CATARACT OP Update - a bit desparate for info

[Anna Mason]

Well what can I say yesterday was a Major Trial and I have been on a bit of a Rollercoaster of emotions. Where to start?

Well I went in at 12.30 anticpating what improvement in vision I might gain from having my cataract removed and a carefully calculated and measured lens fitted.

The consultant arrived and sat down on the bed. I had my list of questions and then he dropped the bombshell. He had spent several days contacting various experts and feeding my figures into national and international databases and had some major discussions on the subject. I am only the 2nd case in the uk they have encountered that is this complex.

Basically my left eye is very long which leaves me feeling like I must be a gargoyle. My Kerataconus in that eye is very advanced and the combination of the two has made it impossible to measure for a definitive lens. One measurement came out at minus 10 which would need to be specially manufactured and they were not certain enough of this to proceed. The normal is a minus 1.

So they have removed the eyes natural lens and not replaced it. The jury is out as to whether this is good or bad at the moment I am clueless.

My vision out of the eye today is no worse without the lens in fact I would say it is slightly better in that the blurs I have are better.

In two weeks I can put my old lens in but cannot be fitted for a new lens until June probably.

Can someone please please direct me to some sites I can read up on this.

[Andrew MacLean]

Anna

I am so sorry to learn of your setback.

If you Google Cataract Keratoconus you will find loads of sites that deal with this combination, but I am not sure that they cover your own complication.

Every good wish.

Andrew

[Anna Mason]

I feel like I am tightrope walking on Barbed wire.

[Anna Mason]

Nope no useful sites nothing mentioned no lens implant. The saga continues I am going to Oxford at end of may to try and fit a lens and maybe another op to chuck an IOL in after that.

Isnt it wonderful to be a very interesting case

[Anne Klepacz]

Hi Anna,
I'm no expert on this, but what you say has reminded me of my inpatient stay for my first graft. This was back in 1986 when it was still normal to stay in hospital for 3 days for a graft and almost everyone else on the ward was having cataract operations. So I got chatting to some of them. Clearly cataract surgery has changed hugely since then but the practice back then was to do a replacement lens for the older patients while the younger patients simply had their natural lens removed and were then fitted with a contact lens. I imagine (in fact I think I was told) that this was because the replacement lenses used 25 years ago didn't last for ever so they weren't given to younger patients who went down the contact lens route instead. In other words, this used to be standard treatment. So you may well find that when you can be fitted with a contact lens, your vision will be back to what it was pre cataract. Obviously the people I talked to didn't have KC as well, so presumably their contact lens was much less complex.
I hope one of our expert posters will be along in a minute to tell me if I'm talking rubbish!
All the best
Anne

[Anna Mason]

Thank you very much Anne. I must admit the lens that was removed had been swinging the lead for a while now.

Oxford are going to talk to Uncle Ken as apparently he has strong views on what thingummyjigs are possible with scleral I us this word as it was something totally different which I cant remember.

[rosemary johnson]

Anne, I'm sure you're right: it's the old way to do cataracts, just to remmove the patient's own cataracty lens and leave nothing in its place.
And then send the patient for contact lenses.
Until recently, that was oneo f the main uses of scleral lenses - for people who'd had cataracts removed. I rememer Ken saying how the two groups differed - the caract patients were oh so grateful for anything, the KC people were ever-critical.
eg.
Cataract patient Oooh, doctor that's so wonderful. I can even read my knitting patterns again no
Person with KC: Well. it's much better that it was, ut I still aren't going to pass the sight test for my private pilot's licence!
Roseamry

[Anna Mason]

Love that Rosemary but in my case thanks very much but I need to be able to tow a horsebox and gallop cross country and hedges ditches and rails

[Anna Mason]

Quick up date - well I have found one small benefit. I no longer need to use reading glasses to read my mobile phone or a book. I just shut my good eye and let the waster without a natural lens or contact lens do the work its actually giving me an opportunity to rmove the lens from my good eye for a break.

Must remeber its not cool to navigate a touchphone with your nose though.

[Lynn White]

Hi Anna,

Let me back up and explain some things ... so bear with me for a few sentences here.

The cornea does the bulk of the work in refracting light as it passes into your eye. Once through the cornea, the light is fine tuned by the lens, especially for reading, so that everything is in focus for you at any distance you want. Therefore your overall vision is determined by the combination of powers of your natural cornea and lens.

When you develop a cataract, the lens grows thicker and becomes denser, so that it changes the way you focus. This can do all sorts of weird things to people's vision, so you can imagine that the combined effect of distortion from KC and a cataract can be pretty challenging for the visual system.

Now to the removal part. As Anne indicates, years ago, they just removed the lens when it formed a cataract and the person had to put up with high powered thick glasses to see with. As technology improved, people were fitted with contact lenses after cataract removal and then came along the idea of replacing the natural lens with a plastic one. This was a huge breakthrough but for success, it relied on being able to calculate what power you needed for the replacement plastic lens.

This power was calculated with a formula based on various measurements of your eye, which include the curvature of the front of the eye and an ultrasound scan of the length of your eyeball. It took quite a few years until this formula was reliable enough to allow people to have pretty good vision after surgery. Quite a lot of people ended up having significant spectacle refractions after the cataracts were out and implant put in. Often, the two eyes did not match at all after surgery had been done on both. Eventually, technology and measurements evolved and now the whole procedure is pretty slick - we do take it for granted to be honest!

Even then, some people had "odd" combinations of power between the lens of the eye and the cornea and ended up not needing a lens implant at all. After all, the replacement lens power is simply calculated to fine tune what your own cornea does. If your own cornea does the job you don't NEED an implant lens. This was often the case for people who were quite short sighted. The lens in the eye is around +12.00 in power and if you were actually 12.00D shortsighted, then you could often see OK with just your own lens taken out. This is a bit simplistic, but hopefully you will get the drift!

OK... lets get down to your situation. You can become shortsighted either by the eyeball becoming longer (axial myopia) or the cornea becoming steeper (refractive myopia). In "normal" eyes, long eyeballs are normally associated with large,flat corneas and those with steep corneas often have small, short eyeballs. Now with keratoconus, the rule book goes out of the window and you can have a large eye with a flat cornea which then becomes steep when keratoconus develops. This appears to have happened to you so that you have a LOT of shortsightedness from more than one cause.Therefore, in order to FULLY correct your vision with an implant lens, they would need one that is quite high minus in power and such lenses are not "standard issue".

Now, why I gave you the history of lens implants is that its not so long ago that having the absolute spot on correction for a lens implant was deemed almost a "luxury". When I first qualified as an optom, we were still at the stage where there were not even implants! So, your situation appears complex from the point of view of what is now deemed "normal". When I first qualified, it was something we would all take in our stride.

So, from what you say you can read without any help from glasses or contacts which means you have a certain level of shortsightedness remaining, as predicted. Once the eye has settled, you can be refracted. Then it is a case of deciding whether to put in an implant OR you do have the option of having all the correction in a contact lens.

The issue for the surgeon is that he may still not be able to correct ALL your shortsightedness with an implant lens if they can't manufacture one with the right power. So, you will then have the choice: do you not bother with an implant at all and just wear a CL that corrects your residual vision or do you have an implant that partly corrects your vision and still wear a CL to correct the rest. Bear in mind, if you COULD get a lens that FULLY corrected your shortsightedness, you may STILL have to wear a lens in order see better because of the KC. In this respect, you are not like "normal" cataract patients.

Once you have seen Ken and he sorts out what your final prescription is, you will then be in a situation where you will know what can be done.

I hope this helps and please do ask me if you want to know anything else.

Lynn