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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7812
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I had cataract surgery in both eyes about 6 years ago. Three

Resolved Question:

I had cataract surgery in both eyes about
6 years ago. Three months after the surgery, I had what I saw as a
lightening storm in my head. First right eye, then
left eye a few days later. This left my good vision
severely diminished. Went to retina specialist who
agreed with me, but suggested I not have the
surgery to remove them, as it has a lot of
risks. I said I would try to live with it, but it
has been very hard. The original cataract surgery
also affected a muscle imbalance in my eyes , that
I have had since childhood. It has also become
much more pronounced. I have double vision
all the time now, bad depth perception, balance
problems and greatly diminished vision in
dim light. In the last year, I have also developed
sub posterior cataracts, which have put a white
haze in my vision now. Glare is a real problem.
Here's my question. I have found a doctor who
feels he can fix/improve my eye muscle problem,
which he says will also help with the double vision
and balance problems. By the way, my
horizontal vision is at a 15 degree tilt.

He has a colleague that can take care of the
secondary cataracts for me.

The floaters, no one wants to tackle I guess
because of risks involved.

I am looking for some good advice before I
proceed. Which surgery should I have first?
What do the surgeries I mentioned involve?
How much risk is there? How long recovery
time is involved?

I know this is a lot of info, but I need more
feedback before I take the next step. No one
in my family can really relate. They just kind
of pretend I'm ok, even though I stopped driving
at night and have to have help getting around
in dim light. Also, I own my art gallery and
I am a professional artist along with my husband
and son. This has put quite a damper on my
painting career of 35 years. Thank you for
your time! Susan
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 :

Are you available to chat?

Dr. Rick :

 


I see that you are offline. I will switch to Q&A format. This format works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

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.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 1 year ago.
I would have the YAG laser capsulotomy done first. This surgery has almost no risks to speak of. It is a simple, painless, in-office treatment that takes about one minute per eye and you can return immediately to your normal activities.

I would then have the strabismus surgery to correct your double vision. The muscles are removed from your eyeballs and re-positioned. This has risks of infection, bleeding, globe perforation and possible retinal detachment, poor results, need for more surgery etc. It is done under general anesthesia in an outpatient surgery center. You go home that day. The recovery time varies but can be a month or so.

What can you do about the floaters? Well, floaters don't go away, and they don't really get worse. Over time they tend to "sink" out of your central vision and you brain "filters" them out so you don't notice them so much anymore. They almost never cause significant visual problems except, of course, if they cause a secondary retinal detachment as discussed above. The only way to decrease or remove the floaters is with a major surgery called a vitrectomy. As a retinal specialist for almost 2 decades I've only done this procedure to remove floaters in a handful of cases.

Here is a video of the actual surgery to remove floaters:
http://www.retinavitreous.com/video%20files/intro_floaters.html


I would counsel you to think very, very hard before having this surgery because, if things go wrong, they can go really wrong with, sometimes, blinding consequences.....And, although this rarely happens (especially in my hands ;-), if it happens to you have to be able to say to yourself "well, I tried to get rid of my floaters and, even though things are worse now, I would still do the same thing again".

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


I wish you the very best and hope you can get back to painting soon :)
Customer: replied 1 year ago.
Thank you for so much good information. I did have a couple more questions, but plan to make it worth your while. I want to make sure we are speaking of the same type of cataracts. I have already had lenses removed and implant lenses put in. These new cataracts, that I have had for about a year now, are common after cataract surgery, I am told. It's kind of like looking through a thin white cotton ball. Vision is especially bad looking down and for reading. Is this the type you are speaking of? If so, I agree with your order of things. How long would I have to wait after the laser surgery, before having the eye muscle surgery? Would I have to use drops or any post laser treatments afterwards, of the laser surgery?

I have had floaters almost all of my life, due to being very nearsighted. Those rarely bothered me and they would just zip by my visual field. So, i understand what you said about the brain filtering these out.These post cataract floaters are different. I have had them for 6 years now. They are slow moving and grayish in color. They will almost linger in my line of vision and I have to wait for them to "move on". I was also told that they would continue to stay this way and not get better. However, I am thinking that if I have the laser surgery first, then the eye muscle surgery, that would eliminate a lot of my symptoms. If I can have visual improvement after these two surgeries, I will put up with the floaters and count my blessings!
Look forward to hearing back from you. Susan
Expert:  Dr. Rick replied 1 year ago.
Susan,

Yes. I understand what you are talking about. What you have is called a posterior capsule opacity. A common lay-term is "secondary cataract" We are both talking about the same thing :)

Technically, you could have the Yag laser surgery and then be wheeled into the OR for the strabismus surgery....that is how safe the laser is. Of course, from a scheduling point of view, that probably won't be done ;-)

The laser surgery will not, most likely, do anything for these "post cataract floaters" as you describe them. The only way to get get rid of 'em is with a posterior vitrectomy and gas/fluid exchange.

If they are really, really, really bothering you then I'm sure you can find a retina doc to remove them for you. As I said before, I have done surgery for floaters during my two+ decades of practice...but I was dragged kicking and screaming to the OR :)

I think putting up with the floaters is a wise decision.

I wish you the very best. Have a good evening.


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.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7812
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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