Questions to ask (potential) new dr. BEFORE surgery on my second eye?
Posted , 3 users are following.
After a less than satisfactory first implant (Vivity) which resulted in a refractive suprise (-0.75sph and +0.5cyl), I decided to interview at least a second ophthalmologist before going ahead with the second eye.
I am meeting with them tomorrow. I assume that I have to be careful not to disparage the previous doctor—which other than the refractive surprise did a good job—but what are some good questions to ask?
Here's what I plan to ask:
"What type of lens and target do you recommend for my second eye?"
"What can we do in order to minimize the odds of another refractive surprise?" (Ideally I'd like to have multiple measurements taken—at least a couple with two different devices/doctors and at different times of day, but I don't know if this is done or how to coordinate it.)
"What can be done to minimize the possibility of PCO?"
Are there other important things to ask, for example about the tools/techniques they use (laser vs. scalpel, Ora, etc.)?
Thank you!
0 likes, 8 replies
Lynda111 RandallG
Posted
I hope your ophthalmologist in a Anterior Segment Cornea specialist.
I don't think anything can be done to prevent PCO. It happens, eventually, to many post-cataract surgery patients.
ORA is very precise, but not all cataract surgeons have access to that.
Multiple measurements, yes. I hope they are using the latest devices like Lenstar, etc, and a Certified technician to operate it.
About an hour before you have your measurements, put some Systane (or another brand) Non Preservative artificial tears in your eyes. Studies have shown it can improve measurements.
There are other members here who are very well-informed about optics who can advise you about various lenses and the refractory target.
RandallG Lynda111
Posted
Thank you, Lynda. Very useful.
RonAKA RandallG
Posted
I think you should be clear in what your objectives are and then ask for the lens type and target. For example you could say you are disappointed with your distance vision in your first eye and want to recover that with your second eye. Be prepared for the answer that they may recommend the Vivity again but targeted to plano this time, or they could recommend the PanOptix (which I would not). I think in the Alcon line the Clareon monofocal is your safest choice. And you should be prepared if they use J&J to have a whole different discussion. They may push Eyhance, Tecnis 1, Symfony, or Synergy.
.
On the refractive surprise, the unfortunate reality is that going back to the surgeon that did your first eye may be the best. They have a big advantage because they will have your first eye measurements, the predicted outcome for refraction, and now your actual outcome. They should be able to figure out why they missed and make the necessary adjustments. But there is no harm I guess in getting a second opinion. They however will be at a bit of a disadvantage unless your first surgeon is willing to share your data. If you are able you should ask the first surgeon's office for the IOLMaster Data Calculations. That would be very informative to the second surgeon. They could compare it to their own measurements and calculations to what you actually got.
.
I would ask what instrument they use for taking measurements. The preferred choice in my opinion is the IOLMaster 700. Second choice would be the LENSTAR LS 900. In either case they should also use the Pentacam. This will flag any astigmatism issues and give a second value of predicted residual astigmatism.
.
I would also ask what formulas they would use to calculate the lens power to be used. I believe the best ones are the Hill RBF 3.0 formula, and the Barrett Universal II formula. Ideally you want them to use both and show you the predicted results from both , and have the justify which they are using and why.
.
I am not convinced of the value of multiple measurements over time if they are done properly with one of those two recommended instruments. I am also not convinced of the value of laser and ora. You can do it, and pay extra for it, but not seen anything to justify the value off it. But, probably no downside in doing it either other than cost.
.
On PCO you will always take your chances. I think the Clareon lens may have some small advantages in resistance to PCO, but it is a risk reduction, not a sure thing.
.
Hope that helps some,
RandallG RonAKA
Posted
Thank you, Ron. Very thourough—as always—and it helps A LOT.
I have also thought about going back to the first surgeon—and still might since, after all, they have the history/data (as you mention.)
But I hesitate and wanted to speak to someone else because, besides the -0.75 "refractive surprise", my first surgery did not go as smoothly as I expected. For example, he did have to put in a stitch because he said that the lens would not stay put, and I was in the OR and "under the knife" for close to 25-30 minutes instead of the anticipated 10-15 minutes. It was a bit nerve wracking being there that long and I was aware that things were not going as smoothly as they usually do. Was that a matter of surgical skills/experience, or my eye/case being particularly challenging? Or both?
I have scheduled two consultations with new doctors. This one tomorrow, and (in February) one who is in the top 5 US ophthalmologist based on Newsweek's annual Best Eye Doctors (which may very well be more of a marketing gimmick) and has published a few papers on cataract surgery.
I did a bit of homework, but I was very casual with my first selection of surgeon and lens because EVERYONE of my family and friends who had the operation told me, it's a piece of cake, in-an-out in a couple of hours and you'll see great by dinner time. Now I know better and I want to make a more informed decision.
Thank you again for the information.
RonAKA RandallG
Posted
Perhaps if you have a cordial discussion with your first surgeon and ask for an explanation for the surprise miss and at the same time ask for the IOLMaster Calculation sheet you should get informed as to why they missed. Say you will think about it, and ask to take a copy of the Calculation sheet. Perhaps they will offer to do the second eye for free..., and if nothing else you will have the calculations to show your other second and third opinion surgeons.
Surprises do happen, so it would be a good idea in any case to not be accusatory in dealing with your surgeon.
RandallG RonAKA
Posted
Great suggestion. I would never be accusatory ... especially since I may go to him again. And I like the guy. And, as you've said, surprises do happen.
I wonder if one of the reasons for the miscalculation is that because of Covid I was wearing a mask in the waiting room for ~1hr before they took the eye measurements—and I had my mask on while taking those measurements—and there have been several reports of impact/irritation of ocular surfaces.
Sample article from Ophthalmology and Therapy:
"During the current coronavirus disease 2019 (COVID-19) epidemic, the concern for reducing disease transmission has led to a worldwide increase in face mask utilization. During this period, we have observed a corresponding increase in ocular irritation and dryness among regular mask users. This finding has not been previously described in the literature but has important implications on eye health and infection prevention, as mask use is likely to continue for the foreseeable future."
I could definitely feel my eyes being affected by the mask and the air flow toward the yes, but I though that if that could have been an issue they would have mentioned it.
RonAKA RandallG
Posted
I doubt it is anything as simple as eye irritation due to air flow from the mask. After having two eyes done for cataracts and consulting with two clinic on Lasik, I have had my eyes measured and tested many times. I think the big difference can be the skill of the technician doing the measuring. For that reason there may be value in two tests by two different technicians.
Lynda111 RandallG
Posted
Randall
For most people cataract surgery is a." piece of cake."
But not for all people. Let the us know how it turns out for you.