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Ask Dr. A.S. Desai Your Own Question

Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2160
Experience:  MS Ophthalmology with 11 years of surgical expereince
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74 year-old male, and on 1/9 and 1/23 of this year I had cataract

Resolved Question:

74 year-old male, and on 1/9 and 1/23 of this year I had cataract surgery and a standard introcular lens implantation in both eyes for distance only. My left eye which was done on 1/23 turned out very good resulting 20/20 to 20/25 vision in left eye without glasses: however, my right eye which was done on 1/9 didn't turn out as well. My vision now fluctuates between 20/40 and 20/50 without glasses in the right eye.
On 4/10/12 I had YAG Laser Treatment on my right eye to remove scar tissue and was supposed to improve my vision. However, there was no improvement. In fact, I now have floaters in my right eye which was not there before.
There were not any conditions in the eyes prior to surgery other than myopia, nearsightedness.
Is there any treatment or corrective surgery to improve the vision in my right eye?
Why did the results differ on each eye? Is it possible an error was made in measurement or needed strength in implanted lens?
Should I hold off on having YAG in the left eye which has perfect vision, since I am concerned about getting floaters in this eye as well?

The lens specifics are: model sn60wf
lens is acrysofIQ
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 2 years ago.

Dr. A.S. Desai :

Hello, Welcome to Just Answer

Dr. A.S. Desai :

Are you available for chat now?

Dr. A.S. Desai :

How is the vision in the right with glasses for the distance? I am to understand that the vision in the right for distance is 20/40 without glasses.

Dr. A.S. Desai :

If the vision in the right eye improves with glasses then it could be due to some amount of astigmatism ( slight change in the corneal curvature ). But in case the vision does not improve with glasses ( excluding posterior capsular opacification or PCO for which you were given YAG laser treatment too) then a dilated eye exam would help to know if there is any retinal cause for the reduced vision.

Dr. A.S. Desai :

It is possible that you have noticed the floaters only now after the cataract surgery. Floaters are common in those with myopia and is an age related change in the eye resulting in posterior vitreous detachment or PVD. Floaters would have occured irrespective of the laser treatment.

Dr. A.S. Desai :

If you have clear vision in the left eye with 20/20 vision, the chances of it having PCO is very unlikely or if present then it is away from the centre and not hindering the vision. So even if you do undergo YAG laser treatment in the left eye for PCO , it will not cause floaters and is a safe office procedure.It is not mandatory at this stage since the vision is 20/20 in the left eye, it can be done later too.

Dr. A.S. Desai :

It is very rare for an error in calculation of the power of the IOL to be inserted .

Dr. A.S. Desai :

If it is indeed due to an improper calculation of IOL then there should be an improvement in vision to 20/20 with glasses or with pin-hole in the right eye. In rare cases the wrong power IOL can be explanted and the correct IOL can be inserted . But this is a very tedious procedure and is not without its own risks.

Dr. A.S. Desai :

I guess you have stepped away from your computer at the moment. In that case I will exit from the chat and switch over to the Q&A mode so that you can view the answer later.

Dr. A.S. Desai :

Please let me know if there is anything else that I can answer for you.

Customer:

What is the pin hole in the right eye mean?

Dr. A.S. Desai :

Pin hole test is a simple test in which the vision is tested by placing an occluder with a central tiny hole in front of the eye to be tested.

Dr. A.S. Desai :

The vision will improve if there is astigmatism or improper power IOL. If the vision does not improve with pinhole then the cause for reduced distance vision could be due to some posterior segment( retina or optic nerve) problem.

Dr. A.S. Desai :

Though PCO is another important cause , it is not mentioned here since you did not benefit from YAG laser.

Dr. A.S. Desai :

Do you have any more questions to ask?

Customer:

can you clarify PCO and how to determine if this applies to me?

Dr. A.S. Desai :

PCO or posterior capsular opacification can occur as a post-operative complication in which the thin membranous capsular bag which holds the IOL begins to get opacified. This can occur sometimes when the peripheral cells in the capsular bag begin to multiply and cause a thin film of opacity.

Dr. A.S. Desai :

Once detected PCO can be treated with YAG laser treatment.

Dr. A.S. Desai :

It is identified after dilatation of the pupil and the eye is visualised on the slit lamp by the ophthalmologist.

Customer:

I see, so since this eye did not get better with YAG, is there anything else I should do with this eye?

Dr. A.S. Desai :

Since the right eye did not improve with YAG laser treatment, other causes for reduced vision post cataract surgery can be looked for such as macular edema, optic neuropathy, age related macular degeneration, myopic chorioretinal degeneration and so on. A dilated eye exam should be able to detect if any of these are present.

Customer:

how long after YAG before I should get the dilated eye exam? Also, hold off on left eye YAG, and for how long?

Dr. A.S. Desai :

There is no time restriction for the dilated eye exam and can be done anytime after the YAG treatment. As for postponing the YAG therapy in the left eye , it can be done even after 3-4 months depending on the site of the PCO and how much of the central pr pupillary zone is affected.

Dr. A.S. Desai :

or

Dr. A.S. Desai :

Does that make sense?

Dr. A.S. Desai :

I can only see that you have stepped in and out of the chat but nothing more.

Customer:

is this follow up eye exam considered a part of the medicare follow up program?

Dr. A.S. Desai :

Yes it is a part of the follow up if there has been a complication or unsatisfactory result .

Customer:

just about finished. what are the possibilities after the dilated exam? is it surgery again, or some other treatment?

Dr. A.S. Desai :

If the dilated eye exam reveals any posterior segement problem such as in the retina/macula or in the optic nerve ( less likely to be so in your case as the vision is relatively good), then it is more of medical line of treatment and not surgical.

Customer:

if not surgical, then you are referring to medicine or eye drops perhaps?

Dr. A.S. Desai :

yes

Customer:

would a contact lens in right eye also be a viable option? or is it not recommended since I have plugs in my eyes for dry eye?

Dr. A.S. Desai :

In that case contact lens would not be a good option considering the fact that you have dry eyes too.

Dr. A.S. Desai :

I hope that answers your questions to your satisfaction.

Customer:

can i use contact lens solution for the dry eye? if so, can i wear just one contact lens without one in the other eye?

Dr. A.S. Desai :

No it is better not to use contact lens solution for dry eyes. Instead you can use preservative free lubricating eye drops such as Refresh tears eye drops , 1 drop 4 times a day on a regular basis for the dry eyes. You can wear contact lens in one eye only too if you feel comfortable and if you are bale to focus with both eyes after it.

Customer:

thank you

Dr. A.S. Desai :

Thank you and best wishes.

If you are satisfied with the answer , please press the accept button so that I get my dues.

A bonus and/or positive feedback are welcome.

Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist

Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2160
Experience: MS Ophthalmology with 11 years of surgical expereince
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Dr. A.S. Desai
Dr. A.S. Desai
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MS Ophthalmology with 11 years of surgical expereince