard. If you have an image size disparity before surgery, I'd strongly advise you to discuss this with your retinal specialist. Dr. Charles is well-known nationally, and I'm sure that he'd be willing to communicate with your doctor about the potential value of including an ILM peeling in your procedure. (BTW, few retinal surgeons relate to the term "aniseikonia"; they seem to have their own vocabulary. But if you describe the image size problem, they'll understand.)
Dr. Gerard de Wit of the Netherlands is (at least in my opinion) a world authority on retinally-induced aniseikonia. His website at opticaldiagnostics dot com contains lots of info about this condition and its treatment with corrective lenses. There's also an aniseikonia support group on yahoo with good info.
My double vision happened before I developed the ERM. It was caused by the breakdown of a phoria secondary to monovision contact lens wear, so I didn't want to risk even modified monovision post cataract surgery. It might actually be a good idea for you to determine the cause of your double vision before you have cataract surgery; you'd have to see a pediatric/strabismus ophthalmologist. (It's probably, but not certainly, related to the ERM.)
I hope my references don't get censored; this website discourages links to other sources of info. If they do get deleted or you have other questions, send me a personal message.
Thank-you, Jodie. What you say confirms what I've been thinking in the last few days - that I should ask my surgeon about a conventional lens.
I hope you don't mind if I ask you also about the aniseikonia that you had after your ERM surgery. I've been trying to research this and other matters in posts on this site and also on Google but don't have your great ability to distill the (often contradictory) information into practical conclusions. Also, I think the matters you've had to deal with are very similar to mine.
I think my right eye has retinally-induced aniseikonia from an ERM (smaller image, double vision). I'm hoping that this will be at least partly corrected by an ERM peel that will likely be done a few months after the cataract surgery. Do you think it's ok to just ignore the aniseikonia for now?
However, in the cataract surgery, should I aim for plano for both eyes because of the aniseikonia - rather than the slight weakening (-.5 and -.75) I'm considering to preserve some intermediate vision? (I think you said that you requested plano for both eyes because of double vision and eye muscle problems but am not sure whether this was double vision related to your aniseikonia.)
Thanks for your cheerful prediction too, Jodie. I'm sure you're right about freedom from high myopia. I can't imagine being able to wake up and see without correction. Even if my vision is not perfect it's bound to be better than the coke-bottle glasses I've been wearing for 3 months.
You definitely don't sound like a candidate for the Acrysof toric lens. And although the aspheric lens represents the latest technology in monofocal IOLs, the few independent studies I uncovered failed to demonstrate the benefits of an aspheric lens over a conventional one. Instead, they showed that most people who have a conventional lens in one eye and an aspheric in the other eye can't tell the difference. I predict that you'll be very pleased with your surgery results with either; it's really great not to be burdened with high myopia.
Jodie, thank-you again for your very helpful response. I'm about -8 and -12 D so am not sure why the cataract surgeon would be recommending the toric lens. I'll ask him about this.
Naoye, as far as I can determine, Alcon's Acrysof toric iol is still only available in a limited spherical power range (16.0 D to 25.0 D). If you are very myopic and wanting to correct your vision for distance, it is extremely unlikely that anything in this range would work for you. So you might not even be a candidate for the toric lens. (For comparison, I was about -6.75 D and needed a 14.0 D lens--lower numbers correct more myopia.)
Laura4, according to Alcon's toric power calculator, the 1.50 D toric model is supposed to be appropriate for eliminating between .75D and 1.50D of astigmatism. So I guess you were in the range (but barely).
In early April, I'll see with my cataract surgeon to decide on the type of lens. I would like to ask you a few more questions, if you have time to consider them.
Just to summarize things I've already mentioned:
My prescription is high, pupils are small and astigmatism in my left eye is -1.5 and in my right eye is between -1.5 and -2. I won't be able to wear contact lenses afterwards because of pterygia. Lately, I've been seeing more distortion and a smaller image in my R eye with some double vision - but hopefully this will be improved with an ERM peel after the cataract surgery.
My cataract surgeon has recommended a toric lens because it would correct the astigmatism without LRI and without wearing glasses all the time. He says he has implanted many of them since last year. However, he'd probably be quite willing to use another lens as he says I'm borderline.
In a 2007 post, Jodie mentioned that the aspheric lenses work better with larger pupils and that they improve contrast sensitivity and distance vision. She also mentioned that near and intermediate vision are not as good as with a conventional lens but that was not important to her because she planned to wear multi-focal contacts post-surgery.
Here are my questions:
- Because of my small pupils and inability to wear contacts, do you think I would be better with just a conventional lens rather than an aspheric one?
- With either an aspheric or a conventional lens, I would have LRI or wear glasses all the time. Would LRI be risky for me because of a previous HSV infection?
- If I did get a toric lens, would my small pupils make me less prone to dysphotopsia?
- On the other hand, would my high prescription or other factors make me more prone to it?
- Are there any particular questions I should ask my cataract surgeon?
Thanks very much for reading this long post and for considering my questions.
.8 D of astigmatism is very little, and it could have been corrected with a limbal relaxing incision, as Dr. Hagan stated. My technical knowledge about toric lenses is limited, but I remember reading an article someplace about determining which toric lens to use. I'll try to find it again. Would it be possible to safely explant your toric lens?
The only reason given for both the negative and positive dysphotopsia is the usual answer - it can sometimes happen.
I hope I am understanding the technology of these Toric lenses. I believe there are 3 models in 3 different powers. Mine was the lowest, an SN60T3. If Dr. Hagan is correct, and it's not possible to do more adjustment of the power from the 1.5 of my model than it would be true that I would not medically have been a candidate for even the lowest power Toric. But I still am not sure of my technical understanding. I was also told that a 1.5 would adjust back to a 1.0. Even so, that's crazy if I only had .80 to begin with.