Want to explant IOL, but doc says it isa bad idea

Hi. I live in the nw corner of Washington State. Is he supposed to be a top expert? Thanks.

he is an expert on lens exchanges. i will see him later this month. i saw him four years ago. it will be 5 years post op for me and i too have very hazy pco and have put off yag. he was recommended to me by top univ of iowa (#6 in opthalmology) doctor especially for lens exchange.

lens exchange is a risky procedure nevertheless. PRK would be a safer and less invasive option for you than lens exchange.

Why do you want a lens exchange? Was this suggested for you? Was PRK suggested also?

I'm wondering if I should cancel my appt for the YAG now. I've held out this long because I was searching for a way out of my dilemma. My PCO is VERY, VERY cloudy/filmy. For 3 years I've pretty much used only one eye, and I'm an artist. ugh!

i suffer from extreme positive dysphotopsia due to large pupils. and i never got much intermediate from symfony.

my pco is very cloudy too. i have even posted a picture of it on one of the threads here that doctor wong took. for last 3 years i was miserable but covid and work from home helped. my other eye surgery in may made me functional again. that eye does not have PD but it has the panoptix not symfony.

Hi. I'm in Bellingham, Wa. Why do you ask? Thanks!

Hi. I'm an artist. I wanted to be able to draw w/out glasses. And read in bed- which unfortunately is what my doc was targeting for- I found out my -2 eye (it has really healed down to a -1.50.) is sufficient. From the beginning, I knew I would need glasses for driving, this was OK.

A lens exchange would give me a far more useful range. I blew it!!!

Lasik and PRK are both effective when reducing myopia. You could get the -3.0 D eye reduced to what you want it to be. I think that would be far less risky than a lens exchange. PRK is bit more invasive with the cornea peel, but probably results in just as good or better outcome. Athletes in contact sports do the PRK instead of Lasik to avoid cutting the flap and risking that it dislodges. PRK is more stable.

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If you are happy with the near vision in your -1.50 D eye for reading and art work, you could potentially go right to plano in the other eye and be eyeglasses free.

So PRK is FAR less risky? Doesn't it make your eye surface weaker? Do you know the long-term side effects? Thanks!

Yes, PRK is less risky, but far less may be an exaggeration. It takes longer to recover from but is more durable and better suited than Lasik if you have a thinner cornea. It can be used in some cases where Lasik cannot.

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Here are some articles I had saved on the subject, when I was considering the procedures.

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Healthline What’s the Difference Between PRK and LASIK?

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Michigan Medicine University of Michigan LASIK vs. PRK: Which Vision Correction Surgery Is Right for You?

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CRST PRK Versus LASIK After Cataract Surgery

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I recall you have had prior Lasik? If so, you may want to consider custom or topography guided laser surgery. It can be used with both Lasik or PRK. A detailed topographical map is made of the cornea and then is used by the laser to make a detailed correction to the shape of the cornea rather than just a general power or astigmatism correction programmed in without consideration of the actual shape of the eye (that is the standard way). This way they may be able to work around or even correct prior damage to the eye. It costs extra and not all Laser clinics have the equipment do do it, but in your case it may be worth it. If you consider it I would do a consult with at least two or three clinics that offer the custom procedure to see what they say.

Did you have PRK? What did you decide to do? t/u

I saw two laser surgery clinics and was rejected by both of them. I wanted to get rid of my astigmatism in my left near eye, and at the same time increase my sphere myopia which was in the range of -1.0 to -1.25 up to -1.50 D. I had -0.75 D cylinder. The first clinic said they could correct the cylinder to near zero but could not increase the sphere to maintain my reading ability. The second clinic was more detailed in their measurements and diagnosed keratoconus in the eye. Because of the condition of my cornea they said the results of laser surgery would not be predictable. They said other clinics might risk it, but they would not. I am now still seeing this second clinic to monitor the keratoconus to see if it is stable or not. I think Lasik or PRK are both off the table for me. I have very good near vision and was only looking to increase it to excellent. Not enough up side to take a risk on the surgery. We never got to the level of detail of choosing between PRK or Lasik.

So what are you going to do?

So you are trying to perfect your IOL outcome, rather than asking for an exchange, correct? Were you discouraged from having an exchange?

It is a bit of a long story. My surgeon when he did the initial measurements said that I had irregular astigmatism in this eye and it probably could not be improved with a toric lens. It was my second eye to be done and nearly two years went by before it was time. This time he said I would benefit from a toric and seemed to totally forget about the irregular astigmatism issue. He was in the middle of changing offices and did not have the ability to look at my topography images and said he would have to call me back. After he got his act together he did call me back and was all of a sudden on the fence about using a toric or not. He would not say that a toric would work for sure and that I could always get Lasic to correct any residual astigmatism. So I went for a non toric lens. I got -0.75 D astigmatism and unlike my other eye which I have astigmatism as well, it caused a drop down shadow on letters (this is my near eye for reading), especially with white text on a black background. When I told the surgeon about it he said it was the astigmatism and immediately offered to exchange the lens for a toric! I was shocked. Why didn't say that before the surgery? I knew the risks of a lens exchange and said no that I would not go ahead with it, but would pursue Lasik instead. He did some referrals for me and I quickly found out that Lasik (or PRK) was not going to be the silver bullet for my issue.

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The bottom line is that with this keratoconus issue and Lasik not being advised, this is kind of the end of the road for me. That said I do read very well and can't complain very loudly. I can read J1 on a Jaeger chart, but if I could dump the drop shadow I think I could read ever better. It was an attempt to go from very good to excellent reading vision that did not pan out.

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I now think a toric lens would have been the answer for me (but not sure enough to risk a lens exchange). The second Lasik clinic I saw showed me what my corrected vision in this eye was with only sphere correction and compared it to both sphere and astigmatism correction using a phoropter. The difference was striking. It is obvious to me that despite the astigmatism being irregular it was quite correctable with standard lenses (in the phoropter). The toric IOL would have worked equally as well. The surgeon really should have done the same thing and showed me what I could see with and without cylinder correction. If I had seen that, I would have went for a toric lens for sure. He didn't take the time to do that, and this is where I ended up. The reality is that cataract surgery is a cookie cutter assembly line procedure. There is not much time allowed for details like this.

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I just remind myself that I am eyeglasses free and got very close to where I wanted to be.

Yes, I'm learning the very hard way that cataract surgery is indeed an assembly line procedure. I thought I had done my due diligence. And thought my surgeon did too- but obviously they do not spend time on each case and rely on their techs, who want to speed things along- UGH.

I did not have prior Lasik.

The other point that I did not pick up on was that I did get an improvement in vision with a toric contact lens when I was simulating monovision. I should have concluded from that observation that a toric would have been of value to me.