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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience:  Eye Physician and Surgeon
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My eyegalss prescription is: OD Sphere +.75 Cylinder -.75

Resolved Question:

My eyegalss prescription is:
OD Sphere +.75 Cylinder -.75 x Axis 090
OS Sphere +.75 Cylinder -.50 x Axis 067

I am a female , 66 yrs. old in good health who wears multifocal lenses and has worn them for approximately 20 years. I have been told at my last eye exam in August '11 that I will need cataract surgery in two years. The left eye would correct to only 20-30. Right eye corrects to 20-20, the left eye having a more advanced cataract. I am begining to experience some glare problems, more in sun than night time. I am a Landscape Designer and installer. I work outside from sun up to sun down in the warm months and do graphic drawings down to a scale of 1/16". Can I have limbal relaxing surgery for the astigmatisim and multifocal lens implants for the presbyopia when it comes time to have the cataract surgery? I have HATED my glasses each and every day since I have had to wear them. Unitil the presbyopia began I did not wear glasses at all.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. James replied 2 years ago.

Dr. James :

Hello.

Customer:

Hello Doctor,

Dr. James :

Are you currently considering cataract surgery?

Customer:

Yes

Dr. James :

Have you consulted with a cataract surgery who implants multifocal lenses?

Dr. James :

.

Customer:

No. I have not. I wanted to learn as much as I could about what I can reasonably expect prior to discussing it with an eye surgeon And, I'm obviously hoping, post cataract surgery, to take my glasses and drive over them with my car. Several times.

Dr. James :

haha... yes.

Dr. James :

From your glasses prescription, it appears you have only a very small amount of astigmatism.

Dr. James :

That that amount, it may not be necessary to perform timbal relaxation incisions.

Dr. James :

*With that amount, it may not be necessary to perform limbal relaxation incisions.

Customer:

Well, that's good news. Do you have a particular multifocal lens implant type that, in your experience, is best suited for this type of correction?

Dr. James :

i do not implant the lenses myself. Other colleagues have had great success with the ReStor lenses.

Dr. James :

The Crystalens had a lot of potential, however, has not fully lived up to them.

Customer:

This is exactly the kind of information I was looking for. Can you tell me what questions I should ask when seeing the eye surgeon?

Dr. James :

The questions to ask is how much astigmatism do you have.

Dr. James :

in your glasses, it is little but the surface of your eyes may have more astigmatism (i.e. corneal astigmatism).

Dr. James :

with higher level of astigmatism, then you may need to have timbal relaxing incisions.

Dr. James :

Laser refractive surgery may be more precise an a better option.

Dr. James :

So, you should ask your surgeon if timbal relaxing incisions or laser would be better.

Customer:

Ok. If the astigmitism is such that I would need laser refractive, is that still compatible with a multifocal lens implant?

Dr. James :

yes.

Customer:

Great! You've been a great help. I feel much more confidant in uderstanding what I can expect when I see the surgeon. However, one more question. With one eye more compromised than the other, how long is the wait to have the second less affected eye done?

Dr. James :

Unfortunately, that is a more difficult question.

Dr. James :

Many surgeons are hesitant to operate on 20/20 eyes.

Dr. James :

If you have the left eye done, but the left eye is still 20/20, you may have to wait until the left eye worsens.

Dr. James :

You can choose to have surgery on the left eye done earlier than intended in the right eye results are what you expected.

Customer:

I didnt understand that. The left eye is 20-30. Right eye Ok.

Dr. James :

Sorry, i switched the eyes.

Dr. James :

If you operate on the left eye, and the right is still good (i.e. 20/20), then you may have to wait until it worsens.

Customer:

Then esentially I would be walking around able to read without glasses from the corrected eye and not from the uncorrected eye. Awkward! So, you mean that I could choose to have surgery done on the right eye earlier if the left eye results are what I expected? It seems my choices are to put this off as long as possible or battle my health insurance company to pay for the less problematic eye. I understand that health insurance doesn't cover lens upgrades or refactive surgery. I'm prepared to pay, but it would be nice to have at least some of the basic surgery cost covered. I'm not keen on having one eye uncorrected and the other corrected either.

Dr. James :

That is correct, medicare and insurance companies do not pay of the lens upgrade.

Dr. James :

Insurance does not pay for surgery on 20/20 eyes either.

Customer:

Well, Just knowing what my options are is a very good thing. I'm in the process of choosing a surgeon and will certainly be informed about what to expect. You've been extremely helpful. In case you're wondering, at this moment I'm thinking I need to wait as long as I possibly can. Also I will go for eliminating the need to wear glasses, no matter the cost. I'm going to accept you answer now and I will certainly leave good feedback and a tip. You've earned both.

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
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