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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11364
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I had cataract surgery last Monday. After the surgery, my

Resolved Question:

I had cataract surgery last Monday. After the surgery, my vision immediately changed from near sighted to far sighted. My surgeon says this is uncommon; but can happen. Now I will need glasses for distance instead of only for reading.

This is my "good" eye. The left eye was "lazy" as a young child and could never be corrected (though patches and exercises were used). I am quite concerned because I am due to have surgery on the bad eye in about six weeks.

Could a wrong len have been used, was the eye measured incorrectly, or could the len have been made improperly? Can this situation be reversed? Thank you very much for your help. Judi

Submitted: 5 years ago.
Category: Eye
Expert:  Dr. Rick replied 5 years ago.
Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Yes, that is entirely possible. Your vision after cataract surgery depends upon a couple of factors, the most important of which is the power of the artificial lens placed inside your eye at the time of surgery.

Dr. Rick :

What can be done about this? Well, as you have already noted, you can wear glasses. The other thing that can be done is to exchange the intraocular lens for one of a different power. Now that your surgeon knows what your final refractive error is with the current power IOL it should be easier to pick a different IOL to give you whatever postop refraction you would like: Nearsighted, Plano, or farsighted.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

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Dr. Rick :

I see that you are offline. I'll switch over to the Q&A system. This system 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 5 years ago.
Let me know if there is anything else you would like to discuss pertaining to this issue.
Customer: replied 5 years ago.

I really prefer to have vision as it was before, i.e. use reading glasses. If the procedure is redone, does that mean I have to pay another copay and then my insurance and Medicare are rebilled? If this is done, would insurance and Medicare refuse to pay for 2nd procedure on same eye?

One other question, please....since left eye is the "lazy" one, when cataract is removed from that eye, what could happen. I don't use that eye much and don't want to lose what vision there is in that eye. Thank you.

Expert:  Dr. Rick replied 5 years ago.
That is an excellent question and, as a surgeon, I must admit that my staff don't let me play around with the billing stuff :) so I really don't know how the insurance payments would work.
The best person to ask about these things would be the staff member at your surgeons office who deals with the insurance companies and medicare.
After removing the cataract from your lazy (amblyopic) eye you can expect your vision to return to the level it was before the cataract became an issue.....kinda like it was when you were 45 years old or so. The removal of the cataract in this eye wouldn't be expected to cause any loss of vision as long as there are no adverse surgical events....
Does this help?
Customer: replied 5 years ago.
Okay, I understand that. However, why is the vision in my right eye so different? Seems something crazy happened there. I realize it may be a few weeks before optimun vision returns. Bur frankly, I am really concerned. I can't even drive at this point. Shouldn't the surgeon have warned me this might happen or could there have been some way of keeping the chances of this odd occurance from happening. My right eye is much worse than it used to be.
Expert:  Dr. Rick replied 5 years ago.
You are correct in that it is early to be able to say what your final, best corrected (with glasses) visual acuity will be when all the healing in done in your right eye.
From what you posted it does seem, however, that your surgeon did a "test" refraction soon after you noticed the problems with your distance vision and noticed that you were now more far sighted then he would have expected from his pre-op calculations. You did not say what number he found you needed at that point to get your best corrected visual acuity, or where on the chart you could see with it in place using the phoropter so I really can't remark on that at this point. It is likely, however, that you could expect excellent distance vision except it would require "plus" (hyperopic) powered glasses to get that vision -- and that was NOT the pre-op plan.
I am sure that somewhere in the consent form it talks about "surprise" post op need for thick glasses but, I agree, that isn't what most folks would consider a least not after the stuff has hit the fan. Since this is a very rare issue, I don't think a special 5 minute talk about this possible issue is indicated. Heck, if it was then every pre-op consent would take all day long.....
I understand that without glasses right now your right eye vision is very poor....but the question is what can you see with your best glasses in place? So to be fair, when you say that your right eye is worse then it used to be you need to compare apples to apples and only apply this vision test when wearing your best glasses in each case.
Of course, your primary question is that you don't want to use glasses for distance vision and what can be done -- and lens exchange is one solution to this problem.
I hope I've helped to clear up some of these issues for you. I wish you the best in your upcoming surgery. Remember this, however. If you have lost confidence in your surgeon you can go somewhere else to have the other eye done, or just take a wait and see approach. There is no rush when it comes to cataract surgery in the vast majority of cases.
If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button/positive feedback for this encounter. I would also be happy to continue to answer any more questions you have until we have resolved your concern.
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