112 Comments

  1. I have been told that my implanted lens is on an angle and there is a samll possiblity that during replacement of the lens it may slip back in to the viterous humor.

    What are the chances of this happening?
    What specality should an opthalmologist have to do this surgery?

    What is the possibility of permanent damage being done to my eye?

    What would have caused this slippage of the lens?

    My opthalmologist never mentioned it, but sent me to an optomertrist to have ??? drops for a dilated pupil. The opthalmologist never explained why I needed this and the optometrist would not touch my eye. Please help

  2. Well,
    Hard to say given your history. Sounds as if anything could have happened:

    1. The implanted lens may be at an “angle” because it tilted as your capsule contracted.
    2. One of the haptics of the lens implant may be sitting in the sulcus
    3. You may have had some zonular dehiscence with instability of the supporting capsule.
    4. You may have had a posterior capsular tear during the first surgery (common)

    You should really speak with an ophthalmologist whom you trust to look at your eye under the microscope and give you an opinion and give an opinion on your chances … I’m just guessing.

    I will say that this kind of lens tilt can happen after surgery, even after a “perfect surgery” without other complications or difficulties.

    As for the chances of a “dropped implant” … this is really a possibility, as a secondary operation is much more complicated and difficult than the primary surgery. If the lens DOES drop, it’s not the end of the world … but you’ll need another surgery by a retina surgeon to remove it.

    Like I said, though, you really need to see an eye doctor to examine your eye closely and discuss this with you as it’s almost impossible to guess without seeing the eye.

  3. Bhargav Raut says:

    Hello,
    i am a medical student at the end of my second year of medicine.
    I recently heard about a new invention in cataract surgery:
    Its called the Nanoknife.
    Its supposed to drastically reduce capsular opacification after surgery.
    Do you know about this?
    Thanks
    P:S– this page helped me get through my end of rotation exam really well.

  4. trapti sharma says:

    hi,
    i would like to know the blood sugar cut off level & b.p prior to cataract surgery or any ophthalmic surgery.
    thanx

  5. C. Allan Young says:

    Following a disasterous cataract surgery. (Eyeball filled with debris that required vitrectomy that led to CME) I eventually developed an elliptical iris that allows light to leak past the lens implant and being unfocussed produces haloes and glare. Is this a common complication? The article is good and I liked the style. C. Allan Young

  6. yasser maslamani says:

    dear all,
    i am pharmacist and so interested in cataract surgery. But I have one question: what is the role of viscoelastic substances like(H.A) in cataract surgery??
    thanks

    Editors Note: The viscoelastics used in surgery serves two purposes. The first, is to provide protection to delicate structures inside the eye – primarily, the endothelial surface of the cornea (those endothelial pump cells are very sensitive and don’t regenerate when lost). The second purpose is to keep the anterior chamber deep (keep the eye from ‘deflating’ when removing instruments and inserting the implant).

  7. I would like to know how you determine (about) the preoperative myopia of a patient that had cataract surgery without an implantlens, and who needs a refraction of +3 in his glasses.
    Could you also include a formula? Thanks!
    ( I like your website a lot!!)

  8. And can you help me with this: it is generally assumed that high(er) myopia correlates with low(er) vision. Is this true? Can’t find anything good about it. Thanks!

  9. My mom recenty had eye surgery to have cataracs removed.
    In a recent surgery, her doctor told her one of her lens in her right was tilted. The doctor said my my mom can see netter than before…but said she may trouble later with sunlight. Should she have another surgery to fix it? Are we doing more harm than good.

  10. I had cataract surgery in June ’08 (IOL implant) and later, in July 09, had retinal reattachment surgery (intraocular surgery with gas bubble)on the same eye for a partially detached retina. The retina had two flap tears that were repaired (cryo and laser). Five months post retinal surgery I have distorted vision in the operated eye: the image I see slants downward, from right to left (sloping horizontal axis of image) and the image tends to be elongated vertically. My IOL was sutured in place at the start of the retinal surgery, I assume as a precautionary measure. Is it possible that my IOL was somehow displaced during my retinal surgery and is causing this vision distortion, or is it more likely that other reasons for the distortion are more likely? Is there a way an ophthomalic exam can determine whether the IOL is in the right place?

    Thank you for your assistance. Your web site has been very useful to me.

    Steve

  11. Can you please tell me where did you derive the A-constant in the SRK meaurement..

  12. hello,

    pls tell me what is the cutoff glucose level before cataract surgery.

    my dad(diabetic) had 140 fasting on the morning of surgery.the diabetologist told the nurse on phone to give 4 units of insulin.so he was given…and in an hour,his level came down to 133.his surgery was performed.On the night after surgery..his ocular pressure had increased,he had pain.but mannitol to reduce pressure was gvn only next day…when v reported agin to hospital.and later tht day v came to knw tht diabetologist was denying tht he said the nurse to gv insulin to my dad.i mean he was like i first said the nurse to give bt then later denied.i dont know y he behaved tht day,isnt 140 more for fasting,n gvn insulin must have only benefitted him na??
    Now 3 wks later,when he is facing probs with vision, n also floaters,doc(opthlmologist) has told he has gt retianl swelling,he was gvn tricot inj. n he is on acular eye drops now for 2wks.pls gv info.

  13. thank you vvvvvvvvvvvvvvvvvvvvvvvvvvvvvery much

  14. Thanks for such a wonderful e learning chapter!
    Dear Sir,
    I’m a 3rd year medical student in India and I’ve an interesting doubt. Can the patient see the operative procedure when done since his Optic nerve is not targeted in Anesthesia?
    Thanks again.

    1. Björn Johansson says:

      Dear Raviteja,
      good question – some patients are worried before surgery that they will see large knives and needles moving just in front of their eye. Luckily, the microscope lamp is so strong that the operated patient cannot see any details with the operated eye, and the other eye is covered by sterile cloth. So no need to worry about seeing fearful surgical tools.
      On the other hand, if you use subtenonal or (less common today) retrobulbar anesthesia, the optic nerve is blocked and the patient will experience that what vision they have goes away. This might scare them if they are not told in advance that this is normal and that vision will return after the anesthesia.
      Best wishes
      Bjorn Johansson, associate professor Linkoping University Hospital Sweden

  15. good luke for all student of medical
    and best wishes

  16. NSENGIYUMVA Emmanuel says:

    Thank you!!!! you give important things.

  17. what happens when a lens turns after cataract surgery?

  18. My Ophthalmologist told me today that my lens implant had slipped changing the shape of my eye which resulted in a astigmatism and vision change. Can this be corrected? Did he not put the lens in correctly?

  19. sir i just want to know can we dilate the fundus by using tropicamide while we are using steriod eye drop

  20. lin companion says:

    My sister recently had cataract surgery. She now can read and see w/o glasses. She had worn glasses since she was 1 yr. old due to “short eye”…Could this type of surgery be done years earlier to spare her needing glasses for all those years?

  21. during eye refraction through retinoscopy sometime scissor reflexes are seen,instead of maridian reflexes,what should proper step for the neuterlization is require.

  22. leala davis says:

    what happens when the pupil sticks to the replacement lens not allowing the pupil to function

  23. hi
    i am a medical student of final year mbbs … we have ophthalmology subject in final year.. you book ,videos and fun part have helped me a lot, and have created a special interest in this subject.. thanks a lot, your work is really appreciable

  24. christiane says:

    hi iam a med student from germany and got ophthalmo for my last oral examination… this site helped me out a lot!! makes learning about the eye fun 😀 thanx!!!

  25. Hi…
    I am an Optometrist
    I dont seems to find any information regarding “Cortical cataracts.”..but runs into them off and on from refering Doctors.
    Please help!!

  26. Abul Sharah says:

    This is my first time to go to your website. I found it informative and educational. I have a question though. I need to have cataract surgery for both eyes and I have two option for the type of IOL: i)lens in one eye that will provide near vision and an IOL in the other eye that will provide distance vision, ii)lens in both eyes that provides distant vision. Can you tell me the pros and cons of the two options? Thank you.

    Tim Root: Abul, here is my standard response to patients concerning cataract-monovision:
    Monovision is when one eye is set for distance, while the other is set for near. Many contact lens wearers use a “monovision contact prescription” to avoid reading glasses. Most will set their dominant eye for distance and their non-dominant eye set for reading.

    While some people (like my mother) tolerate this imbalance well, other people hate monovision. The disparity between their eyes makes them sick to their stomach and unsteady on their feet. The blur at distance ruins their depth perception for driving, and reading becomes a chore because one eye is doing all the work.

    Imagine if we set your eyes permanently this way during your surgery. If you don’t like your monovision, it’s going to be hard to change those implants! At least with glasses or contacts we can take them off or pop them out.

    If you’ve been using monofocal contacts for years without issue (or your eyes are “naturally” focused this way), then we may purposefully shoot for monovision … but not without discussing this at length during your clinic visit.

    In the end, most people prefer to have both eyes in synch with each other. You can always put a contact in one eye for monovision afterwards if you really want it.

  27. My daughter was born with congenital catarracts and had then removed at six months old. The lens capsules were removed during the operation. Can you tell me if there is an artificial lenses that can be implanted that doesn’t require the lens capsule to be present?

  28. Elizabeth Maness says:

    Sir,
    I had cataract removal and a partial corneal transplant in my right eye in June 2007. I developed high eye pressure the evening after the surgery which was releved the next morning. Otherwise, everything was fine. In the spring of 2009, I had to have a YAG procedure due to clouding of my vision. This was successful. I have again developed clouding in the eye, essentially in the same area as before. Is it possible that I need another YAG? What could cause this to happen? I do have Type II diabetes, but it is controlled.

    Thank you,
    Elizabeth Maness

  29. I am doing Cataract+IOL surgery audit( biometry) to find out our predict errors and then cutomise our A constsnt, could you please help me where can I find causes for refracive deviation to design my proforms please.

    Thank you

    Mabruka Azzaruk

  30. Sid Cullingham says:

    After 2 years of lens replacement for cataracts, I woke up this morning, and can see an outline of my new lens ( I believe this is what I am seeing) No pain or pressure. Just disruptive. Any ideas?

    Tim Root: Sid, you need call your local ophthalmologist. If you are seeing something round in your vision … it’s probably NOT the implant, but more likely a vitreous detachment. Many people see a round, clear floater (called a Weiss Ring) when the vitreous jelly inside the eye contracts. While vitreous detachments are usually harmless, this is sometimes a harbinger of more serious problems like retinal detachment, so call your ophthalmologist first thing and get that eye checked out today.

  31. dear sir
    iam a pilot and have flown since 1993. throughout i had a slightly blured vision in my left eye recently during optalmic eye check up with dilation it was diagnosed that i may be having the coronary cataract or some call as blue dot cataract ,should i continue to fly

  32. alan hunter says:

    i am a 47 yo male,in 1986 i had a tramatic cateract,had an intraicular implant done at the jewel srien clinic at UCLA.all done under workman’s comp. i got a small settlement,alot of grief.10 yrs of dry eye,chemical sensitivity,the worst was the iliments growing like grains of sand.my lawyer was smart and got a judgement for lifetime medical. well its 24 yrs later and the lense has slipped out of its mounting. so it seems to me putting a new lens in asap is the smart thing to to. ..now the foot draging by the ins company.seen 3 specialists that do not want to touch it,seems the groove the lens sits in is eroded away.this is going on a year now and im very frieghtened. i want to go back to jewel stien and have it done despite the risk,which im told is 50/50 of loss of vision.the ins company offered me 15k.i said no.they are asking for a counter offer and termination of the settlement.i now have contracted AIDA and liver failure. so i am over whelmed. hould i settle and whats that worth? what would that link of surgury cost? is fixing the eye doable. please give me your two cents.it woud mean the world to me.sincerely,alan hunter..818 692 1420

  33. hi, My mother inlaw had cataract surgery and during surgery her iris slipped out,had a small tear,fixed they said .This is only happened yesterday.Today she is not seeing that well,I told her to give it a few days since she had the toric lens.I had never heard of the iris slipping out.What is your take on this. Thank you

  34. Dear Sir/Madam,

    My name is Les and I am 60 year old male living in Australia. About 12 months ago I began to experience unusually unstable vision. The moment I stayed in the sunlight for about a minute or longer without wearing sunglasses my vision the next day would go blurry and stay that way more or less. Gradually my vision turned to opaque and partially distorted when looking out close or far. A few years ago I got myself a pair of pin hole glasses for reading and it was working just fine. I tried to put them 10 months ago and I have noticed that pin holes this time were turning into white haze. As it is of now I can hardly read wearing them because my vision is dim and kind of distorted and I see through white fog. I went to see an eye doctor and he said that there is some protein layer formed which kind of obstructs the lenses. On top of it if I look at something out there my eyes ache and sting and it is not comfortable at all times. I am forced now to wear sunglasses at all times for the reason mentioned above.
    I’d appreciate your comments if you don’t mind.

    With regards,
    Les

  35. doreen schleifer says:

    50 year old post-LASIK patient (15 years ago) with great results. Now had aggressive cataracts removed and single distance implants in both eyes. HATE VISION! why is my distance vision soo strange and disorienting even though acuity is 20/50? Have no near or mid vision at all and little depth perception. Peripheral vision on left side poor. Now need progressive eyeglasses full-time and even these do not fix problems. Need YAK in both eyes (1 week post surgery), PRK in left eye and surgeon suggests LASIK again in both eyes. Will this help-is it likely to correct mid and near or at least improve without compromising distance vision? Are piggyback lenses an option? Any other suggestions? My surgeon is not exactly forthcoming with info. Has anyone else experienced such traumatizing vision after catatact removal?

  36. phyllis beving says:

    I know a man about 50 years old who lost a lens due to a childhood accident. He’s not been under the care of a doctor since then. Could that lens be replaced after all these years. He was recently diagnosed with diabetes.

  37. nileema borade says:

    hi
    my born with cataract, we do the surgery and remove the cataract when he is 2 months old. we use external lens now he is 4 years old. when we do the final operation and implant internal lens. please tell me urgent

  38. Hildegard Fricke says:

    Hallo,

    My wife Hildegard (84) had her first catarac operation 5 weeks ago. The membrane behind the eye was raptured, resulting in very extensive pain for almost 2 weeks. The surgeon assured her,she will be alright and prescribed eye drops she took every 2 hours during the day, and a guard was over the eye during nights. She seen der doktor twice during the next 4 weeks, and today he revealed that he could not detect the implanted lense and suspected it disappeared in the lower eye. To retrieve it she would have to consult a retina surgeon, or he could ignore the lense and install a replacement without further cost to Hildegard.
    The hidden lense would be of no harm to her. She opted for that solution. Hildegard has to see the doctor again in 4 weeks. By then her injured eye should be healed and the procedure could take place. Milder pains are still prevailing, but further eye drops are necessary. She would like to know what the possible outcome oft this misshab
    could be. Your professional answer would be very much appreciated.
    Hildegard

  39. Hi
    I had both lenses removed in the 1970’s due to cataracts and
    hve worn thick bifocals and contact lenses since then. Are atificial lenses an option for me?

  40. ignatious says:

    hi, i am a young man in my early twenties.the problem is my vision is very poor in the dark, do i need to wear some spectacles????

  41. @ignatious Is ur vision poor just in dark or blurred even in day time?? n do you notice glare on seein bright light? n wat abt double vision? n do u c black spots?

  42. With cataract surgery, assume a lens with 31.00 diopter was implanted by one opthamologist and resulting vision was worse than prior to surgery. A second opthamologist was consulted and after testing recommended a 27.00 diopter lens. The eye which has yet to be operated was to be a 34.00 diopter lens per the first opthamologist while the second opthamologist recommended a 30.50 lens. During testing in the office of the first opthamologist they had considerable difficulty in getting measurements and had to adjust the ultrasound apparatus to get the instrument to read. Is it possible this might suggest why the recommendations were so much different? Question – what to do in making a decision about surgery on the second eye?

  43. I had surgery 1 yr. ago & lens was put in wrong. I seem to be looking thru fog. I had Laser treatments on both eyes & now having trouble with my right eye now & no help for left eye. Could I have a second surgery to correct that bad lens or do I have to put up with this forever? It is ruining my
    life. I fell recently & crackd a rib because I can’t see properly. Please let me know what you think about a second surgery, so I know what to do. Thanks.

    This is my valid email address.

  44. I heard that it is a good idea not to do lots of reading within first week after cataract surgery. The rapid changes in the size of pupils can result in IOL sticking to it. Bit it is ok to watch TV at a distance. Is this correct?

  45. dora parker says:

    I had cataract surgery and everything was good and seeing good. went back to the doctor and she said she would do a yag lazer on the eye and thats all you would ever have to do. after doing it i now see hugh starburst whenever car lights or other lights hit it. what went wrong? the doctor said there is nothing she can do about it.

  46. What could be the reason if blood comes out during laser operated cataract eye surgery?

  47. I recently had cataract surgery in left eye and now i can see the rim of the new lens as a dark curvy image,this is very uncomfortable and irritating: my question can the lens be taken back out and replaced with another one?

  48. thaaaaaaaaaaaaaaanks

  49. My mum has just had her cataract on her first eye today, but they took out her old lens but could not put a new one in. She therefore has to wait 2 weeks and go back to outpatients to see the consultant. Does anyone know why they could not put a new lens in? and why would she have to wait for 2 weeks?

  50. Hi

    Due to a severe blow to the side of my head, the left eye lens is almost detached and wobbly. The surgeon says there is a high risk that the lens will fall back into the eye on attempted removal for replacement with a lens implant as at present the ‘bag’ behind the lens is falling over the upper edge of the lens.

    Although I can ‘see’ with the eye, vision is extremely poor and out of sync with the other eye.

    I am told that vision with this eye will never be as good as before the accident.

    What are the risks in this type of surgery?

    Kind regards
    Keith Harris
    editor
    newsmedianews.com

  51. Your article is very informative. Thanks for the good works.

    In the cataract surgery procedure, a small top part of the anterior was ripped or tear to get access into the len itself. After the IOL was injected and placed firmly inside the capsule, what happen to the ripped part? Would it grow or heal back again to cover the len?

    Thanks.

    A K Teo
    Singapore

  52. i had cataract surgery 4 weeks ago. there was a complication due to the cornea being soft. i had stitches, but, i was always myopic and now, i can see very clearly near, but far objects are distorted (unable to focus clearly) the surgeon says it is astigmatism, WHICH I NEVER HAD BEFORE! What am I to do before he does the right eye when i cannot see out of the left?

  53. I am a medical student, in my 4th year
    this topic helped me so much in my finals
    I love ophthalmology more and moreee :))

  54. wonderful guide.
    Would like u to put some clips on SICS for the benefit of us in the third world.
    Exceptional guide for trainees

  55. On my lens implant card s there are two numbers used in the power identification part. Right has 22.0 D and left has a 21.5 D . What do these numbers mean?

  56. Bonnie Henson says:

    First surgery with Starr implant on distance lens for monovision resulted in 20/20 the day after surgery, but the lens vaulted a month later (an unusual outcome, I’m told), which meant wearing a -1.25 strength contact lens to be able to see clearly. During second surgery three months later, a different surgeon rotated the Starr lens nearly 360 degrees to correct the vaulting problem. It didn’t. Now he wants to perform YAG Laser on capsule so lens will “relax.” However, I fear complications (such as later retinal detachment). The options? YAG laser or wearing a -1.0 soft contact the rest of my life to correct to 20/20. (The latter doesn’t put me off, since I’ve worn contacts for many years with no problems.) Seeking input from other professionals about these two options.

  57. Hi Dr. Root!

    I’m a final year med student from Germany, and after already using your brilliant site to study for my ophtho exam a few years back, I’m now returning to revise for my state exams. Your humorous approach to education is truly refreshing between reading so many dry books. Thank you for that, I wish there were more professors like you.

    Here are some things I noticed when reading this chapter, for your consideration:
    “The lens can even use it’s mighty-morphing transformer powers to change shape and thus it’s focusing power!”
    – I’m not a native speaker, but I’m fairly sure it should be ‘its’ both times – not ‘it’s’! I’m a grammar nerd, okay.

    You name the nuclear cataract as the most common form – in my German book it’s only second place (with ~30% of cases) after the cortical cataract (~50% of cases in the senile category). Maybe this differs in different populations?!

    Many thanks for your hard work,
    Sophie

  58. hello…i was diognized with coates disease at the age of 4 in my left eye and had already loss my vision completely in that eye.years after cataract developed on that eye…it has been almost 12 years now the cataract is mature…my doctor never wanted to remove it because he thought my eye would become dry…bt before 4-5 months ago i had convinced him to operate to remove the cataract..bt during the surgery he said that the cataract is too hard and would need to use cutter that can damage my eye….so it was just left there…i would like to know if something could be done…is performing surgery to that eye can damage it…or maybe i should consult some more experienced doctor…and what will happen if i let the cataract unremoved…any kind of suggestion would be helpful..thank you

  59. I had cataract surgery (simple IOL) with corneal loosening for astigmatism yesterday. I had a bleeder in the anterior chamber. The bleeding appears to have stopped and there is no apparent increase in interocular pressure. Today it was 12. How common is this situation and what are the percentages for a positive outcome. I am now taking Besivance, Prednisolone and Ketorolac drops in the affected eye. The surgeon appears competent and performs over 75 cataracts surgeries per month. I do have severe myopia (-11)

  60. Helenea Dennis says:

    Enjoyed this article as well as the different scenarios, it is helping me to learn.
    I had a cataract removed earlier this month, I am 54, this was the result of an horse related injury to this eye years ago.
    My vision is worse and was told that the zonule fibers are weak and unable to sustain the lense and being fitted for a contact.
    In reading over this information as well as being a Medical Massage Therapist, I am wondering what I can do to help my eye strenghten. I look at muscles in a different way and understand their healing. Have added eye exercises (I just found this out yesterday) working acupuncuture points, added larger doses of Magnesuim as well as a repair tendon/ligament formula (Chinese formula) to see if this would help to strengthen the fibrillin.
    It is so close to the surgery my Doctor, who is amazing, said there may be a possibility of it strengthening.
    Any other suggestions? I feel very fortunate that if worse comes to worse, I can resort to a contact.
    I am thrilled and awed at this procedure and the human body.
    Thank You,
    H. Dennis.

  61. Sharon Nelson says:

    I had catarac surgery and crystal lens implanted. It has been nearly 3 mos now but I continue to see some colors differently. I was a decorator, wardrobe consultant prior and I KNOW colors. However, now some of the same things I KNEW (and everyone else knows) are black, look navy blue. Also, some colors look plum when, in fact, they are actually gray or charcoal. Have you heard of this and will it correct itself or is there any way to fix it?

  62. Sharon,
    Colors are a subjective phenomena. Not all people see the same shade of a color or even the same color when they look at an object. Having been a decorator you must have come across what seemed to be terrible color schemes to you, but not the your clients who were not seeing the same colors you.
    There are some physical characteristics of the human body that are exactly the same with all humans but color vision is not one of them. As we age the crystalline lens turns yellowish. After your operation you are seeing through the same eyes as a child and the colors are enhanced. A simple test for you take is to look at the blue flame of a gas fire and you will see a purple haze around it which you may never have seen before but has always been there.

  63. Julian ketcher says:

    Hi there,
    I am a 40 year old man. Some 10 or so years ago I had a trauma to my right eye, this led to a detached retina.
    The treatment originally was stitching the retina back in place, this didn’t work so the next treatment was ‘posturing’ with a gas bubble in the eyeball. This too was unsuccessful and the final treatment was to remove the viscous fluid and replace it with a heavier fluid which held the retina in place while it healed.
    This appeared to be successful but the liquid led to a cataract being formed.
    I had a lens replacement. It seems to be a fixed focus, mid range. In a dark room with a light source behind the person I am talking to, the lens can appear to be reflecting light and shimmering.
    The vision in my left eye is perfect.
    My iris in the right eye doesn’t seem to change size when bright light is introduced. Is a fixed iris the result of the lens replacement? Am I more susceptible to bright lights? Is this a medical fact or is it dependent on aftercare and treatment?
    Many thanks in advance

  64. Great Site! Very helpful for my MS3 ophthalmology rotation. Thank you for making it available online for free.

  65. charlotte lee says:

    Hi, Had caataract surgery about 6 years ago with no problems. Drove to CA and when I went through two tunnels, I thought the lights were out in them because I could not see even the car in front of me, Thank God that the tunnel wasn’t that long. Is this common with implanted lens or were the lights really off?
    If it is my eyes, don’t know how I can drive long distances again for fear of this happening again.

    Thank you very much
    Charlotte

    Tim Root: Charlotte, your experience does not sound like a cataract or lens issue, but rather a slowness of dark adaptation. This could be a normal aging change, or could be the sign of retinal problems. For example, I often hear this complaint from people with macular degeneration. I recommend seeing your eye doctor to look into this.

  66. I had a lens implant put in in January. Then a month later my retina detached. Retina surgeon said the implant was loose and I was wondering if this could have caused my retina to detach.

  67. There is some thought as to adding a post-op topical NSAID (ketorolac) esp with diabetics to reduce the possibility of CME…?

  68. Gemma Hughes says:

    Hi,

    My 15 month old son has just been diagnosed with ectopia lentis in both eyes which he has had since birth. He doesn’t seem to have any other symptoms which would indicate any syndrome but he is currently being checked. The doctor has referred him to have regular checks, is it more than likely that he will need surgery to remove the dislocated lense and to put an artificial one in? If so what ramifications does this have? Will he still need glasses or contacts? Will he be able to play sport and in particular contact sport if he wishes when he is older? Or will we have to sit him out of sport????
    His lenses are currently too high, what will he be seeing? He doesn’t seem to have much of a problem with his sight but he is too young to tell. When he does have surgery, will that be it, or will he be having monthly checks for the rest of his life?

  69. CarolLynn Williams says:

    In the 3rd paragraph, there is a typo: Psudophakic…

    …which should be Pseudophakic.

  70. sultana razia says:

    hi, i m 36 years old, i m remothoid artritis patient. i was take joint injection take deltason medicine oral. six months i was not seeing anything clear, doctor said i need facco surjery, my present vision is 6/12, after 8/12 then i will ready to surjery ,now continue giving eye drops . plz tell me what lens i will take both two distance lens or only far distance lens or both. when i will do my surjery, plz tell me what should i do.

  71. Margaret Haze says:

    My accommodating lens failed–I had 20/20 for 4 weeks and then in dropped to 20/60. Went to another specialist and he talked about piggybacking another lens on. What would be the success of this?

  72. I ad cataract surgery on my right eye five months ago and had a ReStor lens implanted. I have had difficulty since with stinging in the eye and aching around the eye socket. I have been to several ophthomalogists but none can suggest anything but eye drops which do help with the stinging but not the pain on the outer edge of the socket. Any ideas what can be done? Could the wrong size lens have been implanted?

    1. Not allergic to drops by any chance.

  73. Hi your book is very educative .am an ophthalmic nurse. I want to know the post operative management and complications after surgery. Thanks hope to hear from you

  74. I recently had cataract surgery on my right eye. They put in a crystal lens.
    It’s been several weeks now and although I can see up close I cannot see in the distance. My doctor told me that the crystal lens moved forward and they will now have to do lasik.
    I don’t understand how the crystal lens can move forward if it is been embedded in my eye.
    Should I go to another optometrist for another opinion?

  75. Hello, my 1 year old grandson has ectopia lentis both eyes, his pupils are also misaligned. He is to have lens replacement, how often will he require this as he grows? and how will he accomodate if zonules are ‘snapped/weak? He has had blood tests to confirm or rule out Marfans or other cause but not had results yet. He is bright knows what things are and if instructed to pick up say, ball he will crawl to it and pick it up. he is able to see the tiniest things and watches tv and recognises people no problems. My daughter had obstetric cholestasis during her pregnancy and traumatic forceps delivery could this have any bearing? Any information you have would be greatly appreciated, thankyou Julie.

  76. Amir Nasser says:

    Hello,I am 70.I had cataract removed and they put Lens.But still I need long sight pair of glasses.Could I have second surgery to get lens that does not need long sight glasses.
    Thank You.
    Amir

  77. sthembile says:

    Hi. i would like to ask. my brother had an eye operation 12 years back and now he says the eye does not see. i would like to know if is it possible for him to do another eye operation so that the eye can work again. Im so hurt about this im worried about this thing.

  78. Hello, my 65 year old mum had successful cataract surgery 3 years ago on both eyes; she had severe myopia and astigmatism. Recently one of the replacement lenses came loose and has been floating around in her eye. The surgeon told her that, due to her severe eye conditions, he cannot redo the surgery and the only option is to remove the lens altogether without replacing it. Will she be able to see afterwards? I’m worried about her. Thanks!

  79. I am 67 and had cataract surgery three weeks ago on my left eye. Before that I was very very nearsighted, corrected by glasses. I chose the lens to see distant objects clearly. Although my vision at long distances is fairly clear there is no distance where I see text as clearly as with my right corrected by glasses. And although I was told that reading glasses will be needed once my vision is fully stabilized I notice that no over-the counter glasses help at all with my reading currently. So why will they work later since shouldn’t I be close to done with the healing by now?

    I have delayed doing my right eye as I am concerned that my current healing is not on track. Other problems include:
    Contrast seems too sharp. It’s like I’m looking through a lens that is too strong for my acute nearsightedness.
    Blues and whites look purplish particularly if bright.
    Too light sensitive.
    I can’t focus both eyes together.
    Tiny black dots moving across my vision
    When looking at text – hazy, blurry, shimmering, sometimes double image (white text on black background.

    I saw my opthamalogist last ten days ago and she said my eye is just inflamed and she now has me taking Prednisone drops 8 times a day.

    Is something wrong and if so, how can it be fixed.

    1. @WillfromSF Will, I don’t normally answer questions like this on my website (this is more of a medical student teaching project) but I’ll make a couple of comments.

      1. Blurry Vision: You’ve had one cataract surgery, but If you haven’t been given glasses, yet … there is no way to know what your vision is going to be. If you can’t see well at “any distance” than you might have some residual astigmatism that only glasses will fix. Here’s a trick … punch a hole in a piece of paper, and try looking through this pinhole around your house. If your vision is markedly improved, then we know that glasses will probably get you that clarity you want.

      2. Light Sensitivity: This sounds like some residual inflammation (called iritis) as your eye doctor described. Prednisilone eye drops 8x a day is a LOT … indicating that there is indeed some residual inflammation seen on exam. This is good … as the drops will treat it.

      3. Tiny black dots: This is likely vitreous floaters. While usually harmless, they can be a sign of more serious problems like an impending retinal detachment or infection. Mention this to your doctor (who has probably already looked in the back of your eye to check the retina).

      Ultimately, your eye condition can ONLY be evaluated by an exam, so don’t take this as medical advice.

      Everything your telling me sounds pretty typical, however … while most people have excellent results, some people have more inflammation and take longer to get there. If your symptoms worsen suddenly … see your doctor immediately. If you are unsure of your eye’s progress, then get a second opinion from another doctor in town. Finally, hold off on the second cataract until the first eye is to your liking. Good luck!

  80. I appreciate the very useful info, Dr. Root, as I am really perplexed (as you could tell) about how best to manage the situation in light of getting on with my life. Very helpful.

  81. Question: Can lens replacement surgery be done a second time in same eye?

    After having left eye with cataract/lens replacement vision is now only 20/40. This is dominate eye that was to be for distance. Holding off now on second eye though it too needs surgery. Was planning on having that eye for reading. Now trying to figure out what to do next.
    Question is can the left eye have another lens replacement to correct vision. Is lens replacement a one time surgery per eye?

    If I have right eye done for distance also what is best approach ? How will the eyes even up? Can my right eye have 20/20?

  82. Mary Beth says:

    After cataract surgery with a Technis single focus IOL, I see a 1/4 halo with starburst to the top left of my right eye and a 1/4 “glint” to the bottom right at night around lights and glare, also In the day if it is dark inside and bright outside. It makes night driving very distracting and I avoid it. I also randomly see a disturbing moving pattern of silver or grey overlapping trapezoids, triangles? on the peripheral right side of the implant eye. It has been 10 months since my surgery. My doctor says the lens is perfectly placed and that is all. Can you help me understand why I have this problem? It makes me want to have the IOL removed. I was better off with the cataract. Thank you.

  83. jon battle says:

    I’m a 58-year-old with retinal detachment history both sides, good results, but in my first RLE (next is postponed for the moment) a deficiency of zonules turned up. About 120 degrees of the arc are absent. Surgeon went ahead and implanted anyway, and commented that she also inserted another component (MA68?) to help stabilize. She rejected the capsular ring option for fear of the whole thing falling back into the (vitrectomied) eye. My Qs:
    – Will the 120-degrees arc of ‘absent zonules’ increase and and thus destroy the whole thing?
    – Is there any surgery that can stabilize the new lens and substitute for deficiency of zonules?
    – I ask because having this ‘sword of Damacles’ – it could fall to pieces any moment – is a serious option-blocker and potentially will cause me great harm.
    ?

  84. Carol Maher says:

    Yesterday I had realignment surgery for out of position PC IOL. I am addicted to reading on my iPhone. Could this cause more problems with healing or possible new slipping g out of position of the lens even though I am focusing with the other eye while reading? That is is the recovering eye using the muscles to focus even if eye closed? I’m really scared I will wreck my eye. Drs nurse said it was ok to read on iPhone.

  85. Evelyn Morris says:

    Hello, I had A Yag laser procedure done 3days ago,since then I am experiencing what appears to be a membrane causing a momentry blurry vision, I have a few floaters also,but was told this was normal.Do you think this should be reported to my Opthalmologist?.

  86. Ann Windchy says:

    I am allergic to PMMA liquid and powder mixture when it gets on my skin. I also can not wear the silicone nose pads as I get extremely red areas under them and I know it is an allergy also. What kind of lens should I have for my cataract surgery? I also have astigmatism. I have been advised to get laser surgery in conjunction with the cataract surgery. Is it a good idea to do both at the same time. Can you do one first? then the other. What complications can I expect.

  87. sir… i am having a black spot on my eye lens…… at the time of seeing it will in front of my eye lens…….. it is disturbing a lot to me-……. so please give any solution

  88. jon battle says:

    – patient’s remark to Jnnny’s query re her 65-yo ‘mum’ (usage important – presumably a Brit)…
    – you have not listed and obviously cannot list all the details on a site like this, but a couple of things are clear:
    (i) You need a second opinion. Is your mum going to Moorfields? Private health? Discuss with GP. Unfortunately in the UK, if you are already seeing specialists not in Moorfields, it is difficult to get into Moorfields. But try. And you might get a consultation with the best Private Health surgeon you can find. Good luck – 200 pounds for a half-hour chat. BTW from my own long and at times unhappy – but finally good – experience with NHS eye-surgery staff they have been over the entire range from (a) incompetent to (b) world-best. So you need to find (b).
    (ii) you need to become ‘your own expert’, so do lots of googling, esp surgeons’ blogs.
    (iii) how good is the fellow eye? Your mum’s overall quality of life over the next 10 years is paramount. At one extreme, 2 years of ‘surgery-and-recup’ misery is bad. On the other, 10 years of bad-vision misery is worse.
    (iv) To answer the q of aphakic vision – in principle obviously this is possible with thick spex as was the standard of practice until the 60s when IOLs became universally accepted. But in your mum’s specific case, whether that is an acceptable solution, only you and your mum, with expert help of a specialist, can determine.
    (v) Good luck.

  89. Why would I get sunglasses effect in my eye. It usually happens in the morning as I am awakening. It appears that I have sunglasses on, but just one eye? I have ask my eye specialist about this, but he doesn’t seem to have an answer.

  90. ROXy wall says:

    I had a hard fall on my bottom yesterday 4 weeks after my catarac surgery i am 63 i am not seeing as well in that eye today and wondering if the fall is the reason ? i have no pain just blur & some double vision with reading i am not sure if it started before or after the fall my vision was 20/20 and clear until the last couple of days THANK YOU SO MUCH IHOPE TO HEAR FROM YOU! ROXY

  91. Roxy wall, you need to see your cataract surgeon to look at your eye. There are many reasons … both from your surgery and neurologically … why you might have double vision. Call your eye surgeon.

  92. i had cataract removed but no lens was placed by surgeon.
    he said i had missing zonules.
    what can i do

  93. After 3 detached retinas in the last 10 months, I have an Aphakik eye. My surgeon is a truly Great Man, well respected and knowledgeable.

    However I would like to know what the new implant is made from. The proposed new lens is from Alcon Labs. Acrylsof. I have read the information from the manufacturer and the clinical trails and it says safety is “reasonable” for three years. I have asked for a sample to get it analysed to see if any of the ingredients may cause me problems, but have come to a complete dead end. My surgeon just says he has had no problems in 15 years. Alcon wont even answer my mails.

    If I buy a tin a baked beans then the ingredients are on the side! Am I being unreasonable in asking for the safety of an implant? Am I the only one? Any constructive comments gratefully received.

    1. Paul,
      The implants we use (I also use the Alcon lenses) are made of an acrylic plastic that has been in use for decades. I’ve never had a patient have a reaction to the material and have never heard of ANYONE having a reaction to this kind of plastic. Because of this, eye doctors don’t routinely discuss this possibility with their patients. There are so many OTHER things that could go wrong with a cataract surgery … the implant “material” is the aspect you should be LEAST worried about. With prior retinal detachment, you are at higher risk for lens dislocation, zonular dehiscence, re-detachment, capsular insufficiency, macular edema, corneal edema … you get the idea.

      I searched around Alcon’s website, and found a PDF with some more data on the implants in question:
      http://www.alconsurgical.com/pdfs/TOR240-DFU.pdf

      Finally, I can see why your surgeon was hesitant to give you a “sample” … we don’t have “samples” to give out. These things are packaged in sterile boxes and somewhat expensive. The surgery center or hospital “owns” the hardware and if your doctor doesn’t own the center … he can’t walk over and grab one. Even then, he wouldn’t be able to get your medical insurance to cover the loss. Finally, I’m not sure what kind of testing you could even perform with such a small piece of plastic … it would fly off your finger if you breathed hard.

      Good luck with your surgery!

  94. Hi all. My son had a cataract surgery when he was 5 months. And At his 8 yrs old we decided to put a lenses to help him with vision and by not wearing thick eye glasses. But After Lense implant Doctor cleared many scar Tissue on my sons eye before implant was succesfully done. He had been prescribed with Prednisolone Acetate 1.0% and Ketorolac Tromethamine Opthalmic solution. And when they check the pressure of the eye it was high and prescribed with 2 new drops. and on the 2nd month to present he was still getting the 4 drops and pressure still didnt drop to normal eye pressure. I wanna know why my sons eye pressure didnt drop at all was the anti inflammatory drops are causing them not to make my sons eye pressure drop? and i read some articles that u cant use the 2 drops for more than a month. please give me idea on what should i know about. Thnks

  95. john waters says:

    4/8/14
    Hello, hopefully someone can help!
    Due to accident have been blind in left eye for 17 yrs. but 6 months ago a catatract developed in right eye and soon thereafter started loosing all vision bothclose and far.

    Had Cataract Surgery 4/3/14 and right after vision was 99% both near & far next day Dr. said all lookks great and i was suprised i could see so well and was happy, i only had slight light sensetivity to headlights during day and all stop lights till i got up close.

    Sat 3rd day after, got up and noticed stuff was fuzzy on walls and on TV i could no more make out small letters and faces were also messed up unless a close-upshot, then i drove and noticed that all road/street signs were un-readable unless i got right next to them, no matter how large they were.

    Sunday am i called Dr and explained that in 2 days all went bad and my distance vision was the worst prob. since anything further than 4 feet was unfocused, i had a distance lens put in 21.0D but thought something was wrong,so she said come in Mon for checkup (1 week early).

    Later Sunday i noticed with a lot of Blinking i could momentarily read letters in distance and the next morning on way to Dr. i could not make out any street signs unless i was totally at a stop and still could not read any above me at a light!

    I had been told before surgery i would have only close-up vision probs and would need read classes, however for 2 days after Surgery, i needed nothingwhen i got to Dr. she tested my Vision and said my Close-up had gotten better than day after Surgery, but i explained on way down to her that all signs were fuzzy etc…..

    She said it could take 6 weeks till i was healed from Surgery, but she did not explain why distance Vision had got so bad and seemed upset that i came in and told me to calm down.

    I simply dont understand why with a lens for distance it had the opposite affect?

    Could somebody explain if my probs are normal? Thank’s

    1. John, when your surgeon chooses a lens to give you good “distance vision” there is no way to guarantee you’ll end up perfect. The lens calculations we use to pick your implant are based on average eyes, and everyone has different internal eye anatomy. Occasionally, someone will end up different than expected and still need glasses for both distance AND near vision.

      Also, the implant tends to shift and settle into its final position in the eye over several weeks, so it is common for your focal point to shift during this time. This is why we don’t prescribe glasses for at least three weeks after cataract surgeon. Everything you have written sounds normal … just make sure you get your eye checked to rule out more serious problems like infection.

  96. I just ended up watching all your video lectures. Currently studying for my specialty entrance exam (equivalent of the USMLE)

    amazing work you have done. thank you very much. i wish you all the success and hope you make it as far as you wish and even more.

  97. My daughter was born with a torn lens in her left eye. We discovered the blindness in that eye when she was 4 years old. After trying several treatments, we decided to remove the lens with hopes of getting vision through a contact lens. Unfortunately, we were not successful. In her “good eye” which is not so great, she has a “lazy, wondering eye”, and , now 15, she is more bothered by the appearance of this than the blind eye. So, my questions are: 1. We have been told differing opinions on the possibility of surgically replacing the lens to correct the blindness, what are your thoughts and what is the optimum age is surgery is possible? and, 2. Can her lazy eye be corrected by surgery and do you feel the risk might be too great? thanks so much!

  98. Pat Owens says:

    My father (82) recently had cataract surgery. The doctor said he had a very small eye. Fluid was leaking at the incision site so they tried glue and it did not hold so they put in two stitches. Three weeks post op they remove one stitch and the fluid begins to leak again. He states it was to soon to remove the stitch. He then glued and placed a contact lens on the eye and states now the stitch that remains will be there for at least another month. Do the lens come in a size to fit your eye or are they all the same other than the strength of the lens. I am afraid this lens is to big and it will not seal at all. Any comments would be helpful.

  99. Ankit Niranjan says:

    Question- can lens replacement surgery be done a second time in the same eye?
    After having eye with cataract/lens replacement vision is now only 20/40 and I still need long and reading sight of glasses.
    Could I have second surgery to get the lens that doesn’t need long and reading sight glasses.
    Plz sir suggest me
    Thank you

  100. fayaz rashid says:

    when are you giong to upload its video ??

  101. joe wright says:

    twenty some years ago I had cataract surgery. I am now having trouble with that eye. What chances are there that the lens is going bad?

  102. carol cooper says:

    Your article was very informative, thank you. Just one question: I have just had cataract surgery but the diopter is different from what was intended. Do the zonal fibers function when a new lens is inserted such that the diopter changes?

  103. Manuella R Glore says:

    I had cataract surgery on both eyes several years ago. I was not given an option of having replacement lenses. Can lenses be instilled after cataract surgery?

  104. Jon Battle says:

    Joe Wright – you don’t elaborate what you mean by “go bad”. See a specialist. Presumably you already know about capsule clouding, but if you don’t,that would be #1 possibility, fixed with trivial laser. Never mind the others, just see the specialist.

  105. I love the book – and I am jealous of your many talents!!

    On cataract surgery, for local anesthesia, you say “We can also perform a retrobulbar block by injecting lidocaine/bupivicane into the retrobulbar muscle cone”.
    Is it true to say that the retrobulbar block procedure is no longer encouraged and now a subtenon block is much preferred as this have been proved to be safer?

  106. Lynn Burkhart says:

    You are to be commended for your talking your time to educate both students and the public. In today’s world, it is uncommon for a professional to publish an easily readable text on this normally esoteric subject.

    Indeed, as I talked to a doctor who was interviewing me for cataract surgery, I had asked several questions which led him to get up and walk away, referring me to the young lady who was his assistant. He described the surgery several times as easy, even stating that I could within the first year remove the lens with no problem and change it out.

    I realized if I was to feel comfortable, I’d have to start at the basics and gain a much better understanding of the eye composition as well as a more in-depth overview of the cataract procedure.

    As you know, physicians generally treat their patients from an authoritarian viewpoint and my experience was quite negative. I started a technology company where we manufactured several types of hydrogels for use in various industries, having PhDs in polymer science working for me.

    Although I am retired now, I can say I’ve never treated staff nor customers with a demeaning attitude. Frankly, it’s offending and speaks negatively of the persons character.

    I find your writing quite helpful, and speaks quite well of your professionalism. Thanks!

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