Iol exchange after cataract surgery miscalculation
Posted , 9 users are following.
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.
1 like, 49 replies
Sue.An julielyn
Posted
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.
julielyn Sue.An
Posted
jantje32476 Sue.An
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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.
Sue.An jantje32476
Posted
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.
julielyn jantje32476
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diane48177 julielyn
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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.
jantje32476 julielyn
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God bless.
j_89867 julielyn
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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?
Guest julielyn
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Guest julielyn
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And I have already written about my good results. It got buried in the posts around 10 pages down I guess because I had a good result. The posts with complications get bumped up often, not posts like mine with good results with non-toric monofocals set for distance, although I am the only person who has posted so frequently about my good results on here and probably only one of a handful who ever posted about it at all. The rest of the people don't bother to inform anyone about it since they had the same results as I did and they're just living their life never thinking to post about it on an eye forum and I know there are many (plus most of them didn't have Lasik before cataract surgery, so supposedly their IOL power was even easier to figure out than mine was).
Guest julielyn
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Then on top of it, when I post about my results, people think I'm one in a million who have that outcome especially since my intermediate vision is so good without glasses. Since there's no one else posting about their good results with non-toric monfocals set for distance on here (without any monovision, not mini, not micro, not any), I can't really prove anything to the contrary even after I posted studies I found and everything else I posted. So I basically give up trying at this point lol....
Guest julielyn
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LOL I meant monofocals in case anyone really thinks there's such a thing as monfocals and that's why I had such a good result!
Guest julielyn
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What kind of lens is in your left eye? I assume it's a non-toric lens?
Guest julielyn
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Here's an article on surgically induced astigmatism (copy and remove spaces) www. eyeworld. org/ article-determining-your-surgically-induced-astigmatis
Guest
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Oh and one person on here assumed I have astigmatism and that's why my results were so good since astigmatism can either make your vision better or can make it worse. No that's not it either. I have very mild astigmatism in one eye and the other eye has none. When I close the eye with the mild astigmatism, I can see fine without glasses at all distances with my other eye that has no astigmatism, again except for very tiny print (and I'm talking about maybe J1 or J2 printed material I would need readers for and when I test it on a Jaeger reading chart I found online, I can even read J1 and J2 on my laptop at 14 inches away without glasses with the eye with no astigmatism and also with both eyes together).
Guest
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Guest
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And when I close the eye without the mild astigmatism, I can still read J1 on the online Jaeger reading chart, but it's a little harder to read than it is with the other eye or with both eyes together.
Guest
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And if anyone in the future reading this thread looks for my old posts, they were made with a different account than this one. Also, I don't come on here much anymore, so if anyone has any questions, send me a private message.