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Old 02-11-2013, 05:16 PM   #31
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Quote:
Originally Posted by xx1944 View Post
VITct I meant what model IOL did you have??? Like Alcon,Abbott,BL,Staar...???? and the model
name..
xx1944: Intrigued by your question, I asked my cataract clinic (PCLI, Bellevue, WA) about my IOLs (however, my cat. sx was 11 years ago, and may be superceded by better technology now) - Manufacturer: Chiron/LoLab/I.O. (now bought by Bausch & Lomb), Single-Focal Length, Model 80958, Different powers in both eyes, but same optics and lengths. I got back 20/20 after the cataract surgeries for distance vision and have been very happy with them, although, I have to use reading glasses, of course. The IOL specs are very much dependent on how accurately the dr measures your eye, and, I understand, there is a "surgeon factor" in the specs. of IOLs!

I read on the web that now they have multi-focal IOLs and even for astigmatism (toric) but each has its own pros and cons, so you have to be careful in what you get. There are also mono-focal lenses with distance vision in one eye and near-vision in the other. Sometimes, I think, although we feel like we know a lot from the web, we don't know, as patients, the interpretation of the results of clinical trials, the long-term risks, the real scientific details, etc. Isn't it in your best interest, to let your surgeon select the manufacturer and the model, once you let him/her know your choice for what sort of vision you want - I mean, single vs multi focal, want to let blue light in or not, etc.?

IOLs also can sometimes cause secondary cataracts, as happened with my right eye, but not the left one. But that is easily correctable with a few-minutes of Nd:YAG laser treatment. However, note that all of this also increases the chances of retinal detachment.

Last edited by vitcat2; 02-11-2013 at 06:48 PM. Reason: typo

 
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Old 02-11-2013, 05:46 PM   #32
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

tubint: As I understand, one of the reasons the ERM is formed on top of the retina is due to body's immune response when a retinal tear is formed after, say, posterior vitreous detachment (which by itself is natural with aging, and, typically, not harmful), and glial cells, along with other cells (RPE cells, leucocyctes, etc.) start oozing from inside the retina to its outside (near the vitreous) simply to protect the retina. But this can cause the wrinkling on the outside of the retina and poor vision, including waviness, etc.

In my case, with the right eye, there was, unfortunately, a retinal tear created in the untreated sector (9:00 to 12:00). I used to see moving pearl-like objects at the very bottom portion of my right-eye vision once in a while (this was 2+ years ago) and which I did not report to the dr then because I was really scared of going through vitrectomy, and thought it was simply some after-effect of the (12:00-3:00-6:00-9:00) laser retinopexy. Now, I think, it must have been those glial cells escaping from underneath the retina and forming an ERM. With regards to that I had two questions: (i) My OCT shows the ERM but I have 20/20 vision, and Amsler grid test was/is normal. I have seen "ILM Peeling" thread where people quote some numbers from their OCT's - are they thicknesses of the ERM at the fovea, or what are they? My dr didn't tell me any numbers, and chose not to do any ERM peel when he did my viterectomy to that eye. (ii) Importantly, does the ERM slowly grow in thickness, or does it become stable after a few months? The prospect of going through another vit. sx for the ERM few years down the road really bothers me.

 
Old 02-12-2013, 08:35 AM   #33
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

To my knowledge, the ERM stabilizes after a certain period of time, which of course is different with everyone. By the time I went in for an exam, my ERM was a 4+, which the Docs rate as about the worse it can get...hence my 20/200. I assumed my declining vision was due to eye makeup infection or something like that, so I waited to have it examined.

I NEVER had eye problems before that ERM so once diagnosed I spent a couple months researching ERM's and went to 4 Retina Sp. with new OCT's at each office. I was hoping the scar tissue would break loose from my macula and clear my vision, but was told that hardly ever happens...so went for the surgery.

The number of 400 that I mentioned with my OCT result is the average central thickness of the retina. On the OCT tests the thickness measurements are different at each point along the line of your retina.
Seems the Docs don't spend much time going over these results with their patients (probably because it takes time) so you have to ask to GET COPIES PRINTED OUT FOR YOUR RECORDS. I get copies on the spot so I can point and review them with my Ret. Sp. in the office at the exam. They owe you the answers so that you better understand these important healing guages.

 
Old 02-13-2013, 02:30 PM   #34
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

tubint:
As you suggested, I have asked my dr's clinic to send my OCT scans, and they are going to send them as CD's rather than e-copies because, I guess, the files may be too long. My dr had shown them to me pre- and post-op on his computer screen and did actually discuss with me some of the features - like, showing where the wrinkling was with the ERM on the right eye, or none on the left and that it was flattening on to its base RPE properly with no fluid behind it after the vit. sx., etc. I guess, for the right eye, which showed ERM, since it was asymptomatic (that is, it showed no vision problems: 20/20, no waviness/wiggliness on Amsler grid, etc.), I am gusessing, he considered it as a non-issue, at this stage, and did not tell me any retinal thickness metrics, etc. It turns out that actually he does answer a whole bunch of questions I have, and spends reasonable time with me on that, but I did not think of asking him more about ERM then. By the way, these are all black 'n white OCT scans, although I have seen some on the web which are colored - most likely after some sort of dye injection which separates the different layers in the retina.
After you talked about your "delay in focus" issue and "IS/OS junction" problems, I found a bunch about the second topic on the web, but not much on the first. The focus delay must be really strange, although you say your corrected visual acuity is pretty good. I hope it will improve with time, but this IO/OS stuff is pretty delicate and goes far beyond just retinal detachment (has it anything to do what others have called "missing pixels?"). I used to think that retinal tear, macular RD and vitrectomy is bad enough, now I am slowly learning through this thread and others on HB that there can be far stranger and more complicated issues with the retina, structural & neuro-adaptive - with or without RD.

 
Old 02-13-2013, 02:42 PM   #35
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

xx1194: Did you finally select your IOL's for the cataract sx.? I was just curious how you came to your decision, and what you/dr selected finally. Btw, I have heard that doing vitrectomy just for the floaters, no matter how annoying, is not that common because there are always so many risks involved in this surgery. Did your dr tell you the root-cause of so many floaters, or he just couldn't see well inside the eye due to the cataracts? Usually, with aging, there comes "vitreous detachment," which is very common and non-threatening, unless the vitreous was tugging your retina so hard that it created a retinal tear and/or retinal detachmnent. It happened with my left eye. I hope after the cataract sx. in both eyes you start seeing much better, and don't have to go through any vit. sx. Pl. keep us posted.

Last edited by vitcat2; 02-13-2013 at 02:43 PM. Reason: typo

 
Old 02-13-2013, 02:47 PM   #36
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi Budjd: Haven't heard from you in some time. How did your visit to the dr go? Any hopes of improving your vision with either of the macular holes? Please keep us posted.

 
Old 02-13-2013, 03:10 PM   #37
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

In trying to get to the root cause of my visual distortion issues after the macular RD repair, I have learned a couple of things from the web which may, perhaps, help others in giving some sort of closure to their problems (perhaps, not):
The change in image size, sometimes called as micropsia/macropsia, can come from the "change in distance between the cones in the fovea." The cones, which give us visual acuity and color perception, are very small photoreceptors (0.0004 mm to 0.004 mm) and bunched really tightly in the fovea (175,000 per square mm) and face the RPE base. So, when cryopexy is done for the macula/fovea during the retinal repair, these cone cells can get displaced somewhat, perhaps, even destroyed (as my dr told me). Thus, their pixel addresses in the brain are not only changed but, sometimes, just wiped out, and the brain re-groups info from the neighboring cells and re-learns, but that takes time! So, certain neuro-adaptive visual exercises may, perhaps, help accelerate that healing process.
Similarly, I am trying to find the physiological root-cause of the waviness/wiggliness in my vision. Not that knowing it will improve my vision, but, I guess, that's just my way of coping with the visual limitations I may have later. I know it has something to do with the "edge-detection" algorithm that our brain (visual cortex) utilizes, but that's that. And, in reality, I am worried if that will ever go away in my case, although the visual acuity may get slightly better (e.g., the left eye is already seeing better at certain "intermediate" distances than my dominant eye, like, the dashboard, but the wiggliness at microscale remains!).

Last edited by vitcat2; 02-13-2013 at 04:41 PM. Reason: typo

 
Old 02-13-2013, 03:42 PM   #38
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Vit I had my cat surgery scheduled for next week but i canceled it today because the Doctor would not install any other lense than the Baush IOLs that he gets a discount on.
He has a business relationship with Baush and Lomb. I did extensive research on this unusual 4 haptic IOL and it had documented problems with IOL shift, Inflammation,
iritis. That doesnt mean most people arent happy with them but most is not good enough.
The bottom line is that there is no great IOL right now but I bet in the next 5 years there will be. I reviewed many lense data documents and I think the best IOL in monofocal right now is the Tecnis 1 piece and the Tecnis 3 piece 9003. The Alcon 1 piece mono SN60WF is ok
too but it has a slight yellow tint to it and I dont want any tint. They should make it with or without a tint. I have contacted about 6 Opthalm. docs and it is difficult to get their office
assistants to say what kind of lense they use. They usually dont know and that is absurd to me.How could a good assistant not know those things.??Please office folks... learn about
any important issues that a patient would need to know.
Anyway when ever you consider IOLs and your cat surgeon, make sure you find out if
your doc will let you choose. I wasted 200 bucks on a clinic that I will never go back to.
Another thing... if the clinic has their own surgical center inhouse, then expect to pay
about 2500-2800$ if you are a cash payer. If they dont have their own center than expect to pay about 4000 -5000$. Hospitals are thieves. They survive by stealing ridiculous
fees for anethesia and room rentals.
It would be great if people who had Cat. surgery at a real modern and excellent Eye
center could post here where it was and the full breakdown of prices etc. Who was the Doc? Did he have experience with many IOLs or just a couple.? The vast majority of Docs only know a couple and if you had them install an IOL that they didnt know, it would be like having an in experienced Doctor do your surgery.I will spend an additional 2 months getting an appt. with the right Doc here in the SE and I might even end up going out west to a clinic I went to last year. What a frkkn waste of time. Hey Doctors, if you
have a modern clinic and much experience then post here and let us know where you are
and definitely say which IOLs you use and how many by brand that you have installed.
And remember that most people want monofocal.
I would like to also hear from people who had floaters bad before IOLs and what the floaters seemed like after IOLs. Worse or better??

 
Old 02-13-2013, 04:00 PM   #39
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

xx1944:
One cautionary suggestion - If your numerous floaters are, by any chance, for retinal tear or detachment, time is of essence. My RD grew from peripheral RD to macular RD in 7 hours, and, unfortunately, I was out of town then, and couldn't see my dr for 24 hrs. Of course, you have never mentioned RD as a reason for your potential vitrectomy. In your case, if that means the dr needs to do cataract sx to get a clearer picture inside of the retina/vitreous then the details of the IOL are of relatively less importance, and, I would think, any reasonably good IOL should do. Looks like tubint and I have had very good vision with standard single-focal length IOLs (although mfgs are different). I am just saying that time is very important if it has anything to do with retinal repair - waiting 2 months may be too long!

 
Old 02-14-2013, 02:08 PM   #40
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

I have had floaters for 8 years. I have been to several docs for full exam including the best clinics in America and the latest was just a couple months ago. My retina looks good all around. I am a lifelong myopic and that makes me more likely for floaters. But floaters change your life in a way that only the person suffering could know. We are a small private club of misery. btw, I also have cats now so even if I dont have a Vitrectomy ,I have to do the IOLs because cataracts are already diminishing my vision.

 
Old 02-14-2013, 07:19 PM   #41
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

xx1944: I was also a myopic since age 23, or so, and had some floaters. Now I am 58. Just before I had cataract sx., some 11 years ago, it was getting really tough to see properly but I don't think I had too many floaters at that time; may be, the usual floaters that everybody has and lives with. Cat. sx. simply made the quality of my life much better - everything was cleaner, whiter, and I had 20/20 in both eyes with the IOLs, and later on came my reading glasses (+1.5D). Lots of floaters became a real issue for me only before the retinal detachment recently in both eyes, six months apart - they also happened just before the vitreous detachment in the left eye, but the dr said not to worry then as RD hadn't happened. So, in my case, the process was reversed - first cat sx, then vit sx - and that is not that common. Let's hope the cat. sx. improves your vision so much that you simply don't have to go throught the pain of vit. sx.

 
Old 02-14-2013, 11:23 PM   #42
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi. Im answering your post because your post came to my email which caught my eye and I also am new to this group and see how hard it is to get started with people answering you. I myself had my first optical migraine as I found out the next day what it was, when I was approx. 31years old. I am now 55, almost 56 and also found out 2 years ago that I have cataracts. 2 years ago I was told "it will probably be 10years before you do anything about your cataracts, but because of the severity of my nearsightedness they are already bothering me, like yourself. And, being a woman am in a constant state of panic. Like yourself extremely nearsighted having worn glasses since age 7, but extreeemly nearsighted, legally blind at 5/2000. I also have been to many doctors, I don't know if I have seen the "best" but I have seen and do see on a regular basis a retina specialist. While they all do perform full exams, I seldom feel like they spend any time with me at all, after the dilation period, and have questioned the Dr. on more than one occasion "why are you finished already" he simply replies "I don't see anything different" until now of course with the cataracts, which he is constantly telling me "don't worry about them yet" . Now, as far as the floaters go, I 100% agree with you in the way that no one on the planet understand how annoying they are. It took me at least a dozen or more years to really get "used to them" but on a clear day they stand in the way of everything and there is no way to accurately explain them to anyone. If they become worse after cataract surgery, well let just say the entire field of vision will be nothing but floaters and it will be quite challenging.
I was wondering: how long have you KNOWN about your cataracts? I see your floaters have been around for 8 years. My floaters came all of a sudden after an optical migraine occurred after a session playing the trumpet. I literally BLEW my eyes out. I imagine that is what happened as I immediately quite playing and to this day have yet to have another one. It happened to me at night, the very next morning I went to the Opthml. and he told me what he saw. Floaters and explained to me what I must have had. Said he it not come out in my eyes I would have experienced the worst Migraine headache you can imagine. I have met people who have them (optical migraines with flashing lights) all the time, but all my damage was done at one time I was never so scared in my life when those flashing lights came in the dark of the night and lasted 20minutes. The floaters immediately followed and have been with me ever since. I cope every single day, but like I said am quite used to it and am very thankful that I can at least still "see". Some years ago, at least 15 I asked my specialist (retina) is there anything that can be done about these floaters, as I was losing my mind.....he mentioned a vitrectomy was available but he did not recommend it as there was a 50/50 chance of permanent blindness. Reading these message boards, I imagine these odds have changed as it seems fairly common place procedure now, as far as I am reading and would not mind someone reading this who has had one please lmk what you were told before you had yours.....my doctor, all those years ago, probably more than 15actually, totally said NO.

So again as you appear to be extremely nearsighted, I was wondering how LONG have you actually KNOWN about your cataracts, assuming your DR. told you right away when he found them in early stages? Or, What stage did he tell you you were in when he discovered them, and how long ago was that? Did he ever tell you how Long it would be before you would not be able to "take it" anymore? Will he do the vitrectomy at that time? All of this stuff is so new to me and I guess because Im so panicky my Dr. does not want to give me any info at this time....he still thinks I am going to have 6-8 more years.....I don't think so. I HOPE so but I already am suffering from a pretty bad case of "DRY EYE" yet another something new I was not ready for.....

Sorry for the long post, but it seems as if we have similar problems and you are more knowledgeable than I. Where are you in the country? I am in-between Baltimore and Wash. D.C. and was thinking about the Wilmer Eye Clinic at Johns Hopkins, Balt. Md. Have you heard of it? Do you have any experience with them? I have asked all around on the message boards of 4 different sites and no one seems to have any knowledge about them. Or they are ignoring me. They are supposed to be #2 in the country with somewhere in Miami FL being #1 according to Readers Digest this month, I believe. Or was it AARP? Now I cant remember where I just read it, cant remember - well this is a WHOLE 'nother issues, isn't it. Oh brother. Thank you for reading, please answer when you can. Mary.

 
Old 02-15-2013, 07:01 AM   #43
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Hello Misano and group...
I have not posted in a while but I hope I can help. Im in Miami, 65 and as you, been very nearsighted "forever"...from wearing "coke bottles" in school because they were supposed to be safety glass back then. I have posted much a few years ago here.
I had early cataracts in 40's which came from high myopia and poor eating habits lol. My implants were approx -11 and I was left with -2 and astigmatism. I was finally able to see!! Myopia then re-progressed to -5. Ten years later my vision deteriorated and wavy lines etc...from retina scaring. All issues are from our stretched eyes. What is your RX?
I finally took the chance on a vitrectomy and the healing process was long but I now appear to be in the 20/30 range, with several problems, but manageable.
The new theorys today also have changed the acceptable eye pressure for double digit myopia (which we are, even with implants, due to eye shape) to a maximum of 15 instead of 24 for glaucoma watch..
Anyway, hands down Bascom Palmer in Miami is the VERY BEST, there is no second place...except maybe Moorefields in England. I will help you any way possible, but this is where you need to make an appointment ASAP.
M
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Old 02-15-2013, 01:28 PM   #44
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

tubint:
In trying to see how my visual distortions may reduce in the future, I remember you, or, somebody else on another HB thread, writing that if the difference in diopter numbers between the two eyes is more than 2D then it is difficult for the brain to fuse the two images from the two eyes, and can lead to poor stereoscopic vision. In my case, my right eye is 20/20 for distance but +1.5D for near vision, whereas, the left eye (w/ recent vit. sx.) is 20/50 and I don't know its D for near vision. So, when defining the difference in D for above purposes do we need to compare the D (a) for same distance (far or near), that is, apples to apples, or (b) something else, such as, the worst combo?

For example, in my case, 20/20 is 0D (plano), and 20/50 is about -1D to -1.25D, depending on my astigmatism, although there is no such true one-to-one correspondence, I understand. Does it mean the difference in D for me, for the above purposes, is 1.25D max. (0-(-1.25)) for distance vision, which is smaller than 2D, and, hence, okay for distance stereovision? Or, should I be comparing -1.25D for left eye and +1.5D for right eye, which gives a max. difference of 2.75, and which is higher than 2, and, hence, not good? Somehow, the latter does not sound right because I am mixing corrected vision for different distances. In practice, I know, I can presently see good, natural 3d depth at closer distances than farther, and it is slowly getting better and better (at 5+ weeks).

 
Old 02-15-2013, 03:25 PM   #45
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

tubint: Just got back my pre- and post-op OCT scans, as you had suggested! They sent me a CD...what a wealth of information! It has not only black 'n white photos, but also colored (no dye injection was used on me . Further, it has not only 2d b/w cross-sections of the retina (on two orthogonal axes), one of which (from nasal to temple C/S) the dr had shown and discussed with me, but also colored 3d shapes of the ILM (inner) and the RPE (outer) layers, with the thickness distribution shown as contour plots from ILM to RPE. For example, my average retinal thickness in the measurement volume is 300 micro-meters, much smaller than what you quoted for yourself, 400, and at the fovea, it is only 255, etc. This is exciting info, although, I don't quite know what I will do wih it, other than comparing it later on if things go boink with my ERM. I wouldn't have asked for it, if you hadn't suggested. Now, I can compare them with the text-book images obtained from googling, and learn about this fascinating field. There is a whole load of qualitative info there, but as patients, what else can one see and interpret from these OCTs, you think?

Last edited by vitcat2; 02-16-2013 at 06:37 AM. Reason: typo

 
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