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Iol exchange after cataract surgery miscalculation

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julielyn
julielyn

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

49 Replies

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  • julielyn
    julielyn

    Posted

    @2 month follow up visit to surgeon yesterday.  He’s pleased with results of exchange. Says I’m within .25 of correction. I don’t see how that is possible!!  Before surgery I could see distance better than what I have now. I have a shadow effect on letters. Although I can read the chart at 20/20 it is not what I expected to be 20/20 crisp clear vision. He would like to leave it alone and expect clearer results in 6 months. I’m not buying it. As for left eye. He would like to perform yag now then go on to PRK or lasik if possible to reopen original lasik flap. I’m not willing to do yag just yet. I want another opinion. I had a second opinion a few months ago before exchanging right eye iol. The 2nd dr (cataract surgeon)suggest incisions to reduce astigmatism, possible iol exchange to restor 3.0 and lasik. He also said I had a slight tilt to the left eye lens. I think I will go to another dr that does the PRK or lasik and see what they say before I commit to this lense by the Yag procedure. 

    Will keep you all posted 

    • Sue.An
      Sue.An julielyn

      Posted

      Hi Julielyn- I probably should go back and see your original post as answer is likely there.

      But just wondering how with cataracts your vision was better then than now 5 months post cataract.  With cataracts I could read big E on the chart and struggled to read anything else on the eye chart at the optometrist.   I had delayed 4 months so that my insurance plan year would kick in and pay for the visit as I was thinking I just needed new glasses.   Although she had me go through the reading chart exercise she already knew by the vision tests by machines (that day they retook several readings) and in her office first thing after chart reading is she was unable to correct my vision due to cataracts.  She then had me look at some lines and asked me when they lined up.  I also suffered double vision with cataracts.

      So my question is were your cataracts affecting your vision if you could still read 20/20 line?   Why would your doctor suggest having cataract surgery if your vision was correctable?

      I will go back and read your posts as I am drawing a memory blank.   I too would be frustrated to be told I can see 20/30 and all was fine when my experience everyday told me otherwise.  That chart is in the best of conditions through mirror and right amount of bright lighting - unlike real life vision.

    • Sue.An
      Sue.An julielyn

      Posted

      My bad should have read your original post.   I am not sure surgeons are upfront with lasik patients about the implications of what happens when you get cataracts later in life.  Even with prior lasik measurements there can be problems with calculating the power.   Aside from that most seniors who have cataracts cannot recall what good vision is and cannot compare it to when they did.  My surgeon had conversations with me about the fact that someone in their 70s or 80s gain something from cataract surgery whereas someone like me on their early 50s will lose something and have to compromise.  And that was true no matter which lens I chose.  I was lost in a daze for weeks struggling with that.

      You likely are in that same category for different reasons.   The IOLs are never going to give you that vision of your youth.  There is contrast reduction (25 to 20%) - even my contrast in low lit restaurants with cataracts was better than what I have with Symfony.  I need good lighting.  It is something I learned to take with humour as that is my disposition.  I will joke with my table mates about my senior moment (and don’t mean memory) and use the flashlight on my iPhone to read.  I hope one day these will be better but it’s better than it was with having to wear coke bottle glasses.

      If there is a concern about not being 20/20 I would double check with another doctor/optometrist totally unrelated to your surgeon.  Go even to Lens Crafters or Pearl Vision and see their optometrist.  Get a written prescription- that way you will know what it is for sure. 

      Wish you all the best - sure sounds frustrating at the moment.   It could be with lens exchanges there is more healing and time as well.   If you are off target by .25 that sounds good.  It may be you won’t get glasses free and a little correction with those (especially if you still have astigmatism) it will crisp things up.

    • jantje32476
      jantje32476 Sue.An

      Posted

      Sue.An, that original post left an impression on me. Can't really put a finger on it, mostly with her inflammation and "wrong power was installed". I skimmed through an article by a French cataract surgeon wrt ex-Lasik patients and IOL Power calculation - will search for it and get back here.

      R1) 12/21/2017 ~ Her 1rst eye (RE) was done with a multifocal Toric lens. She had "horrible vision, no clarity at any distance, and when lowering the dose of prednisone drops, eye strain/pain and light sensitivity to the point it woke (her) up at 5am, only to wear sunglasses in the house to get to (her) drops and ibuprofen.

      R2) 12/22/2017 ~ (Her) first follow up on 1st eye (RE) was the day after surgery. (She) was asked to return the next business day (Tuesday after xmas).

      R3) 12/26/2017 ~ she returned to the Ophtomologist, "where it was mentioned that the wrong power was installed and a swap might be in the future but dr wanted to "wait and see' and was confident that second procedure would be successful, so (I went ahead). "

      R4) Fastforward to the 3rd week of January/2018. "So, here I am a month out from first procedure, and there is little improvement in 1st eye (RE). dr says, we may not need to replace that IOL after all."

      R5) 4/26/2018 ~ She had iol exchange in right eye (first eye).

      R6) 2 weeks later ~ 2nd week of May/2017. A follow-up visit to the Ophtomologist. She was "on durezol steroid drop and over the counter dry eye drops. There is still daily fluctuations and not reading 20/20  more like 20/40 and blurry. Lasik enhancement has always been a follow up option." "dr said yag would be our next procedure as cloudiness on back of lens is forming. " "Yag will be done @ 3 month mark then we will consult with lasik or PRK to tune in @ 2 weeks following yag. "

      L1) 12/28/2017 ~ Her 2nd eye (LE) was done with just a mutlfdocal lens.

      L2) 12/29/2017 ~ "2nd eye (LE) follow up the following day gave (her) much more clarity at a distance than the 1st eye (RE), but then again, there was little to correct distance wise prior and (she) had no astigmatism in that eye.  No close up vision was clear. " "a lasik enhancement has re-entered the conversation."

      L3) Her 2nd eye (LE) too had inflamation. "But now since the reduction of prednisone has caused a flare up, (her) vision that was better in second eye has gotten much worse.

      L4) 2 weeks after her 1st eye (RE) IOL exchange surgery ~ 2nd week of May/2017.

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

      "There is no reason to have that large of astigmatism after surgery when (she) had zero before. @.50 astigmatism is calculated for such a surgery. Also, (her) second opinion showed a “ mild tilt” in the lens position. And (she) 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. "

    • julielyn
      julielyn jantje32476

      Posted

      Thanks for putting it in order smile

      Suean. My meaning of “I could see better before” refers to the shadow effect I have while reading the eye chart. If I could draw a picture of something with a shadow, now the shadow is longer and more dramatic than previous to cataract surgery. Yes I agree having a light source helps tremendously!! 

      I’ve decided to think things through over the weekend about yag on the left eye. My choice to have another opinion is still valid and I will research places in Miami for yag and lasik/PRK. I originally had lasik at millennium eye in ft lauderdale area, but when I spoke with a rep they wanted to wait 3 months post last surgery, regardless if I only wanted one eye evaluated. 

      I don’t want to over react or decide too quickly as yag seems to make the lens practically permanent. A few days to settle my thoughts will help. 

    • Sue.An
      Sue.An julielyn

      Posted

      So hard and now creates suspicion on surgeons clinics  etc..     I wouldn’t have another procedure done till some real answers are found.
    • jantje32476
      jantje32476

      Posted

      FWIIW, I am posting this hoping that those of you with better understanding of the refractive knowledge can shed some light.

      Note the date was September 2014, almost 4 years ago. Yeap, even then eye-surgeons had the 4th generation formulae to calculate the IOL Power and tools to measure the Corneal Power after corneal refractive surgery.

      source:  réalités ophtalmologiques # 215_Septembre 2014_Cahier 1_5/7

      " ... in situations where the keratometry has been surgically modified, before the onset of cataract, as for the eyes having undergone refractive surgery (Lasik, PKR, radial keratotomy, etc.). In these circumstances, it is important not to use keratometry (since it has been modified by surgery) for the prediction of ELP, but it is also important to measure it well."

      "For this purpose, there are several methods that are particularly suitable for operated refractive surgery eyes: corneal topography, estimation of anterior and posterior corneal Gaussian power (BESSt formula) [4], clinical history method, refraction techniques after rigid contact lens application."

      Translated to the layman's language, standard IOL power formulae can lead to significant unintended postoperative refractive errors, plus special methods should be used to determine Corneal power.

    • jantje32476
      jantje32476

      Posted

      I went to the "accessdata fda" site.  Two reports made (1 for left eye & 1 for right eye) on 01/16/2018 echo your events.We do not know your Model#. In these 2 instances, the doctor was sticking to "wrong power".

      - - - - - - - - - -

      ACRYSOF IQ RESTOR SINGLEPIECE IOL

      Reporter Occupation:     Health Professional

      Type of Report:     Initial

      Report Date:     01/16/2018

      Date Device Manufactured:    01/24/2016

      Model Number: SV25T0

      Event Type:  Injury   

      Event Description:

      A nurse reported that following an intraocular lens (iol) implant procedure the patient was not happy with vision. The iol was explanted in a secondary procedure due to "change power, lasik patient, iol master recommended up one power". Additional information was requested

      - - - - - - - - - -

      ACRYSOF TORIC ASPHERIC UV ABSORBING     SINGLEPIECE IOL

      Reporter Occupation:     Other

      Type of Report:     Initial

      Report Date:     01/16/2018

      Date Device Manufactured:    06/28/2017

      Model Number: SA6AT4

      Event Type:  Injury   

      Event Description:

      A facility representative reported that following an intraocular lens (iol) implant procedure, the iol was exchanged due to wrong power. The iol was exchanged for a difference of 1. 5 diopters. Additional information was requested.

  • julielyn
    julielyn

    Posted

    Once again , during exchange surgery the ORA was used and giving a different position for the toric multifocal lens. The dr had marked the previous position because we knew I had zero astigmatism. It baffled the dr enough for him to leave the operating table to refer to my charts. He then decided to go up 1.5 on the lens size. Going from 20.5 to a 22.0. And position the toric in the original position. Post op results say I’m within .25 of correction. Since iol can only adjust to .5, I’m as close as humanly possible to correct.  Now, I did not ask if I have a new astigmatism in the exchanged eye, as things are still fluctuating, and should honestly wait 6 months before final results are in. I still have the rim effect in right eye. And my blurry vision can be narrowed down to a shadow effect say in the 2 o’clock position. The left eye shadow effect is at 12 0’clock position. Both eyes together give a all around blurry vision. 

    Hope this helps 

    • jantje32476
      jantje32476 julielyn

      Posted

      Hi julielyn, pls read your message. The free online Q&A period by a real US Board certified Ophthalmologist (Lasik & Cataract Surgeon) is on now until this coming Friday. kindest regards,

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