Iol exchange after cataract surgery miscalculation

Eye care
1

I’m a previous lasik patient.  (2001 corrected far vision). I had cataract surgery in right eye 12/23/2017  and left eye the following week. Immediately the right eye was a problem, and we continued on with second procedure because the dr said he knew what to do to correct the issue.

I had iol exchange 4/26/2018 in right eye. Yesterday I had my 2 week follow up. I am currently on durezol steroid drop and over the counter dry eye drops. There is still daily fluctuations and I am not reading 20/20  more like 20/40 and blurry. Lasik enhancement has always been a follow up option. 

During exchange  surgery, which took much longer than expected, my cornea started to dry out, removal of iol was difficult. I could see all the tools needed ( and started to feel fearful of pain as I could start to feel pressure). The Ora machine was used and once again calculations were off. Luckily the dr marked where the toric lens was previously placed in the eye, because the Ora was giving him a new markings that didn’t make sense. He stepped away from the table to consult my chart and decided to go up 1.5 instead of what we thought was a solid 1.0. Previous iol: restor multifocal toric 20.5D 1.5 cyl +2.5 add power new iol: restor multifocal toric 22.0D 1.5 cyl 2.5 add power

During yesterday’s follow up dr said yag would be our next procedure as cloudiness on back of lens is forming. Again, this was expected due to now my 3rd operation in that eye. Yag will be done @ 3 month mark then we will consult with lasik or PRK to tune in @ 2 weeks following yag. Also eye pressure was 25 when normally 12 -13 dr said that’s from the durezol. 

When I inquired about the left eye 20/50 (which now has 1.25 astigmatism) dr said he’d rather see me have lasik to correct because the iol exchange was so tramatic. 

My personal opinion here and still some raw emotions: 3 months from now I will be consulting yet another opinion on iol exchange in left eye. There is no reason to have that large of astigmatism after surgery when I had zero before. @.50 astigmatism is calculated for such a surgery. Also, my second opinion showed a “ mild tilt” in the lens position. And I believe that was caused during a horrific reaction to stepping down dosage from pregnozone drops. The change to durezol drops has cured that problem for now. My hopes are that the astigmatism and visual accuracy will be restored with lasik or PRK and not another iol exchange. But if an iol exchange is needed, I will go to another dr with much more experience and confidence. 

My dr has experience in cataract surgery, but has done very few exchanges. 

I am able to write this review without glasses, but things are not clear. Also where I once had a depth perception issue, that seems to be resolved. ( I get on and off a boat daily, and that has been a challenge seeing how far away I have to step, luckily the preception was things were farther away and I didn’t stub a toe. Haha) . I return to the dr in one month and hopefully things in right eye will settle down and 20/20 vision will appear. Unfortunately it’s just too early to tell how close I will be at this point in time. But it’s a lot better than what I had 

I’m grateful for the exchange, but obviously had hoped for a clearer outcome. I’m also grateful for not having any residual pain other than a few days of tenderness at the incision. 

I hope my results are able to help the next generation of surgeons and previous lasik patients in finding the correct lens the first time. 

2

I had cataract surgery on both eyes in the last 6 weeks,I ended up having cloudiness on the back of the lens.Schedule to have the lens cleaned by laser on June 9th. hopefully it does the truck without other complications.

Has for my left eye the surgery /lens implant left me with a black shadow in the corner of my eye ,very annoying,The Dr. claims it should go away in 4 mounts.I also get flashes when moving my head in the dark,like you had turned a switch on and off.plus I on my last follow up when he schedule me for the laser  on my right eye ,he tells me the left lens is also cloudy.I think if I would have foreseen the future regarding this surgery/lens implants,I would have stuck the blurred vision and left the cataracts alone. 

3

Multifocals are problematic in everyone's eye, probably more so in people who had Lasik.

4

I had Lasik and have 2 monofocals set for distance and hardly ever need glasses, except for reading tiny print or an entire book. Multifocals and other premium IOLs like the Symfony lens (and trifocals) are risky and don't guarantee any better vision than what I have with standard, non-toric monofocals set for distance.

5

And I have read about quite a few cases of people with standard non-toric monofocals set for distance who don't need glasses ever, not even to read tiny print.

6

Once you have cataracts that have progressed to the point where your vision can no longer be corrected with glasses or contact lenses there is no choice other than cataract surgery.  Alternative is to go blind.  Waiting till cataract is very dense makes the removal more difficult for surgeon.  So if vision can’t be corrected with glasses better than 20/40 one is facing cataract surgery.

7

And my vision is 20/20 in one eye and close to 20/20 in the other eye, so my distance and intermediate vision are also excellent. My first operated eye is the 20/20 eye and I could see fine basically at all distances even before I had my 2nd eye surgery. I only needed over the counter mild readers for very small print right after my first surgery (and that improved over time). I drove to the doctor the day after my first surgery and could see my car's speedometer and the rest of my dashboard perfectly with no glasses (it was crystal clear).

8

That is quite an ordeal.  Makes one think twice about IOL exchanges.  Fonhope after all this you will end up with better vision Julielyn.

As far as surgeons go I really don’t think they have anything to gain by really informing patients who want lasik or PRK of the risks and possible other complications down the road when their near sight needs correcting or they get cataracts.

Best wishes to you.

9

And I didn't have ORA either, another waste of money in my opinion (but if someone's doctor included it in the fee and insurance covered it, I would do it).

10

And my doctor isn't the one who said people who had Lasik shouldn't get premium lenses (he would have happily took my money for premium lenses). That was from my own research, although I think the risk of complications from premium lenses is probably equal in people who had Lasik and people who didn't have Lasik (or other refractive surgery).

11

And for anyone reading this who's considering getting Lasik, PRK, Smile or any other refractive eye surgery, if I could do it over, I wouldn't get Lasik again or have any other refractive surgery. The risk of serious, irreversible complications is not worth it.

12

Andi77, could you start your own discussion about your concerns. Thanks 

13

Thanks sue an. I’ll keep you posted 

14

Thank you for sharing your valuable experience and knowledge on this very technical subject matter. Appreciate it very much especially when you ought to be resting imho. Your right eye will settle down to 20/20 or even better.

God bless.

15

Sue.An, I learn a lot from reading your replies. Are you in the medical field?

During julielyn's IOL exchange surgery, "Ora machine was used and once again calculations were off. "

A study done in early 2017 found that "the absolute error was statistically smaller in those eyes where the ORA and IOLMaster recommended the same IOL power based on preoperative target refraction, compared to instances in which IOL selection was based on ORA or IOLMaster alone."

Thus, if the eye surgeon uses both the ORA and the IOLMaster to obtain the IOL power, he is more likely to achieve his preoperative target refraction.  This could be an interesting outcome of the postoperative refractive results.

Apparently, cataract surgeons have a number of formulas used to decide the IOL power, and they disagree on which one with how many variables usw.

 

16

If anyone wants info on my experience you can write to me privately since I generally don't follow these discussions.

17

No not in medical field at all.  In banking field.  I read a lot though.  Especially if I am faced with something or a friend or family member is.  There is lots of good info on the Internet.  I used to blindly (pardon the pun) accept whatever a doctor would  say but it is always a good idea to read up on whatever you are going through so that you can ask informed questions.  Medicine I have found isn’t so black and white and with so many side affects to drugs these days I prefer to deal with minor issues naturally vs popping a pill for everything.   Although some take even that too far and in doing so harm themselves and others.

I live in a smaller province in Canada.  Our hospital does yet have the latest of equipment like ORA.  I did have a surgeon with lots of experience though and I had never had lasik or PRK done.

18

I’m not sure which calculation machine was used in the office before surgery, if it was the iol master or not. I’ll have to double check my charts. Either way nothing is absolute in the medical field. My second opinion dr while reviewing my chart from first surgery stated “ he did the best he could” referring to the first surgery with the calculations given. Again, I am not placing blame or complaining. Simply passing on my experience and my opinion of what I would like to do in the future. I do not regret my decisions nor am I in fear of what could have happened. There are risks to every medical procedure. 

19

Hi Julielyn, I've been following your journey since I first joined these pages. You responded to me right after my first post. I live in Michigan, and also had Lasik. My first eye after cataract surgery settled at 20/40, and this is my dominant eye so I'm not real happy with these results, as I have to wear glasses to get that crisp clear vision I want. The second eye is 20/20 but the posterior capsule tore during surgery. My cataract were posterior polar cataracts and the biggest risk when removing this type of rare cataract is the risk of capsule tear. I'm seeing a retina specialist regularly now until they feel comfortable that I'm 'out of the woods' I guess. Going back to the right eye (dominant eye) the reason I settled at 20/40 is due to Lasik 22 years ago. Even though I did provide my pre Lasik numbers. I don't blame the doctor either. I'm grateful to have my vision but I still do NOT want to wear glasses. I hope I can either wear a contact in that eye, but I'm reading that its hard to wear contacts after Lasik because of the change in the shape of the cornea. 

I go back on the 21st to for my 4 week post op on the second eye and plan on discussing options with my doctor then.

Keep us posted on your developments. As I mentioned before, cataract surgery and its results are not the same for everyone.

 

20

Thank you for your information.  I am sorry it wasn't an easier procedure.  I am considering have a lens exchange in my right eye.

Has anyone else had a lens exchange...hopefully successfully?