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Posted By: grelber Cataract surgery and IOL replacement - 05/09/17 05:42 PM
Given the numerous and apparently long-in-the-tooth FTM members, I suspect there may be an untapped reservoir of experience with respect to cataract removal and intraocular lens (IOL) replacement among same.

Two weeks ago I had a very dense cataract removed (since I was effectively blind = no useful vision in that eye) and replaced with a top-notch IOL (Alcon's AcrySof Toric IOL). For ca 30 minutes post-surgery the vision in that eye was eagle-eye superb. Then the inflammatory process set in which caused my vision to return to the status quo ante — not at all enjoyable.
I was advised that, because of the density of the cataract, higher power of ultrasound needed to be employed in emulsifying the cataractous lens, which in turn produced much greater inflammatory reponse than usual.
I was put on a couple of anti-inflammatory ophthalmic meds which (to my mind at least) should resolve the condition. But at this point the vision in that eye is extremely hazy (although considerably less so than earlier) but doesn't seem to be noticeably progressing to a proper resolution (ie, clear vision). Again, I have been reassured by my surgeon that it should resolve.
I am getting more and more discouraged about the slow if not stagnant pace, especially since my other eye has an incipient cataract which will need to be dealt with in short order but which can't be until I have useful vision in the first eye.
I have no intention of going down the white-cane road.

So, does anybody have similar experience and/or pearls of wisdom to impart with respect to the above?
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 05/09/17 09:48 PM
My initial experience and that of the many people I have known duplicates yours, but none of our cataracts were anywhere near as advanced as yours and with three exceptions none had any post-operative problems. One woman whose cataracts were developing very rapidly and another who apparently whose cataracts had existed for a very long time did suffer a degree of vision loss due to post-operative swelling that lasted for a few days to a week. The third exception, my mother-in-law, lenses did not set properly, slipped out of position and had to be replaced.

Given the description of the severity of your cataracts and the high powered ultrasound used to dissolve the diseased lens post-operative swelling would not appear to be unexpected. Neither would it surprise me if the shape of your eye was distorted and would take some time to return to normal. In that case no amount of anti-inflammatory would help and frankly I have not found anti-inflammatory meds to be particularly helpful anyway.

I can certainly understand your angst and impatience. If it were me I would probably be oscillating from hope though depression and anxiety to terror too fast for my Mac mini to keep up with. I would counsel patience, but that is too obviously easier said than done.

Don't forget to check back in when the swelling goes down.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/09/17 10:59 PM
Info and caring most appreciated.

The IOL and lens capsule are fine. The primary issue/concern is the keratitis (inflammation due to corneal infiltrates) which should be amenable to the steroid and NSAID topical meds which I'm using. The haziness (my main complaint) due to infiltrates seems to be gradually resolving; I can actually read ~ make out the FindTunedMac banner at the top of the page, but I certainly can't read what I'm now typing.

So, patience is the only option ... but the angst won't go away until the keratitis does.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/09/17 11:40 PM
Originally Posted By: grelber
So, patience is the only option ... but the angst won't go away until the keratitis does.

Optimistic patience!

Negativity never assists in the healing process.

After my surgery I got into the rotten habit of looking at everything as if it were an eye chart, and it was a BAAAD, negativity inducing, albeit difficult to avoid, thing!

Shut down your iMac, have a glass of wine, and look out the window at some nature that requires neither great focus nor high resolution, and let the thing do its own thing in its own time.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/09/17 11:56 PM
Originally Posted By: artie505
Originally Posted By: grelber
So, patience is the only option ... but the angst won't go away until the keratitis does.

Optimistic patience! ...
Shut down your iMac, have a glass of wine, and look out the window at some nature that requires neither great focus nor high resolution, and let the thing do its own thing in its own time.

As a wine maker, a glass of wine is never far from hand, especially when I'm diddling around on my iMac.
The only drawback to communing with nature via my eyeball is that it's through a fog (= haziness) which not only makes such disagreeable but also refocuses attention on the "disability". But your point is well taken, and I will strive to find a brighter side.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/10/17 12:12 AM
Originally Posted By: grelber
The only drawback to communing with nature via my eyeball is that it's through a fog (= haziness) which not only makes such disagreeable but also refocuses attention on the "disability".

More-so than communing with something that requires greater visual acuity and may be harder on your eyes?

By the way, I speak from experience; looking out my window at the waving trees and rippling foliage was what got me through the first days after my surgery.

(Looking out through my cataracts during the years before they were operable convinced me that impressionistic painting was, at the outset, realism as seen through fading eyes.)
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 05/22/17 08:00 PM
So Grelber, how goes it with your eyes? 👀

Your friends on FineTunedMac want to know‼️
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/22/17 09:02 PM
Originally Posted By: joemikeb
So Grelber, how goes it with your eyes?

Not as well as it might. Despite the IOL unfolding as it should and the capsule being healthy, the haziness/inflammation in the cornea refuses to abate in properly progressive fashion, no matter how much various steroids and/or NSAID is applied. My surgeon believes that it should resolve with time — even though most cases resolve over the short term, ie, less than the 4 weeks that have passed since my surgery and implant.
Some days the haziness is equivalent to that associated with the incipient cataract in my other eye; some days considerably worse. So, it's a roller coaster ride in the negative sense of the term.
I can't have my other eye operated on until the visual acuity improves substantially and remains stable. The current situation is not auspicious.
I have no intention of ever joining the white cane brigade.
Now I must hone my wakizashi (and katana, if I can find a second) in preparation for my impending blindness.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/23/17 08:23 PM
Somnabeach! It may be a bit premature to report, but ...

I just switched to prednisolone acetate 1% for corneal inflammation. The haziness seems to have cleared dramatically and both eyes have the same focal distance.
Given the blue filter in the IOL, everything seems sharper and brighter via the left eye, especially when I compare it with my right eye (with incipient cataract), which lends a decidedly yellowish hue to everything.
Now it's wait and see if this holds. If so, I can stop honing my wakizashi.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/23/17 08:39 PM
Originally Posted By: grelber
I just switched to prednisolone acetate 1% for corneal inflammation.

That's the go-to opthalmic drug...the one that was prescribed after my both of cataract surgeries...the one I use for my uveitis flareups.

I wonder why it took so long for your docs to prescribe it? confused

At any rate, I'm happy to hear that you're having success with it. cool
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 05/23/17 09:31 PM
👍 🖖 and 🤞

Glad you are seeing clearly now‼️If this were a text message it would have a shower of balloons and confetti!
Posted By: jchuzi Re: Cataract surgery and IOL replacement - 05/23/17 10:03 PM
Great news! The only ill effect from my wife's cataract surgery was that her sex urge disappeared... confused
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/23/17 11:28 PM
Originally Posted By: artie505
Originally Posted By: grelber
I just switched to prednisolone acetate 1% for corneal inflammation.

That's the go-to op[h]thalmic drug...the one that was prescribed after my both of cataract surgeries...the one I use for my uveitis flareups.
I wonder why it took so long for your docs to prescribe it? confused

Immediately post-surgery I was using an antibiotic + steroid (dexamethasone 0.1% which is ca 6x stronger than pred), but that didn't seem to do the trick. Steroids are generally contraindicated when the eye is compromised (such as through surgery or viral infection) but it's a trade-off in terms of healing. Some folk may find that steroid use is problematic. My surgeon's extensive experience led him to the protocol he standardly uses; other practitioners prefer pred + antibiotic.

On that basis my surgeon decided to try an ophthalmic NSAID (Nevanac®) to achieve similar results. Not so much.

So we agreed that perhaps a course of pred acetate 1% would be the next best bet — which so far it seems to be.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/23/17 11:31 PM
Originally Posted By: joemikeb
👍 🖖 and 🤞
Glad you are seeing clearly now‼️If this were a text message it would have a shower of balloons and confetti!

Merci.

Just a note: At first blush (and at my iMac's screen resolution of 1920 x 1080) that first emoji looks as though it's giving the finger. I had to enlarge it 20x to realize that it's actually "thumbs up".
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/23/17 11:35 PM
Originally Posted By: jchuzi
Great news! The only ill effect from my wife's cataract surgery was that her sex urge disappeared... confused

Mayhap she finally recognized that the object of her desire was not quite what she thought it was? tongue smirk
Posted By: jchuzi Re: Cataract surgery and IOL replacement - 05/24/17 01:01 AM
Originally Posted By: grelber
Originally Posted By: jchuzi
Great news! The only ill effect from my wife's cataract surgery was that her sex urge disappeared... confused

Mayhap she finally recognized that the object of her desire was not quite what she thought it was? tongue smirk
When I was working, my colleagues loved to needle people, and I became a good target when I told them that my wife had very poor eyesight (20/400). One guy looked at me appraisingly and said, "Well, that explains it."

I guess that I led with my chin.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/24/17 07:53 AM
Originally Posted By: grelber
Immediately post-surgery I was using an antibiotic + steroid (dexamethasone 0.1% which is ca 6x stronger than pred), but that didn't seem to do the trick. Steroids are generally contraindicated when the eye is compromised (such as through surgery or viral infection) but it's a trade-off in terms of healing. Some folk may find that steroid use is problematic. My surgeon's extensive experience led him to the protocol he standardly uses; other practitioners prefer pred + antibiotic.

On that basis my surgeon decided to try an ophthalmic NSAID (Nevanac®) to achieve similar results. Not so much.

So we agreed that perhaps a course of pred acetate 1% would be the next best bet — which so far it seems to be.

I'm curious about the dexamethasone...the fact that your surgeon defaults to oral steroids when I'd expect default use of a topical.

Or did he go directly to the dexamethasone because of the degree of trauma?
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/24/17 09:38 AM
Originally Posted By: artie505
I'm curious about the dexamethasone...the fact that your surgeon defaults to oral steroids when I'd expect default use of a topical.
Or did he go directly to the dexamethasone because of the degree of trauma?

Not oral. His post-surgical protocol called for Tobradex®, Alcon's ophthalmic combination of the antibiotic tobramycin 0.3% + dexamethasone 0.1% (for several weeks).
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/24/17 10:00 AM
Originally Posted By: grelber
Not oral. His post-surgical protocol called for Tobradex®, Alcon's ophthalmic combination of the antibiotic tobramycin 0.3% + dexamethasone 0.1% (for several weeks).

Thanks for filling in the gap in my memory.

I thought I remembered dexamethasone as a drop, but I couldn't find any reference to it as such, but now that you've mentioned Tobradex®, I remember that one of my doctors once prescribed it for conjunctivitis without asking whether I had insurance that would cover its then outrageous cost; I declined.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/24/17 06:07 PM
Originally Posted By: artie505
... now that you've mentioned Tobradex, I remember that one of my doctors once prescribed it for conjunctivitis without asking whether I had insurance that would cover its then outrageous cost ...

Regarding the latter: I don't know what it goes for in your bailiwick, but north of the 49th it's provincial formulary approved and runs ca $11-12 [US$8-9] per 5-ml bottle (+ whatever the dispensing fee is, depending on pharmacy).
Jes so's ya no.


Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/24/17 10:48 PM
Originally Posted By: grelber
Regarding [Tobradex®]: I don't know what it goes for in your bailiwick, but north of the 49th it's provincial formulary approved and runs ca $11-12 [US$8-9] per 5-ml bottle (+ whatever the dispensing fee is, depending on pharmacy).
Jes so's ya no.

mad (Link)

or, if you don't care for generics,

crazy (Link)
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/25/17 08:52 AM
Originally Posted By: artie505
Originally Posted By: grelber
Regarding [Tobradex]: I don't know what it goes for in your bailiwick, but north of the 49th it's provincial formulary approved and runs ca $11-12 [US$8-9] per 5-ml bottle (+ whatever the dispensing fee is, depending on pharmacy).
Jes so's ya no.

mad (Link)
or, if you don't care for generics,
crazy (Link)

Holy crap!

As far as I'm aware, a generic version of Tobradex® isn't available in Canada — at least it's not listed as an option in the provincial formulary (which governs what pharmacies can charge).
So it's very surprising the cost would be so much lower here, especially since we're only just now working on a national prescription drug plan which would lower prices even more.
[I had forgotten that you guys have so-called Rx "coupons"; such things are unknown in these here parts.]

Now I (sort of) understand why a relative of mine who also just underwent cataract surgery with IOL replacement was so irked at the cost of post-surgical ophthalmic drops — over US$200 for Prolensa, Durazol, and Polytrim (Polymixin B sulfate and trimethoprim), even with copay calculated in. Sheesh.

Addendum: Under our medicare system (provincially administered) the total cost of cataract surgery including IOL implant is covered. If one compares the underlying cost here with the cost my relative paid, ours would be about 1/3 or 1/2 of the latter. Double sheesh.
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 05/25/17 03:25 PM
Originally Posted By: grelber
So it's very surprising the cost would be so much lower here, especially since we're only just now working on a national prescription drug plan which would lower prices even more.
[I had forgotten that you guys have so-called Rx "coupons"; such things are unknown in these here parts.]

Not unsurprisingly our drug costs are so high because the congress in its wisdom(?) chose enriching the drug companies and Wall Street investors as the greater good over lower consumer costs by refusing to allow the largest single health care provider (Medicare) to bargain with the drug companies on drug prices. As the largest single payer that means Medicare pretty well sets the prices and since, by law, they cannot negotiate price which means the price ends up being whatever the drug companies can get away with.
Posted By: Virtual1 Re: Cataract surgery and IOL replacement - 05/25/17 04:16 PM
Originally Posted By: joemikeb
Not unsurprisingly our drug costs are so high because the congress in its wisdom(?) chose enriching the drug companies and Wall Street investors as the greater good over lower consumer costs by refusing to allow the largest single health care provider (Medicare) to bargain with the drug companies on drug prices. As the largest single payer that means Medicare pretty well sets the prices and since, by law, they cannot negotiate price which means the price ends up being whatever the drug companies can get away with.

Sounds like Reagan's "trickle-down economics" - that's the plan that "if we make the rich people even richer, they'll start giving their money to the other 99% and we'll all be wealthier". (as if THAT ever happens)
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/25/17 04:57 PM
Originally Posted By: joemikeb
Not unsurprisingly our drug costs are so high because the congress in its wisdom(?) chose enriching the drug companies and Wall Street investors as the greater good over lower consumer costs by refusing to allow the largest single health care provider (Medicare) to bargain with the drug companies on drug prices. As the largest single payer that means Medicare pretty well sets the prices and since, by law, they cannot negotiate price which means the price ends up being whatever the drug companies can get away with.

Lovely. crazy And the BS you're now going through with respect to health care "reform" is going to make things even more dire. tongue

On this side of the border medicare is funded federally through (income) taxes by means of distribution to provinces which provide the health care. (This represents ca 40% of annual budgeting. [I trust that ryck (or others) will correct me if I'm wrong.])
Individual provinces and sometimes provincial conglomerates bargain with the drug companies for "best prices". The federal government wants to initiate a national plan to do the same thing, with even greater benefits (ie, lower prices) across the board. Yay for us.
Posted By: ryck Re: Cataract surgery and IOL replacement - 05/26/17 08:24 AM
Originally Posted By: grelber
On this side of the border medicare is funded federally through (income) taxes by means of distribution to provinces which provide the health care. (This represents ca 40% of annual budgeting. [I trust that ryck (or others) will correct me if I'm wrong.])

It depends whether you're looking at the federal or the provincial percentage - in individual provinces you are right, the number is about 40% of the services provinces provide. Federally, the number is between 11 % and 12% of GDP.

Percentages aside, in actual dollars our healthcare system is about $6,000 per person. Because our system is paid from graduated income taxation, that $6,000 average is going to be greater or lesser to the individual taxpayer, depending on their income.

However, our system provides equality in healthcare. Any person requiring it - no matter whether they're a millionaire or a homeless person sleeping under a bridge - gets it.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/26/17 02:24 PM
Thanks for fleshing it out.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/26/17 03:23 PM
Originally Posted By: grelber
Somnabeach! It may be a bit premature to report, but ...
I just switched to prednisolone acetate 1% for corneal inflammation. The haziness seems to have cleared dramatically and both eyes have the same focal distance.
Given the blue filter in the IOL, everything seems sharper and brighter via the left eye, especially when I compare it with my right eye (with incipient cataract), which lends a decidedly yellowish hue to everything.
Now it's wait and see if this holds. ...

Man, the eye thing just keeps on and on ...
It's one step forward then one step back then one step forward and two steps back ... etc. One day out of 4 I'm encouraged, 1 day discouraged, 2 days depressed.
Some days the vision is just about perfect, then it goes completely hazy again, then bulbar scratchiness (± pain) ... even with all the meds.
Street lights have a rainbow circle with haze around them; not so with my cataractous eye.
It's going on 6 weeks since the surgery, so I'm close to calling it a "fail".
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 05/26/17 03:47 PM
Originally Posted By: grelber
Even with all the meds.
Street lights have a rainbow circle with haze around them; not so with my cataractous eye.
It's going on 6 weeks since the surgery, so I'm close to calling it a "fail".

I can only imagine your frustration but as far as the street lights go, I had problems with street lights and especially headlights for nearly a year after my surgery. More annoying than anything serious, it sometimes made night driving difficult. I found BluBlocker "sun" glasses helped a lot. Later on I found some really expensive amber lens shooting glasses to be better albeit several times more expensive. Even though my surgery was 17 years ago and the street/head light halo long since disappeared, I still wear a pair of amber lens sunglasses when driving at night on all but the darkest country roads. If you try this I strongely urge you to avoid polarized lenses.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/26/17 04:08 PM
The Alcon AcrySof® IOL has UV and blue-filtering — essentially it's an implanted BluBlocker — with all the benefits of the latter and actually better than shooter's amber lenses*, with which I quite familiar being a target shooter and practical shooter.
That's why the on/off haziness due to inflammation is so irksome, not to mention the flare.

* In case you'd like to follow up, there's a good article on same in Eye 2016; 30: 215-221 (at www.nature.com/eye).
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/29/17 09:54 PM
Once again, it may be premature so I'm hesitant to comment on it but ...

The (white to white/blue) haziness and lack of reasonable distance focus — especially because these come and go, sometimes even over the course of 10-15 minutes — seemed to indicate that the problem is not inflammation or inflammatory corneal infiltrates, since that is not typical behavior for inflammation (which should get better or worse, not fluctuate). Add to that intermittent bulbar and retrobulbar pain. So I had to think that maybe the various meds, from steroids to NSAID, were more the culprit than the cure.
So I decided to quit all of the meds to see what happens. My last pred dose was over 24 hours ago. Since mid-morning I noticed in the bright sunlight that not only was my left eye no longer hazy but also had better visual acuity and less haziness than my right eye — which heretofore had never been the case — and so it remains as of this writing.
The proof of the pudding will be that the situation remains stable. If so, then my supposition will be accurate and when I see my surgeon in a couple days, I will point at him and say, "J'accuse!" tongue I will also set up the appointment for the surgery on my right eye (before the end of June), with the option to abort if things go south in the interim.
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 05/30/17 03:47 PM
I've got my fingers crossed for your successful experiment. Your rationale seems sound, at least to my non-medical point of view.
Originally Posted By: grelber
I will also set up the appointment for the surgery on my right eye (before the end of June), with the option to abort if things go south in the interim.

You always have the option to abort, but hopefully by then you will be reveling in the joy of the improved vision in your other eye and eager to have it in both.
Posted By: ryck Re: Cataract surgery and IOL replacement - 05/30/17 10:13 PM
Originally Posted By: grelber
The proof of the pudding will be that the situation remains stable. If so, then my supposition will be accurate and when I see my surgeon in a couple days, I will point at him and say, "J'accuse!" tongue I will also set up the appointment for the surgery on my right eye (before the end of June), with the option to abort if things go south in the interim.

Originally Posted By: joemikeb
I've got my fingers crossed for your successful experiment.

Hear, hear! All the best for a successful outcome.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/31/17 12:13 AM
Paraphrasing joemike, I've got my eyes crossed for you! tongue

Since you said earlier that dexamethasone is 6.5 times as strong as prednisolone acetate I've been curious about why your surgeon defaulted to such a strong drug, and following your story, I've suspected for a while that your problem could be steroid overdose.

I hope you've nailed it!

Interesting that everybody I know or have run across that has had cataract surgery has had both eyes done in quick succession, while my surgeries were six years apart.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/31/17 08:16 AM
Originally Posted By: artie505
Since you said earlier that dexamethasone is 6.5 times as strong as prednisolone acetate I've been curious about why your surgeon defaulted to such a strong drug, and following your story, I've suspected for a while that your problem could be steroid overdose.

The difference in strength is why the formulation with dexamethasone is 0.1% whereas that for prednisolone is 1% — so that the amount per drop is approximately equal (to achieve the same effect).
Still not sure if my supposition vis-à-vis adverse side-effect is correct. The haziness still comes and goes, although with longer periods of clear vision than before; but scratchiness and general bulbar discomfort ~ pain has returned. So there's something going on which requires further medical elucidation.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 05/31/17 09:58 AM
Oops! Forgot to do the math, not that it changes my guess. (Have oyu ever had a reaction to a steroid?)

At any rate, we're all rooting for you.
Posted By: grelber Re: Cataract surgery and IOL replacement - 05/31/17 01:46 PM
Originally Posted By: artie505
... ever had a reaction to a steroid?

Only appropriate (ie, salutary) ones — via all routes: oral, injectible (both regular and depot) and topical.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/01/17 09:03 AM
I worked in a drugstore in the 60s, and the common sentiment back then was that if the US FDA had been in existence in the 40s, cortisone would never have been allowed to reach ANY market...SCARY stuff, but it sure does an awful lot of good before it kills you. tongue
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/01/17 02:43 PM
OK, latest ophtho consult:

• Haziness due less to keratic infiltrates than posterior capsule opacity — again, due to aggressive ultrasound phacoemulsification necessary for the dense cataract. Underwent YAG laser capsulotomy which should resolve the tissue issue; a couple of weird floaters appeared in the wake of same — annoying little zippets, as a friend who underwent the same procedure recently has labeled them.
But it sure did clear up the haziness. Everything seems outrageously bright and clear ... don't have to go downtown to see the bright lights.
(Strangely, the sowbug-sized vitreous floater which has been my constant companion for a dozen years seems to have taken a holiday in the wake of the laser treatment. We shall see.)

• Discomfort/pain at incision site due to regenerating corneal nerves; this too should resolve with time.

• If all goes according to Hoyle, the cataract surgery and IOL replacement in the right eye should go forward in a couple weeks.
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/07/17 05:42 PM
Update:
The eye (a week after the capsulotomy) seems to have cleared considerably, with sharp images in distance vision and very little if any flare or glare. The clarity is excellent more often than not; and I just discovered that the taupe-colored house across the street is actually grey.
The floaters come and go. The discomfort/pain due to incision healing ~ corneal nerve regeneration seems to be controllable with Nevanac® when necessary (ie, once every so often).

The following ought to freak out folk south of the 49th:
I just acquired the provincial fee schedule (of covered services) for physicians.
Exclusive of extraneous prep, cataract surgery is $311.50 + IOL implantation $86; my posterior capsulotomy was $138.
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 06/07/17 07:29 PM
My ophthalmologist has told me the occasional floater is a fact of life for those who live long enough.
Posted By: jchuzi Re: Cataract surgery and IOL replacement - 06/07/17 07:40 PM
Originally Posted By: joemikeb
My ophthalmologist has told me the occasional floater is a fact of life for those who live long enough.
Sad, but true. My wife and I have had floaters for several years. That's a small price to pay for living long enough to develop them. grin
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/07/17 08:50 PM
Originally Posted By: joemikeb
My ophthalmologist has told me the occasional floater is a fact of life for those who live long enough.

"Occasional" floaters come and go and are usually bits of uveal tissue or red blood cells which eventually disappear. Some floaters — such as the sowbug-sized one I've had for a dozen years as a result of a vitreous separation — one has to live with or have removed via vitrectomy (which can have the serious downside of blindness). Once all my cataract issues have been resolved and have settled down for a period of time, I may have the vitrectomy if the big floater presents more problems; since the surgery it seems to be less obvious, so we shall see whether it's worth it down the road.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/08/17 08:28 AM
Even after having dealt with floaters for close to 20 years I still swat at some of them. crazy

Every once in a rare while I get a "shower" of them, which is pretty disconcerting, but there's never been an underlying cause that my ophthalmologist could determine.
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/08/17 08:33 AM
Originally Posted By: artie505
Every once in a rare while I get a "shower" of them, which is pretty disconcerting, but there's never been an underlying cause that my ophthalmologist could determine.

Those "showers" are likely red blood cells (which can be identified by their being black/dark with a white/lighter center, since RBCs are biconcave) and are likely due to a brief rupture of a capillary — and they dissipate almost as quickly as they appear.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/08/17 08:51 AM
Originally Posted By: grelber
Originally Posted By: artie505
Every once in a rare while I get a "shower" of them, which is pretty disconcerting, but there's never been an underlying cause that my ophthalmologist could determine.

Those "showers" are likely red blood cells (which can be identified by their being black/dark with a white/lighter center, since RBCs are biconcave) and are likely due to a brief rupture of a capillary — and they dissipate almost as quickly as they appear.

I've never been able to get one of them to stand still long enough for me to examine it. tongue

They haven't dissipated at all quickly, though; it's taken several days for an entire shower to disappear, during which time the real bugs have a field day. grin
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/08/17 03:22 PM
Originally Posted By: artie505
I've never been able to get one of them to stand still long enough for me to examine it.

If the component bits of the showers/swarms all look the same, even if you can't get a good look at them (which is usually the case) and they're about the size of a bullet (as in bullet list), they're probably RBCs (vs chunks of uveal lining).
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/08/17 03:47 PM
Originally Posted By: grelber
If the component bits of the showers/swarms all look the same, even if you can't get a good look at them (which is usually the case) and they're about the size of a bullet (as in bullet list), they're probably RBCs (vs chunks of uveal lining).

It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.

I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/08/17 04:11 PM
Originally Posted By: artie505
It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.
I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.

YAY! And RAH! Much better that way ... and keeping a good thought that it stays so.
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/08/17 09:20 PM
Originally Posted By: grelber
Originally Posted By: artie505
It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.
I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.

YAY! And RAH! Much better that way ... and keeping a good thought that it stays so.

Much appreciated! smile
Posted By: plantsower Re: Cataract surgery and IOL replacement - 06/12/17 09:24 PM
Yikes, I was looking for something here and found the sentence, "it's been quite awhile since I last experience a shower" and thought "what?" It took awhile before I found out it was an eye condition. Well, on with my search.


Originally Posted By: grelber
Originally Posted By: artie505
It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.
I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.

YAY! And RAH! Much better that way ... and keeping a good thought that it stays so.
Originally Posted By: artie505
Originally Posted By: grelber
Originally Posted By: artie505
It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.
I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.

YAY! And RAH! Much better that way ... and keeping a good thought that it stays so.

Much appreciated! smile
Posted By: MacManiac Re: Cataract surgery and IOL replacement - 06/13/17 12:23 PM
Move along.....nothing to see here. blush confused cool

Wonder what the FBI would make of the "shower" reference....?

They're listening, you know.
Posted By: plantsower Re: Cataract surgery and IOL replacement - 06/13/17 03:07 PM
I know!! LOL! mad

Originally Posted By: MacManiac
Move along.....nothing to see here. blush confused cool

Wonder what the FBI would make of the "shower" reference....?

They're listening, you know.
Posted By: grelber Re: Cataract surgery and IOL replacement - 06/20/17 02:03 PM
Update:
Yesterday morning I had my second cataract removal surgery and IOL implant (right eye).
Procedure and post-op recovery were several orders of magnitude less problematic than my first one 8 weeks ago.
Within 10 hours vision with the new lens (Alcon AcrySof® IQ UV with blue-light filtering – same as the first) was nigh unto perfect — no haze, distance visual acuity is essentially equivalent in both eyes, crispness, clarity and brightness are equivalent in both eyes.
At the moment visual acuity is 20/50 in left eye, 20/60 in right eye. As things settle down over the next weeks to months, acuity should approach 20/20.
So, let's hope that everything continues to go according to Hoyle.
Posted By: jchuzi Re: Cataract surgery and IOL replacement - 06/20/17 02:56 PM
Fingers crossed, and good luck!
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/20/17 03:22 PM
Originally Posted By: jchuzi
Fingers crossed, and good luck!

Second the motion!
Posted By: joemikeb Re: Cataract surgery and IOL replacement - 06/20/17 06:05 PM
🤞 (This emoji doesn't look much like tossed fingers, but that is what it is purported to be). 😆
Posted By: artie505 Re: Cataract surgery and IOL replacement - 06/20/17 10:44 PM
Originally Posted By: joemikeb
🤞 (This emoji doesn't look much like tossed fingers, but that is what it is purported to be). 😆

I second that emojion! (Which is more or less what Smokey had in mind.)

(If the fingers had been tossed they wouldn't still be attached to the hand. wink )
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