Need advice. Blurry vision since cataract surgery 5 months ago.

Eye care
1

I really hope someone can help me because I don’t know what to do any more. I am exhausted, frustrated and not getting any cooperation/answers from my doctor/surgeon. I’ve had blurry vision in my left eye (OS) for five months since my surgery — it is worse than before the surgery.

My doctor’s office never gave me a follow up appointment other than the morning after my surgery. While I was communicating my vision concerns to them via their Health Portal (because nobody answers the phone) that something was wrong and I needed an appointment, the nurse said Dr. So and So said to just keep using the artificial tears. I said I’ve been doing that 4X/a day and it’s not helping. I also have eye pain and burning. I finally got an appointment with the doctor after 5 weeks post op. He looked at my eye and said I needed YAG laser procedure. He didn’t dilate my eyes. Just looked at them through his machines. I said will that help my vision? He said yes.

I had the YAG 9-weeks post cataract surgery. It did nothing for my blurry vision in fact made it worse because of the inflammation it caused. The only thing I noticed is that a film was lifted from my eye.

So after that I was in excruciating pain and contacted the office via the portal from you know where. They said to come back in a week. The doctor looked at my eyes (no dilation) and said I had inflammation. Gave me steroid drops. I took those for a month and scheduled an appointment with another doctor at the same clinic because I was not getting anywhere with this guy. My eye was burning, in pain and photophobia, etc. on top of the fact that I couldn’t see because of the now even worse blurry vision. This doctor diagnosed me with Iritis. More steroid drops and some dilation drops for burning/pain. I asked him why my vision was still blurry and he said he had no idea since he didn’t do my surgery. Then he dismissed me at my last appointment at my one month follow up and said there’s nothing more he could do and was referring me to a neuro-opthalmologist.

I didn’t really think I’d get an objective opinion from another doctor at the same clinic but I was extremely worried about my eye. After I was dismissed from the last doctor, I thought I could get an objective second opinion yesterday at a totally different clinic/doctor. But no. He said he couldn’t do anything because he didn’t do my surgery. But he could do laser surgery on my eye if I wanted it. He was totally rude and dismissive.

My suspicion from day one is that my surgeon gave me the wrong prescription for my lens. But I have no idea how to find out. I asked him point blank if that was possible and he said absolutely not. In the meantime, I was never told or given literature on what type of standard monofocal lens he was going to use. He also will not release the reasoning behind why I was approved for cataract surgery. I asked and they (the nurse) emailed me – it was a combination of your vision/glare testing and one other test I forget the name. My vision in that eye was 20/20. But I had really bad glare/halos when driving during the day and night which made my overall vision numbers worse. I wasn’t complaining about having surgery. I just wanted to understand the facts or what did they submit to insurance?

They also won’t tell me what formula the doctor used to arrive at my prescription for my IOL. I am convinced that the prescription is wrong because nothing else is wrong with that eye based on all of the tests. So far I have gone to 3 ophthalmologists (including the surgeon) for eye exams. Nothing wrong except inflammation and of course my vision is now approximately 20/80. What is the big secret about determining cataract approval? And why would he not give me information on what formula/method he used to arrive at the lens prescription?

Does anybody know if it’s possible to determine if the wrong prescription lens was implanted?

I saw some paperwork AFTER my surgery with the word Lenstar. And, the lens he used is Tecnis Eyhance monofocal. That was on the surgical notes paperwork from the surgery center because it was not in my file with this doctor.

Here’s an excerpt from the Tecnis Eyhance literature:

*Prior to surgery, the surgeon must inform prospective patients of the possible risks and benefits associated with the use of this device and provide a copy of the patient information brochure to the patient.

Some autorefractors utilize only the central part of the IOL to calculate the refraction of the eye and that is the region where the TECNIS EyhanceTM deviates from the monofocal design which could result in a wrong estimation of the refraction. Manual refraction with maximum plus technique is strongly recommended."

Okay I’m not a doctor but I’ve had to learn more in the past 5 months than any person would care to — especially with one bum, blurry, burning left eye and the other eagerly awaiting its own cataract surgery which sadly won’t be any time soon.

Are most patients told which specific lens the doctor is going to use as well as the vision expectations in numbers? I was only told by my surgeon that my distance vision would be corrected and I’d keep using my reading glasses. I was good with that. Well I’m not good now.

Sorry for this long posting. I didn’t know how to shorten it without leaving off important facts. If anyone could offer advice I would greatly appreciate it. I really just want to understand what happened. But I’m hitting road blocks all along the way. Which makes me even more suspicious. Thank you!

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"Does anybody know if it's possible to determine if the wrong prescription lens was implanted?" . Yes, all you need is a phoropter test and an eyeglass prescription. That will tell you what correction is needed to bring your vision back to plano. . What country are you in? For US and Canada there have been court decisions that determined that medical data belongs to the patient, and they have to give it to you. You may have to ask for it in writing, and pay their out of pocket costs to produce it, but that is usually the cost of a mouse click and a few sheets of paper. . They are obligated to give you a credit card piece of paper that documents what lens was used in your eye, the serial number, and the power of the lens. That should be given to you when you exit the surgery. The card comes with the lens they implanted.

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I am sorry for what you are going through. If you are in the USA, I would go to your cataract surgeon and request a complete copy of your medical record. Per the HIPPA law,, they must comply. I would then try find a cataract surgeon at a nearby medical school who will read your record, examine your eyes, and hopefully advise you. I know you are worried, frustrated, and tired of seeing doctors. But you need to do it. I wish you well.

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To clarify they said you were 20/20 before surgery but had glare? And you had a cataract as well? . Also did you ever visit an optometrist after the surgery? And will glasses correct you to 20/20? . It does sound like there may be something else going on other than the IOL or the IOL power. I wonder if a cornea specialist or retina specialist might have more insights?

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Normally you would have been supplied with compound drops that include steroid and antibiotic.

At this point I suggest you get your eyes tested by an optometrist, just as if you were being fitted with glasses. Ask for the prescription in writing. A prescription will have 3 numbers for each eye.

I have no insight as to your more complex questions.

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It would help if we knew where you were located. If you're anywhere near one of the top eye hospitals, that's where I'd try to get an appointment.

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That's great information. Thank you Ron. I'm in the US. I have all of my medical files because I requested them in writing from their outside records company. However, they neglected to include lens information that the doctor used to decide upon my prescription. And other pieces of info that were not in my records.

And yes, i did get a card AFTER my surgery telling me which model lens was inserted, serial number etc. It would have been preferable to have had that BEFORE my surgery. I went in blindly (no pun intended) for this surgery without any detailed information. Thanks for your help!

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You're very kind thank you Lynda. I am in the USA and did get my records (or at least the ones I know about) however there is missing information that I believe the surgeon doesn't want to disclose. I am not too far (albeit several hours driving) from top eye medical facilities but I am going to fly to see a doctor next week who previously worked at the Mayo Clinic and has his own practice now. Thank you for your help!

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Yes that's correct David. No, I didn't see an optometrist. I was supposed to have a 1 month follow up with my cataract surgeon but they dropped the ball and didn't schedule me. Then I couldn't get in until 5 weeks post surgery.

I went to a different ophthalmologist at another clinic a few days ago and he said my cornea and retina looked fine although I have inflammation. Then he patronizingly said there's nothing wrong that I can see. And since he didn't do my surgery he couldn't comment.

I'm pretty sure my vision can be corrected, however I want to know what is going on with my eye before I correct it. If there is an incorrect IOL in there I'm not real happy about it. It's totally irritating my eye and also making my chronic migraines even more frequent because I have blurry vision and a cataract in the other eye. Sorry, that's more information than you need :) Thank you for your input!

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Thanks Trilemma. I did do all of the compound eye drops pre and post surgery for 3 weeks. I am not going to a optometrist at this point unless my new 4th doctor recommends it. But I appreciate your suggestions.

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Thanks Bookwoman. I am in the Southeast USA. I was going to go to Wills Eye in Philadelphia but decided it was easier to fly to a Mayo Clinic doctor in Florida.

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The most important information you are missing at this point is the refraction (eyeglass prescription) at 5+ weeks after surgery. That tells you where you have ended up compared to the distance vision (0.0 sphere, 0.0 Cylinder) that you were targeted to get. It is best to get this refraction from an optometrist that is financially independent from the surgeon that put the lens in.

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It is best to get this refraction from an optometrist that is financially independent from the surgeon that put the lens in.

Yes. Lay out the $60 for a good cause.

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I hope the Mayo Clinic can help. you. Let the forum know what they tell you. BTW, since you're in the Southeast. the Bascom Palmer Eye Institute in Miami, FL is one of the world's best.

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You really should go see an optometrist. Any place will do… Costco, a glasses place in the mall, whatever. You don't need a referral of course just to get a glasses prescription. This could tell you a lot. If the issue is simply a missed target and not something more serious they can figure that out.

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thanks Ron --- The doctor/surgeon never discussed targeted vision with me or what he had hoped to achieve. He simply said my distance vision will be corrected with that monofocal lens and I will need to continue w/reading glasses. There was some vision test numbers from my pre-cataract appt with him but he never said what they meant. I just obtained them from my online portal account.

They only checked my vision the morning after my surgery and said your eye is healing well.

I am going to get all of this information when I see the Mayo doctor next week. He is objective and an excellent background. And he has all of my medical records.

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Thanks Lynda --- I will definitely keep everyone posted. If I don't get enough answers next week, I'll keep heading south to Miami ;)

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Besides a current eyeglass prescription the next most important document you need to see is called the IOL Calculation sheet. It documents the eye measurements, the intended target and the expected outcome with the lens power they use. Your can find an example of this data sheet by googling this: . IOLMaster 700 Quick Guide Printing Functions EN PDF . See page 5 of this document for an example of an IOL Calculation sheet. If you look at the right hand side for the OS (left) eye, you will see a Target ref of "Plano". That means a target of 0.00 D, or in plain words, Distance, as you were told. Then near the bottom are some potential lens powers that could be used to achieve plano. Two different formulas are being used to calculate what each power would do. One is the commonly used Barrett Universal II formula and the other the Barrett TK formula. They give different results and the surgeon has to decide which formula to believe and use. If we stick with the Barrett Universal the eye in this example is predicted to achieve a refraction (Ref D) of -0.05 D with a +11.75 D. Most surgeons in this situation would likely choose the +12.00 D lens with a predicted outcome of -0.22 D, or very slight myopia. This is to reduce the risk of going positive or far sighted. . If you had this sheet from your surgeon you can use the power on the card you got for the lens to see what was predicted as the outcome for that lens power. And, if you get an optometrist refraction (eyeglass prescription) you can compare what you got to what was predicted. If there was a significant miss, and that can happen, it would explain your less than crisp vision. . If there was a miss, all of this information is very important as it would determine what adjustments may be necessary to get an accurate outcome with the second eye. The other use of this document would be for your new surgeon to compare the eye measurements in the upper half to what they get when they measure your eyes. Some reasons for a "miss": . 1. Incorrect eye measurement 2. Less than ideal formula used 3. Simple mix up where the wrong power was inadvertently used. . Keep in mind that this IOL Calculation sheet will be in your surgeon's computer, and may or may not be included in your "medical records". You may have to request it in writing to get it. . Hope that helps some,

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You are so smart Ron. That is such helpful information. It really helps me understand everything a whole lot more. Now trying to get my doctor to release his sheet but I know he has to by law. So I guess I will first try going through their Health Portal. That should be interesting.

I thank you very much and will let you and everyone know how it goes. I really appreciate it.

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One more thing, is that was is called a Manifest Refraction? My file has numbers in two areas. One says Manifest Refraction and the other Manifest Refraction #2 (Auto).

I'm just wondering if they do the IOL calculations manually and also with a computer program. Or just solely a computer?

I also don't understand how they determine approval for cataract surgery. The nurse told me they include glare testing and I believe keratometry. The glare testing brought my 20/20 vision in my left eye to 20/80. This was of course done prior to my surgery.