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Ask Dr. Dan B. Your Own Question
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I recently had cataract surgery with a lens replacement in

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I recently had cataract surgery with a lens replacement in my right eye. The lens was targeted to provide good distance vision (a Toric IOL astigmatism-correcting monofocal lens). However two months later I only have good vision at 1-3 feet.

I had a retinal deteachment several years ago, and there is a bit of scar tissue from that surgery. In response to the results my doctor said that apparently the algorithm that calculates the lens Rx didn't provide the correct information because of the retinal detachment.

I also need the same surgery for my left eye. Three are a couple of options here, but the best choice appears to be to choose a lens that corrects my left eye to match my right eye. After I expressed my displeasure with hold the results for the first eye my doctor said he would just take whatever the insurance paid, and only charge $395 for the lens (normally $1,200). A nurse friend said all this sounded "fishy". She asked if they used the correct lens; I believe the doctor mentioned that the correct lens was used in the follow-up exam.

Question 1 - Could there have been an error here?
Question 2 - Should I go ahead with surgery on the second eye, are do some more investigation into whether there was some kind of error made? I would like to do the surgery this year as I have met my insurance deductable.

Doctor DanB : Hello and thanks for your question. Are you available to chat?


Doctor DanB : Unfortunately, errors in calculation of the lens implant power do happen. Most of the time, approximately 90% of the time, the appropriate lens power is calculated such that the desired refractive state is reached. However, for numerous reasons such as an excessively long or excessively short eye, an eye that has had prior surgery or trauma, the measurements that are taken to determine the power of the lens implant sometimes are not as reliable as we would like. This sounds like what happened to you.

Could the calculation really be off so much that I wind up with near vision instead of distance vision?

Doctor DanB : For your other eye, presumably it has not had surgery or does not have other abnormalities that would make lens implant calculation difficult, I would not expect a refractive surprise such as one that you had with the first eye. Knowing that, I think it would be okay to get the toric implant in the fellow eye. What your doctor has offered does not sound fishy, but sounds like it was offered with good intentions to show that he or she is trying to have your best interests at heart.
Doctor DanB : Unfortunately, yes, a miscalculation could result in clearer near vision than far vision.

Knowing I had a prior retinal detachment, should the physician have used multiple devices or programs to take measurements in order to verify the individual results?

Doctor DanB : It is difficult to say from my end whether your surgeon should've use multiple means of measurements to calculate your lens implant. If, looking at the scans, there were abnormalities visible, that can and usually does prompt the surgeon to seek additional measurements to verify the first, but without looking at the scans and seeing a visible abnormality of the quality of the scans, I cannot say that he was wrong in not using additional measurement means.

PS - I don't know that he didn't use multiple measurements. Also I'm not looking for grounds for a lawsuit, but I'm just trying to feel comfortable in making the decision to proceed with the second eye. I think this covers all my questions.Thanks again. XXXXX

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