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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8325
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I had Bilateral Cateract surgery in 2011; Left eye 7/27 and

Customer Question

I had Bilateral Cateract surgery in 2011; Left eye 7/27 and Right eye 8/13; I had the Advanced lens implant and have had trouble with my Left eye since surgery. Had Left laser done without improvment. Now, almost at nearly 2 years out my left eye vision is musch worse. Current exam (7/2/13) shows a Retinal fold with a near future eval for surgery. ? What can cause this fold? How successful / risky is surgery. Can I just get glasses to cover the deficits?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. My name isXXXXX and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

I am a retina surgeon.

Dr. Rick :

Are you available to chat?

Customer:

Yes

Dr. Rick :

What is your current vision in the left eye, with your best glasses in place?

Dr. Rick :

And what, if you remember,was your best corrected vision in that eye before the retinal problem started?

Dr. Rick :

I do not agree about removing the multifocal lens.....in the majority of cases it can be removed at any point....although it might be technically more difficult later on...

Dr. Rick :

That being said an experienced cataract surgeon should be able to remove your lens and put another lens in your eye even now....

Dr. Rick :

Of course, that would not do anything to change your situation with an epiretianal membrane and macular pucker.

Customer:

No glasses but did try 1.5 readers. Do not know what eye tested at office but he told me that left eye was never 20/20; With the readers I can see your remarks and read them with study as there is a grayness over the words and have to study each word.

Dr. Rick :

Ok. Thanks for that extra information.

Customer:

He did give me a script for glasses if any information on the script would be helpful I can share that with you.

Dr. Rick :

Concerning your retina problem......I do not recommend retina surgery for this issue until such time the best possible vision is reduced to the 20/40 level do to the macular issues

Dr. Rick :

Thanks, XXXXX XXXXX is not the information that would be helpful.

Dr. Rick :

What are you hoping to do/what has your eye doc recommended at this point?

Dr. Rick :

To directly answer your posted question, in my hands epiretinal membrane peel is very successful with less then one in 500 risk of complications and, in the majority of cases, 3 lines of improvement in final vision

Dr. Rick :

But it is a big surgery and has all the risks of intraocular surgery along with special retinal risks....

Dr. Rick :

I see that you are typing....I will standby

Customer:

I did get a second opinion 6 months ago and was told that the lens could not be removed because it was healed and it would be major surgery with stitches and certainly a possibility of loss of vision. Again, I understand the "good ole boy" stand together network in my town with physicians. (I have only been retired 6 months and was a hospital nurse as well as an office manager in a physician's office) I also understand the potential liability fear so know that the second opinion would not take on a problem case. My current physician - have an appointment 7/23/13 to intertain the idea of lens removal and "general issue" (my definition) replacement as well as the retinal surgery and then trifocal glasses following both procedures

Dr. Rick :

The difficulties that you have been told about doing a lens exchange at this point are correct.....it may require suturing the posterior chamber lens in place and other fancy surgical steps, but it is not impossible....many experienced surgeons would gladly do the surgery for you.

Dr. Rick :

Talk to this doctor. He loves challenging eye cases:


 


http://www.finemd.com/meet_your_doctor_dr_fine.html

Dr. Rick :

If you were thinking of doing both the lens exchange and the retinal surgery, it would be important to have your cataract surgeon and retina doc work very, very closely in order to plan the best course of action for your particular eye issues.

Customer:

How successful is the retinal surgery/ I could go through life with my current vision (considered a handicap as my definition) but at least I can see. Just because I have a problem, does not necessarily mean that a doctor "must do something" Just be honest and straight forward to tell the the benefits and risks. I know if problems continue to be discussed then a physician feels the responsibility to DO SOMETHING. I don't want to risk the vision that I do have for a Dream of something better.

Dr. Rick :

Without actually examining your eye I can't say exactly what your actual risks/benefits of retina surgery are -- especially since it seems that your lens is also causing some of the vision loss.....

Customer:

The same surgeon does both procedures.....and he considers himself an expert and specialist

Dr. Rick :

That being said, in over two decades of retina practice, I've almost never had a patient end up with worse vision after this type of surgery.......

Dr. Rick :

If your retina doc says you would benefit from this type of surgery then you should go ahead....it is what I would call the "bread and butter" type of surgery we do...not to say that it is easy or risk free, but that retina docs are very well trained on the mechanics of this type of operation.

Customer:

Are there any specific questions that I could ask when I do see the surgeon for eval?

Dr. Rick :

You should make sure to bring your notes concerning your lens issues and discuss this with her.

Dr. Rick :

But other than that, no specific questions are needed....she will go over her findings and recommendations after looking at your retina etc

Customer:

I might add: The purpose for the lens exchange is because with glasses he stated "with this lens you would not be able to get the vison that you want or expect. So with the lens change glasses would be more beneficial.

Dr. Rick :

It sounds like you might not be happy with the vision after the lens exchange either......kinda between a rock and a hard place.

Customer:

Thanks, XXXXX XXXXX I fully understand all of the issues. I am not trying to be difficult, just would like someone to say " the results of the cataract surg is what it is......so live with it. The retinal issues are something different and are not related to the success or failure of the prior surg.

Dr. Rick :

It looks like the internet connection was lost for a few moment.....

Dr. Rick :

I understand what you are looking for but, from what you've told me here today, I think the best course of action would be to do nothing at this point -- that is if, as you mentioned, you can function OK with the vision you currently have.

Dr. Rick :

If you are hoping to get a lot better vision in an eye that "works OK" I feel you are taking a lot of risk for not much gain.

Dr. Rick :

You have to ask yourself: "If I have this eye surgery and go blind, or loose this eye completely, will I be happy knowing that I at least tried to make things better?"

Dr. Rick :

Does this make sense to you?

Customer:

Thanks, XXXXX XXXXX helpful. Will the retinal issue stabilize or can I expect continued deterioration. Since it is a new (for me) issue within the last 2 years.

Dr. Rick :

Usually an epiretinal membrane gets slowly worse. At your age, you might be hit by a runaway bus before the retina problem gets to be a major issue :)

Dr. Rick :

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

Customer:

Thanks pleased with the information.

Dr. Rick :

Let me know if I can help you in the future. Have a good day.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8325
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Customer: replied 1 year ago.

Didn't think I had any more questions but........What causes fetinal folds? Looks like congenital and dysplasia are inherited trates? This appeared after the cataract surgerg and was not noted prior to that time. So what events may cause this to spontaneous appear.?

Expert:  Dr. Rick replied 1 year ago.
Joan,

There are many things that can cause retinal folds. One common issue that can bring this on is called an epiretinal membrane. This membrane grows when certain cells get loose inside the eye, settle on the surface of the retina, and start to make a thin film. This film then contracts and wrinkles the retina.

The good news? This "film" can be "peeled" if it gets too bad and the retina wrinkles "smoothed" out.

Does this make sense to you?
Customer: replied 1 year ago.

Would the laser I had done on that eye make or change this fold?

Expert:  Dr. Rick replied 1 year ago.
Joan,

No. The laser you had would not impact the fold at all.

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Dr. Rick
Dr. Rick
Eye Doctor
8325 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest