Disturbing opthalmologist visit

I went to the othalmologist today to get a second opinion on my various
eye miseries. I'd be interested to hear the opinions of any
professionals in the group on these things that happened:

- They dilated my eyes, and my left eye was back to normal in about 4
hours. My right eye, which is also my drier eye and worse Rx eye is
still un-dilating after 12 hours. This has to mean something, but what?

- I was prescribed Ciloxan ointment for meibomian (sp?) gland issues.
I'm to put the ointment on my lid margins and lashes every night,
apparently forever (the Rx goes for 2 years). Reading on-line
indicates that this is intense stuff. Is this a good idea?

- He said I have cataracts. I'm only 39, so this was a shocker. I
don't think I've noticed anything visually. He was fairly casual, like
we'll keep an eye on it. It seems like I should be very concerned
since my corrected vision is good now and I'm not seeing any signs of
presbyopia. Abruptly losing the ability to focus my lens at this age
is like a nightmare. Am I over reacting?

--

Mike Tyner wrote:

>
> "Chuck" <(E-Mail Removed)> wrote
>
> > - They dilated my eyes, and my left eye was back to normal in about
> > 4 hours. My right eye, which is also my drier eye and worse Rx eye
> > is still un-dilating after 12 hours. This has to mean something,
> > but what?
>
> It means the corneal epithelium in your right eye was compromised by
> drying issues, damaged to the point the dilating drop could penetrate
> maybe 4 times better and therefore hit you four times as hard and
> last four times longer. No big deal. Visine is capable of dilating in
> this circumstance.
>
> > I was prescribed Ciloxan ointment for meibomian (sp?) gland issues.
> > I'm to put the ointment on my lid margins and lashes every night,
> > apparently forever (the Rx goes for 2 years). Reading on-line
> > indicates that this is intense stuff. Is this a good idea?
>
> Unless you develop an allergy to ciprofloxacin, it isn't a big deal,
> though I doubt anyone expects you to use it continuously. It is often
> argued that chronic use of antibiotics fosters resistant organisms
> but I've been told that topical medications don't contribute much to
> that phenomenon. When the symptoms disappear you might quit using it.
> If so, and then you start up again later, use it full-bore, regularly
> and continuously for at least two weeks.
>
> > He said I have cataracts. I'm only 39, so this was a shocker. I
> > don't think I've noticed anything visually. He was fairly casual,
> > like we'll keep an eye on it. It seems like I should be very
> > concerned since my corrected vision is good now and I'm not seeing
> > any signs of presbyopia. Abruptly losing the ability to focus my
> > lens at this age is like a nightmare. Am I over reacting?
>
> Cataract surgery could still be decades away. Your accommodation will
> be gone in ten years regardless. And there are plenty of cataracts
> that never develop to the point of affecting vision.
>
> Relax. Your problems and the doctor's suggestions are all pretty
> mainstream.
>
> -MT

Thanks for the input. Regarding the differential dilation, it's now
morning and there is still a difference between my eyes - the right eye
still can't go as small. It's been maybe 21 hours now. It's an odd
coincidence that the technician spent a LONG time using the little
light to check my eye dilation. She went back and forth between eyes
for a few minutes and then even called someone else in to check it out.
The second person said it was within tolerance. Can it be connected?

How many years until they have replacement lenses that can accomodate?
Wikipedia tells of some sort of hinged design that is FDA approved, but
I don't get the impression that they are in wide use. Must be some
downside?

--

On or about Fri, 25 Sep 2009 12:26:55 GMT did "Chuck" <(E-Mail Removed)>
dribble thusly:

>Thanks for the input. Regarding the differential dilation, it's now
>morning and there is still a difference between my eyes - the right eye
>still can't go as small. It's been maybe 21 hours now. It's an odd

In addition to just lasting longer for the reasons Mike Tyner mentioned,
another possibility is that you're among the 25% or so of people who have
different pupil sizes. My right pupil is always bigger, and I don't notice
any visual difference.
--
- Mike

Ignore the Python in me to send e-mail.

> > > He said I have cataracts. *I'm only 39, so this was a shocker. *I
> > > don't think I've noticed anything visually. *He was fairly casual,
> > > like we'll keep an eye on it. *It seems like I should be very
> > > concerned since my corrected vision is good now and I'm not seeing
> > > any signs of presbyopia. *Abruptly losing the ability to focus my
> > > lens at this age is like a nightmare. *Am I over reacting?

Well, I don't know how abrupt it will be. Cataracts grow over time.
I don't know how long a time it will take for this one to impair your
vision (I have the impression, perhaps wrong, that they grow at
different rates for dif people). In any case, if the cataract is
becoming a problem, you'll be able to see yourself that your vision is
getting worse. It's easily visible!
(Important warning: if it does become bad enough that you want to have
it operated on, don't wait, because I just learned that mine is now a
more difficult operation because it has developed too far. But long
before that stage, you wouldn't be able to see out of the eye, so
there'd be no question something needed to be done.)

I got presbyopia around age 43. I gather that almost everybody gets
it at some point, usually (I'm told) in their 40s.

Don't freak until you see something freaky.

> How many years until they have replacement lenses that can accomodate?

They have them now.

> Wikipedia tells of some sort of hinged design that is FDA approved,

Yes, that's the one. "Crystalens". Think it's the only accommodative
lens out there right now, but more types are being developed.

> I don't get the impression that they are in wide use.

They are. However, I'm not getting them in my eyes.

>*Must be some downside?

Yes, I gather there is. This product has gone through several
improvements, so I think the current version is better than those 3-4
years ago. However, as I understand it (others please step in if I'm
wrong), the tradeoffs are:

1) Compared to a monofocal lens, the accommodative does not give quite
as good acuity.
2) The accommodative lens doesn't always accommodate quite as well as
the original biological (non-presbyopic) lens. So many people still
have to wear glasses afterwards for *some* distances.
3) The a. lens can't be positioned in the eye quite as accurately as
the monofocal (ask your doc about this), so you might end up focusing
at a slightly dif range of distances than was planned. Also, if you
had both eyes done, they would probably end up being dif from each
other. I'm not sure exactly what effect that would have on your
vision.

#1 was enough to put me off. I wanted the most failsafe thing out
there.
But if not having the aggravation of glasses is more important to you
than perfect acuity, you might want the accommodative. Oodles of
people have them; you could ask those people.
Thankfully, by the time you need this done, lenses may be better than
they are now.

Liz in Indy
USA

On Sep 24, 9:01*pm, "Chuck" <nos...@nospam.com> wrote:
> I went to the othalmologist today to get a second opinion on my various
> eye miseries. *I'd be interested to hear the opinions of any
> professionals in the group on these things that happened:
>
> - They dilated my eyes, and my left eye was back to normal in about 4
> hours. *My right eye, which is also my drier eye and worse Rx eye is
> still un-dilating after 12 hours. *This has to mean something, but what?
>
> - I was prescribed Ciloxan ointment for meibomian (sp?) gland issues.
> I'm to put the ointment on my lid margins and lashes every night,
> apparently forever (the Rx goes for 2 years). *Reading on-line
> indicates that this is intense stuff. *Is this a good idea?
>
> - He said I have cataracts. *I'm only 39, so this was a shocker. *I
> don't think I've noticed anything visually. *He was fairly casual, like
> we'll keep an eye on it. *It seems like I should be very concerned
> since my corrected vision is good now and I'm not seeing any signs of
> presbyopia. *Abruptly losing the ability to focus my lens at this age
> is like a nightmare. *Am I over reacting?
>
> --

Mike Tyner tends to give exceptionally good advice.

Good luck, Mastiff!

I wonder how a cataract surgery could be harder or easier? My limited
understanding is that they remove your lens and put a new one in. It
doesn't seem like how bad the original lens is would be a factor. But
then I haven't done much research yet.

I keep reading that people develop presbyopia in their 40's, but I know
lots of people at work older than me who don't appear to be using
reading glasses or bifocals or anything. A few are.

The thing about it is that I don't expect that _all_ accomodation is
lost until a person is 60 or older. Though I may be wrong. I expect
the ability to accomodate is slowly lost as you age. Zero accomodation
would mean vision that starts to be blurry/annoying within 20 feet or
so, since I'm used to good acuity. It seems more severe than just
needing reading glasses to read, but maybe someone can correct me on
that.

I don't know if anyone will see this old thread, but if so, I'd be
interested to hear comments on the idea of putting astigmatism
correction (for corneal astig) into the replacement lens. If there
might be one up side to this it could be that I could lose my glasses
for distance.

Ideally I hold out for 10 years and by then they have a good
accomodating lens...

Liz wrote:

> > > > He said I have cataracts. *I'm only 39, so this was a shocker.
> > > > *I don't think I've noticed anything visually. *He was fairly
> > > > casual, like we'll keep an eye on it. *It seems like I should
> > > > be very concerned since my corrected vision is good now and I'm
> > > > not seeing any signs of presbyopia. *Abruptly losing the
> > > > ability to focus my lens at this age is like a nightmare. *Am I
> > > > over reacting?
>
> Well, I don't know how abrupt it will be. Cataracts grow over time.
> I don't know how long a time it will take for this one to impair your
> vision (I have the impression, perhaps wrong, that they grow at
> different rates for dif people). In any case, if the cataract is
> becoming a problem, you'll be able to see yourself that your vision is
> getting worse. It's easily visible!
> (Important warning: if it does become bad enough that you want to have
> it operated on, don't wait, because I just learned that mine is now a
> more difficult operation because it has developed too far. But long
> before that stage, you wouldn't be able to see out of the eye, so
> there'd be no question something needed to be done.)
>
> I got presbyopia around age 43. I gather that almost everybody gets
> it at some point, usually (I'm told) in their 40s.
>
> Don't freak until you see something freaky.
>
> > How many years until they have replacement lenses that can
> > accomodate?
>
> They have them now.
>
> > Wikipedia tells of some sort of hinged design that is FDA approved,
>
> Yes, that's the one. "Crystalens". Think it's the only accommodative
> lens out there right now, but more types are being developed.
>
> > I don't get the impression that they are in wide use.
>
> They are. However, I'm not getting them in my eyes.
>
> > *Must be some downside?
>
> Yes, I gather there is. This product has gone through several
> improvements, so I think the current version is better than those 3-4
> years ago. However, as I understand it (others please step in if I'm
> wrong), the tradeoffs are:
>
> 1) Compared to a monofocal lens, the accommodative does not give quite
> as good acuity.
> 2) The accommodative lens doesn't always accommodate quite as well as
> the original biological (non-presbyopic) lens. So many people still
> have to wear glasses afterwards for some distances.
> 3) The a. lens can't be positioned in the eye quite as accurately as
> the monofocal (ask your doc about this), so you might end up focusing
> at a slightly dif range of distances than was planned. Also, if you
> had both eyes done, they would probably end up being dif from each
> other. I'm not sure exactly what effect that would have on your
> vision.
>
> #1 was enough to put me off. I wanted the most failsafe thing out
> there.
> But if not having the aggravation of glasses is more important to you
> than perfect acuity, you might want the accommodative. Oodles of
> people have them; you could ask those people.
> Thankfully, by the time you need this done, lenses may be better than
> they are now.
>
> Liz in Indy
> USA



--

> I wonder how a cataract surgery could be harder or easier? *My limited
> understanding is that they remove your lens and put a new one in. *It
> doesn't seem like how bad the original lens is would be a factor.

Well, that's what I thought too, but I was wrong.

Apparently as my cataract got more opaque, some of the material inside
the lens broke down, and continues to break down. I think (?) it
turns from solid into liquid, so (because of osmosis) more water
enters the lens, so the lens swells up. It swells forward a bit into
the front part of the eye.

It's harder to operate on a lens that's swollen and is pressing out,
because they have to cut open the lens bag. When they do this, I
think it can be messy.

Also, if the cataract is opaque to light, this makes it harder to take
measurements of the inside of the eye. You need these measurements to
accurately choose what power of plastic implant to put in.



> I don't know if anyone will see this old thread, but if so, I'd be
> interested to hear comments on the idea of putting astigmatism
> correction (for corneal astig) into the replacement lens. *If there
> might be one up side to this it could be that I could lose my glasses
> for distance.

There are toric lenses that correct for astigmatism. I am told, but
don't know if it's true, that they work best if you have a lot of
astigmatism.

Another lovely disadvantage to Crystalens (I'm sorry, but they make
the product; I only report!) is that SFAIK, it does not block longer-
range UV light as well as monofocal lenses do. Thus, you want end up
wanting to wear UV-blocking glasses afterwards. Probably this too
will change by the time you need them.
Heaven knows.

Liz in Indy (I think it's Indy)

In article
<f84f7f34-b6d6-46f1-8f9e-(E-Mail Removed)>,
Liz <(E-Mail Removed)> wrote:

> > I wonder how a cataract surgery could be harder or easier? *My limited
> > understanding is that they remove your lens and put a new one in. *It
> > doesn't seem like how bad the original lens is would be a factor.
>
> Well, that's what I thought too, but I was wrong.

I was nervous enough before the surgeries, and wasn't told about any
complications, so I tried not to read about them. That just would have
made me more nervous, without good reason.

> Also, if the cataract is opaque to light, this makes it harder to take
> measurements of the inside of the eye. You need these measurements to
> accurately choose what power of plastic implant to put in.

That's not my understanding at all. It's difficult to measure anything
optically when you are looking through a lens and don't know its power.
The cataract changes its power, in unpredictable (in detail) ways.
These measurements are all done using sound waves, as far as I know.

> > I don't know if anyone will see this old thread, but if so, I'd be
> > interested to hear comments on the idea of putting astigmatism
> > correction (for corneal astig) into the replacement lens. *If there
> > might be one up side to this it could be that I could lose my glasses
> > for distance.

I don't know much about this, and didn't choose to do it, although I
have considerable astigmatism in one eye. For a normal cataract
surgery, the surgeon sticks the lens in at any old rotation. The lens
is rolled up in a tube, and unfolds inside the eye. To correct
astigmatism, the lens has to be at a particular rotation. This adds
complication to the procedure. In addition, nothing is holding the lens
in place at first except some very flimsy plastic "fingers". The lens
can, and does sometimes, rotate. This requires another surgery, since a
lens to correct astigmatism does a lot more harm than good if it is at
the wrong angle of rotation. There is also surgery to the cornea to
correct astigmatism. This can be done at the same time. I would think
it could also be done separately, but don't know.

> There are toric lenses that correct for astigmatism. I am told, but
> don't know if it's true, that they work best if you have a lot of
> astigmatism.
>
> Another lovely disadvantage to Crystalens (I'm sorry, but they make
> the product; I only report!) is that SFAIK, it does not block longer-
> range UV light as well as monofocal lenses do. Thus, you want end up
> wanting to wear UV-blocking glasses afterwards. Probably this too
> will change by the time you need them.
> Heaven knows.
>
> Liz in Indy (I think it's Indy)

--
Dan Abel
Petaluma, California USA
(E-Mail Removed)

> I was nervous enough before the surgeries, and wasn't told about any
> complications, so I tried not to read about them. *That just would have
> made me more nervous, without good reason.

I hear you! They told me about this one because it affects the type
of lens - they want one with soft haptics, that are easier to work
with in case the tissue is damaged. The take home lesson, without
needing any detail, is that one shouldn't wait too long to get
surgery, or the surgical procedure gets harder.


> > Also, if the cataract is opaque to light, this makes it harder to take
> > measurements of the inside of the eye. *You need these measurements to
> > accurately choose what power of plastic implant to put in.
>
> That's not my understanding at all. *It's difficult to measure anything
> optically when you are looking through a lens and don't know its power. *
> The cataract changes its power, in unpredictable (in detail) ways. *
> These measurements are all done using sound waves, as far as I know.

They also have a new machine that uses light, called an IOLMaster.
This cannot be used with the opaque cataract. The sound waves are
used instead.

Liz