Plans going forward
Posted , 6 users are following.
Hello,
I posted back in the summer, after cataract surgery (I had -5.25 vision and .75 diopters of astigmatism) and placement of PanOptix left me with a bad result. I had my old posts removed as I had launched a formal complaint against the original surgeon. That is now resolved and I am moving forward.
After the original surgery I was left with 1.0 diopter of astigmatism which my surgeon refused to address. Near and middle distance vision was horrible and far distance also was less than optimal. I sought 3 additional opinions:
- First consult suggested Lasik to eye to provide correction, followed by placement of IOL in other untreated eye. This was not appealing to me due to my history of very dry eyes.
- Consult with Shannon Wong. At this point I had grade 1 PCO. He suggested replacing lens with Synergy and addressing the PCO, then doing other eye. However, due to distance and the number of visits required, as well as the costs ($$$), I decided against it.
- Surgeon #3 agreed with others as far as need to repair the refractive error and the PCO. However, he felt lens exchange is too risky for the amount of potential benefit. His plan was to do YAG, allow healing, do PRK to reduce refractive error, (less likely to produce dry eye issues) then carefully choose PanOptix for other eye. I agreed.
I did the YAG three weeks ago. I was up to grade 2 PCO by then and I do have clearer vision since. The refractive error is unchanged, and when he showed me what my distance vision may look like after PRK, I admit I was underwhelmed. I do, need my near vision improved, so I have PRK scheduled for 2 weeks from now. I am dreading it.
What threw me for a loop during the last visit, was the doc's suggestion that I place a monofocal IOL in the opposite (dominant) eye when the time comes. What?!?! He had assured me than PanOptix was appropriate. I also would much prefer to be nearsighted than not in the long run. Reading glasses have been so frustrating for me during this period of unbalanced vision.
I have an appointment with my trusted optometrist for next week, to get his input. I have always been under the that a true result is hard to assess until both eyes are corrected, so i am confused by current docs sudden thoughts about a monofocal in dominant eye.
In any case, I remain sad and confused. What was supposed to be a straight forward process is anything but.
Thanks for reading. Please provide input if you are so inclined.
0 likes, 8 replies
RonAKA SadEyes
Posted
Operated eye: LRI is an alternative to PRK for small amounts of astigmatism, but I don't think is suitable for spherical error. Consider that small amounts of astigmatism may actually improve your close vision. I have 0.0 spherical and -0.75 cylinder in my IOL monofocal eye, and can read down to about 18 inches. I originally thought about LRI to reduce the astigmatism, but now have decided I like it where it is. I get 20/20 distance vision with it as is, and better than average intermediate vision for a monofocal.
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Non-Operated eye: If you could get good closer vision in the operated eye, then a distance monofocal in the dominant non operated eye may be a good idea. However, if you need better close/intermediate vision then another PanOptix is probably better.
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I would defer any decision on the non-operated eye, until after you have had the work done on the operated eye.
Robert42113 RonAKA
Posted
Ron, what is the axis on your monofocal eye? I've been trying to decide if I want a toric IOL or not. I could have roughly -1.1 cyl (non-toric) or 0.1 cyl (toric). My astigmatism is diagonal (not WTR or ATR) and somewhat asymmetric, which makes me cautious of using a toric lens. I've read that some astigmatism WTR improves DOF, ATR doesn't change DOF much, and that diagonal is not as well-tolerated in general. The fact that you are getting 20/20 with -0.75 is promising. I also figured I could get LRI later to reduce the astigmatism if I didn't like the results. What do you think?
RonAKA Robert42113
Posted
This is a complicated area, which I do not pretend to understand fully. My astigmatism pre-op was -2.75 at 108 deg. However that was with my cataract and error in the natural lens. The surgeon said I had 0.0 to 0.4 astigmatism in the cornea based on the two different methods he used to measure it. I got no indication of angle. He said it was not enough to merit a toric. Post surgery the eyeglass prescription was 0.0 spherical, 0.75 at 80 deg.
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My simplistic thinking on this is that a toric is not worth it, if the cylinder is 1.0 D or less. LRI is an option after the fact. Some will do it during the catarct surgery, but they are guessing a bit as they don't know what the actual outcome will be.
Robert42113 RonAKA
Posted
OK, sounds like you had negligible cornea astigmatism, so nothing was there to correct in the first place. I'm surprised you had so much after the surgery. I guess that points to one danger of a toric lens - you can't predict what the effects of the surgery are going to be, so your lens may end up being the wrong choice anyway. My surgeon said his rule of thumb is to not use toric if the astigmatism is going to be less than 1.5 D. If I went for LRI I would do it later after the eye settled.
lucy24197 Robert42113
Posted
There's a good article--search "Phaco Incisions can improve or worsen Astigmatism" by Uday Devgan that talks about the effect of the cataract surgery incision based on the direction of your astigmatism.Unfortunately it doesn't address your case with a diagonal astigmastism, but it does explain why WTR astigmatism can worsen while ATR can improve.
rwbil SadEyes
Posted
I am a little confused about what was/is the root cause of your vision issues after cataract surgery. When these 3 doctors saw you did they all say you only issue is refractive error, astigmatism and PCO and no other eye condition what so ever? In other words besides cataracts you have no other eye issue. This is important as I would not recommend a defractive IOL if you have other eye issues. And depending on exactly what the issue was I might have suggested lens replacement before doing YAG as Dr. Wong recommended.
If Dr. Wong suggested lens extraction and replacement with Synergy IMHO something else must be going on beside refractive error, Astigmatism and PCO as they all could be corrected for your PanOptics IOL. You have not stated the core reason he made this suggestion. It seems like something else is going on such as you are not adopting to the PanOptics IOL, othwise why would he suggest doing a high risk extraction and implantation of another defractive IOL.
At this point you have done YAG so IOL replacement would be VERY high risk and Dr. Wong might be the only doctor that would even attempt it.
The Ophthalmologist should be able to show you what you vision will be with the refractive error and astigmatism correct for. Is your vision “GOOD” when the doctor corrected for refractive error and Astigmatism. If not, why not?? It is also possible your eye needs more time to heal.
“true result is hard to assess until both eyes are corrected, “
That statement is misleading IMHO. Many doctors will say that due to studies show patients are happier when both eyes are correct. What a shocker! Of course if you have the same IOL in both eye producing the same image you will see better than if you have a cataract still in one eye. Unless you are doing a monofocal I am a big believer in doing 1 eye at a time and evaluating the results, before deciding on the 2nd eye. You can certainly asset the vision quality in 1 eye without doing the 2nd eye.
I personally would not make any decision on the 2nd eye until the first eye is done and healed and you can 100% evaluate your vision. If you vision is still "Bad" then I would not be putting a defractive IOL in your 2nd eye, unless you 100% know the reason for the bad vision and it is something that the other eye would not be affected by. If you want to gain some close go with the Vivity.
SadEyes
Edited
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rwbil SadEyes
Posted
"In large part, I think Dr Wong wanted to use the Synergy because it had just been released in the US."
I am sorry but something else is going on here. I seriously doubt that is the reason Dr. Wong gave as it would probably fall under malpractice IMHO.
Dr. Wong has done videos comparing Synergy to PanOptics.
There must be a REAL reason for suggesting that IOL switch and it has to be something other than refractive error and astigmatism as all those can be corrected for. Extracting an IOL is not some simple minor surgery without risk. They basically are digging the IOL out. There needs to be a pretty darn good reason to do it. You have not provided details of what issues you have, what your eye and vision conditions are, what the doctors stated and why and gave that advice. You have not even stated what refractive mark you hit. After cataract surgery are you Myopic or Hyperbolic and what is the exact Diapator.
What exactly is the refractive error? Maybe the refractive errors is so great and you stated you did not want to wear contacts or eyeglasses and there are other issues you are having with the PanOptics so he made that suggestion.