Shooting after cataracts surgery

[baldhunter]

I just went to schedule my cataract surgery a couple of weeks ago.I have a real high astigmatism in both eyes.I looked into what type of lenses would be good for me,along with some help from here too,before I saw the doctor.I was hoping he would do the Toric lenses.They did the final evaluations and measurements and the doctor suggested the Toric lenses.He said I was not a candidate for multifocal lenses,but the Toric would give me very good regular and distance vision.He said I still may need some readers for close up work and reading.My surgeries are scheduled for the last week in July and one week later the first week of August for the second eye.My cost for the surgery,lense and eye drops that I purchased from their office that was a premix of three type of drops came out to $1320.00 per eye with Medicare and United Health Care PPO insurance.The drops were $75 out of pocket expense.I could have had a prescription for the eye drops,but it would have been three prescriptions and insurance may or may not cover it.I went with theirs because I only had to put one drop in my eye instead of three drops each time.After wearing glasses with astigmatism correction for 62yrs,I am so ready to have this surgery.I have been having my cataracts checked for the last three years.The doctor said I had them but they weren't quite ready.This past April he said they were ready and whenever I wanted it done just let him know.I started noticing a small change in my vision around January.When I saw the doctor in April,I could tell it had become a little worse.Since then I can really tell it's getting worse.I was taking with the girl that was scheduling my surgery.I was telling her how quickly my vision is changing.She said a lot of people tell her the same thing,once it starts changing it can change fast.If I can see without glasses with the Toric lenses like in the picture,I'm going to be very happy.It will be a life changing event for me to see clearly without glasses.You also have to put drops in your eyes for three days prior to surgery and four weeks there after.It also comes with post surgery instructions:
NO stooping,bending,lifting over 10lbs.Avoid strenuous activity.Rememberto keep your head above your heart for 2 weeks.

 

[Rick Richard]

I just went to schedule my cataract surgery a couple of weeks ago.I have a real high astigmatism in both eyes.I looked into what type of lenses would be good for me,along with some help from here too,before I saw the doctor.I was hoping he would do the Toric lenses.They did the final evaluations and measurements and the doctor suggested the Toric lenses.He said I was not a candidate for multifocal lenses,but the Toric would give me very good regular and distance vision.He said I still may need some readers for close up work and reading.My surgeries are scheduled for the last week in July and one week later the first week of August for the second eye.My cost for the surgery,lense and eye drops that I purchased from their office that was a premix of three type of drops came out to $1320.00 per eye with Medicare and United Health Care PPO insurance.The drops were $75 out of pocket expense.I could have had a prescription for the eye drops,but it would have been three prescriptions and insurance may or may not cover it.I went with theirs because I only had to put one drop in my eye instead of three drops each time.After wearing glasses with astigmatism correction for 62yrs,I am so ready to have this surgery.I have been having my cataracts checked for the last three years.The doctor said I had them but they weren't quite ready.This past April he said they were ready and whenever I wanted it done just let him know.I started noticing a small change in my vision around January.When I saw the doctor in April,I could tell it had become a little worse.Since then I can really tell it's getting worse.I was taking with the girl that was scheduling my surgery.I was telling her how quickly my vision is changing.She said a lot of people tell her the same thing,once it starts changing it can change fast.If I can see without glasses with the Toric lenses like in the picture,I'm going to be very happy.It will be a life changing event for me to see clearly without glasses.You also have to put drops in your eyes for three days prior to surgery and four weeks there after.It also comes with post surgery instructions:
NO stooping,bending,lifting over 10lbs.Avoid strenuous activity.Rememberto keep your head above your heart for 2 weeks.

View attachment 583821View attachment 583822

And don't forget to shake the heck out of the medicine bottle to ensure good mix prior to application into the eye.

 

[Frog4aday]

@Frog4aday
Hi! I am 77 yo with PSC in both eyes, Astigmatism of; Right = 1.07 D @ 0* and, Left = 0.48 D @ 96*. I will be having Cataract Surgery and am trying o decide between regular lenses with LRI as part of Cataract Surgery for Right and the same for Left or, a Toric Lens for Right. I have choice of Lenses with Technis Monofocus being my current inclination. Your "Off-the Record" remark / comment would be sincerely appreciated. Thank you for reading!

Hey @stever88
Sorry for the slow response.
I am not a doctor and I don't know your ocular history so of course the best decision is to go with what you and your doctor agree suits YOUR situation best.

Hypothetically, if it were me with the astigmatism you indicated, I would get a toric IOL in my right eye to correct the one diopter of astigmatism.

In the left eye, I would go w/a simple monofocal IOL (the Tecnis lens is very good) and NOT have the LRI due to the less than half diopter of astigmatism in that eye. Some of that astigmatism could be lens based (vs. being in the cornea) and after surgery you may only have a quarter diopter remaining and that won't even be noticeable, especially if your surgeon makes the phaco probe incision in the optimal location.

LRI is a valuable tool in the eye surgeon's "tool kit" for correcting astigmatism but I think a toric lens in the right eye and a standard monofocal lens in your left eye will be just fine to give you great post-op vision w/o risking any complications that come with doing an LRI.

Again, you and your doctor know your eye history & pre-op exam results so hopefully the two of you come up w/a plan that best works for your eyes & post-op goals. Good luck!

 

[Frog4aday]

Had my right eye done May 15th along with a Vitrectomy. My vision is jot as good (blurry) at distance as prior to the surgery. Doctor says give it a couple of months more to stabilize and he will tweak it to get rid of the residual astigmatism.

Hey Rick,
I'm bummed to hear your vision is worse now than before the surgery (did I read that right?)

Has your surgeon mentioned "macular edema" (macular swelling) to you? Are you still using the "milky" looking eye drops (prednisone), several times a day?

Doing a vitrectomy on top of the cataract extraction means more surgical time in the eye and that can make the macula angry. In time, and with medicine (anti-inflammatories, like prednisolone) that edema can go down & vision will (should) get better.

You could also have a posterior capsular opacity (PCO) and they will be able to clear that up w/a YAG laser treatment 90 days after your surgery.

The comment about waiting several months then correcting residual astigmatism is odd to me, but I will trust your surgeon is keeping a close eye on you and has a plan to get you fixed up. Maybe he was hoping the cataract surgery would fix more astigmatism than it did & there is enough left over to need an LRI at some point to sharpen your vision up? He will hook you up w/whatever you need to get you seeing as good as possible, I'm sure! They want you happy.

 

[Frog4aday]

Had surgery last week in the left eye. LRI and standard lense. Been a rough week with 3 days of major irritation and currently distance vision is blurry with close vision crystal clear. Oddly my follow up apt shows I'm 20/20 but was told to chill out and be patient. Next apt is 2 weeks. Hoping it settles in and my far vision is good. My right cataract is beginning to be more evident.

Hey @BrentM
Three days of post-op irritation is not the norm, but when you get LRI, those are extra incisions to the cornea that can take 24 to 72 hours to heal, so that's likely what was going on. Hopefully you are past the worst of it now.

You said your NEAR vision was "crystal clear" but far was blurry, then reported that your visual acuity was 20/20. Was that your DISTANT visual acuity? Or NEAR? Regardless, the good news is it means your macula is fine (not swollen.)

But if your DVA (distant visual acuity) is poor & your NVA (near visual acuity) is really good, the question becomes - was that the goal (i.e., planned outcome)?

Some people get monovision (one eye set for good DVA, one eye set for good NVA). And if that was the plan and this was meant to be your good NVA eye, then all is well. If not, and if things don't get better, your surgeon owes you an explanation. I guess we'll see how things look for you in two weeks. I'm hoping things improve and you just keep seeing better w/more time and healing. Keep us posted.

 

[Frog4aday]

<SNIPPED A BUNCH OF STUFF> You also have to put drops in your eyes for three days prior to surgery and four weeks there after. <SNIPPED A LITTLE BIT OF STUFF>

@baldhunter
I hope your upcoming surgery goes great and you are seeing well very soon.

I wanted to touch on your eye drops. The clinic providing you an "all-in-one" drop for a low price ($75) is very nice. Having to buy all three drops separately can get expensive and having only one drop to instill four times a day (at first) is a time-saver.

More and more eye surgeons are going to a "drop-less" surgery, where the patient doesn't have to put in eye drops at all. The doctor injects antibiotics & an anti-inflammatory at the time of the surgery so the patient can skip using eye drops entirely.

I only bring this up so people reading this aren't confused. Some docs still require eye drops (sometimes two, sometimes three), whereas some inject medication @ the time of surgery and don't require you to use eye drops. Both systems work fine. Both are 'normal'.

If you are told to use eye drops...USE THEM! One drop is your antibiotic, to prevent infection. Super important!
The other drop(s) are anti-inflammatory meds to calm your eye and prevent macular edema. The two enemies of a good surgical outcome are infection & inflammation. Take the drops as directed! You want to see, right? No drops = no good. Just asking for trouble. (As you can see, the "drop-less" surgery is so much nicer - you can't screw it up, ha!)

One eye drop is cloudy/milky looking and you will taste it (it tastes bad/bitter.) This is prednisolone and it needs to be shaken really(!) well before use. Smack the bottom of the bottle on a table a few times and shake vigorously. You need to get those white particles off the bottom & mixed into the liquid for the drops to work. Smack-smack-smack, then shake-shake-shake-shake...shake, then use.

 

[Rick Richard]

Hey Rick,
I'm bummed to hear your vision is worse now than before the surgery (did I read that right?)

Has your surgeon mentioned "macular edema" (macular swelling) to you? Are you still using the "milky" looking eye drops (prednisone), several times a day?

Doing a vitrectomy on top of the cataract extraction means more surgical time in the eye and that can make the macula angry. In time, and with medicine (anti-inflammatories, like prednisolone) that edema can go down & vision will (should) get better.

You could also have a posterior capsular opacity (PCO) and they will be able to clear that up w/a YAG laser treatment 90 days after your surgery.

The comment about waiting several months then correcting residual astigmatism is odd to me, but I will trust your surgeon is keeping a close eye on you and has a plan to get you fixed up. Maybe he was hoping the cataract surgery would fix more astigmatism than it did & there is enough left over to need an LRI at some point to sharpen your vision up? He will hook you up w/whatever you need to get you seeing as good as possible, I'm sure! They want you happy.

You read that correctly. My vision is blurry at distance. Doctor says it is "residual" astigmatism from previous surgery many years ago. So, I go back in 6 weeks and I am not exactly sure what will happen, but he is adamant that I will not have to go back to glasses….his confidence level.

Anyway, thanks for asking and we will see what happens.

 

[BrentM]

You read that correctly. My vision is blurry at distance. Doctor says it is "residual" astigmatism from previous surgery many years ago. So, I go back in 6 weeks and I am not exactly sure what will happen, but he is adamant that I will not have to go back to glasses….his confidence level.

Anyway, thanks for asking and we will see what happens.

You and I seem to be on similar journeys. Ugh.

 

[LRNut]

It has been several months since I had my LAL cataract surgery. All I can say is that it has been life changing. I highly recommend this procedure; my surgeon didn't even mention Toric lenses; he simply said if you want to see perfectly without wearing glasses, go with LAL. Best $10,000 I ever spent.

 

[stever88]

Hey @stever88
Sorry for the slow response.
I am not a doctor and I don't know your ocular history so of course the best decision is to go with what you and your doctor agree suits YOUR situation best.

Hypothetically, if it were me with the astigmatism you indicated, I would get a toric IOL in my right eye to correct the one diopter of astigmatism.

In the left eye, I would go w/a simple monofocal IOL (the Tecnis lens is very good) and NOT have the LRI due to the less than half diopter of astigmatism in that eye. Some of that astigmatism could be lens based (vs. being in the cornea) and after surgery you may only have a quarter diopter remaining and that won't even be noticeable, especially if your surgeon makes the phaco probe incision in the optimal location.

LRI is a valuable tool in the eye surgeon's "tool kit" for correcting astigmatism but I think a toric lens in the right eye and a standard monofocal lens in your left eye will be just fine to give you great post-op vision w/o risking any complications that come with doing an LRI.

Again, you and your doctor know your eye history & pre-op exam results so hopefully the two of you come up w/a plan that best works for your eyes & post-op goals. Good luck!

Hi @Frog4aday!

Thank you so very much for taking time out of your day to read, digest & Reply in a thoughtful manner! Your observations are appreciated and will be a considered aspect of my overall thought & evaluation process going forward!

Have a good day!

 

[stever88]

@Frog4aday - Update, I am seeking a Second Opinion. What resources are available to research the efficacy of the different manufacturers & lens types and success rates of the different IOC procedures?

Thank you for your consideration!

 

[BrentM]

@Frog4aday - Update, I am seeking a Second Opinion. What resources are available to research the efficacy of the different manufacturers & lens types and success rates of the different IOC procedures?

Thank you for your consideration!

Good luck. My LRI in the left was a fail. Supposed to correct astigmatism, restore far sight. I now have a weird distortion on the left side of the left eye that messes with peripheral vision, I am near sighted, and have astigmatism. Still waiting on surgical center to get back to me to see what the plan is to fix this royal F up.

 

[Rick Richard]

I have a return appointment in two weeks to see what they are going to do with the astigmatism that is still there after my lens replacements.

 

[baldhunter]

Had my right eye done this morning.I Had the Clareon Toric IOL lense installed.Though I'm still in the recovery stage after just a few hours,I can see well enough to read fairly well without readers.My vision is still a little blurry right now,but it looks like everything is going to be OK.I see the Dr. in the morning and the left eye is scheduled for next Monday.This will be the first time in my life to be able to see without glasses.