Cataract, Haze, Double

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Cataract, Haze, Double

Postby questions » Sun Jul 20, 2008 12:10 am

Hi Glenn,

Hope you can answer or point me in the right direction regarding my questions.

1. How does PRK affect the future outcome of cataract surgery? Will it worsen any existing condition (starburst, halos, ghosted/double/secondary)? For anyone who had PRK surgery, what would you do to recommend them to do?

2. What's the likelihood of haze or scar forming after the steroid drops have been stopped? I heard of late onset corneal haze. That makes me a little worried. I do use sunglasses. Are all patients at risk for haze after one year?

3. I am about 4 month post customvue PRK. I started seeing double images close to one month. The images started to subside or close in very gradually after 1 1/2 month (I switched from one steroid drop to another). One eye no longer has this issue but the other still sees a secondary image when I look at a computer monitor with thin color lines against a black background (yes, the room is very well lit). The same happens with LED alarm clock under dim light condition, although this does not seem to be a problem under bright condition. A doctor in the office who examined me during my last postop claims that this is a result of dry eye. Do you think there's other explanation?


Thanks for your time.
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Re: Cataract, Haze, Double

Postby LasikExpert » Sun Jul 20, 2008 5:29 am

questions wrote:1. How does PRK affect the future outcome of cataract surgery? Will it worsen any existing condition (starburst, halos, ghosted/double/secondary)? For anyone who had PRK surgery, what would you do to recommend them to do?


Myopia (nearsighted, shortsighted) and hyperopia (farsighted, longsighted) vision is commonly caused by the eye being elongated or short, respectively. All corneal refractive surgery including Lasik, All-Laser Lasik, PRK, Epi-Lasik, LASEK, and Intacs change the refractive error, but does not change the length of the eye.

Cataract surgery involves removing the natural lens within the eye and replacing it with an artificial lens. This artificial intraocular lens (IOL) has a refractive power that is selected to mimic the refractive power of the natural lens. The process to determine the appropriate IOL power is to measure the axial length of the eye.

The length of the eye is the same after PRK, but the refractive error has been changed at the cornea. If you were myopic 5.00 diopters before PRK, the measurment of the length of the eye will still show that you are 5.00 diopters myopic even though that myopia has been resolved at the cornea through PRK.

For this reason it is very important to have your pre-refractive surgery measurements for the cataract surgeon, even if it is just your original eyeglass prescription. Many refractive surgeons are taking the measurements for the IOL before refractive surgery so all the data is ready. It is possible to calculate the proper IOL power without the pre-refractive surgery information, but it is more challenging.

Cataract surgery with traditional IOLs do not have a bad reputation of causing halos, starbursts, etc. The multifocal IOLs do. If you select a traditional monofocal IOL for cataract surgery after PRK your night vision will likely be very similar after cataract surgery as it was before cataract surgery.

questions wrote:2. What's the likelihood of haze or scar forming after the steroid drops have been stopped? I heard of late onset corneal haze. That makes me a little worried. I do use sunglasses. Are all patients at risk for haze after one year?


Late onset corneal haze does occur, but it is relatively rare. It almost never occurs with PRK if the patient's refractive error is about 6.00 diopters or less. It almost never occurs with Lasik even with greater refractive error.

The exception to the rule is if steroid treatment is inappropriate. Another patient recently posted about what appears to be a very agressive use of steroids and subsequent corneal haze. A competent doctor and a paitent who follows the doctor's advice nearly always avoid this problem.

questions wrote:3. I am about 4 month post customvue PRK. I started seeing double images close to one month. The images started to subside or close in very gradually after 1 1/2 month (I switched from one steroid drop to another). One eye no longer has this issue but the other still sees a secondary image when I look at a computer monitor with thin color lines against a black background (yes, the room is very well lit). The same happens with LED alarm clock under dim light condition, although this does not seem to be a problem under bright condition. A doctor in the office who examined me during my last postop claims that this is a result of dry eye. Do you think there's other explanation?


Dry eye is a very reasonable explanation. Dry eye can cause inflammation of the cornea. Inflammation will cause an irregular refractive error similar to astigmatism. Light passing through this irregular area may focus off-center and create the ghost images.

Different light colors travels at different wavelenghts and different wavelengths can be affected differently by irregularities in the cornea. LED lights, especially red ones, are often problematic when normal daylight and other colors or even red from a non-LED source is not a problem.

The dry eye needs to be treated and managed fully before you really know what would be the best response.


questions wrote:Thanks for your time.


Glad to be of service.
Glenn Hagele
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Postby questions » Wed Jul 30, 2008 3:41 pm

Hi Glenn,

Thanks for the response. I want to obtain a copy of my medical record from the surgeon. Do you know if the cost is regulated? How much should I expect to pay for this?

Regarding corneal haze, are patients susceptible to this when they don't wear sunglasses after one year? I had moderate myopia (around -4.00, had wavefront guided PRK with 0.75 planned overcorrection). I am still going to be careful after one year, but would like to know the risks compared to normal eyes that never had PRK.

Also, can you recommend people on how they go about post 1 yr check up and beyond? Aside from the one year postop that patients have at the laser center, would you recommend them to visit an independent opthamologist (or other specialist) and if so, how do we go about searching for these doctors?

Thanks again.
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Postby LasikExpert » Wed Jul 30, 2008 8:49 pm

questions wrote:I want to obtain a copy of my medical record from the surgeon. Do you know if the cost is regulated? How much should I expect to pay for this?


I do not know of any regulation regarding pricing of medical record duplication. The cost may range from a nominal amount to about $75-100, depending upon the size of the record. Do ask that any color reports be color copied.

questions wrote:Regarding corneal haze, are patients susceptible to this when they don't wear sunglasses after one year?


UVA and UVB light has been shown to contribute to vision limitations and this seems to be especially true immediately after surface ablation techniques like PRK, LASEK, and Epi-Lasik, however it would be difficult to say how much, if any, additional diffuculty you would have if you are not properly protecting your eyes.

questions wrote:...but would like to know the risks compared to normal eyes that never had PRK.


The risks of enhancement PRK are virtually the same as the first surgery, however your doctor now knows how your cornea responds to treatment. This can be an important advantage.

questions wrote:Also, can you recommend people on how they go about post 1 yr check up and beyond? Aside from the one year postop that patients have at the laser center, would you recommend them to visit an independent opthamologist (or other specialist) and if so, how do we go about searching for these doctors?


The health of your eyes needs to be checked on a regular basis. How often depends upon your individual circumstances. People with diabetes should be checked more ofthen than those without. Anyone with a history of glaucoma needs to be checked more often. People over 40 need to be checked more often. It would probably be wise for you to see an ophthalmologist at least each year after your refractive surgery until that doctor instructs otherwise.

Your medical insurance probably has a panel of approved ophthalmologists who can check the medical health of your eyes. Routine ophthalmic exams are likely covered under your major medical health insurance plan.

Optometrists are also trained to diagnose and treat many eye health problems.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California

Postby questions » Fri Aug 01, 2008 3:15 pm

Hi Glenn,

Sorry for so many follow up questions, but another just came to my mind this morning. My surgeon said that he performs overcorrection (0.75) to compensate for the natural progression of myopia. Given my original prescription around -4.00, is it problematic if I am not seeing better than 20/20 after 3 months? I think I meant to ask, are there possible issues with my eyes that I should take notice. Many thanks for your response.
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Postby LasikExpert » Fri Aug 01, 2008 5:10 pm

Your doctor can perform a refraction (which is better, one or two?) to determine your current refractive error. You may have some residual refractive error or overcorrection that is causing poor vision quality.

An overcorrection of 0.75 diopters for someone who was 4.00 diopters myopic (nearsighted, shortsighted) seems a bit high, however the surgeon may know from prior experience that his particular treatment plan results in this much Lasik regression.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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