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I had lasik and then a prk touch up 4 years ago. Recently

I had lasik and then...
I had lasik and then a prk touch up 4 years ago. Recently cataracts were affecting my vision and I had the first one done last week. The day after the iol implant (for distance) my vision in that eye was 20/25 the next day I woke up with blurry vision. With permission from my ophthalmologist, I went out of town for a few days and will see him tomorrow. In the meantime, my vision is still blurry and I have found that if I put my reading glasses on, the vision is crisp. So now my eye must have a +2 prescription. I don't know what the Dr will say tomorrow, but I would like to be prepared ahead of time with solutions, alternatives, why in the world did this happen? And can it be corrected. I do not want to wear glasses. :-( So without seeing my eye, do you have some theories about what has happened and how it will be dealt with?
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Answered in 1 hour by:
7/25/2013
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Verified
Doctor DanB : Hello and thanks for your question. Are you available to chat?
Doctor DanB :

First of all, let me say that in cataract surgery, there is often times a fair amount of inflammation that can cause blurry vision, fluctuating vision, or changes in vision. Generally, the further out from cataract surgery you get, the less there are vision fluctuations and the more consistent the measurement of your final refractive error after surgery is. So as far as what could be causing this, the first and very most likely is normal post-operative fluctuations in vision related to inflammation. That's why I never get too excited about what the vision is doing until after the first week when the largest swings in refractive error after surgery tend to be gone. Second, however, is the possibility that the measurements of the eye the led to the calculations enabling your surgeon to predict your ultimate refractive error may have introduced some fallability into the equation. It can be noticeably more difficult to predict the power of IOL implant necessary to produce a desired refractive state once someone has had corneal refractive surgery such as LASIK and/or PRK. This is because these laser surgeries change the basic assumptions we hold to be anatomically true and consistent and which allow us to use certain formulas with relative reliability.

Doctor DanB :

Now, what to do in your situation. First of all, don't panic. It is very possible that your refractive error continues to shift and fluctuate and that several more days after the surgery will help to weed out inflammation as a cause for the refractive error. If, after 1-2 weeks you find that your refractive error is still around a +2, then your options are thus: 1) see if an enhancement can safely be done to your corneal refractive surgeries (less likely given that you've already had one), 2) discuss with your surgeon exchanging the lens implant for the appropriately powered implant, or 3) wear a contact lens. I know none of these are very palatable, but these are your real world options--of course all of this is dependent on your exam, which (as you've astutely pointed out), I can't assess. Does all this make sense?

Doctor DanB :

Does this information help address your concerns? Do you have any other questions about this?

It appears as though you are not in the chat room currently. I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need. If you would like to ask further questions or clarification regarding anything I've said, please let me know and I will be happy to address your concerns when I return to see if you've responded. If your concerns have been resolved...

Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation
you must see an eye doctor. Thanks for your inquiry!

Doctor DanB :

Any questions about what you've read?

Customer:

it's been a week today.

Customer:

it's been a week today and it's for sure at least +2

Customer:

if an exchange is done how long does one usually wait to do that after the first surgery? I also read a bit about piggyback lenses

Doctor DanB :

Then I think it's more likely that this refractive error is real. Exchanges generally are best done in the first 4-6 weeks, but still can be done after that safely. Yes, piggyback lenses are also certainly an option and sometimes a better one than just exchanging the lens.

Customer:

next week I am supposed to have the other eye done, and I question the intelligence of doing that since the first eye isn't right

Doctor DanB :

I think there is a fair amount of wisdom in waiting to settle the first eye and figure out what happened.

Customer:

so when I talk to the ophthalmologist tomorrow, I will discuss cancelling the surgery for the second eye, and possibly scheduling something to be done to the first eye. How long do you think I will need to wait to have the first eye fixed to a more optimal vision. EVERYTHING is blurry right now unless I put on reading glasses. :-(

Customer:

I wondered if it's safer to do an exchange or piggyback quickly after the first surgery or to wait

Doctor DanB :

Well, how long you wait would generally be up to you and your surgeon (with your surgeon's preferences taking priority over mine certainly). But I would want to see the refractive error stable for 3-4 weeks before I operated a second time to correct it.

Doctor DanB :

I think waiting to do either one for a stable refractive error is the safest thing to do.

Customer:

thanks for your help. seems like if it weren't for bad luck, I'd have no luck at all. :-(

Customer:

planning a big trip and now will have poor vision

Doctor DanB :

Sorry to hear that. If it's any consolation, you've got company in that bad luck department. Try to have fun anyway! I hope this has been helpful.

Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.

Customer:

how would you deal with a cataract in one eye and +2 in the other to try to have decent vision on a trip to Europe?

Doctor DanB :

It depends on your refractive error in the cataract eye. What is it?

Customer:

-4.5

Doctor DanB :

Hmmm.. I think you would be best to try to wear some contacts for the vacation. That would eliminate the unsteadiness you are likely experiencing.

Customer:

do you think a contact could be used in the eye that just had surgery too?

Customer:

yes it's a mess :-/

Doctor DanB :

Yes, it can.

Customer:

great that's a big help thank you!

Doctor DanB :

My pleasure. Do you have any other questions about this?

Customer:

no you eased my mind and verified what I thought was wrong. although I realize my appointment tomorrow will verify it, at least I am armed with good information. thank you

Doctor DanB :

My pleasure. Hope this has been helpful. And try and have a good vacation despite this :)

Doctor DanB :

Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.

Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Verified
Dr. Dan B. and 87 other Eye Specialists are ready to help you
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Customer reply replied 4 years ago

apparently I can still ask questions of you? I had my appointment and the ophthalmologist told me everything looks great and I have a slight rx for being far sighted. I told him I can see nothing in focus and don't consider +1.75 a 'slight' rx.

He said we can do a piggyback procedure in a month. He isn't sure my insurance will cover it since my eye can be corrected to 20/20 with glasses and or contacts.

He is going to do my left eye next week with a -2.50 for up close/mono vision. saying if it ends up -2.50 that is good and if it does what this eye did, it won't go into being far sighted.

questions.... I don't know how much a piggyback procedure costs. I've been researching the cost but can find nothing. This is a big factor in my decision. They are checking the insurance and if it doesn't cover it, it will cost less doing it in office. Do you know approx what a piggyback procedure costs?

second question... I don't know if I should trust him to do the left eye since he missed the mark with my right eye. If I am nearsighted at least I can see up close. This farsightedness is horrible. :-(

thank you so much

Unfortunately, I really can't comment to any degree of certainty how much that piggyback lens procedure might cost you. The reason being is that there are so many variables involved including location, surgeon, anesthesia services. However, I would expect it to be somewhat similar to the original cataract surgery costs though maybe a little bit less.
If I were you, I would seriously think about postponing your other eye and getting a second opinion from another cataract surgeon. To make you monovision in your second eye when your first eye is significantly hyperopic, I think it would be very difficult to tolerate unless you had a long history of this similar arrangement in contact lenses. You risk nothing by waiting. By forging ahead with this arrangement at this time with your uncertain refractive error in your first eye, you risk being incredibly unhappy and even more procedures. My rule is to go slow and be sure.
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Customer reply replied 4 years ago

thank you I actually have had monovision for 20 years so that is good but I worry the second eye will end up hyperopic also and wonder if I need to find a different surgeon. Seems to me the surgeon I have should have been closer to the targeted distance vision.

Refractive surprises are not uncommon, nor is it necessarily comment on the technical proficiency of your surgeon. However, what does give me pause is the fact that he does not have a plan to take care of the first eye before operating on the second.
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Customer reply replied 4 years ago

that is extremely helpful thank you

You're welcome. Good luck.
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Dr. Dan B.
Dr. Dan B.
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Category: Eye
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