Can IOLs be removed years later?

Hi all,

I have cataracts at a young age (34) and will require surgery in both
eyes. While there is a lot of new technology regarding accomodation
and such, none of them are perfect.

Basically, what I'd like to know is if I get a standard (or maybe even
something like Crystalens) IOL now, in say 10 years when all kinds of
new technology is avaiable, will I be able to safely swith out my old
IOLs for something new? One doctor I visited said that whatever
technology I get now I will be stuck with for the rest of my life, and
that is not good news.

So, anybody know?

Thanks.

 

I don't know, either. I know my doctor said that my IOLs would be good
for the rest of my life. I would guess that some doctors would not do the
surgery due to the risk, but that some might. I would also guess that
many insurance companies would not pay for the second surgery. When you
think about it, you will be facing the same problem that everybody else is
having with presbyopia. If the insurance company pays for it for you, how
can they justify not paying for it for everybody else who can no longer
focus both far and near?

 

IOL's can be explanted, but it is difficult to do once they are well-healed
in. Early on (in the first 1-2 months) the capsule has not permanently
encased the IOL yet, so you can tease the bag away from the IOL and haptics,
and rotate the lens out. Once it is fibrosed in, it is much more difficult,
and the replacement IOL can't usually go back into the back, since its edges
have stuck together and the new IOL won't sit correctly. Capsules like these
tend to get torn during explantation, leading to vitreous loss. The new IOL
then goes in the sulcus, where a flexible lens like the Crystalens would not
work, since it depends on being in the bag.

Also, any intraocular surgery entails risk of infection, and the time
required to fiddle around with the lens explantation increases this risk.
Sometimes the haptics are so fibrosed in that one has to cut the haptics,
remove the optic, and leave the haptics in place.

Bottom line - I wouldn't plan on this for later. Also, since the new lens
probably can't go into the bag, you cut yourself off from using types of
newer optics that only work in the bag.


David Robins, MD
Board certified Ophthalmologist
Pediatric and strabismus subspecialty
Member of AAPOS
(American Academy of Pediatric Ophthalmology and Strabismus)

 

question: do you also lose your accomodating ability when the lens is
replaced ? So, once you pick either near of far for a focal point, you
need glasses for the other. This is no matter at what your age the
operation is done. Correct?

 

Correct. The good thing is that most people get an IOL because they are
having cataract surgery. Generally people get cataracts when they are
older. Old people have usually already lost some or all of their
accommodation anyway, so they aren't losing much if anything. I was very
used to OTC reading glasses anyway, so it wasn't a drastic change for me
when I had cataract surgery. I've had it in both eyes now.

 

Hi Dan,

I'm at the point now where I should consider having cataract surgery in my
other eye. I've had a IOL for a few years in my left eye. Did you have any
problems with the second surgery and how did your overall vision improve or
degrade?

George

 

My first surgery went really smoothly. I was told to expect to be off
work for two days. I would be fine the second day, but residual
tranquilizer made it unsafe to drive. My doctor retired, and I got a new
one. When it came time to have the second eye done, I knew from reading
this group that things were different. When I asked my doctor about how
much time I would be off work, she said I could go to work the next day!
If I had had half a brain, I would have gotten a clue that maybe there
wasn't going to be a problem with residual tranquilizer because I wasn't
going to get as much. With the first surgery, I had a local anesthetic so
I couldn't see or feel anything. With the second, she just used a topical
on the eye, so I could still see. I didn't realize how much of a problem
that would be. Although there was no pain, I could feel the pressure and
movement, and that was very uncomfortable. Before the surgery, I told the
anesthesia guy that I wanted lots, as I was very nervous. He hesitantly
explained that the doctor didn't believe in that. Then they completely
covered my face, except the one eye. I didn't like that either. The
whole experience was very unpleasant, unlike the first one. Mercifully,
it was short. I had considerable pain the first evening.

After 30 days I saw the OD and found that I had 20/20 UNcorrected vision
in that eye. After living with thick glasses for many years, that was
really welcome.

 

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Hi Dan,

Thanks for the feedback. I had general anesthetic like you for my first operation
here at the Eye Institute. Also had an local anesthetic injection to immobilize
the eye. That left a bruise under eye (like a shiner) for a few days. I asked OD
why he used this procedure rather than one you described. He said it was a more
conservative approach. It was not unpleasant.

I guess what I wanted to know was how is your eyesight now that both eyes are
corrected? Any problems seeing at distance? Out of focus problems? Probably need
reading glasses... right?

George

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operation


I didn't have a general, just a good dose of tranquilizer. I was awake
the whole time, but had enough tranquilizer that I didn't have any
problems. The guy before me had a general, though. He also had his
pre-op appointment before me. My wife and I were sitting in the waiting
room, and we could hear the doctor yelling at him. When we went in to see
the doctor, he was shaking his head sadly. He knew we had heard the
yelling, and he explained that the guy was deaf, and he couldn't get
through to him to explain what would happen during the surgery. He wasn't
willing to have the patient awake if he didn't understand, so he ordered a
general.

I needed reading glasses before the surgery, so it's no big deal that I
need them now, although I need them more now than I did before. I had a
retinal detachment in one eye, well before the first surgery, and I
haven't ever quite recovered from that. The cataract surgeries were both
very successful, although I strongly favor the eye that didn't have the
detachment. I have 20/20 vision and am quite happy with it. I have no
focusing problems.

 

Thanks for the insight. I need reading glasses now since, as you know, can't focus
the darn IOL <grin>. But it's a small difficulty to bear as I now pass drivers
licence without need for glasses. I'm hoping that if or when the next surgery takes
place that both eyes will blend together nicely. The darn eye with cataract is
changing so fast it went from far sighted to near sighted in only two years. And
it's darker and has color whereas the IOL is clear and colorless.

BTW, I didn't have a complete general. It knocked me out at first, then I came to
during end of operation. It was a strange sensation. Since I'm a trumpet player
in my spare time, in my stupor I asked OD if I could play the trumpet after the
operation. He asked if I could play trumpet before operation. I said yes. Then he
laughed and said it would be ok and I could play without problems, but should wait
a few weeks.. Strange what you say when you're half out of this world.

George