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#44548 - 05/09/17 10:42 AM Cataract surgery and IOL replacement
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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?

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#44551 - 05/09/17 02:48 PM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Online
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
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.
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#44554 - 05/09/17 03:59 PM Re: Cataract surgery and IOL replacement [Re: joemikeb]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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#44555 - 05/09/17 04:40 PM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
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.
_________________________
The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44556 - 05/09/17 04:56 PM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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#44557 - 05/09/17 05:12 PM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
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.)


Edited by artie505 (05/10/17 12:49 AM)
_________________________
The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44678 - 05/22/17 01:00 PM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Online
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
So Grelber, how goes it with your eyes? 👀

Your friends on FineTunedMac want to know‼️


Edited by joemikeb (05/22/17 01:01 PM)
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#44679 - 05/22/17 02:02 PM Re: Cataract surgery and IOL replacement [Re: joemikeb]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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#44684 - 05/23/17 01:23 PM Re: Cataract surgery and IOL replacement [Re: grelber]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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#44685 - 05/23/17 01:39 PM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
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
_________________________
The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44686 - 05/23/17 02:31 PM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Online
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
👍 🖖 and 🤞

Glad you are seeing clearly now‼️If this were a text message it would have a shower of balloons and confetti!
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#44687 - 05/23/17 03:03 PM Re: Cataract surgery and IOL replacement [Re: grelber]
jchuzi Online


Registered: 08/04/09
Loc: New York State
Great news! The only ill effect from my wife's cataract surgery was that her sex urge disappeared... confused
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Jon

OS 10.15.3, iMac Retina 5K 27-inch, late 2014, 3.5 GHz Intel Core i5, 1 TB fusion drive, 16 GB RAM, Epson SureColor P600, Photoshop CC, Lightroom CC, MS Office 365

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#44688 - 05/23/17 04:28 PM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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#44689 - 05/23/17 04:31 PM Re: Cataract surgery and IOL replacement [Re: joemikeb]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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".

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#44690 - 05/23/17 04:35 PM Re: Cataract surgery and IOL replacement [Re: jchuzi]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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

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#44692 - 05/23/17 06:01 PM Re: Cataract surgery and IOL replacement [Re: grelber]
jchuzi Online


Registered: 08/04/09
Loc: New York State
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.
_________________________
Jon

OS 10.15.3, iMac Retina 5K 27-inch, late 2014, 3.5 GHz Intel Core i5, 1 TB fusion drive, 16 GB RAM, Epson SureColor P600, Photoshop CC, Lightroom CC, MS Office 365

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#44694 - 05/24/17 12:53 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
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?
_________________________
The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44695 - 05/24/17 02:38 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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).

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#44696 - 05/24/17 03:00 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
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.
_________________________
The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44699 - 05/24/17 11:07 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.



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#44700 - 05/24/17 03:48 PM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
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)
_________________________
The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44701 - 05/25/17 01:52 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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#44702 - 05/25/17 08:25 AM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Online
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
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.
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#44704 - 05/25/17 09:16 AM Re: Cataract surgery and IOL replacement [Re: joemikeb]
Virtual1 Offline


Registered: 08/04/09
Loc: Iowa
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)
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#44705 - 05/25/17 09:57 AM Re: Cataract surgery and IOL replacement [Re: joemikeb]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
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.

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