Symfony/Synergy Update - 10/8 weeks later

Thanks @RonAKA. Yeah, I think I saw on another thread where you mentioned PVD so I looked into it. The literature on Google Scholar notes that it happens up to 12 months with the RD window of two years after surgery. The prevalence of PVD significantly reduces more toward the 12 months however. From what I've read, the PVD is caused by the disruption to the bag (cannot remember the medical term for this) in the eye. The literature says that rates of PVD after cataract surgery have improved since medical procedures have improved, but still an ongoing, albeit rare, issue. It is also more prevalent in males than females.

Did your other eye also go through it? I also read that once one eye starts the other will follow within a few months.

I just had my second eye done with a monofocal Clareon two weeks ago. No issues with it yet -- fingers crossed!

Awesome! Great to read this 😃 I meant did your other eye also go through PVD? The literature says that one will start the process a few weeks to a few months after the first one goes through it.

No PVD with the second eye, but I have only had the Clareon lens in for 19 days now. I sure hope it does not go that way as it is the eye that I read with. The PVD shows up somewhat annoyingly against a white computer screen background. But now with my left Clareon eye at about -1.5 D I really only use that one for computer screen reading and can pretty much ignore the PVD which hangs around in my other eye. Have not worn glasses since my second eye was done. I keep reaching for them like they are on my face, but there is nothing there! Nice to be essentially eyeglasses free.

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It seems to me that there is nothing that can be done to reduce the risk of PVD now. If it happens it happens. The good news is that the PVD I have in my first eye seems to be very slowly reducing in size and density. When it first happened it actually looked like a fairly sharp image of a solitaire engagement ring, with the claws on top but the diamond missing. I can no longer see the distinct ring part, and the top has been reduced to a fainter glob shape. I really do hope it goes away. It really does not interfere with my vision, but when it catches your eye, it is a distraction.

Yes, I did some quick Google checks and found the following study results. Their conclusion was that at up to 6 months post cataract surgery there is no elevation in PVD risk, but at 12 months the risk of PVD in the surgery group compared to the control group was 7 times higher. Ouch! I was not aware of any such risk. My PVD occurred at 10 months so it fits this conclusion.

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"The mean PVD stage significantly progressed over the 12 months in the surgery group (P = 0.0004), but did not change significantly in the non-surgery group. The PVD stage did not differ significantly between groups at 2 days, or 1, 3, and 6 months postoperatively, but was significantly more progressed in the surgery group than in the non-surgery group at 12 months (P = 0.0390). After adjusting for age, sex, axial length, and baseline PVD stage, the relative risk for progression to complete PVD was 7.1-fold higher in the surgery group than in the non-surgery group (P < 0.0001, 95% confidence interval 2.9–17.3)."

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Progression of posterior vitreous detachment after cataract surgery Shunsuke Hayashi, Motoaki Yoshida, Ken Hayashi & Kazuo Tsubota

I read a lot of research literature on this subject and much of it suggests that the risk of psudophakic RD in a highly myopic eye doesn't go down with years. The two years that you mentioned seems to be the median time to retinal detachment. Moreover, some evidence suggests that the risk increases after 4 years, see Sheu et al. 2010. Late Increased Risk of Retinal Detachment After Cataract Extraction, American J. of Ophthalmology 149, 1, 113-119.

Hi @RonAKA - sorry for the delay in response. Glad to read you are now glasses free - congratulations 😃

Yes, that is the study that I read. I actually saw the retinologist last week for a post-op check up and everything looked fine. I asked about the 'risky period' for complications and he said 1 year. I am going to take Sue's advice though and just live my life and try to stop worrying about it. My sight is amazing and I go to bed each night and wake each morning trying to focus on the gratitude of it 😃

Yes, live your life is good advice. I suspect there is not one single thing that can be done to prevent PVD. It is not worth worrying about.

Thanks for sharing. I also read (I cannot remember where) that new/advanced surgery techniques have reduced the risk so hopefully that is true.

I think the other aspect to look at when selecting a cataract surgeon is the amount of time he/she allows for consultation and consideration of different lens options. The surgeon I had is a provincial university teaching professor and I have no reason to doubt his skills as a surgeon. On my first eye I was pleased with his approach and allowance of time for consultation, but my first eye was kind of straightforward and did not require much time. This was not the case on my second surgery which was to deliver monovision in the close eye. He is transitioning his practice from a public healthcare option to more of a private clinic practice. Now his practice is spit between a public facility which has the best instruments, a private office which has less sophisticated instruments, and a new clinic where he does the actual surgery. This makes it more difficult to have all the information in one place to discuss how the options are best suited to my eye. I have come away with 20/20+ vision in my distance eye and J-1 reading in my near eye, but I still wonder if a better option was left on the table. I simply did not get the time allowed to thoroughly discuss the pros and cons of each of the options.

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This is a hard factor to consider in advance however, as you really can only get it from other patients who have had similar requirements, and have seen the same doctor as the one you are considering. The reviews on him at the ratemds site were very good originally when I first got started with him, but the last two reviews are not good at all, and reflect similar views to what I experienced. Perhaps this is the result of his transition in the business model to deliver the service.

Thanks @Rwbil - I think people in general are worried and scared when they come here - I know that I was! Terrified, in fact. You helped, believe me 😃

Hi @RonAKA - I was less than enthused with the information my surgeon gave. Discussing different lenses seemed like something he was not willing to do. It was extremely off putting and I am feeding this back to him when I find the right moment. I am, however, so glad I decided to trust him. He was a bit like "i am God and this is my decision" when I started to really probe into why these lenses..it wasn't a nice feeling as a patient - but I guess they get overwrought with Dr. Google all day long and lose patience with their patients. I don't know, but that side of things most certainly could have been better and I'll do my best to convey that to him when the moment is right (I will send him a letter). He also farms everything out to his staff and just sees the patient once before surgery and then day of surgery. I haven't actually seen him since the day of the 2nd surgery as his optometrist does all of the follow-ups.

Thanks @Rwbil - I think people in general are worried and scared when they come here - I know that I was! Terrified, in fact. You helped, believe me 😃

Jennifer, same here. I agree! I asked my surgeon what lens. She told me "Alcon" and that was it. More evaluation needs to be done before outfitting a patient with a particular lens. I have not seen my surgeon since she put in my IOLs in June. I was farmed out to the Opthamologist, which might have been ok had I not had complications. Even after my complications, I still have not received a call, text, letter, smoke signal, NOTHING. I even sent an email saying that I would like to see her given the issues that I am having.

Now, the Opthamologist has stopped communicating with me. I think it might be because I requested all my records late last year. He's a young guy in a large practice. I'm sure he's been told what to do. He was freely communicating with me via email, and after my appointment with him in December, he suddenly stopped.

Either way, it's totally unconscionable. I paid good money for a "premium" lens and the doctor can't/won't make time to see me and I'm having issues. I had another doctor, in the practice, do my YAG, as I was so disgusted with her. They should let their patients know that they are going to go ghost after they get your money and do your surgery. I entrusted my eyes to you, and that is best you can do??? I am livid, but trying not to focus on it. I have to figure out the best course of action. I will deal with her later.

DMarie2020 I am so sorry to read this. Please consider leaving a Google review. It can help others and also sometimes helps to garner some attention from the business.

I have one already written an in depth review and am waiting till I am done with my 2nd/3rd etc "opinions" because you never know who knows who, and if they see me leaving a less than complimentary review about another doctor, they may blacklist me. That is the only reason I have not posted that review. I plan to address whomever own the practice, as well as send a letter to my insurance company about using them as an in network provider. They got $5000 from me and about $5000 from the insurance. They might want to know about their providers lack of service. I will also post to every doctor review site available to me.

My biggest reason will be to alert others to the avoid the doctor that did my cataract procedure.