Post-op vision worse than pre-op vision 2 months after cataract surgery. Need help!!!

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I hope the community can help me here…    

I am a 49 year old male that just underwent cataract surgery for both eyes 2 months ago, and now am currently experiencing worse vision than before my cataract surgeries (I was 20/40 pre-op in both eyes and am worse than 20/60 in both eyes now.  My history is as follows: Had Lasik (and a touch up a month later) 20 years ago and unfortunately was not able to get these records from that doctor since my records were long since destroyed. Currently posterior chamber intraocular lenses are both with mild central posterior capsular plaque, and I also have severe dry eyes.   Everything else is OK.  My doctor has recommended YAG laser to clear the plaques, and thinks that it may be the plaques that are causing my horrible post-op vision, but I am hesitant as I understand it may be difficult to change my IOL later on if I have the YAG laser treatment.  I also wonder if the doctor maybe put in the wrong power lenses?  Doctor has ‘concluded’ that I will need glasses/another Lasik procedure done to correct my vision rather than him trying to re-calculate the Toric placements or try a different lens and is trying to scare me with all the risks by going back into the operating room...blah..blah..blah.  But why would I want glasses or Lasik when I have paid for the premium lenses?  And how in the heck is it possible that my vision is still actually worse after surgery 2 months later?  This makes no sense to me!  I wonder if DMO doctors get into trouble (or get pressured) into not going back to the surgery room with patients (for costs)?  I honestly am not looking for 20/20 vision correction, heck I would be happy with 20/30!

Below is a break down what my exams showed:

I had Acrysoft IQ torics put in both eyes with the power 18.5D/1.50CYL

Day 1, post-op exam for left eye:

20/25-2 with no pinhole test done at this time (At this time I was happy and thought that it was a successful surgery for being the day after for this eye)

(pre-op was 20/40, no pinhole test done at this time either)

1 month post-op exam for left eye:    

20/60-1 with pinhole at 20/25-1 (Yikes! What happened here?)

 

 

Day 1, post-op exam for right eye:

20/50 -1 (pre-op was 20/40 with pinhole at 20/30-2) Uh Oh, not nearly where I was with the left eye at 1 day post op.

1 month post-op exam for right eye:

20/60 with pinhole at 20/30  (Ugh!)

 

My current manifest refraction:

Right -1.00 (sphere)   Cylinder -.075

Left -0.75 (sphere)      Cylinder -.050

 

I am going to get a second opinion to see what a different doctor says before I try the YAG laser to clear up my plaques…..sigh…I’m just beyond broken here….any help or insight given is much appreciated!  And if able I will post info from second opinion Doctor on this.

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19 Replies

  • Posted

    Your left eye may have developed PCO. 

    But since your right eye never improved you may have IOL with incorrect power. Did they use ORA during surgery. It is recommended if you have had lasik previously to calculate / confirm the IOL power. 

    At 49 you are a young patient. Did you have posterior sub capsular cataracts?  

    Thanks for sharing. Sorry you are going to have to go through this and good luck in your journey. 

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    • Posted

      Hi, I had mild cataracts that my separate optometrist  caught early on.  Not sure if my Kaiser doctor used ORA during the procedure.  When the doctor operated he stated that he tried to get rid of the PCO in both eyes (the left eye has slightly more plaques) by scraping (not sure if this is the correct terminology)?  But he was afraid to scrape too hard because he stated that it may cause tearing.  

      I also wanted to add that the doctor is stating that the Toric IOL is in the same position and hasn't shifted, so apparently that's not the problem.  He also stated that the 'calculations were and are still correct' though I'm not so confident with that response given my current situation.  I don't know if my previous Lasik surgeries have anything to do with this (I know that there can be inherent invariables).  So I guess I will get my second opinion (though my HMO probably will not have an appointment for me for a few months since they are booked solid).  Thank you so much.

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  • Posted

    Welcome to the forum, you are not alone in your complaints, although I never had any lasik treatment for my eyes ( luckily I had 20/20 vision until I hit my mid forties), I did develope some astigmatism in both eyes one more than the other and of course the need for reading glasses which comes with the aging process. Then along came cataracts in both eyes one more than the other. I stopped driving at night unless I was very familiar and the road was well lighted. I decided to have the cataract surgery this year one eye done in April and the other in May. I came to this forum after my surgeries and I started the discussion " Double vision after Cataract surgery" although double vision wasn't my only complaint, I also had burning eyes and blurry vision, over the past few months my vision has deteriorated. However I've learned a great deal from other people's post which has helped me in dealing with my surgeon. I've also done some research albeit after the fact it still helpful. I was prescribed steroids & antibiotics for both before and after the surgeries. I recently looked up the side effects of this steroid and wouldn't you know it, it's exactly what I am experiencing and it sounds very similar to what you have posted. My last conversation with my surgeons they indicated that I had mild PCO which conflicts somewhat with what the retina specialist that they sent me to told me. So I will need to follow up with them to see if this mild cloudiness is what's causing all my problems or is it a combination of mild PCO and adverse reaction to those steroids. I would suggest you Google "side effects of steroid eyedrops" or better yet if you remember the name use it in the search engine. Good luck!

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    • Posted

      Yes, so my doctor actually had my stop taking one of my steroid drops because he stated that it can cause a bad case of dry eyes (even more than my already severe case).  I will take your advice and do some more of my own research..thank you!
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  • Posted

    My suggestion is to assume (unless proved otherwise by tests) that you have all three issues; viz, Posterior Capsule Opaqueness (PCO), dry eyes and wrong IOL prescription.

    Since you have significant amount of the needed spherical and cylindrical corrections, the IOL prescriptions were not correct. Moreover, since the vision became worse with time, the toric lenses may have rotated from  the installed position. Personally, I would strongly prefer a LASIK enhancement to having the lenses re-done. I chose to have a LASIK enhancement done for my right eye due to the toric lens rotation from the installed position. Fortunately for me, my surgeon was willing to do the LASIK enhancement as well as  re-positioning of the lens at no charge (that was part of his premium lens cost package).

    However, before you have LASIK enhancement, you should take care of the PCO (if significant) by the YAG laser, if needed. Otherwise, the PCO could make the correct LASIK enhancement harder.

    Making sure that your eyes are not dry is a good idea irrespective of whether your IOL prescription is off or you need to get rid of the PCO. Good eye drops and/or supplements such as Fish Oil capsules can help reduce the eye dryness.

     

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    • Posted

      Yes, my optometrist told me many years ago to use a high dosage of high quality fish oils so I have been doing that for years every single day even before my cataract surgery.  You're right, I do need to get some good drops for my dry eyes so I will do that asap.  I also wanted to add that the doctor is stating that the Toric IOL is in the same position and hasn't shifted, so apparently that's not the problem.  He also stated that the 'calculations were and are still correct' though I'm not so confident with that response given my current situation.  I don't know if my previous Lasik surgeries have anything to do with this (I know that there can be inherent invariables).  So I guess I will get my second opinion (though my HMO probably will not have an appointment for me for a few months since they are booked solid).  I wish they could just take out the premium lenses I paid for and put standard IOL's in and refund my $2000 extra I paid so I can use it for the Lasik, but then again I guess this isn't walmart, LOL.  Thank you for your response.

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    • Posted

      With your current prescription of

      "Right -1.00 (sphere)   Cylinder -.075

      Left -0.75 (sphere)      Cylinder -.050"

      how can the doctor claim that the lens has not rotated and the "'calculations were and are still correct" ?

      What a  ridiculous statement to make!

      The PCO and the eye dryness may make your vision worse, but those don't change prescription much.

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  • Posted

    I am going through the same situation as you,the day after surgery (follow -up) after having my right eye done I was happy as a lark nearly 20/20 vision.Approximately a week later I developed this cloudiness in my right eye.

    I contacted the surgeons office and they scheduled an appointment for me and was told I need YAG to clear it up.He didn't mention of any risk involved or that I would not be able to have the lens implant changed it need down the road.

    At that time I was scheduled to have my left eye done 3 weeks after the right eye.At that time he told me that he would set up an appointment to have the YAg treatment performed ,once the three weeks surgery on my left eye had passed.

    Sorry to disappoint you,but after the YAG treatment I didn't get any better results ,only it got worst.Upon my follow -up appointment he told be both lens were fine.So I had several questions for him,one included,so if my eyes are fine why is it that my eyes are even worst than even before the lens implants were installed,I can't read the first line on the eye chart now,but before any eyes had implants ,I could read three lines on the chart.I guess he the( surgeon),didn't like my questions and said to speak with my regular eye Doctor and have my reading glasses upgraded.If the cloudiness in my left eye drove me nuts,you can think about having  YAG done on it.So if the first YAG treatment on my right eye made it worst ,I am definitely not going to have the left eye done and have no option of having the lens replaced ,which certainly looks like it may have to because of the dark/shadow and the flashes of light I see in the dark.Also when I go to a store with bright lights I have to wear sunglasses,everything looks hazy/foggy.I just hope it works out OK for you but I feel sorry for patients that may have experienced the problems those implants have caused me.I was told I had two options on the lens,the hard type lens versus the soft lens which was suppose to be a better choice,which is what I went with.Good luck with your decision on whether to get YAG treatment,get all the info. and advice you can. 

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    • Posted

      Yikes!  So I guess first thing Monday I will stick to original plan and seek a second opinion.  I don't want to be pressured into doing the YAG if there is a chance the second doctor will want me to change my lens out.  Thank you so much for your advice and have a pleasant day!

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  • Posted

    I also wanted to add that the doctor swears that the Toric IOL is in the same position and hasn't shifted so apparently that's not the problem.  He also stated that the 'calculations were and are still correct' though I'm not so confident with that response.  So I guess I will get the second opinion (though my HMO probably will not have an appointment for me for a few months since they are booked solid).  Thank you so much for all of your insight, I truly appreciate it!

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  • Posted

    Good Morning

    When I did get to see my regular eye doctor for a second opinion,he agreed that back of my lens were very cloudy and I should proceed with the YAG treatment.I questioned him on what if I need to have the lens replaced, his response was why would you want to replace the lens?I responded by saying if the lens was defective or becomes an issue.He said the lens was in place and the only issue was the cloudiness.

    So a long story short I proceeded with the YAG treatment and the results in my condition made it worst.Mabye I was just one of the unlucky ones who has this treatment that didn't benefit from it and now I will have to go with full-time glasses rather than just reading glasses that I was previously using.I hope all goes well for you and you get better results than I did,have a great day.   

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  • Posted

    I feel you, and am in the Boat. 

    My first iol was installed December 2017 and was “the wrong power” the second eye was the following week and the sr assured me that he knew what to do on the second eye. 

    End of April we exchanged the iol from a 20.5d 2.5 restor multifocal toric to a 22.0 2.5 multifocal toric and I’m still having problems. The exchange surgery was very stressful because my dr had only done a few and took his time, the ORA miscalculated once again and the dr stepped away from the operating table to refer to my chart and went back and forth with some numbers and finally decided on the lens I have. Also the ORA said to put the toric in another position...my current prescription is still not revealed to me. I’ve asked for my records to be sent to me, as I will be consulting yet another second opinion. “ we got you as close as humanly possible” was the dr comment. I can read 20/20 distance with a shadow effect in the 2 o’clock position. This is worse that what I had prior to cataract surgery. As for the left eye. I’m .75 off with an astigmatism of 1.25. When I never had an astigmatism in the first place. There is always an astigmatism after surgery of @ .50. Not 1.25!! So my left eye is also worse after cataract surgery. 

    I’m also a lasik patient of 2001 who had her records. 

    Yag has been suggested for next week for the left eye. I told dr I’d get back to him. For right now, I’m not willing to accept this left lens. I don’t believe he corrected it properly and is afraid to do another exchange because of his inexperience. I will be going to another cataract surgeon to see if they are able to correct with just a lens and not lasik/PRK follow up. My dr isn’t willing to answer my direct questions. And only answers with “pamphlet information”. I’m beyond frustrated because I’ve also said the same thing...why would I pay for prescription lenses only to wear glasses as a final result? Totally feel mislead and taken advantage of. 

    Hang in there. And please get another opinion before yag as its setting that lens as a permanent solution. 

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    • Posted

      Julielyn- yes strongly pursue another opinion.  You need a skilled specialist. My own surgeon was top cataract surgeon in province where I live and he told me prior to surgery that if I wanted a lens exchange he doesn’t do them.  He was careful to give me info on lens types pros and cons but as we all know it is a difficult choice and not like a pair of shoes you can try on for fit.  Even armed with all the info you really are playing a game of cards.    Seek out someone that specializes in lens exchanges.  Your own doctor from what you describe isn’t capable of providing the answers you need.
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    • Posted

      I continue to be amazed at the lack of communication and information available to cataract patients here in the US.

      My doctors chose the lenses' power and the manufacturer. I wasn't consulted or told what these lenses were or if I had a choice of manufacturers.

      I had two decisions to make in this entire process. One was whether I wanted to pay $4000 per eye for the use of a laser which would include my choice of premium lenses or pay nothing and go with the Medicare approved standard replacement lenses using standard (non laser) surgical technology. I chose to go with the Medicare approved standard with the exception of one toric lense at an additional charge of $2000 for that non standard lense. This seems to be the way cataract surgery is approached here, keeping our decisions to a minimum. It's the lack of information which goes along with the keeping our decisions to a minimum tgat really bothers me.

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    • Posted

      It is the same here in Canada. 1) Standard lens: you pay nothing. 2) Premium lens: roughly 1/3 the price you pay in the US.

      I would have chosen the Premium lenses, but am not a suitable candidate like some others with "pre-existing" eye condition (retina etc) and/or family history (AMD etc).

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    • Posted

      I totally agree. While I was up at sighttrust in ft lauderdale. Premium lenses were@ $3400 per eye and much more information was given. Like target ranges and would I prefer reading or mid distance. One or the other would be targeted ...it’s like pulling teeth to get a direct answer. 
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    • Posted

      I must correct myself on one thing, the doctor did discuss with me whether reading close up or mid range or distance, which was most important to me . I had forgotten about that conversation in the aftermath of the surgeries. They weren't pushing for laser or premium lenses, I was all set to go forward with the multi focus premium lenses until a friend told me that she had heard that there were issues with those lenses and keeping focused, which made a whole lot of sense to me. So I elected to correct the astigmatism and would if necessary resort to over the counter readers. I only wish now that readers would work.

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