Advice needed - Cataract Surgery Lense Dilemma (after a vitrectomy)
Posted , 8 users are following.
First, thank you in advance for any advice or experience you might be able to share. Eight months ago, I underwent emergency eye surgery for a detached retina (vitrectomy).The retina has healed but I've now developed a cataract.I've seen two highly regarded cataract surgeons. One referred to me by my eye surgeon (retina specialist) and the other referred by a number of local optometrists. Both cataract surgeons have recommended two different plans! One surgeon recommends removing the cataract and inserting a lens for improving distance vision. My "good" eye would need Lasik surgery two weeks or so later though. Otherwise, I'm told, my eyes will be in "conflict" with each other and glasses won't remedy the problem. He believes this plan will provide me with a chance to be free of glasses, except for needing readers. The other surgeon recommends inserting a near distance lens for close up vision. I would then not need surgery on the "good" eye. Since I have been nearsighted all my life and have worn glasses/contact lenses to correct my vision, the close up lens makes sense to me. Close up vision is what I'm used to and I only have the one eye with a cataract. Everyone who has had cataract surgery seems to go with distance lenses though - and who wouldn't want to be free of glasses? What would you do? Has anyone had experience with the near vision lens? This is all so nerve wracking and I sincerely appreciate advice!
0 likes, 36 replies
Guest mjcg
Posted
Sorry to hear about your emergency retinal surgery. So scary. I also had that, minus the vitrectomy. A year later, I had cataract surgery on the other eye, and opted for an intermediate/near monofocal lens as Sue An mentioned. I was also used to being mildly nearsighted, and did not want distance correction as I did not want to entirely give up my near vision (I find readers are way more inconvenient than distance glasses; others feel just the opposite). A year out I am still very happy with my vision overall (about -1.25D in the cataract eye; -1.5D in the other) and would definitely do it again. If you are used to being nearsighted and are fine with wearing glasses for distance, I would strongly urge a near or intermediate correction, and avoid ANY unnecessary surgery on the other eye. For some reason, many surgeons assume everyone wants distance correction, but I can assure you many people are happier being able to read and use the computer without glasses. As others here already mentioned, it would be helpful to know your age and current Rx. While it's not possible to get individualized medical advice from lay persons in an online forum, I think it's helpful to find that others have been in your situation and have had similar questions. It's essentially a permanent decision so take your time and don't dismiss your own judgment too quickly.
Sue.An Guest
Posted
Thanks BellaD - so happy to hear you are doing well!
Guest Sue.An
Posted
Thanks! OK except for some PCO the MD says not enough to operate yet. (Don't want to veer off topic here so I'll check out or start another thread. Did you have YAG?)
Sue.An Guest
Posted
Haven't had a yag yet. No noticeable difference in vision however I will see my optometrist in January sometime and will get a more accurate picture of where I am . my near vision seems to have improved a bit more but when i compare distance to what my husband sees I cannot see as far (ie road signs).
mjcg Guest
Posted
Hello BellaD! I'm so happy to hear from you!! In SueAn's reply she recommended that I reach out to you. Just like you mentioned, I have also always needed vision correction for distance (I'm 63 years old now). I always wore contact lenses but then presbyopia set in (around my mid 40's) and I would purchase cheap reading glasses (mono and multi-focal contacts never worked for me). I was always losing them! And then I developed dry eyes and contacts became uncomfortable so it was easier to give them up and just wear progressive glasses. I've been ok with glasses because there are so many nice styles available, plus progressive lenses handled both the distance and close up vision for me. Anyway, I was going along with life ok and then POW this retina detachment came out of nowhere. Not an injury, it just happened. Vitreous fluid breaking up and tugging on the retina. One of those unexpected reminders about how fragile we all are. The surgery was traumatic for me, even though it wasn't life threatening. My primary care doctor told me that in his years of experience the most emotional packed surgeries involved the heart and the eyes. Makes sense with the heart being the center of love and our "souls." The eyes representing independence and our view of the world around us. So, here I am eight months later and grateful my sight was saved but terrified of another eye surgery and wondering how to truly repair my "broken eye" with cataract surgery. I find it really helpful to hear other people's experiences and can't tell you enough how much it means to me to be able to "talk" things out here. I trust both surgeons, but I am leaning toward getting the near vision lens. Retinal detachment increases if you've gone through it before and cataract surgery increases the risk more. So leaving the "good" eye alone seems to make the most sense. But I still love the idea of never needing glasses 😎
seeherenow49806 mjcg
Posted
So sorry you had the Retinal Detachment, mjcg! I've heard from various eye doctors over the years that people with high myopia (nearsightedness) are at greater risk for RD. Because my myopia was much higher than yours, my first cataract surgeon sent me to a retinal specialist before he would agree to do any cataract surgery at all. Luckily, I was ok.
There may be a silver lining for those of us with high myopia, tho. I'm not sure, but there may be a correlation with a physical measurement of the eye called axial length being longer in high myopes and the resultant depth of field achieved with a standard monofocal IOL. My sister (with an expreme prescription of -10D before cataracts) had cataract surgery on both eyes and can now see 20/20 both near and far with only standard IOL's in both eyes.
In my case (with -8D pre-cataract) I chose a standard IOL in my dominant left eye set for very mild myopia (-0.5D). The end result settled between -0.25 and -0.5D in that eye and I'm seeing 20/20 or 20/25 (varies slightly) distance, and 20/20 or 20/15 near. So I'm very happy with that choice! You may be equally lucky, don't know.:)
i chose a Symfony in my right eye set for slightly more myopia (-01.0D), and I'm getting even better near vision than in my left eye. It's still healing, so I'm not sure of final results. But so far, I'm seeing 20/25 or 20/30 distance and 20/15 or 20/12 near. I expect the distance will improve. I just finished the weeks of post-surgery eye drops a few days ago, so there will be much more healing and improvement to come.
I think that when this surgery first came out, the patients may have had different lifestyles than patients in their 60's have now. They were more inclined to blindly follow doctors' recommendations and didn't have the internet to do their own research. We are very fortunate things have changed. But not all doctors have caught up with their patients yet.:) So they just assume that people want distance in both eyes and readers for life. But I definitely prefer to have the only need for glasses to be when driving at night in an unfamiliar area! Otherwise, I don't need them.
There is a difference between mini-monovision and regular monovision. Most younger surgeons now will only recommend the "mini" version, easier to adjust to. Really worth trying the contact trial for at least a few days , before making any final decision, even with the dry eyes.
Also, I agree with others here - I wouldn't do any surgery on your good eye until you really need to. Most surgeons automatically suggest surgery as the best course of action. but it isn't always so. you may not need surgery in that eye for 5 or 10 years! By then there could be much better options available for you. Who knows? Medicare might cover "premium" lenses as a standard treatment by then. So take your time...:)
Sue.An seeherenow49806
Posted
Agree wholeheartedly with you about today's patients and can only see it increasing in the future. I don't believe we want to see distance well and wear readers. With smartphones and tablets and active lifestyles today's patients certainly demand more. Hopefully the selection of lenses will be greater and better as time goes on. If surgery is covered if one chooses a standard lens I really cannot see why the surgery wouldn't be covered and patient just pays for upgraded lens. That is the way it works in Canada. In fact province of Quebec I hear pays for the premium lens as well. So likely you are right and changes will come.
mjcg seeherenow49806
Posted
Hello Seehernow! Yes, we are so fortunate that things have changed and new technology provides us more options (though it makes the decision tougher). I'm grateful for the internet allowing us to do research and weigh ALL our options. Do you remember when we could call the local library and ask the reference librarian questions? But only 3 questions a day? Or needing Encyclopedia's to find answers to our questions? I can't imagine not being able to find information immediately and that it's usually always updated information! I now know more about the eyeball then I ever wanted to! Vitrectomy surgery was only first conducted in the 70's - and despite how complicated it is, the actual surgery has vastly improved over the years. For instance, although I had a gas bubble inserted to help the retina heal (talk about a weird experience), I did not have to do 24 hour face down positioning for 8 weeks like the old days. Only 30 minutes of face down on the hour, every hour, for seven days. And, heck, that positioning process was hard enough! I'm just still so grateful to have not lost my sight. I must admit, I am leaning toward not having surgery on the right (good) eye. Hearing that you have done fine with the close up lens is so helpful to me... especially since the majority of people get distance corrected.
Bravogoldenk9 mjcg
Posted
i had vitrectomy and then a cataract.I had a symfony lens withfull range of vision. My detachmentwas not at macula.I had 20/20 vision.I DID HAVE A SMALL CATARACT IN NORMAL EYE AND ELECTED TO HAVE IT REMOved 6 months later.Also with symfony lens.
ODDLY MY EYE WITH THE VITRECTOMY HAS MUCH MORE BRILLIANT VISION which drs now attribute to lack of vitreous and any floaters.ONE PLUS FOR A MISERABLE OPERATION,
i am in a hurry and can answer more ..sorry for caps..SO ETHING ODD WITH COMPUTER
soks Bravogoldenk9
Posted
Thanks for posting your experience. It is good to know that Symfony is an option after RD. Most surgeons I have read want to stick with monofocals after visual complications. I am wondering if the Symfony calculations for a RD operated eye would be different than a normal eye. The reason being I already have a Symfony, so if I were to get an RD would the refractions change as a result of fixing RD. I worry about RD due to being in 40s. I am surprised they didnt do vitrectomy on your other eye too anyway.
mjcg Bravogoldenk9
Posted
Hello Bravo! The surgeon recommending I get the close-up vision lens, mentioned she uses the symfony lense for multi-focus (as I recall), but that it's not covered on insurance and would be $3,000/eye. I would also need to have both eyes corrected with this lens. She didn't push it much and I don't know if that was because she thought I couldn't handle the cost ($6,000 is a lot to part with - but it is my eyesight!) or if she thinks it's wise not to do surgery on the "good" eye since it increases the chance of RD. I wonder if when I have the cataract surgery if my RD eye will "see" as yours does. No floaters, etc. I also had RD without the macula being affected (thank goodness!). It is so HARD to make this decision of what type of lens to use and which surgeon to go with. I don't want to make a mistake with my vision... aaack!
Bravogoldenk9 mjcg
Posted
the retina and cataract surgeon work at same hospital.I INITIALLY DID RESEARCH ON SYMFONY CLINICAL TRIALS IN EUROPE AND SAW KLEINMANN IN ISRAEL USEDTHEM WITH ALL SORTS OF CONDITIONS WITHSUCCESS.IT HAD JUST BEEN APPROVED IN US AND THEY BOTH (surgeons)WERE SKEPTICAL BUT I WANTED IT SO SURGEON DID IT MENTIONING ZONULES COULD HAVE BEEN WEAKENED BY RETINA SURGERY.HE HAD A BACK UP MONOFOCAL.ANYHOW NEXT AM HAD 20/20-2 vision in that eye.IT WAS CRYSTAL CLEAR ...SECOND EYE WAS DONE 6 months LATER BUT NOT QUITE AS GREAT THO 20/20 as well
BOTH DRS CONCURRED THAT I WAS THE FIRST TO GET THE LENS AFTER RETINA REPAIR AND OPENED THE DOOR FOR OTHERS....REALLY DAMAGEDRETINAS PROBABLY WOULD NEVER BE GOOD NO MATTER.IWAS CONCERNED THE VITRECTOMY EYE WAS SO PERFECT COMPARED TO THE NORMAL EYE...THEY GUESSED IT WAS DUE TO THE CLEAR SALT WATER COMPARED TO AN OLDER PERSONS VITREOUS.ONE PLUS FOR AN UNPLEASANT EXPERIENCE!
I AM SORRY ABOUT THESE CAPITAL LETTERS....
I FIND IN GOOD LIGHT I CAN READ ANY SMALL PRINT AND HAVE GREAT DISTANCE VISION......IN LOW LIGHT SMALL LETTERS FADE BUT ARE NOT BLURRED.THINK IT Is CONTRAST SENSITIVITY FROM MULTI FOCAL TYPE LENSES WHICH SPLIT LIGHT
I HAD MANY MEASURING SESSIONSAND AN ORA WAS USED TO CHECK STRENGTH OF LENS.....IT COSTS MORE BUT IT ISWORTH IT TO ME.ALSO THERE ARE HALOS AT NIGHT BUT I BARELY NOTICE THEM
Bravogoldenk9 mjcg
Posted
I am a fanatic researcher and watched allthe discussions on Eyetube.Saw all theexperts from major eye hospitals .YOU CAN GO TO FACEBOOK?Look up EYEWORLD magazine and find a link to tneir expert discussions..See if any are near to you as tney are active surgeons
MY DRS both said not every one getting retina surgery turns out so well for various reasons..the cataract was depressing as it developed steadily though slowly..I really wanted it to be history.I been nearsighted before and go worse after the surgery so felt having full range of vision was what would make me happy....tossed all glasses andeven found reading glasses never were used..just used lightt o see tiny print..
Some people have hated the fact night visionwith an open pupil can create halos around lights ...depends on how fussy one is
mjcg Bravogoldenk9
Posted
I've had halos and glare with nighttime vision most of my life, so that would not prove any different too me. I appreciate the recommendation to check out youtube and facebook... never even occurred to me. Thank you, thank you, THANK YOU!
Bravogoldenk9 mjcg
Posted
you could splurge and get second eye done since most of us will get a cataract sooner or later..perhaps extreme but nice to have great vision...I had mild cataract in non vitrectomized eye but chose to get it done.We have very good insurance which covered the surgery but paid extra for symfony lens.I understand there is a trifocal being approved in usa ...whether this isnsuperior to symfony is up to you to research.
if you find eyetube look at archives of 2016 DRS Donnenfeld, and Holladay at the Hawaii eye meeting for discussion of the extended depth of focus lens
As i me tioned the bonus of the vitrectomy for me was amazing clarity ..over time floaters and age cloud the vitreous slightly so that the salt water or whatever is much clearer..Though again each of us have different results
i must say when i realized i had a detaching retina i was miserable.Being told i would get more nearsighted due to a buckle and a cataract was awful so to get these results is a pleasure...
Dr s are careful about the multifocals including symfony as some people get hysterical about halos and starbursts and complain....that is the price paid for no glasses...so it is easier for them to just recommend monofocals and not have complaints.
i think i read the symfony might be better than a trifocal for retina patients.there is a technis vision app showing the way things look with various lenses..
mjcg Bravogoldenk9
Posted
I'll check out the 2016 DRS... I've been searching youtube and have found lots of good information. Most of the research I've done supports the surgeons recommendation that I get a monofocal lens for near distance, adjusted so both my eyes will work together, and leave the good eye alone. Again, this is the way I'm leaning. I'm used to wearing glasses and I've been nearsighted all my life. Again, halos wouldn't bother me too much since this is how my sight has always been, especially at night. I'll do more research on the symfony lens though. Maybe that IS the way to go (though I like the idea of leaving the one eye alone haha). It will cost me $6,000 but since I get a new pair of glasses every year that alone would be paid off in 6-10 years since progressives are so dang expensive. I do wish I had more time... but I can't see out of the RD eye. It progressively grows worse and both surgeons said it's time to come out (before it gets any thicker). Decisions, decisions, decisions.... I'd prefer trying to decide if I should get a side of fries with my burger!
mjcg
Posted
By the way, my surgeons (both the retinal specialist surgeon and the cataract surgeon) are at the Kellogg Eye Institute in Ann Arbor. The patient care there has been outstanding and I know I'm in good hands. I'm grateful to be so close with all that happened when my retina detached. Did you do facedown positioning? I did 30 minutes on the hour, every hour for seven days straight. At night when I slept I had to stay on my left side. That and dealing with the gas bubble was mental torture. The bubble vanished just short of the eight week mark. That was a happy day for me. But then the cataract took over... I really will be so grateful just to see clearly again.
Bravogoldenk9 mjcg
Posted
yes kellogg and other eye hospitals get the best ! My retina dr gave me a pessimistic talk i guess to not get my hopes up.I had to look down and sleep acertain way mainly i guess as detachment was in upper side of retina thankfully not macula..Alsoi if i did not i might get an immediate cataract from the gas....and on and on about horrors!!
.i remember the terror of the immediate surgery and a group of residents observing tne buckling while i was in twilight zone.All healed well and i even sent for operating report to relive tne horror of what went on
DR Shannon wong has lots of youtubes.He even had the symfony in one of his eyes to improve his reading as presbyopia set in..He is much more informative than any dr i had and his information is great.
I must say to wake up every am with bright clean vision is such a pleasure.No glasses or contact lenses.As mentioned the eye with vitrectomy which had been my weaker eye is now much brighter or whatever ...Drs concurred it is lack of vitreous, unusual as most retina patients are not always so lucky to get everything back to normal.
who is you cataract surgeon?PERHAPS HE IS ONTHE EYETUBE MEETING VIDEOS?My dr was and is also a cornea specialist and he discussed dry eye as a consequence of aging and its effect on cornea along with astigmatism.NEVER KNEW SO MUCH ABOUT EYE BEFORE!Whoops there go the capital letters again.
my suggestionis to continue research as no dr really has time to fully answer everything.MULTI AND SYMFONY will have night halos..CHECK APP store for technis visualization of various lenses.I must say i feel renewed with child like vision.
mjcg Bravogoldenk9
Posted
I also know more about the eye than I ever thought I'd know (haha)! I appreciate your positive outlook considering all that you've been through.I've checked out youtube (Dr. Shannon)... and you know how it goes... the more information you have the more difficult it is to reach a decision.
Bravogoldenk9 mjcg
Posted
I LOVE THE CLARITY AND FOCUS OF TNE SYMFONY
NO TRIFOCAL WAS AVAILABLE WHEN I HAD SURGERYI KNOW BETTER SURGEONS OFTEN INCLUDE TOUCH UP LASIX AND LASER REPAIR OF ASTIGMATISM WHENDOINGTNE PRICY SURGERY .SEEMS NEW GOAL AS OPPOSED TO THE PRIMITIVE PAST IS TO OFFER PERFECT VISION OR AS CLOSE AS POSSIBLE
KLEINMANN DID USE SYMFONYIN RETINA PATIENTS
HE IS ON YOUTUBE DISCUSSING IT?BIG PROBLEM IS HALOS WHICH TO SOME LIKE ME ARE NOT A BIG DEAL
HUNTING ABOUT WILL BRING EYETUBE WITH I TERVIEWS FROM ALLTNE MEETINGS WITH PRESENTERS LIKE DONNENFELD! HOLLADY ETC
THINK INSURANCE AND MEDICARE COVER THE SURGERY BUT NOT THE SPECIAL LENS
IT IS A QUESTION IF YOUWANT TO SPEND MONEY ON IT OR ON SOMETHING ELSE IN LIFE
I MUST SAY I AM REJUVENATED SEEING LIKE A CHILD AGAIN
I REMEMBER WAKING UP VERY EARLY AM AND SEEING VIOLET COLOR OF THE GAS BURNER AND LATER THE GARDEN AND FILLING A BAG WITH OLDGLASSES