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Hi. My name isXXXXX and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.
Sorry to hear about all the difficulties you have been having. As a retina surgeon, let me go over your questions in order:
1. Yes. I believe using the atropine for a year is a good idea. There are no significant risks to the retina from long term atropine use.
2. I would not rush to a clear lens extraction, especially since you seem willing to give the atropine treatment a longer trial. Obtaining the correct post-operative refraction with clear lens extraction can be complicated after having had lasik surgery. You run the risk of making things worse....and you can not "undo" surgery.
If things do not change after a year of atropine, then you might need surgical treatment...
Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations. Thanks in advance, Dr. Rick MD FACS
Hi. Are you there?
Thank you for your answer
Yes I am here
My pleasure. Is there anything else you would like to ask me tonight?
(it is 8 pm here in the USA
I just would like some further information about point 2
In France it's 3 am :D
you say it's complicated to have a correct refraction for the implant after lasik surgery
but i wonder why ?
After lasik surgery it is hard to select the intraocular lens power after your natural lens is removed. If this were to happen you might need to use thicker glasses after the lens extraction than you did before lasik surgery. This is why I counsel patience.
It has to do with the formula for calculating intraocular lens power....
does this make sense to you?
ok that's very clear, thank you. i don't care about having glasses again, i've been through a lot of pain with my spasm, especially when it was not diagnosed yet
I can understand your pain and frustration :(
I hope things get better soon.
and would you advise to have clear lens extraction for both eyes if atropine doesn't work ?
or try just one eye ?
I'd try one eye first and see how it goes.....
do you also know if the ciliary muscle could "push" the implant ?
because it couldn't change the shape of the implant, but i was thinking that maybe it could move it
if the spasm is still active
No. The ciliary muscle will not be able to move the implant. No worries there.
that's at least one good news :-)
Glad to be the bearer of good news :)
would you recommend monofocal implant ?
Yes...especially after all you have been through...keep it simple..
that's what i think as well, i don't want to take further risks if long term atropinization doesn't work
thank you for your answers
My pleasure. Take care.
It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
I have got 3 more technical questions, if you think you would be able to answer them :-)
1. Is there any drop, or another possibility than atropine to paralyse accommodation, without having pupil dilated ?
Because I am always blinded when outdoors, even with sunglasses it is sometimes difficult to stand the light when it is very sunny.
For example, small quantities of botulinum toxin can be used to weaken some overactive muscles (for strabismus...). Is it possible to paralyse the ciliary muscle with this substance ?
2. How is it possible to get an accommodative spasm with such a huge amplitude (5 diopters) right after a lasik surgery ?
Because there are some cases of ciliary spasms released in scientific publications which lead to a difference of 0.25 or 0.50 diopters, sometimes 1 diopter, but my case seems to be nearly unique. All the lasik specialists I met since my surgery told me I was the first one to have a spasm of this amplitude (in france where there are however 150'000 lasik surgeries per year which is a lot).
I found some cases with the same amplitude as me, but for people who have got some head trauma after an accident.
3. Do you know if there is some medical research in the world about accommodative spasm ? Or regarding links between autonomic nervous system and ciliary muscle ?
From what I read in publications, the origin of this phenomenon is relatively unknown
I think we have examined the question from all sides.
Thank you very much for your accurate answers
Thank you for your help.
No I didn't make an appointment at Moorfields yet, and I am not sure if my spoken english is good enough for that. I searched for e-mail contacts to ask some advice but it seems that it's only possible to make a new appointment.
I must see two more specialists my surgeon recommended to me, as wella as an eye hospital in Paris (Les Quinze Vingts), then if i have the feeling that i get no satisfactory answer i will get in touch with Moorfields