Intraocular Lens/Cataract surgery

[charbor]

Hello all,

I'm curious if anyone has experience with lens replacement surgery as a dry eye patient. I am a 41 year old male and have had Sjogren's Syndrome for 8 years, with a great deal of dry eye issues. I have a high level of nearsightedness and would love to be able to have corrective surgery to fix this. I'm very aware of the dangers of Lasik, etc., but I recently saw a new ophthalmologist who told me about new types of IOCs that, according to her, do not contribute to or increase eye dryness and can be performed on dry eye patients with little risk. It is my understanding that the procedure is very similar to cataract surgery, which I know is extremely common. Of course, being skeptical and not wanting to do anything which might make my eye problems worse, I went to a dry eye specialist to get a second opinion. I have a history with this doctor...despite paying him thousands of dollars over a number of months he did very little to improve my condition and I had pretty much given up on him, but I wanted to see what he had to say. As expected, he advised against it and said I should come back to see him again to try to improve tear production (not going to happen; too expensive with too little results).

Anyway, does anybody have any experience with lens replacement surgery (either IOC corrective surgery or cataract surgery)? If I felt I could do it with low risk of worsening my problems I would do it in a heartbeat, as it literally would be life changing for me to not have to wear thick glasses all the time. I think my glasses contribute to eye strain and headaches, and I don't see as well as I did with contacts. I could also participate in sports, running, swimming, etc like I used to. Of course, I don't want to take a big risk either.

Any info or advice would be greatly appreciated!

Thanks!

[indrep]

The facts are even with small incision cataract surgery some corneal nerves will be cut. this breaks the neural loop that plays a part in tear production. Goblet cells are also affected which play a roll in producing the mucin layer of the tear film. The procedure is one of the most successful surgical procedures performed. Ultimately it comes down to how much your desire to be spectacle free is.

[hirentherock]

hi
I have also been looking for people who have gone through catract in course of their severe dryeyes.
I have SJS with severe light sensitivity,One of my eye is aphakik.

The other eye which is only source of vision for me,which is also affected with dryness and severe light sensitivity+nearsightness, needs to get cataract done due to natural lense getting clouded.

Im damn confused what to do as the local doctor whom i check regularly says avoid it for as much time as possible while the cataract specialist said he willdo the surgery anytime upon my decision.Risk involved in the cataract is same as described by Indrep above.But a doctor at hyderabad said i will need BSLs and boosted my morale by saying i wont need to be dependant on others much after the surgery and bsls and will live smoother life for long time hence i need not worry much.

So im going to get operated soon foor cataract.
PM me if u have also decided to go for cataract.

[abbygirl]

My advice to anyone thinking about having cataract/IOL surgery would be to get your dry eyes under control way BEFORE you have the surgery. I had dry eyes prior to my surgery (I was a -13 plus astigmatism). My left eye went well but my right eye had several complications. My dry eye is much worse than it was pre-surgery. My case is unusual but please make sure you cover all bases before having the surgery.
I would be happy to answer any other questions/concerns.
Best of luck whatever you decide!!! I know it is a tough decision.

[charbor]

Thanks everyone for your input!

abbygirl, did you have cataract surgery or did you have corrective lens replacement? Was there a reason one eye did well and the other didn't?

The problem for me is that as a Sjogren's patient there are not many ways to get dry eye under control. At this point it pretty much is what it is. I can keep waiting but if at some point years from now I need cataract surgery and it goes well I will be kicking myself for not doing it sooner.

[abbygirl]

charbor..I had the beginnings of a cataract in one eye and a definite cataract in the other eye. Once you do one eye (especially with my prescription) you have to do the other eye. I have a toric IOL in both eyes. I see great compared to what I saw prior but I still need thin glasses for driving and good distance sight.
I hate to tell you this...but my IOL came out of the capsule 9 days after my sugery (very rare) so I had a second surgery to correct. This caused all kinds of complications that I don't need to tell you about!!! Both of my eyes are drier than before surgery but the difficult eye is really dry. Make sure your doctor takes care in treating your dry eyes during the recovery.
Hope this helps!!

[hirentherock]

abbygal did u try sclerals after cataract to eliminate dryeye effects?
I want to know many things as my cataract surgery is nearing and im in a lot of dilema
would it be better to Pm you?or shall i ask u things in this thread only?
i would like to know the things like...condition before cataract, during cataract an after catatact.also pre and post operative care u were advised to take etc.
my surgery will be scheduled anytime within 2 weeks as catarct is matured in working eye(which is the only source of vision in terms of reading stuffs).The other eye had cataract in year 2000 when the clinic was not equipped and hence surgery was not done properly and lense was dislocated from capsular support.Thereafter none dared to touch my eye here in my state.I went to Shankara Netralaya in 2008 for check up and they first said they will replace new iol for dislocated old iol.
But just befre the surgery doctor informed they will not put new lense but will just remove old one as they found less feasibility of sustaining new oil.

Now im going to get operated by the doctor who won the Binkhorst Medal at the ASCRS meeting in San Diego, March 25-29, 2011 which is given for cataract excellence.

He was of the view that i can be performed but he would like to first operate the working eye, then after the other eye.Lets see whats going to happen.
im afraid i will have to adapt to BSLs after surgery as im too much photophobic.

[abbygirl]

hirentherock..sounds like we have alot in common. It might be best to PM me. Yes, I did try the scleral lens after my surgery and they did not work for me.

[georgiav]

I have had 4 eye surgeries--including LASIK twice (12 years apart--see below), Cataract surgery, and Vitrectomy. My many problems started after the Cataract surgery, not after the ORIGINAL LASIK. The history is very lengthy, but I will do my best to summarize in the hopes of helping the original poster and others:

I had Bi-lateral LASIK performed in 1996 for severe myopia and astigmatism (-10 diopters of myopia with 3 diopters of astigmatism). I did this because I could not wear contacts due to dry eyes (although I never actually felt any dryness back then) and I did not want to wear "coke bottle" glasses at 26 years old. For 12 years after surgery I was extremely happy with my results (never had any problems with dryness).

However, for some reason, in 2007 my distance vision started to go practically overnight. I was told that my posterior sub-capsular cataracts (thought to be congenital) had grown and needed to be removed. Now in retrospect I question whether this surgery was truly necessary because I later found out that the cataract surgeon I was referred to has a reputation for being extremely "aggressive".

At any rate, I had Bi-lateral cataract surgery in 2007 at age 37 with Crystalens accommodating IOLs placed. This is where all the problems started. Another thing I did not know at the time is that it is difficult to calculate the proper lens power for a post-LASIK patient undergoing cataract surgery. So what happened is that I ended up becoming Farsighted in the right eye after the cataract surgery with all sorts of other visual abberations. YAG capsulotumy was performed in both eyes but did not help at all.

Since my Cataract surgeon is also a LASIK surgeon (but not my original LASIK surgeon), in an effort to try and remedy the refractive error created by the cataract surgery, he suggested re-lifting the LASIK flap in my right eye (that had been created 12 years prior) and performing LASIK. Yet another thing I did not know at the time is that apparently nowadays they do not do LASIK enhancements by lifting the flap; instead I was told that they would now use PRK. So in 2008 I ended up having the flap lifted and LASIK performed again in the right eye.

With this 2nd LASIK (12 years after my original LASIK), the surgeon's goal was to make the right eye a -1 (slight monovision to help with reading), but I ended up a -3 in the right eye. Since the left eye is about a -0.50 (with 1 diopter of astigmatism), I now have a real big disparity between the two eyes (much more "monovision" than anyone would ever actually intend for--very confusing for the brain).

In addition to the refractive problems, I also had an intolerable degree of "floaters" I started experiencing after the 2nd and 3rd surgeries. It was said that I had a large vitreal detachment in the right eye that was causing this (no idea how this happened in the course of events). To make a long story short, although it was considered "risky", the only chance I had to rectify the floater situation was to have a "Floater Only" Vitrectomy in the right eye--which I did end up doing in 2009 and it did help with the floaters.

Since Fall of 2010, I have had intolerable dryness in both eyes and have tried all known dry-eye remedies to no avail. Although I never noticed any dry eye symptoms after the original LASIK in the 12 years before the cataract surgery, who knows if it contributed to a cumulative effect of all the surgeries. All I can say is that ALL of the above problems started only after the Cataract surgery and beyond. In terms of the dry eyes, what I have been told by a doctor who performs both LASIK and Cataract surgeries (yet neither on me) is that the "unspoken risk" of these surgeries is that they desensitize the cornea and destroy the feedback mechanism that sends the message to secrete tears.

I wish I could somehow "undo" all of the surgeries, but unfortunately I cannot. I hope my experience is informative for the original poster and others.

[rt1]

Just to add some more data points to this thread, here's my experience in brief.

I've had PIOL (Veriflex, anterior chamber) implants done three years after my dry eye problems (expert diagnosis: MGD) started at age 27. The procedure did not affect my dry eye and I have good vision without glasses (but I've had other complications). A good thing.

I especially agree to two other advises in this thread: be sure that your eyes are well under control and stable and every operation is stressful.