42 year old wife's Posterior subcapsular cataract (PSC) - Part II

Q5

I see some IOLs come with an injector. It looks like IOL exists rolled/folded inside the injector and it is injected inside the capsule and it opens up?

Are all IOLs inserted using an injector or lot of IOLs inserted manually?

I have no idea about the shapes, but all IOL that are used on the European marked are inserted with an injector.

Some manufacturers preload the injector, in other cases the surgeon must do it in his own injector, but in any case the lens is being injected through a 2mm hole, and then unfolds in the capsular bag.

I have seen that in India you can have a "budget" job done, where they make a bigger hole and do not use injectors, probably because the lens they are using is not capable of being squeezed so much, but this procedure will give you much longer recovery time, and more risk of complications.

Yes the square edge IOLs are more prone to positive dysphotopsia, but may help delay/prevent PCO. Round edge and silicone IOLs are best to avoid dysphotopsia, but have increased risk of PCO. There unfortunately is not one that does both. I don't know much about the haptics except that some may be better in the event you need to do a lens exchange.

I have some positive dysphotopsia (IOL flicker) with my Alcon square edge monofocal IOL. Hoping it will be gone in time with neuroadaptation - doctor seems to think so. And I also have trace PCO already not long after surgery.

To be honest to me all this sqare/round shape thing, and prevention of pco, sounds like "selling talk" where they try to come up with a selling point, that does not have that big impact in reality, it sounds a little too much like car dealer talk to me, but off course I have no clue about it.

But sorry to hear you got both problems.

My surgeon told me, that flickering of the lens is common, and it will go away in a few month, when the IOL settles in the capsular, this can take up to 6 month but usually quicker.

Another side effect could be light flickering when you see fluorescent light, and he said I should expect that too with the edof lens, but he also told me that in most cases it goes away within a few month.

He did say that I might need to change the lighting in my garage to LED instead of fluorescent lamps to not be disturbed when I work on motorcycles, and that is really no big deal for me.

I hope for you, your flickering goes away soon, you have taken the most safe choice in lenses, it is really not fair you should be having this problem.

I also have trace PCO already not long after surgery.

Deb does trace PCO mean that currently only your eye doc can see it or you notice it too in your vision?

Is that what YAG laser is used to clear? Are you going to do it as soon as possible or postpone it as long as possible?

...it sounds a little too much like car dealer talk to me, but off course I have no clue about it.

You mean like this description of one of the IOLs- "Active oxygen processing treatment and sharp optic edge to reduce PCO"

Well yes, i think we are being mislead to some extend by the manufacturers in general.

There are so much money involved, Denmark is a small country with a population of 6 million, and here more than 50.000 people gets cataracts surgery each year, so this is really big business worldwide.

And they all struggle to get that little bit of better marked share, just a 1% extra markedshare means millions of extra income.

And when big money gets involved, people always starts to lie, at least just a little bit... 😃

I have not noticed it. I heard the optometrist say "trace PCO" to the tech when she was doing my exam about a month after. I immediately inquired about it. She acted like it was no big deal. She said there was a good chance I was going to get it. She questioned why I was bothered. I said what if I ever need a lens exchange to which she replied your lens is fine. You won't need another one.

One doctor I saw for a consult had in fairly large print on the paperwork - 30% chance of PCO.

Yes YAG laser is used to clear it and I won't do it until/unless it affects my vision.

Good information. Thanks Christian!

I know a doc who told me that eye docs make really good money through cataract operations.

Haven't seen him yet. Appointment is on Wednesday.

I guess all surgeons have their own opinion about things.

But that bifocal is not new at all, it does have the same issues like the trifocals.

But side effects is different from person to person, yesterday I had the At Lara in my dominant eye, I am more than pleased with the result, I am happy I did not go for the monofocal.

But off course it is a personal choice 😃

About working out and stuff - sounds strange to me.

I have seen different surgeons, they say that you should wait at least one week with running and 2 weeks with weight lifting, and other heavy lifting.

On the other hand they say you can use your vision as much as you like, you can get tired in your head the first days, but it does not damage the eye.

Right now I am using my new vision for watching Tour de France, it works very well 😃

While second surgeon seems nice, some of things he said make me wonder if he is current.

I've never heard of a surgeon saying it's ok to do a yoga headstand the next day.My clinic is quite conservative -- I have their guidelines at home, so I may not be quoting exact, but no strenuous activity of any sort for two weeks, no lifting of anything heavier than 25 pounds for I think 3 weeks, and avoiding bending or inverting for a few days. At my clinic, when in the recovery area after surgery, I started to bend forward slightly to reach for the water cooler, and surgical assistant stopped me right away and got the water for me herself. My clinic agrees no concerns with watching TV or computers.I also do quite a bit of yoga, and will skip yoga for at least two weeks (even downward dog is inverted).Golf is not strenuous, but I will skip golf for two weeks -- to me, it's not worth the risk, even if the risk is small.

I don't think any leading surgeon is currently using Lentis multi-focals Lentis has had some very bad press, had to recall some of their IOLs, and have been facing lawsuits MPlus lens (this has been discussed by others in this forum).I've not heard of anything new from Lentis.

Different surgeons having different opinions unfortunately makes our decisions more difficult. I saw surgeons for and against mini/mono. Regarding recovery, go the conservative route. It can't hurt. I took it easy the first week, then slowly resumed treadmill and weight training. I got different recommendations from the same office - 2 days and 7 days. When the doctor said I was released after 2 days, I asked about weight training and she said no, wait a week for that lol.

Yes really weird regarding the second surgeon!

Just called the first surgeon's clinic to ask who will actually be operating, the highly experienced surgeon or the assistant surgeon. They said the assistant surgeon and the highly experienced surgeon will be assisting her!!!! Grrr!!!!

When I had made the appointment I was told the younger surgeon would take all the measurements and the highly experienced surgeon will then talk with us and then also operate.

When we met the assistant she did everything and we never got to see the surgeon! She kind of kept it bit ambiguous as to who would operate plus she was moving so fast that we did not have chance to gather our thoughts!

Here is a link (if post is not removed) where the bifocal you were offered are being testet up against other multifocus lenses.

personally, that would be a deal breaker for me. i wanted someone highly experienced doing my surgery...not a less experienced assistant.

Thanks for your update.

1. My surgeon said no heavy lifting or bending over for 1 week. Also no water immersion, although showering was okay. It was actually 6 days, because my follow up appointment was 6, not 7, days later. Didn't say anything about running but when I trotted to the car on day 1, my mother told me not to, which was a good point. I wouldn't recommend running for about a week, just based on how I felt, not on any scientific evidence. I took it easy anyway, although that was admittedly difficult because it was exciting to see so clearly and I'm a very active person. Sounds like she'll have some endorphin withdrawal by not exercising. By the way, that restriction includes no bearing down hard on a toilet...the idea is not to increase your intra-ocular pressure. So take appropriate measures, hehe! I did have to ask several times to get clear on the restrictions, because they do so many patients the instructions come out like autopilot. And asked specifically about activities like sailing...and he okay'ed my sailing as a passenger so as not to handle anything heavy. Also okay to road cycle, although I did so slowly without any hill climbs. After one week, there were zero restrictions, but my eye still felt a little sore...he said it takes 3 months for the tiny nerves to grow back so that's to be expected.

A friend who had her cataract done in Colombia had to stay there for a whole month, she was told she couldn't fly. Not the same easy restrictions I had...I think that doc was out of date, or used to caring for people who return to less than pristine conditions (more air pollution, unchlorinated water, etc).

The eye drops regimen is very important: definitely follow those. Mine were for five weeks. I set phone alarms to not forget them, and carried them everywhere but it was easy. No refrigeration required.

2. I had no computer restrictions either, but didn't feel like I wanted to stare at a screen. I wanted to look at the panoramas! Things will be very bright (although her cataract lifespan is relatively short, not like most of us who go years with them), so she might want some sunglasses. My instructions were to wear sunglasses for comfort, as needed. The IOLs are all UV blocking. And, she can get reading glasses right away...no reason why not. I bought some my second day, thinking I'd be doomed to using them all along, and now my multifocal eye doesn't need them. Brains are super plastic...hers will adjust no matter what, don't worry. And, the first few days will always be a bit weird...I realize that I didn't know that and so set myself up to be disappointed. Whatever she ends up seeing at the very beginning will be inferior to what she'll end up with. There's a deliciousness to it when it's new, and that's fun...but like new love, the romance will fade. The clarity will settle in as the new normal. I'm still amazed that I can see 20/20 into infinity and can birdwatch without binoculars to 20 meters, but it's less astounding than it was at first.

3. Well, my surgeon said he'd put the Tecnis multifocal lens I received into a two-year old because it has the widest focal range. He seems to understate the halo problems however, if I had to offer my opinion, but I'm still struggling with them a bit. Maybe if I were 2 my brain would disappear them faster! Can't comment on the lens you mention. If she's going to go monofocal, then I wouldn't stress about halos...very very small chance of having them. Just consider that she won't.

My mother is super happy with her monovision. Just an N of one...but admittedly some folks really do find it disturbing. When I tried to do monovision with contacts at age 45, suddenly without warning on a day I was driving on highways, with a difference of 2 diopters between eyes, I HATED it immediately...felt like NO depth perception, and so literally pulled the car over and switched which eye I was going to correct, so I had a difference of just 1 diopter and my dominant eye was set to far. That felt fine. Maybe if I'd stuck with the first arrangement, or had eased into it, it would have been better. Or, maybe the issue was the non-dominant eye being set to far, which is what has caused me so much stress this time too. Apparently dominance is super important to my body-mind.

4. The resident of course wants to operate; she is learning and needs cases. The fact that she's a bit shy about telling you exactly who is operating is not superb...but it's pretty typical. Think about how doctors protect each other in malpractice, etc....there's a bit of a culture of being careful of what you say around patients. Anywho, residents definitely need to learn so we can all have great eye surgeons later, and many do fantastic work...however, judging from the amount of concern you all have, my feeling is you would not be a good patient for a resident.

Your second surgeon seems experienced, but has a couple of things you're not sure about. So I would say you either need a bit more chair time with him to clarify, or you need to check out a third one. Third time's a charm! (Mine was the third one I saw too.)

Tamarinda, quick reply as I on the way out. Not sure if she is resident as she graduated from University in 2009 and has been in this particular eye clinic for 2.5 years.

Either way she is not the one we had chosen for the operation, the qualifying surgeon will be there assisting her. Still not same, or? She will be cutting, cleaning etc., all delicate stuff! We will call today and say this is not what we wanted. We are paying for it!

I will read rest of your post and PM in the train 😃

Hmmm... Yeah, unfortunately your 2nd consult guy is very out of touch with current options and outcomes. I agree with the person who suggested a 3rd consult. It may seem like a lot, but I'm so glad I consulted 3 before any surgery! I used the 1st surgeon for one eye and the 3rd surgeon for my other eye, according to my desired plan and their attitudes and expertise..

There is NO reason to expect your vision to deteriorate after cataract surgery, other than temporary things like PCO which is fixed with YAG, etc. It's not very thoughtful of such old-fashioned doctors to put such negative suggestions into your mind when you're in a vulnerable position as a patient.

There are 2 reasons to limit activity after surgery. One is to minimize any extra pressure in the eye. The other is to keep the head up (not leaning forward or down as in yoga - definitely NO headstands) in order to get the best vision result - by minimizing the degree of movement ("settling") of the IOL within the eye after surgery. The original natural lens is ~3-D egg-shaped and the IOL is ~2D flat, so there's an very small empty space there immediately after surgery. The eye heals with amazing speed, but you want to give it all the help you can.

I was very cautious for the full 2-week period recommended by both surgeons and ended up with a result that was even better than predicted. So definitely worth taking that time. (Maybe your wife could meditate rather than doing physical yoga.:-)

Yes, you can use the computer the first or 2nd day, but chances are you would tire long before 8 hours. Of course, eye doctors always recommend looking up and away from the computer every 20 minutes anyway.:)

If you ask how many cataract surgeries each surgeon has performed, on the phone as you make your initial appointment, you'll have something concrete to base your comfort level on. An experienced surgeon should have done thousands.

Each and every reply from all of you has been very helpful and has provided lot of support in a time where we have felt alone and helpless.

The other thing about the 2nd surgeon was that he injects the eye to numb it. I thought these days the modern way way was to use a spray?

Anyway this morning we called the 1st clinic and spoke to the receptionist about the situation i.e that we were supposed to be seen by the highly experienced surgeon after the younger one had done the measurements. Also that we were told at the time of making appointment that wife would be operated by the highly experienced surgeon. Our referral letter from our eye doc and initial operation appointment was for the highly experienced surgeon.

The receptionist said she remembers us very well and she agrees and she also found the whole situation very weird at the time.

She said that we are in full control and we can change it to how it was actually supposed to be.

She said we have plenty of time until the operation date ( in a month) as the surgeon is on holiday currently. When he gets back we can meet him. So technically he would be the 3rd surgeon we would have spoken with.

We do feel better about the situation now.

The assistant surgeon will call us though (awkward ) lol

The first clinic is more professional looking and is an eye center with many eye docs/surgeons. The second clinic was more 1 man set up.

The surgeon we are planning to go with has done around 10,000 operations according to the assistant surgeon who was eager to operate on my wife.

Actually second surgeon who is in his 60s probably has done tons of operation too. He was bit on the obese side which is bit strange as here docs are very healthy looking in general. Not judging him for his diet but something I noticed due to the field he is in. Then again I have also seen hospital entrances full of thin doctors on cigarette break.

We are on holiday currently for a week trying to celebrate our 20 year marriage anniversary as best as possible with this cloud hanging over our head 😃

Thank you for all the empathy this forum provides which can be lacking sometimes in the real world.

Ok back to bed as I woke up worried in my sleep at 3am.

Congratulations, Viking! Yippee!!!! Sounds like it went beautifully. Are you finding any odd visual effects? How is your visual acuity near, intermediate and far? You must be overjoyed.