Disturbing opthalmologist visit

Discussion in 'Optometry Archives' started by Chuck, Sep 25, 2009.

  1. Chuck

    Chuck Guest

    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?

    --
     
    Chuck, Sep 25, 2009
    #1
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  2. Chuck

    Chuck Guest

    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?

    --
     
    Chuck, Sep 25, 2009
    #2
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  3. Chuck

    Mike Ruskai Guest

    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 Ruskai, Sep 26, 2009
    #3
  4. Chuck

    Liz Guest

    He said I have cataracts.  I'm only 39, so this was a shocker.  I
    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.
    They have them now.
    Yes, that's the one. "Crystalens". Think it's the only accommodative
    lens out there right now, but more types are being developed.
    They are. However, I'm not getting them in my eyes.
    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
     
    Liz, Sep 28, 2009
    #4
  5. Chuck

    Neil Brooks Guest

    Mike Tyner tends to give exceptionally good advice.

    Good luck, Mastiff!
     
    Neil Brooks, Sep 28, 2009
    #5
  6. Chuck

    Chuck Guest

    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...


    --
     
    Chuck, Oct 2, 2009
    #6
  7. Chuck

    Liz Guest

    I wonder how a cataract surgery could be harder or easier?  My limited
    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.


    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)
     
    Liz, Oct 12, 2009
    #7
  8. Chuck

    Dan Abel Guest

    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.
    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 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.
     
    Dan Abel, Oct 12, 2009
    #8
  9. Chuck

    Liz Guest

    I was nervous enough before the surgeries, and wasn't told about any
    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.

    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
     
    Liz, Oct 14, 2009
    #9
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